Physician Order Entry Clerical Support Improves Physician Satisfaction and Productivity.

PubMed

Contratto, Erin; Romp, Katherine; Estrada, Carlos A; Agne, April; Willett, Lisa L

2017-05-01

To examine the impact of clerical support personnel for physician order entry on physician satisfaction, productivity, timeliness with electronic health record (EHR) documentation, and physician attitudes. All seven part-time physicians at an academic general internal medicine practice were included in this quasi-experimental (single group, pre- and postintervention) mixed-methods study. One full-time clerical support staff member was trained and hired to enter physician orders in the EHR and conduct previsit planning. Physician satisfaction, productivity, timeliness with EHR documentation, and physician attitudes toward the intervention were measured. Four months after the intervention, physicians reported improvements in overall quality of life (good quality, 71%-100%), personal balance (43%-71%), and burnout (weekly, 43%-14%; callousness, 14%-0%). Matched for quarter, productivity increased: work relative value unit (wRVU) per session increased by 20.5% (before, April-June 2014; after, April-June 2015; range -9.2% to 27.5%). Physicians reported feeling more supported, more focused on patient care, and less stressed and fatigued after the intervention. This study supports the use of physician order entry clerical personnel as a simple, cost-effective intervention to improve the work lives of primary care physicians.

Benefits and drawbacks of electronic health record systems

PubMed Central

Menachemi, Nir; Collum, Taleah H

2011-01-01

The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 that was signed into law as part of the “stimulus package” represents the largest US initiative to date that is designed to encourage widespread use of electronic health records (EHRs). In light of the changes anticipated from this policy initiative, the purpose of this paper is to review and summarize the literature on the benefits and drawbacks of EHR systems. Much of the literature has focused on key EHR functionalities, including clinical decision support systems, computerized order entry systems, and health information exchange. Our paper describes the potential benefits of EHRs that include clinical outcomes (eg, improved quality, reduced medical errors), organizational outcomes (eg, financial and operational benefits), and societal outcomes (eg, improved ability to conduct research, improved population health, reduced costs). Despite these benefits, studies in the literature highlight drawbacks associated with EHRs, which include the high upfront acquisition costs, ongoing maintenance costs, and disruptions to workflows that contribute to temporary losses in productivity that are the result of learning a new system. Moreover, EHRs are associated with potential perceived privacy concerns among patients, which are further addressed legislatively in the HITECH Act. Overall, experts and policymakers believe that significant benefits to patients and society can be realized when EHRs are widely adopted and used in a “meaningful” way. PMID:22312227

The Benefits and Challenges of an Interfaced Electronic Health Record and Laboratory Information System: Effects on Laboratory Processes.

PubMed

Petrides, Athena K; Bixho, Ida; Goonan, Ellen M; Bates, David W; Shaykevich, Shimon; Lipsitz, Stuart R; Landman, Adam B; Tanasijevic, Milenko J; Melanson, Stacy E F

2017-03-01

- A recent government regulation incentivizes implementation of an electronic health record (EHR) with computerized order entry and structured results display. Many institutions have also chosen to interface their EHR with their laboratory information system (LIS). - To determine the impact of an interfaced EHR-LIS on laboratory processes. - We analyzed several different processes before and after implementation of an interfaced EHR-LIS: the turnaround time, the number of stat specimens received, venipunctures per patient per day, preanalytic errors in phlebotomy, the number of add-on tests using a new electronic process, and the number of wrong test codes ordered. Data were gathered through the LIS and/or EHR. - The turnaround time for potassium and hematocrit decreased significantly (P = .047 and P = .004, respectively). The number of stat orders also decreased significantly, from 40% to 7% for potassium and hematocrit, respectively (P < .001 for both). Even though the average number of inpatient venipunctures per day increased from 1.38 to 1.62 (P < .001), the average number of preanalytic errors per month decreased from 2.24 to 0.16 per 1000 specimens (P < .001). Overall there was a 16% increase in add-on tests. The number of wrong test codes ordered was high and it was challenging for providers to correctly order some common tests. - An interfaced EHR-LIS significantly improved within-laboratory turnaround time and decreased stat requests and preanalytic phlebotomy errors. Despite increasing the number of add-on requests, an electronic add-on process increased efficiency and improved provider satisfaction. Laboratories implementing an interfaced EHR-LIS should be cautious of its effects on test ordering and patient venipunctures per day.

Interventions to increase physician efficiency and comfort with an electronic health record system.

PubMed

Jalota, L; Aryal, M R; Mahmood, M; Wasser, T; Donato, A

2015-01-01

To determine comfort when using the Electronic Health Record (EHR) and increase in documentation efficiency after an educational intervention for physicians to improve their transition to a new EHR. This study was a single-center randomized, parallel, non-blinded controlled trial of real-time, focused educational interventions by physician peers in addition to usual training in the intervention arm compared with usual training in the control arm. Participants were 44 internal medicine physicians and residents stratified to groups using a survey of comfort with electronic media during rollout of a system-wide EHR and order entry system. Outcomes were median time to complete a progress note, notes completed after shift, and comfort with EHR at 20 and 40 shifts. In the intervention group, 73 education sessions averaging 14.4 (SD: 7.7) minutes were completed with intervention group participants, who received an average of 3.47 (SD: 2.1) interventions. Intervention group participants decreased their time to complete a progress note more quickly than controls over 30 shifts (p < 0.001) and recorded significantly fewer progress notes after scheduled duty hours (77 versus 292, p < 0.001). Comfort with EHRs increased significantly in both groups from baseline but did not differ significantly by group. Intervention group participants felt that the intervention was more helpful than their standard training (3.47 versus 1.95 on 4-point scale). Physicians teaching physicians during clinical work improved physician efficiency but not comfort with EHRs. More study is needed to determine best methods to assist those most challenged with new EHR rollouts.

Effects of Health Level 7 Messaging on Data Quality in New York City's Immunization Information System, 2014.

PubMed

Metroka, Amy E; Papadouka, Vikki; Ternier, Alexandra; Zucker, Jane R

2016-01-01

We compared the quality of data reported to New York City's immunization information system, the Citywide Immunization Registry (CIR), through its real-time Health Level 7 (HL7) Web service from electronic health records (EHRs), with data submitted through other methods. We stratified immunizations administered and reported to the CIR in 2014 for patients aged 0-18 years by reporting method: (1) sending HL7 messages from EHRs through the Web service, (2) manual data entry, and (3) upload of a non-standard flat file from EHRs. We assessed completeness of reporting by measuring the percentage of immunizations reported with lot number, manufacturer, and Vaccines for Children (VFC) program eligibility. We assessed timeliness of reporting by determining the number of days from date of administration to date entered into the CIR. HL7 reporting accounted for the largest percentage (46.3%) of the 3.8 million immunizations reported in 2014. Of immunizations reported using HL7, 97.9% included the lot number and 92.6% included the manufacturer, compared with 50.4% and 48.0% for manual entry, and 65.9% and 48.8% for non-standard flat file, respectively. VFC eligibility was 96.9% complete when reported by manual data entry, 95.3% complete for HL7 reporting, and 87.2% complete for non-standard flat file reporting. Of the three reporting methods, HL7 was the most timely: 77.6% of immunizations were reported by HL7 in <1 day, compared with 53.6% of immunizations reported through manual data entry and 18.1% of immunizations reported through non-standard flat file. HL7 reporting from EHRs resulted in more complete and timely data in the CIR compared with other reporting methods. Providing resources to facilitate HL7 reporting from EHRs to immunization information systems to increase data quality should be a priority for public health.

Effects of Health Level 7 Messaging on Data Quality in New York City's Immunization Information System, 2014

PubMed Central

Papadouka, Vikki; Ternier, Alexandra; Zucker, Jane R.

2016-01-01

Objective We compared the quality of data reported to New York City's immunization information system, the Citywide Immunization Registry (CIR), through its real-time Health Level 7 (HL7) Web service from electronic health records (EHRs), with data submitted through other methods. Methods We stratified immunizations administered and reported to the CIR in 2014 for patients aged 0–18 years by reporting method: (1) sending HL7 messages from EHRs through the Web service, (2) manual data entry, and (3) upload of a non-standard flat file from EHRs. We assessed completeness of reporting by measuring the percentage of immunizations reported with lot number, manufacturer, and Vaccines for Children (VFC) program eligibility. We assessed timeliness of reporting by determining the number of days from date of administration to date entered into the CIR. Results HL7 reporting accounted for the largest percentage (46.3%) of the 3.8 million immunizations reported in 2014. Of immunizations reported using HL7, 97.9% included the lot number and 92.6% included the manufacturer, compared with 50.4% and 48.0% for manual entry, and 65.9% and 48.8% for non-standard flat file, respectively. VFC eligibility was 96.9% complete when reported by manual data entry, 95.3% complete for HL7 reporting, and 87.2% complete for non-standard flat file reporting. Of the three reporting methods, HL7 was the most timely: 77.6% of immunizations were reported by HL7 in <1 day, compared with 53.6% of immunizations reported through manual data entry and 18.1% of immunizations reported through non-standard flat file. Conclusion HL7 reporting from EHRs resulted in more complete and timely data in the CIR compared with other reporting methods. Providing resources to facilitate HL7 reporting from EHRs to immunization information systems to increase data quality should be a priority for public health. PMID:27453603

Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations

PubMed Central

Arndt, Brian G.; Beasley, John W.; Watkinson, Michelle D.; Temte, Jonathan L.; Tuan, Wen-Jan; Sinsky, Christine A.; Gilchrist, Valerie J.

2017-01-01

PURPOSE Primary care physicians spend nearly 2 hours on electronic health record (EHR) tasks per hour of direct patient care. Demand for non–face-to-face care, such as communication through a patient portal and administrative tasks, is increasing and contributing to burnout. The goal of this study was to assess time allocated by primary care physicians within the EHR as indicated by EHR user-event log data, both during clinic hours (defined as 8:00 am to 6:00 pm Monday through Friday) and outside clinic hours. METHODS We conducted a retrospective cohort study of 142 family medicine physicians in a single system in southern Wisconsin. All Epic (Epic Systems Corporation) EHR interactions were captured from “event logging” records over a 3-year period for both direct patient care and non–face-to-face activities, and were validated by direct observation. EHR events were assigned to 1 of 15 EHR task categories and allocated to either during or after clinic hours. RESULTS Clinicians spent 355 minutes (5.9 hours) of an 11.4-hour workday in the EHR per weekday per 1.0 clinical full-time equivalent: 269 minutes (4.5 hours) during clinic hours and 86 minutes (1.4 hours) after clinic hours. Clerical and administrative tasks including documentation, order entry, billing and coding, and system security accounted for nearly one-half of the total EHR time (157 minutes, 44.2%). Inbox management accounted for another 85 minutes (23.7%). CONCLUSIONS Primary care physicians spend more than one-half of their workday, nearly 6 hours, interacting with the EHR during and after clinic hours. EHR event logs can identify areas of EHR-related work that could be delegated, thus reducing workload, improving professional satisfaction, and decreasing burnout. Direct time-motion observations validated EHR-event log data as a reliable source of information regarding clinician time allocation. PMID:28893811

Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations.

PubMed

Arndt, Brian G; Beasley, John W; Watkinson, Michelle D; Temte, Jonathan L; Tuan, Wen-Jan; Sinsky, Christine A; Gilchrist, Valerie J

2017-09-01

Primary care physicians spend nearly 2 hours on electronic health record (EHR) tasks per hour of direct patient care. Demand for non-face-to-face care, such as communication through a patient portal and administrative tasks, is increasing and contributing to burnout. The goal of this study was to assess time allocated by primary care physicians within the EHR as indicated by EHR user-event log data, both during clinic hours (defined as 8:00 am to 6:00 pm Monday through Friday) and outside clinic hours. We conducted a retrospective cohort study of 142 family medicine physicians in a single system in southern Wisconsin. All Epic (Epic Systems Corporation) EHR interactions were captured from "event logging" records over a 3-year period for both direct patient care and non-face-to-face activities, and were validated by direct observation. EHR events were assigned to 1 of 15 EHR task categories and allocated to either during or after clinic hours. Clinicians spent 355 minutes (5.9 hours) of an 11.4-hour workday in the EHR per weekday per 1.0 clinical full-time equivalent: 269 minutes (4.5 hours) during clinic hours and 86 minutes (1.4 hours) after clinic hours. Clerical and administrative tasks including documentation, order entry, billing and coding, and system security accounted for nearly one-half of the total EHR time (157 minutes, 44.2%). Inbox management accounted for another 85 minutes (23.7%). Primary care physicians spend more than one-half of their workday, nearly 6 hours, interacting with the EHR during and after clinic hours. EHR event logs can identify areas of EHR-related work that could be delegated, thus reducing workload, improving professional satisfaction, and decreasing burnout. Direct time-motion observations validated EHR-event log data as a reliable source of information regarding clinician time allocation. © 2017 Annals of Family Medicine, Inc.

Engineering the electronic health record for safety: a multi-level video-based approach to diagnosing and preventing technology-induced error arising from usability problems.

PubMed

Borycki, Elizabeth M; Kushniruk, Andre W; Kuwata, Shigeki; Kannry, Joseph

2011-01-01

Electronic health records (EHRs) promise to improve and streamline healthcare through electronic entry and retrieval of patient data. Furthermore, based on a number of studies showing their positive benefits, they promise to reduce medical error and make healthcare safer. However, a growing body of literature has clearly documented that if EHRS are not designed properly and with usability as an important goal in their design, rather than reducing error, EHR deployment has the potential to actually increase medical error. In this paper we describe our approach to engineering (and reengineering) EHRs in order to increase their beneficial potential while at the same time improving their safety. The approach described in this paper involves an integration of the methods of usability analysis with video analysis of end users interacting with EHR systems and extends the evaluation of the usability of EHRs to include the assessment of the impact of these systems on work practices. Using clinical simulations, we analyze human-computer interaction in real healthcare settings (in a portable, low-cost and high fidelity manner) and include both artificial and naturalistic data collection to identify potential usability problems and sources of technology-induced error prior to widespread system release. Two case studies where the methods we have developed and refined have been applied at different levels of user-computer interaction are described.

Integrating clinical research with the Healthcare Enterprise: from the RE-USE project to the EHR4CR platform.

PubMed

El Fadly, AbdenNaji; Rance, Bastien; Lucas, Noël; Mead, Charles; Chatellier, Gilles; Lastic, Pierre-Yves; Jaulent, Marie-Christine; Daniel, Christel

2011-12-01

There are different approaches for repurposing clinical data collected in the Electronic Healthcare Record (EHR) for use in clinical research. Semantic integration of "siloed" applications across domain boundaries is the raison d'être of the standards-based profiles developed by the Integrating the Healthcare Enterprise (IHE) initiative - an initiative by healthcare professionals and industry promoting the coordinated use of established standards such as DICOM and HL7 to address specific clinical needs in support of optimal patient care. In particular, the combination of two IHE profiles - the integration profile "Retrieve Form for Data Capture" (RFD), and the IHE content profile "Clinical Research Document" (CRD) - offers a straightforward approach to repurposing EHR data by enabling the pre-population of the case report forms (eCRF) used for clinical research data capture by Clinical Data Management Systems (CDMS) with previously collected EHR data. Implement an alternative solution of the RFD-CRD integration profile centered around two approaches: (i) Use of the EHR as the single-source data-entry and persistence point in order to ensure that all the clinical data for a given patient could be found in a single source irrespective of the data collection context, i.e. patient care or clinical research; and (ii) Maximize the automatic pre-population process through the use of a semantic interoperability services that identify duplicate or semantically-equivalent eCRF/EHR data elements as they were collected in the EHR context. The RE-USE architecture and associated profiles are focused on defining a set of scalable, standards-based, IHE-compliant profiles that can enable single-source data collection/entry and cross-system data reuse through semantic integration. Specifically, data reuse is realized through the semantic mapping of data collection fields in electronic Case Report Forms (eCRFs) to data elements previously defined as part of patient care-centric templates in the EHR context. The approach was evaluated in the context of a multi-center clinical trial conducted in a large, multi-disciplinary hospital with an installed EHR. Data elements of seven eCRFs used in a multi-center clinical trial were mapped to data elements of patient care-centric templates in use in the EHR at the George Pompidou hospital. 13.4% of the data elements of the eCRFs were found to be represented in EHR templates and were therefore candidate for pre-population. During the execution phase of the clinical study, the semantic mapping architecture enabled data persisted in the EHR context as part of clinical care to be used to pre-populate eCRFS for use without secondary data entry. To ensure that the pre-populated data is viable for use in the clinical research context, all pre-populated eCRF data needs to be first approved by a trial investigator prior to being persisted in a research data store within a CDMS. Single-source data entry in the clinical care context for use in the clinical research context - a process enabled through the use of the EHR as single point of data entry, can - if demonstrated to be a viable strategy - not only significantly reduce data collection efforts while simultaneously increasing data collection accuracy secondary to elimination of transcription or double-entry errors between the two contexts but also ensure that all the clinical data for a given patient, irrespective of the data collection context, are available in the EHR for decision support and treatment planning. The RE-USE approach used mapping algorithms to identify semantic coherence between clinical care and clinical research data elements and pre-populate eCRFs. The RE-USE project utilized SNOMED International v.3.5 as its "pivot reference terminology" to support EHR-to-eCRF mapping, a decision that likely enhanced the "recall" of the mapping algorithms. The RE-USE results demonstrate the difficult challenges involved in semantic integration between the clinical care and clinical research contexts. Copyright © 2011 Elsevier Inc. All rights reserved.

Evidence that electronic health records can promote physician counseling for healthy behaviors.

PubMed

Bae, Jaeyong; Hockenberry, Jason M; Rask, Kimberly J; Becker, Edmund R

Health behavior counseling services may help patients manage chronic conditions effectively and slow disease progression. Studies show, however, that many providers fail to provide these services because of time constraints and inability to tailor counseling to individual patient needs. Electronic health records (EHRs) have the potential to increase appropriate counseling by providing pertinent patient information at the point of care and clinical decision support. This study estimates the impact of select EHR functionalities on the rate of health behavior counseling provided during primary care visits. Multivariable regression analyses of the 2007-2010 National Ambulatory Medical Care Survey were conducted to examine whether eight EHR components representing four core functionalities of EHR systems were correlated with the rate of health behavior counseling services. Propensity score matching was used to control for confounding factors given the use of observational data. To address concerns that EHR may only lead to improved documentation of counseling services and not necessarily improved care, the association of EHR functionalities with prescriptions for smoking cessation medications was also estimated. The use of an EHR system with health information and data, order entry and management, result management, decision support, and a notification system for abnormal test results was associated with an approximately 25% increase in the probability of health behavior counseling delivered. Clinical reminders were associated with more health behavior counseling services when available in combination with patient problem lists. The laboratory results viewer was also associated with more counseling services when implemented with a notification system for abnormal results. An EHR system with key supportive functionalities can enhance delivery of preventive health behavior counseling services in primary care settings. Meaningful use criteria should be evaluated to ensure that they encourage the adoption of EHR systems with those functionalities shown to improve clinical care.

Electronic health record use to classify patients with newly diagnosed versus preexisting type 2 diabetes: infrastructure for comparative effectiveness research and population health management.

PubMed

Kudyakov, Rustam; Bowen, James; Ewen, Edward; West, Suzanne L; Daoud, Yahya; Fleming, Neil; Masica, Andrew

2012-02-01

Use of electronic health record (EHR) content for comparative effectiveness research (CER) and population health management requires significant data configuration. A retrospective cohort study was conducted using patients with diabetes followed longitudinally (N=36,353) in the EHR deployed at outpatient practice networks of 2 health care systems. A data extraction and classification algorithm targeting identification of patients with a new diagnosis of type 2 diabetes mellitus (T2DM) was applied, with the main criterion being a minimum 30-day window between the first visit documented in the EHR and the entry of T2DM on the EHR problem list. Chart reviews (N=144) validated the performance of refining this EHR classification algorithm with external administrative data. Extraction using EHR data alone designated 3205 patients as newly diagnosed with T2DM with classification accuracy of 70.1%. Use of external administrative data on that preselected population improved classification accuracy of cases identified as new T2DM diagnosis (positive predictive value was 91.9% with that step). Laboratory and medication data did not help case classification. The final cohort using this 2-stage classification process comprised 1972 patients with a new diagnosis of T2DM. Data use from current EHR systems for CER and disease management mandates substantial tailoring. Quality between EHR clinical data generated in daily care and that required for population health research varies. As evidenced by this process for classification of newly diagnosed T2DM cases, validation of EHR data with external sources can be a valuable step.

Seniors' views on the use of electronic health records.

PubMed

Morin, Diane; Tourigny, Andre; Pelletier, Daniel; Robichaud, Line; Mathieu, Luc; Vézina, Aline; Bonin, Lucie; Buteau, Martin

2005-01-01

In the Mauricie and Centre-du-Québec region of the province of Quebec, Canada, an integrated services network has been implemented for frail seniors. It combines three of the best practices in the field of integrated services, namely: single-entry point, case management and personalized care plan. A shared interdisciplinary electronic health record (EHR) system was set up in 1998. A consensus on the relevance of using EHRs is growing in Quebec, in Canada and around the world. However, technology has out-paced interest in the notions of confidentiality, informed consent and the impact perceived by the clientele. This study specifically examines how frail seniors perceive these issues related to an EHR. The conceptual framework is inspired by the DeLone and McLean model whose main attributes are: system quality, information quality, utilisation modes and the impact on organisations and individuals. This last attribute is the focus of this study, which is a descriptive with quantitative and qualitative component. Thirty seniors were surveyed. Positive information they provided falls under three headings: (i) being better informed; (ii) trust and consideration for professionals; and (iii) appreciation of innovation. The opinions of the seniors are generally favourable regarding the use of computers and the EHR in their presence. Improvements in EHR systems for seniors can be encouraged.

Depression screening optimization in an academic rural setting.

PubMed

Aleem, Sohaib; Torrey, William C; Duncan, Mathew S; Hort, Shoshana J; Mecchella, John N

2015-01-01

Primary care plays a critical role in screening and management of depression. The purpose of this paper is to focus on leveraging the electronic health record (EHR) as well as work flow redesign to improve the efficiency and reliability of the process of depression screening in two adult primary care clinics of a rural academic institution in USA. The authors utilized various process improvement tools from lean six sigma methodology including project charter, swim lane process maps, critical to quality tree, process control charts, fishbone diagrams, frequency impact matrix, mistake proofing and monitoring plan in Define-Measure-Analyze-Improve-Control format. Interventions included change in depression screening tool, optimization of data entry in EHR. EHR data entry optimization; follow up of positive screen, staff training and EHR redesign. Depression screening rate for office-based primary care visits improved from 17.0 percent at baseline to 75.9 percent in the post-intervention control phase (p<0.001). Follow up of positive depression screen with Patient History Questionnaire-9 data collection remained above 90 percent. Duplication of depression screening increased from 0.6 percent initially to 11.7 percent and then decreased to 4.7 percent after optimization of data entry by patients and flow staff. Impact of interventions on clinical outcomes could not be evaluated. Successful implementation, sustainability and revision of a process improvement initiative to facilitate screening, follow up and management of depression in primary care requires accounting for voice of the process (performance metrics), system limitations and voice of the customer (staff and patients) to overcome various system, customer and human resource constraints.

Safe use of electronic health records and health information technology systems: trust but verify.

PubMed

Denham, Charles R; Classen, David C; Swenson, Stephen J; Henderson, Michael J; Zeltner, Thomas; Bates, David W

2013-12-01

We will provide a context to health information technology systems (HIT) safety hazards discussions, describe how electronic health record-computer prescriber order entry (EHR-CPOE) simulation has already identified unrecognized hazards in HIT on a national scale, helping make EHR-CPOE systems safer, and we make the case for all stakeholders to leverage proven methods and teams in HIT performance verification. A national poll of safety, quality improvement, and health-care administrative leaders identified health information technology safety as the hazard of greatest concern for 2013. Quality, HIT, and safety leaders are very concerned about technology performance risks as addressed in the Health Information Technology and Patient Safety report of the Institute of Medicine; and these are being addressed by the Office of the National Coordinator of HIT of the U.S. Dept. of Human Services in their proposed plans. We describe the evolution of postdeployment testing of HIT performance, including the results of national deployment of Texas Medical Institute of Technology's electronic health record computer prescriber order entry (TMIT EHR-CPOE) Flight Simulator verification test that is addressed in these 2 reports, and the safety hazards of concern to leaders. A global webinar for health-care leaders addressed the top patient safety hazards in the areas of leadership, practices, and technologies. A poll of 76 of the 221 organizations participating in the webinar revealed that HIT hazards were the participants' greatest concern of all 30 hazards presented. Of those polled, 89% rated HIT patient/data mismatches in EHRs and HIT systems as a 9 or 10 on a scale of 1 to 10 as a hazard of great concern. Review of a key study of postdeployment testing of the safety performance of operational EHR systems with CPOE implemented in 62 hospitals, using the TMIT EHR-CPOE simulation tool, showed that only 53% of the medication orders that could have resulted in fatalities were detected. The study also showed significant variability in the performance of specific EHR vendor systems, with the same vendor product scoring as high as a 75% detection score in one health-care organization, and the same vendor system scoring below 10% in another health-care organization. HIT safety hazards should be taken very seriously, and the need for proven, robust, and regular postdeployment performance verification measurement of EHR system operations in every health-care organization is critical to ensure that these systems are safe for every patient. The TMIT EHR-CPOE flight simulator is a well-tested and scalable tool that can be used to identify performance gaps in EHR and other HIT systems. It is critical that suppliers, providers, and purchasers of health-care partner with HIT stakeholders and leverage the existing body of work, as well as expert teams and collaborative networks to make care safer; and public-private partnerships to accelerate safety in HIT. A global collaborative is already underway incorporating a "trust but verify" philosophy.

Electronic Health Record Challenges, Workarounds, and Solutions Observed in Practices Integrating Behavioral Health and Primary Care.

PubMed

Cifuentes, Maribel; Davis, Melinda; Fernald, Doug; Gunn, Rose; Dickinson, Perry; Cohen, Deborah J

2015-01-01

This article describes the electronic health record (EHR)-related experiences of practices striving to integrate behavioral health and primary care using tailored, evidenced-based strategies from 2012 to 2014; and the challenges, workarounds and initial health information technology (HIT) solutions that emerged during implementation. This was an observational, cross-case comparative study of 11 diverse practices, including 8 primary care clinics and 3 community mental health centers focused on the implementation of integrated care. Practice characteristics (eg, practice ownership, federal designation, geographic area, provider composition, EHR system, and patient panel characteristics) were collected using a practice information survey and analyzed to report descriptive information. A multidisciplinary team used a grounded theory approach to analyze program documents, field notes from practice observation visits, online diaries, and semistructured interviews. Eight primary care practices used a single EHR and 3 practices used 2 different EHRs, 1 to document behavioral health and 1 to document primary care information. Practices experienced common challenges with their EHRs' capabilities to 1) document and track relevant behavioral health and physical health information, 2) support communication and coordination of care among integrated teams, and 3) exchange information with tablet devices and other EHRs. Practices developed workarounds in response to these challenges: double documentation and duplicate data entry, scanning and transporting documents, reliance on patient or clinician recall for inaccessible EHR information, and use of freestanding tracking systems. As practices gained experience with integration, they began to move beyond workarounds to more permanent HIT solutions ranging in complexity from customized EHR templates, EHR upgrades, and unified EHRs. Integrating behavioral health and primary care further burdens EHRs. Vendors, in cooperation with clinicians, should intentionally design EHR products that support integrated care delivery functions, such as data documentation and reporting to support tracking patients with emotional and behavioral problems over time and settings, integrated teams working from shared care plans, template-driven documentation for common behavioral health conditions such as depression, and improved registry functionality and interoperability. This work will require financial support and cooperative efforts among clinicians, EHR vendors, practice assistance organizations, regulators, standards setters, and workforce educators. © Copyright 2015 by the American Board of Family Medicine.

76 FR 44021 - Announcement of Requirements and Registration for Using Public Data for Cancer Prevention and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-22

... venture capital arenas for tailored advice on commercialization, integration with existing platforms, and... cancer care? J Natl Cancer Inst Monogr 2010;2010(40):81- 9. 3. Integration: Each entry will be rated on its potential for, or actual integration with, existing electronic health record (EHR; recommended...

Unintended adverse consequences of introducing electronic health records in residential aged care homes.

PubMed

Yu, Ping; Zhang, Yiting; Gong, Yang; Zhang, Jiajie

2013-09-01

The aim of this study was to investigate the unintended adverse consequences of introducing electronic health records (EHR) in residential aged care homes (RACHs) and to examine the causes of these unintended adverse consequences. A qualitative interview study was conducted in nine RACHs belonging to three organisations in the Australian Capital Territory (ACT), New South Wales (NSW) and Queensland, Australia. A longitudinal investigation after the implementation of the aged care EHR systems was conducted at two data points: January 2009 to December 2009 and December 2010 to February 2011. Semi-structured interviews were conducted with 110 care staff members identified through convenience sampling, representing all levels of care staff who worked in these facilities. Data analysis was guided by DeLone and McLean Information Systems Success Model, in reference with the previous studies of unintended consequences for the introduction of computerised provider order entry systems in hospitals. Eight categories of unintended adverse consequences emerged from 266 data items mentioned by the interviewees. In descending order of the number and percentage of staff mentioning them, they are: inability/difficulty in data entry and information retrieval, end user resistance to using the system, increased complexity of information management, end user concerns about access, increased documentation burden, the reduction of communication, lack of space to place enough computers in the work place and increasing difficulties in delivering care services. The unintended consequences were caused by the initial conditions, the nature of the EHR system and the way the system was implemented and used by nursing staff members. Although the benefits of the EHR systems were obvious, as found by our previous study, introducing EHR systems in RACH can also cause adverse consequences of EHR avoidance, difficulty in access, increased complexity in information management, increased documentation burden, reduction of communication and the risks of lacking care follow-up, which may cause negative effects on aged care services. Further research can focus on investigating how the unintended adverse consequences can be mitigated or eliminated by understanding more about nursing staff's work as well as the information flow in RACH. This will help to improve the design, introduction and management of EHR systems in this setting. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The impact of an electronic health record on nurse sensitive patient outcomes: an interrupted time series analysis.

PubMed

Dowding, Dawn W; Turley, Marianne; Garrido, Terhilda

2012-01-01

To evaluate the impact of electronic health record (EHR) implementation on nursing care processes and outcomes. Interrupted time series analysis, 2003-2009. A large US not-for-profit integrated health care organization. 29 hospitals in Northern and Southern California. An integrated EHR including computerized physician order entry, nursing documentation, risk assessment tools, and documentation tools. Percentage of patients with completed risk assessments for hospital acquired pressure ulcers (HAPUs) and falls (process measures) and rates of HAPU and falls (outcome measures). EHR implementation was significantly associated with an increase in documentation rates for HAPU risk (coefficient 2.21, 95% CI 0.67 to 3.75); the increase for fall risk was not statistically significant (0.36; -3.58 to 4.30). EHR implementation was associated with a 13% decrease in HAPU rates (coefficient -0.76, 95% CI -1.37 to -0.16) but no decrease in fall rates (-0.091; -0.29 to 0.11). Irrespective of EHR implementation, HAPU rates decreased significantly over time (-0.16; -0.20 to -0.13), while fall rates did not (0.0052; -0.01 to 0.02). Hospital region was a significant predictor of variation for both HAPU (0.72; 0.30 to 1.14) and fall rates (0.57; 0.41 to 0.72). The introduction of an integrated EHR was associated with a reduction in the number of HAPUs but not in patient fall rates. Other factors, such as changes over time and hospital region, were also associated with variation in outcomes. The findings suggest that EHR impact on nursing care processes and outcomes is dependent on a number of factors that should be further explored.

Usability assessment of an electronic health record in a comprehensive dental clinic.

PubMed

Suebnukarn, Siriwan; Rittipakorn, Pawornwan; Thongyoi, Budsara; Boonpitak, Kwanwong; Wongsapai, Mansuang; Pakdeesan, Panu

2013-12-01

In this paper we present the development and usability of an electronic health record (EHR) system in a comprehensive dental clinic.The graphic user interface of the system was designed to consider the concept of cognitive ergonomics.The cognitive task analysis was used to evaluate the user interface of the EHR by identifying all sub-tasks and classifying them into mental or physical operators, and to predict task execution time required to perform the given task. We randomly selected 30 cases that had oral examinations for routine clinical care in a comprehensive dental clinic. The results were based on the analysis of 4 prototypical tasks performed by ten EHR users. The results showed that on average a user needed to go through 27 steps to complete all tasks for one case. To perform all 4 tasks of 30 cases, they spent about 91 min (independent of system response time) for data entry, of which 51.8 min were spent on more effortful mental operators. In conclusion, the user interface can be improved by reducing the percentage of mental effort required for the tasks.

Design, development and deployment of a Diabetes Research Registry to facilitate recruitment in clinical research.

PubMed

Tan, Meng H; Bernstein, Steven J; Gendler, Stephen; Hanauer, David; Herman, William H

2016-03-01

A major challenge in conducting clinical trials/studies is the timely recruitment of eligible subjects. Our aim is to develop a Diabetes Research Registry (DRR) to facilitate recruitment by matching potential subjects interested in research with approved clinical studies using study entry criteria abstracted from their electronic health records (EHR). A committee with expertise in diabetes, quality improvement, information technology, and informatics designed and developed the DRR. Using a hybrid approach, we identified and consented patients interested in research, abstracted their EHRs to assess common eligibility criteria, and contacted them about their interest in participating in specific studies. Investigators submit their requests with study entry criteria to the DRR which then provides a list of potential subjects who may be directly contacted for their study. The DRR meets all local, regional and federal regulatory requirements. After 5 years, the DRR has over 5000 registrants. About 30% have type 1 diabetes and 70% have type 2 diabetes. There are almost equal proportions of men and women. During this period, 31 unique clinical studies from 19 unique investigators requested lists of potential subjects for their studies. Eleven grant applications from 10 unique investigators used aggregated counts of potentially eligible subjects in their applications. The DRR matches potential subjects interested in research with approved clinical studies using study entry criteria abstracted from their EHR. By providing large lists of potentially eligible study subjects quickly, the DRR facilitated recruitment in 31 clinical studies. Copyright © 2016 Elsevier Inc. All rights reserved.

Lessons from a Successful Implementation of a Computerized Provider Order Entry System

PubMed Central

Jacobs, Brian R.; Hallstrom, Craig K.; Hart, Kim Ward; Mahoney, Daniela; Lykowski, Gayle

2007-01-01

OBJECTIVES The electronic health record (EHR) can improve patient safety, care efficiency, cost effectiveness and regulatory compliance. Cincinnati Children's Hospital Medical Center (CCHMC) has successfully implemented an Integrating Clinical Information System (ICIS) that includes Computerized Provider Order Entry (CPOE). This review describes some of the unanticipated challenges and solutions identified during the implementation of ICIS. METHODS Data for this paper was derived from user-generated feedback within the ICIS. Feedback reports were reviewed and placed into categories based on root cause of the issue. Recurring issues or problems which led to potential or actual patient injury are included. RESULTS Nine distinct challenges were identified: 1) Deterioration in communication; 2) Excessive system alerts to users; 3) Unrecognized discontinuation of medications; 4) Unintended loss of orders; 5) Loss of orders during implementation; 6) Amplification of errors; 7) Unintentional generation of patient care orders by system analysts; 8) Persistence of specific patient care order instructions; 9) Verbal orders entered under the incorrect clinician. CONCLUSIONS Unanticipated challenges are expected when implementing EHRs. The implementation plan for any EHR should include methods to identify, evaluate and repair problems quickly. While continued challenges with this complex system are expected, we believe that the EHR will continue to facilitate improved patient care and safety. The lessons learned at CCHMC will permit other institutions to avoid some of these challenges and design robust processes to detect and respond to problems in a timely fashion to ensure implementation success. PMID:23055847

Evolving vendor market for HITECH-certified ambulatory EHR products.

PubMed

Gold, Marsha; Hossain, Mynti; Charles, Dustin R; Furukawa, Michael F

2013-11-01

The ambitious goals of the Health Information Technology for Economic and Clinical Health (HITECH) Act require rapid development and certification of new ambulatory electronic health record (EHR) products. To examine where the vendor market for EHR products stands now and the policy issues emerging from the market's evolution. Descriptive study with policy analysis. We had 3 main sources of information: (1) documents describing this evolving market, which is not well represented in peer-reviewed literature; (2) operational data on certified ambulatory EHR products and their use by Medicareeligible professionals attesting for meaningful use payments from January 2011 to October 2012; and (3) telephone interviews with 10 vendors that account for 57% of the market. Those attesting for Medicare meaningful use payments used ambulatory EHRs from 353 different vendors, although 16 firms accounted for 75% of the market. The Herfindahl-Hirschman Index showed the ambulatory EHR market to be highly competitive, particularly for practices of 50 or fewer professionals. The interviewed vendors and the external analysts agreed that stage 1 requirements set a relatively low bar for market entry, but that likely will change as requirements get more demanding. The HITECH Act met its initial goals to motivate growth of diverse ambulatory EHR products. A market shakeout may emerge, though current data reveal no signs of it. Policy makers can influence the shape and value of such a shakeout, and the extent of disruption, through their approach to certification and "usability" and "interoperability" strategies and requirements.

EHR Documentation: The Hype and the Hope for Improving Nursing Satisfaction and Quality Outcomes.

PubMed

OʼBrien, Ann; Weaver, Charlotte; Settergren, Theresa Tess; Hook, Mary L; Ivory, Catherine H

2015-01-01

The phenomenon of "data rich, information poor" in today's electronic health records (EHRs) is too often the reality for nursing. This article proposes the redesign of nursing documentation to leverage EHR data and clinical intelligence tools to support evidence-based, personalized nursing care across the continuum. The principles consider the need to optimize nurses' documentation efficiency while contributing to knowledge generation. The nursing process must be supported by EHRs through integration of best care practices: seamless workflows that display the right tools, evidence-based content, and information at the right time for optimal clinical decision making. Design of EHR documentation must attain a balance that ensures the capture of nursing's impact on safety, quality, highly reliable care, patient engagement, and satisfaction, yet minimizes "death by data entry." In 2014, a group of diverse informatics leaders from practice, academia, and the vendor community formed to address how best to transform electronic documentation to provide knowledge at the point of care and to deliver value to front line nurses and nurse leaders. As our health care system moves toward reimbursement on the basis of quality outcomes and prevention, the value of nursing data in this business proposition will become a key differentiator for health care organizations' economic success.

Discovering disease associations by integrating electronic clinical data and medical literature.

PubMed

Holmes, Antony B; Hawson, Alexander; Liu, Feng; Friedman, Carol; Khiabanian, Hossein; Rabadan, Raul

2011-01-01

Electronic health record (EHR) systems offer an exceptional opportunity for studying many diseases and their associated medical conditions within a population. The increasing number of clinical record entries that have become available electronically provides access to rich, large sets of patients' longitudinal medical information. By integrating and comparing relations found in the EHRs with those already reported in the literature, we are able to verify existing and to identify rare or novel associations. Of particular interest is the identification of rare disease co-morbidities, where the small numbers of diagnosed patients make robust statistical analysis difficult. Here, we introduce ADAMS, an Application for Discovering Disease Associations using Multiple Sources, which contains various statistical and language processing operations. We apply ADAMS to the New York-Presbyterian Hospital's EHR to combine the information from the relational diagnosis tables and textual discharge summaries with those from PubMed and Wikipedia in order to investigate the co-morbidities of the rare diseases Kaposi sarcoma, toxoplasmosis, and Kawasaki disease. In addition to finding well-known characteristics of diseases, ADAMS can identify rare or previously unreported associations. In particular, we report a statistically significant association between Kawasaki disease and diagnosis of autistic disorder.

Discovering Disease Associations by Integrating Electronic Clinical Data and Medical Literature

PubMed Central

Holmes, Antony B.; Hawson, Alexander; Liu, Feng; Friedman, Carol; Khiabanian, Hossein; Rabadan, Raul

2011-01-01

Electronic health record (EHR) systems offer an exceptional opportunity for studying many diseases and their associated medical conditions within a population. The increasing number of clinical record entries that have become available electronically provides access to rich, large sets of patients' longitudinal medical information. By integrating and comparing relations found in the EHRs with those already reported in the literature, we are able to verify existing and to identify rare or novel associations. Of particular interest is the identification of rare disease co-morbidities, where the small numbers of diagnosed patients make robust statistical analysis difficult. Here, we introduce ADAMS, an Application for Discovering Disease Associations using Multiple Sources, which contains various statistical and language processing operations. We apply ADAMS to the New York-Presbyterian Hospital's EHR to combine the information from the relational diagnosis tables and textual discharge summaries with those from PubMed and Wikipedia in order to investigate the co-morbidities of the rare diseases Kaposi sarcoma, toxoplasmosis, and Kawasaki disease. In addition to finding well-known characteristics of diseases, ADAMS can identify rare or previously unreported associations. In particular, we report a statistically significant association between Kawasaki disease and diagnosis of autistic disorder. PMID:21731656

Clinician preferences for verbal communication compared to EHR documentation in the ICU

PubMed Central

Collins, S.A.; Bakken, S.; Vawdrey, D.K.; Coiera, E.; Currie, L

2011-01-01

Background Effective communication is essential to safe and efficient patient care. Additionally, many health information technology (HIT) developments, innovations, and standards aim to implement processes to improve data quality and integrity of electronic health records (EHR) for the purpose of clinical information exchange and communication. Objective We aimed to understand the current patterns and perceptions of communication of common goals in the ICU using the distributed cognition and clinical communication space theoretical frameworks. Methods We conducted a focus group and 5 interviews with ICU clinicians and observed 59.5 hours of interdisciplinary ICU morning rounds. Results Clinicians used an EHR system, which included electronic documentation and computerized provider order entry (CPOE), and paper artifacts for documentation; yet, preferred the verbal communication space as a method of information exchange because they perceived that the documentation was often not updated or efficient for information retrieval. These perceptions that the EHR is a “shift behind” may lead to a further reliance on verbal information exchange, which is a valuable clinical communication activity, yet, is subject to information loss. Conclusions Electronic documentation tools that, in real time, capture information that is currently verbally communicated may increase the effectiveness of communication. PMID:23616870

We Work with Them? Healthcare Workers Interpretation of Organizational Relations Mined from Electronic Health Records

PubMed Central

Chen, You; Lorenzi, Nancy; Nyemba, Steve; Schildcrout, Jonathan S.; Malin, Bradley

2014-01-01

Objective Models of healthcare organizations (HCOs) are often defined up front by a select few administrative officials and managers. However, given the size and complexity of modern healthcare systems, this practice does not scale easily. The goal of this work is to investigate the extent to which organizational relationships can be automatically learned from utilization patterns of electronic health record (EHR) systems. Method We designed an online survey to solicit the perspectives of employees of a large academic medical center. We surveyed employees from two administrative areas: 1) Coding & Charge Entry and 2) Medical Information Services and two clinical areas: 3) Anesthesiology and 4) Psychiatry. To test our hypotheses we selected two administrative units that have work-related responsibilities with electronic records; however, for the clinical areas we selected two disciplines with very different patient responsibilities and whose accesses and people who accessed were similar. We provided each group of employees with questions regarding the chance of interaction between areas in the medical center in the form of association rules (e.g., Given someone from Coding & Charge Entry accessed a patient’s record, what is the chance that someone from Medical Information Services access the same record?). We compared the respondent predictions with the rules learned from actual EHR utilization using linear-mixed effects regression models. Results The findings from our survey confirm that medical center employees can distinguish between association rules of high and non-high likelihood when their own area is involved. Moreover, they can make such distinctions between for any HCO area in this survey. It was further observed that, with respect to highly likely interactions, respondents from certain areas were significantly better than other respondents at making such distinctions and certain areas’ associations were more distinguishable than others. Conclusions These results illustrate that EHR utilization patterns may be consistent with the expectations of HCO employees. Our findings show that certain areas in the HCO are easier than others for employees to assess, which suggests that automated learning strategies may yield more accurate models of healthcare organizations than those based on the perspectives of a select few individuals. PMID:24845147

Reducing Wrong Patient Selection Errors: Exploring the Design Space of User Interface Techniques

PubMed Central

Sopan, Awalin; Plaisant, Catherine; Powsner, Seth; Shneiderman, Ben

2014-01-01

Wrong patient selection errors are a major issue for patient safety; from ordering medication to performing surgery, the stakes are high. Widespread adoption of Electronic Health Record (EHR) and Computerized Provider Order Entry (CPOE) systems makes patient selection using a computer screen a frequent task for clinicians. Careful design of the user interface can help mitigate the problem by helping providers recall their patients’ identities, accurately select their names, and spot errors before orders are submitted. We propose a catalog of twenty seven distinct user interface techniques, organized according to a task analysis. An associated video demonstrates eighteen of those techniques. EHR designers who consider a wider range of human-computer interaction techniques could reduce selection errors, but verification of efficacy is still needed. PMID:25954415

Reducing wrong patient selection errors: exploring the design space of user interface techniques.

PubMed

Sopan, Awalin; Plaisant, Catherine; Powsner, Seth; Shneiderman, Ben

2014-01-01

Wrong patient selection errors are a major issue for patient safety; from ordering medication to performing surgery, the stakes are high. Widespread adoption of Electronic Health Record (EHR) and Computerized Provider Order Entry (CPOE) systems makes patient selection using a computer screen a frequent task for clinicians. Careful design of the user interface can help mitigate the problem by helping providers recall their patients' identities, accurately select their names, and spot errors before orders are submitted. We propose a catalog of twenty seven distinct user interface techniques, organized according to a task analysis. An associated video demonstrates eighteen of those techniques. EHR designers who consider a wider range of human-computer interaction techniques could reduce selection errors, but verification of efficacy is still needed.

Modeling healthcare authorization and claim submissions using the openEHR dual-model approach

PubMed Central

2011-01-01

Background The TISS standard is a set of mandatory forms and electronic messages for healthcare authorization and claim submissions among healthcare plans and providers in Brazil. It is not based on formal models as the new generation of health informatics standards suggests. The objective of this paper is to model the TISS in terms of the openEHR archetype-based approach and integrate it into a patient-centered EHR architecture. Methods Three approaches were adopted to model TISS. In the first approach, a set of archetypes was designed using ENTRY subclasses. In the second one, a set of archetypes was designed using exclusively ADMIN_ENTRY and CLUSTERs as their root classes. In the third approach, the openEHR ADMIN_ENTRY is extended with classes designed for authorization and claim submissions, and an ISM_TRANSITION attribute is added to the COMPOSITION class. Another set of archetypes was designed based on this model. For all three approaches, templates were designed to represent the TISS forms. Results The archetypes based on the openEHR RM (Reference Model) can represent all TISS data structures. The extended model adds subclasses and an attribute to the COMPOSITION class to represent information on authorization and claim submissions. The archetypes based on all three approaches have similar structures, although rooted in different classes. The extended openEHR RM model is more semantically aligned with the concepts involved in a claim submission, but may disrupt interoperability with other systems and the current tools must be adapted to deal with it. Conclusions Modeling the TISS standard by means of the openEHR approach makes it aligned with ISO recommendations and provides a solid foundation on which the TISS can evolve. Although there are few administrative archetypes available, the openEHR RM is expressive enough to represent the TISS standard. This paper focuses on the TISS but its results may be extended to other billing processes. A complete communication architecture to simulate the exchange of TISS data between systems according to the openEHR approach still needs to be designed and implemented. PMID:21992670

Prototype Development: Context-Driven Dynamic XML Ophthalmologic Data Capture Application

PubMed Central

Schwei, Kelsey M; Kadolph, Christopher; Finamore, Joseph; Cancel, Efrain; McCarty, Catherine A; Okorie, Asha; Thomas, Kate L; Allen Pacheco, Jennifer; Pathak, Jyotishman; Ellis, Stephen B; Denny, Joshua C; Rasmussen, Luke V; Tromp, Gerard; Williams, Marc S; Vrabec, Tamara R; Brilliant, Murray H

2017-01-01

Background The capture and integration of structured ophthalmologic data into electronic health records (EHRs) has historically been a challenge. However, the importance of this activity for patient care and research is critical. Objective The purpose of this study was to develop a prototype of a context-driven dynamic extensible markup language (XML) ophthalmologic data capture application for research and clinical care that could be easily integrated into an EHR system. Methods Stakeholders in the medical, research, and informatics fields were interviewed and surveyed to determine data and system requirements for ophthalmologic data capture. On the basis of these requirements, an ophthalmology data capture application was developed to collect and store discrete data elements with important graphical information. Results The context-driven data entry application supports several features, including ink-over drawing capability for documenting eye abnormalities, context-based Web controls that guide data entry based on preestablished dependencies, and an adaptable database or XML schema that stores Web form specifications and allows for immediate changes in form layout or content. The application utilizes Web services to enable data integration with a variety of EHRs for retrieval and storage of patient data. Conclusions This paper describes the development process used to create a context-driven dynamic XML data capture application for optometry and ophthalmology. The list of ophthalmologic data elements identified as important for care and research can be used as a baseline list for future ophthalmologic data collection activities. PMID:28903894

Workarounds Emerging From Electronic Health Record System Usage: Consequences for Patient Safety, Effectiveness of Care, and Efficiency of Care.

PubMed

Blijleven, Vincent; Koelemeijer, Kitty; Wetzels, Marijntje; Jaspers, Monique

2017-10-05

Health care providers resort to informal temporary practices known as workarounds for handling exceptions to normal workflow unintendedly imposed by electronic health record systems (EHRs). Although workarounds may seem favorable at first sight, they are generally suboptimal and may jeopardize patient safety, effectiveness of care, and efficiency of care. Research into the scope and impact of EHR workarounds on patient care processes is scarce. This paper provides insight into the effects of EHR workarounds on organizational workflows and outcomes of care services by identifying EHR workarounds and determining their rationales, scope, and impact on health care providers' workflows, patient safety, effectiveness of care, and efficiency of care. Knowing the rationale of a workaround provides valuable clues about the source of origin of each workaround and how each workaround could most effectively be resolved. Knowing the scope and impact a workaround has on EHR-related safety, effectiveness, and efficiency provides insight into how to address related concerns. Direct observations and follow-up semistructured interviews with 31 physicians, 13 nurses, and 3 clerks and qualitative bottom-up coding techniques was used to identify, analyze, and classify EHR workarounds. The research was conducted within 3 specialties and settings at a large university hospital. Rationales were associated with work system components (persons, technology and tools, tasks, organization, and physical environment) of the Systems Engineering Initiative for Patient Safety (SEIPS) framework to reveal their source of origin as well as to determine the scope and the impact of each EHR workaround from a structure-process-outcome perspective. A total of 15 rationales for EHR workarounds were identified of which 5 were associated with persons, 4 with technology and tools, 4 with the organization, and 2 with the tasks. Three of these 15 rationales for EHR workarounds have not been identified in prior research: data migration policy, enforced data entry, and task interference. EHR workaround rationales associated with different SEIPS work system components demand a different approach to be resolved. Persons-related workarounds may most effectively be resolved through personal training, organization-related workarounds through reviewing organizational policy and regulations, tasks-related workarounds through process redesign, and technology- and tools-related workarounds through EHR redesign efforts. Furthermore, insights gained from knowing a workaround's degree of influence as well as impact on patient safety, effectiveness of care, and efficiency of care can inform design and redesign of EHRs to further align EHR design with work contexts, subsequently leading to better organization and (safe) provision of care. In doing so, a research team in collaboration with all stakeholders could use the SEIPS framework to reflect on the current and potential future configurations of the work system to prevent unfavorable workarounds from occurring and how a redesign of the EHR would impact interactions between the work system components. ©Vincent Blijleven, Kitty Koelemeijer, Marijntje Wetzels, Monique Jaspers. Originally published in JMIR Human Factors (http://humanfactors.jmir.org), 05.10.2017.

[From record keeping to scientific research: obstacles and opportunities for research with electronic health records].

PubMed

Scholte, R A; Opmeer, B C; Ploem, M C

2017-01-01

As a result of increasing digitisation of medical record keeping, electronic health records (EHRs) are an attractive source for data reuse. However, such record-based research is still suffering from poor quality of data stored in EHRs. Lack of consent for reuse of data also plays an impeding role, especially in retrospective record-based research. That said, increasing cooperation between healthcare institutions and current attention for EHR organisation also offer opportunities for record-based research. Patient data can be recorded in more standardised ways and in increasingly harmonised EHRs. In addition, if healthcare institutions were to establish a generic consent procedure - preferably with national scope - the potential of EHRs for scientific research could be exploited in considerably better ways.

Ten tips for successful electronic health records deployment.

PubMed

Gasch, Art

2012-01-01

As healthcare providers are increasingly compelled to adopt electronic health records (EHRs) and paper records migrate to electronic files provided to dozens of healthcare intermediaries, breeches of protected health information are skyrocketing, and so are dissatisfaction rates with EHR solutions. This article provides 10 practical tips to ensure a successful EHR system deployment an circumvent EHR land mines.

The Electronic Health Record Objective Structured Clinical Examination: Assessing Student Competency in Patient Interactions While Using the Electronic Health Record.

PubMed

Biagioli, Frances E; Elliot, Diane L; Palmer, Ryan T; Graichen, Carla C; Rdesinski, Rebecca E; Ashok Kumar, Kaparaboyna; Galper, Ari B; Tysinger, James W

2017-01-01

Because many medical students do not have access to electronic health records (EHRs) in the clinical environment, simulated EHR training is necessary. Explicitly training medical students to use EHRs appropriately during patient encounters equips them to engage patients while also attending to the accuracy of the record and contributing to a culture of information safety. Faculty developed and successfully implemented an EHR objective structured clinical examination (EHR-OSCE) for clerkship students at two institutions. The EHR-OSCE objectives include assessing EHR-related communication and data management skills. The authors collected performance data for students (n = 71) at the first institution during academic years 2011-2013 and for students (n = 211) at the second institution during academic year 2013-2014. EHR-OSCE assessment checklist scores showed that students performed well in EHR-related communication tasks, such as maintaining eye contact and stopping all computer work when the patient expresses worry. Findings indicated student EHR skill deficiencies in the areas of EHR data management including medical history review, medication reconciliation, and allergy reconciliation. Most students' EHR skills failed to improve as the year progressed, suggesting that they did not gain the EHR training and experience they need in clinics and hospitals. Cross-institutional data comparisons will help determine whether differences in curricula affect students' EHR skills. National and institutional policies and faculty development are needed to ensure that students receive adequate EHR education, including hands-on experience in the clinic as well as simulated EHR practice.

Factors associated with adoption of health information technology: a conceptual model based on a systematic review.

PubMed

Kruse, Clemens Scott; DeShazo, Jonathan; Kim, Forest; Fulton, Lawrence

2014-05-23

The Health Information Technology for Economic and Clinical Health Act (HITECH) allocated $19.2 billion to incentivize adoption of the electronic health record (EHR). Since 2009, Meaningful Use Criteria have dominated information technology (IT) strategy. Health care organizations have struggled to meet expectations and avoid penalties to reimbursements from the Center for Medicare and Medicaid Services (CMS). Organizational theories attempt to explain factors that influence organizational change, and many theories address changes in organizational strategy. However, due to the complexities of the health care industry, existing organizational theories fall short of demonstrating association with significant health care IT implementations. There is no organizational theory for health care that identifies, groups, and analyzes both internal and external factors of influence for large health care IT implementations like adoption of the EHR. The purpose of this systematic review is to identify a full-spectrum of both internal organizational and external environmental factors associated with the adoption of health information technology (HIT), specifically the EHR. The result is a conceptual model that is commensurate with the complexity of with the health care sector. We performed a systematic literature search in PubMed (restricted to English), EBSCO Host, and Google Scholar for both empirical studies and theory-based writing from 1993-2013 that demonstrated association between influential factors and three modes of HIT: EHR, electronic medical record (EMR), and computerized provider order entry (CPOE). We also looked at published books on organizational theories. We made notes and noted trends on adoption factors. These factors were grouped as adoption factors associated with various versions of EHR adoption. The resulting conceptual model summarizes the diversity of independent variables (IVs) and dependent variables (DVs) used in articles, editorials, books, as well as quantitative and qualitative studies (n=83). As of 2009, only 16.30% (815/4999) of nonfederal, acute-care hospitals had adopted a fully interoperable EHR. From the 83 articles reviewed in this study, 16/83 (19%) identified internal organizational factors and 9/83 (11%) identified external environmental factors associated with adoption of the EHR, EMR, or CPOE. The conceptual model for EHR adoption associates each variable with the work that identified it. Commonalities exist in the literature for internal organizational and external environmental factors associated with the adoption of the EHR and/or CPOE. The conceptual model for EHR adoption associates internal and external factors, specific to the health care industry, associated with adoption of the EHR. It becomes apparent that these factors have some level of association, but the association is not consistently calculated individually or in combination. To better understand effective adoption strategies, empirical studies should be performed from this conceptual model to quantify the positive or negative effect of each factor.

Electronic Health Records: Applying Diffusion of Innovation Theory to the Relationship between Multifactor Authentication and EHR Adoption

ERIC Educational Resources Information Center

Lockett, Daeron C.

2014-01-01

Electronic Health Record (EHR) systems are increasingly becoming accepted as future direction of medical record management systems. Programs such as the American Recovery and Reinvestment Act have provided incentives to hospitals that adopt EHR systems. In spite of these incentives, the perception of EHR adoption is that is has not achieved the…

Implementation of a scalable, web-based, automated clinical decision support risk-prediction tool for chronic kidney disease using C-CDA and application programming interfaces.

PubMed

Samal, Lipika; D'Amore, John D; Bates, David W; Wright, Adam

2017-11-01

Clinical decision support tools for risk prediction are readily available, but typically require workflow interruptions and manual data entry so are rarely used. Due to new data interoperability standards for electronic health records (EHRs), other options are available. As a clinical case study, we sought to build a scalable, web-based system that would automate calculation of kidney failure risk and display clinical decision support to users in primary care practices. We developed a single-page application, web server, database, and application programming interface to calculate and display kidney failure risk. Data were extracted from the EHR using the Consolidated Clinical Document Architecture interoperability standard for Continuity of Care Documents (CCDs). EHR users were presented with a noninterruptive alert on the patient's summary screen and a hyperlink to details and recommendations provided through a web application. Clinic schedules and CCDs were retrieved using existing application programming interfaces to the EHR, and we provided a clinical decision support hyperlink to the EHR as a service. We debugged a series of terminology and technical issues. The application was validated with data from 255 patients and subsequently deployed to 10 primary care clinics where, over the course of 1 year, 569 533 CCD documents were processed. We validated the use of interoperable documents and open-source components to develop a low-cost tool for automated clinical decision support. Since Consolidated Clinical Document Architecture-based data extraction extends to any certified EHR, this demonstrates a successful modular approach to clinical decision support. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Electronic health records and patient safety: co-occurrence of early EHR implementation with patient safety practices in primary care settings.

PubMed

Tanner, C; Gans, D; White, J; Nath, R; Pohl, J

2015-01-01

The role of electronic health records (EHR) in enhancing patient safety, while substantiated in many studies, is still debated. This paper examines early EHR adopters in primary care to understand the extent to which EHR implementation is associated with the workflows, policies and practices that promote patient safety, as compared to practices with paper records. Early adoption is defined as those who were using EHR prior to implementation of the Meaningful Use program. We utilized the Physician Practice Patient Safety Assessment (PPPSA) to compare primary care practices with fully implemented EHR to those utilizing paper records. The PPPSA measures the extent of adoption of patient safety practices in the domains: medication management, handoffs and transition, personnel qualifications and competencies, practice management and culture, and patient communication. Data from 209 primary care practices responding between 2006-2010 were included in the analysis: 117 practices used paper medical records and 92 used an EHR. Results showed that, within all domains, EHR settings showed significantly higher rates of having workflows, policies and practices that promote patient safety than paper record settings. While these results were expected in the area of medication management, EHR use was also associated with adoption of patient safety practices in areas in which the researchers had no a priori expectations of association. Sociotechnical models of EHR use point to complex interactions between technology and other aspects of the environment related to human resources, workflow, policy, culture, among others. This study identifies that among primary care practices in the national PPPSA database, having an EHR was strongly empirically associated with the workflow, policy, communication and cultural practices recommended for safe patient care in ambulatory settings.

Rationale and Design of the Registry for Stones of the Kidney and Ureter (ReSKU): A Prospective Observational Registry to Study the Natural History of Urolithiasis Patients.

PubMed

Chang, Helena C; Tzou, David T; Usawachintachit, Manint; Duty, Brian D; Hsi, Ryan S; Harper, Jonathan D; Sorensen, Mathew D; Stoller, Marshall L; Sur, Roger L; Chi, Thomas

2016-12-01

Registry-based clinical research in nephrolithiasis is critical to advancing quality in urinary stone disease management and ultimately reducing stone recurrence. A need exists to develop Health Insurance Portability and Accountability Act (HIPAA)-compliant registries that comprise integrated electronic health record (EHR) data using prospectively defined variables. An EHR-based standardized patient database-the Registry for Stones of the Kidney and Ureter (ReSKU™)-was developed, and herein we describe our implementation outcomes. Interviews with academic and community endourologists in the United States, Canada, China, and Japan identified demographic, intraoperative, and perioperative variables to populate our registry. Variables were incorporated into a HIPAA-compliant Research Electronic Data Capture database linked to text prompts and registration data within the Epic EHR platform. Specific data collection instruments supporting New patient, Surgery, Postoperative, and Follow-up clinical encounters were created within Epic to facilitate automated data extraction into ReSKU. The number of variables within each instrument includes the following: New patient-60, Surgery-80, Postoperative-64, and Follow-up-64. With manual data entry, the mean times to complete each of the clinic-based instruments were (minutes) as follows: New patient-12.06 ± 2.30, Postoperative-7.18 ± 1.02, and Follow-up-8.10 ± 0.58. These times were significantly reduced with the use of ReSKU structured clinic note templates to the following: New patient-4.09 ± 1.73, Postoperative-1.41 ± 0.41, and Follow-up-0.79 ± 0.38. With automated data extraction from Epic, manual entry is obviated. ReSKU is a longitudinal prospective nephrolithiasis registry that integrates EHR data, lowering the barriers to performing high quality clinical research and quality outcome assessments in urinary stone disease.

Rationale and Design of the Registry for Stones of the Kidney and Ureter (ReSKU): A Prospective Observational Registry to Study the Natural History of Urolithiasis Patients

PubMed Central

Chang, Helena C.; Tzou, David T.; Usawachintachit, Manint; Duty, Brian D.; Hsi, Ryan S.; Harper, Jonathan D.; Sorensen, Mathew D.; Stoller, Marshall L.; Sur, Roger L.

2016-01-01

Abstract Objectives: Registry-based clinical research in nephrolithiasis is critical to advancing quality in urinary stone disease management and ultimately reducing stone recurrence. A need exists to develop Health Insurance Portability and Accountability Act (HIPAA)-compliant registries that comprise integrated electronic health record (EHR) data using prospectively defined variables. An EHR-based standardized patient database—the Registry for Stones of the Kidney and Ureter (ReSKU™)—was developed, and herein we describe our implementation outcomes. Materials and Methods: Interviews with academic and community endourologists in the United States, Canada, China, and Japan identified demographic, intraoperative, and perioperative variables to populate our registry. Variables were incorporated into a HIPAA-compliant Research Electronic Data Capture database linked to text prompts and registration data within the Epic EHR platform. Specific data collection instruments supporting New patient, Surgery, Postoperative, and Follow-up clinical encounters were created within Epic to facilitate automated data extraction into ReSKU. Results: The number of variables within each instrument includes the following: New patient—60, Surgery—80, Postoperative—64, and Follow-up—64. With manual data entry, the mean times to complete each of the clinic-based instruments were (minutes) as follows: New patient—12.06 ± 2.30, Postoperative—7.18 ± 1.02, and Follow-up—8.10 ± 0.58. These times were significantly reduced with the use of ReSKU structured clinic note templates to the following: New patient—4.09 ± 1.73, Postoperative—1.41 ± 0.41, and Follow-up—0.79 ± 0.38. With automated data extraction from Epic, manual entry is obviated. Conclusions: ReSKU is a longitudinal prospective nephrolithiasis registry that integrates EHR data, lowering the barriers to performing high quality clinical research and quality outcome assessments in urinary stone disease. PMID:27758162

Perioperative nurses' attitudes toward the electronic health record.

PubMed

Yontz, Laura S; Zinn, Jennifer L; Schumacher, Edward J

2015-02-01

The adoption of an electronic health record (EHR) is mandated under current health care legislation reform. The EHR provides data that are patient centered and improves patient safety. There are limited data; however, regarding the attitudes of perioperative nurses toward the use of the EHR. The purpose of this project was to identify perioperative nurses' attitudes toward the use of the EHR. Quantitative descriptive survey was used to determine attitudes toward the electronic health record. Perioperative nurses in a southeastern health system completed an online survey to determine their attitudes toward the EHR in providing patient care. Overall, respondents felt the EHR was beneficial, did not add to the workload, improved documentation, and would not eliminate any nursing jobs. Nursing acceptance and the utilization of the EHR are necessary for the successful integration of an EHR and to support the goal of patient-centered care. Identification of attitudes and potential barriers of perioperative nurses in using the EHR will improve patient safety, communication, reduce costs, and empower those who implement an EHR. Copyright © 2015 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

The impact of electronic health records on time efficiency of physicians and nurses: a systematic review.

PubMed

Poissant, Lise; Pereira, Jennifer; Tamblyn, Robyn; Kawasumi, Yuko

2005-01-01

A systematic review of the literature was performed to examine the impact of electronic health records (EHRs) on documentation time of physicians and nurses and to identify factors that may explain efficiency differences across studies. In total, 23 papers met our inclusion criteria; five were randomized controlled trials, six were posttest control studies, and 12 were one-group pretest-posttest designs. Most studies (58%) collected data using a time and motion methodology in comparison to work sampling (33%) and self-report/survey methods (8%). A weighted average approach was used to combine results from the studies. The use of bedside terminals and central station desktops saved nurses, respectively, 24.5% and 23.5% of their overall time spent documenting during a shift. Using bedside or point-of-care systems increased documentation time of physicians by 17.5%. In comparison, the use of central station desktops for computerized provider order entry (CPOE) was found to be inefficient, increasing the work time from 98.1% to 328.6% of physician's time per working shift (weighted average of CPOE-oriented studies, 238.4%). Studies that conducted their evaluation process relatively soon after implementation of the EHR tended to demonstrate a reduction in documentation time in comparison to the increases observed with those that had a longer time period between implementation and the evaluation process. This review highlighted that a goal of decreased documentation time in an EHR project is not likely to be realized. It also identified how the selection of bedside or central station desktop EHRs may influence documentation time for the two main user groups, physicians and nurses.

The Impact of Electronic Health Records on Time Efficiency of Physicians and Nurses: A Systematic Review

PubMed Central

Poissant, Lise; Pereira, Jennifer; Tamblyn, Robyn; Kawasumi, Yuko

2005-01-01

A systematic review of the literature was performed to examine the impact of electronic health records (EHRs) on documentation time of physicians and nurses and to identify factors that may explain efficiency differences across studies. In total, 23 papers met our inclusion criteria; five were randomized controlled trials, six were posttest control studies, and 12 were one-group pretest-posttest designs. Most studies (58%) collected data using a time and motion methodology in comparison to work sampling (33%) and self-report/survey methods (8%). A weighted average approach was used to combine results from the studies. The use of bedside terminals and central station desktops saved nurses, respectively, 24.5% and 23.5% of their overall time spent documenting during a shift. Using bedside or point-of-care systems increased documentation time of physicians by 17.5%. In comparison, the use of central station desktops for computerized provider order entry (CPOE) was found to be inefficient, increasing the work time from 98.1% to 328.6% of physician's time per working shift (weighted average of CPOE-oriented studies, 238.4%). Studies that conducted their evaluation process relatively soon after implementation of the EHR tended to demonstrate a reduction in documentation time in comparison to the increases observed with those that had a longer time period between implementation and the evaluation process. This review highlighted that a goal of decreased documentation time in an EHR project is not likely to be realized. It also identified how the selection of bedside or central station desktop EHRs may influence documentation time for the two main user groups, physicians and nurses. PMID:15905487

Aspects of the Patient-centered Medical Home currently in place: initial findings from preparing the personal physician for practice.

PubMed

Carney, Patricia A; Eiff, M Patrice; Saultz, John W; Douglass, Alan B; Tillotson, Carrie J; Crane, Steven D; Jones, Samuel M; Green, Larry A

2009-10-01

The Patient-centered Medical Home (PCMH) is a central concept in the evolving debate about American health care reform. We studied family medicine residency training programs' continuity clinics to assess baseline status of implementing PCMH components and to compare implementation status between community-based and university training programs. We conducted a survey 24 continuity clinics in 14 residency programs that are part of the Preparing the Personal Physicians for Practice (P(4)) program. We asked questions about aspects of P(4) that had been already implemented at the beginning of the P(4) program. We defined high implementation as aspects that were present in >50% of clinics and low implementation as those present in <50% of clinics. We compared features at university-based and community-based clinics. High areas of implementation were having an electronic health record (EHR), fully secured remote access, electronic patient notes/scheduling/billing, chronic disease management registries, and open-access scheduling. Low areas of implementation included hospital EHR with computerized physician order entry, asynchronous communication with patients, ongoing population-based QA using EHR, use of preventive registries, and practice-based research using EHR. Few differences were noted between university- and community-based residency programs. Many features of the PCMH were already established at baseline in programs participating in P(4).

The Catch to Confidentiality: The Use of Electronic Health Records in Adolescent Health Care.

PubMed

Stablein, Timothy; Loud, Keith J; DiCapua, Christopher; Anthony, Denise L

2018-05-01

This study aims to understand pediatric health-care providers' expectations and the practices they employ to protect confidentiality in electronic health records (EHRs) and subsequently how EHRs affect the documentation and dissemination of information in the course of health-care delivery to adolescent minors. Twenty-six pediatric health-care providers participated in in-depth interviews about their experiences using EHRs to understand a broad spectrum of expectations and practices guiding the documentation and dissemination of information in the EHR. A thematic analysis of interviews was conducted to draw findings and conclusions. Two themes and several subthemes emerged centering on how EHRs affected confidentiality expectations and practices. Participants expressed confidentiality concerns due to the EHR's longevity as a legacy record, its multidimensional uses, and increased access by users (theme 1). These concerns affected practices for protecting adolescent confidentiality within the EHR (theme 2). Practices included selectively omitting or concealing information and utilizing sets of personal and collective codes designed to alert providers or teams of providers to confidential information within a patient's record. EHRs create new and unresolved challenges for pediatric health care as they alter expectations of confidentiality and the documentation and dissemination of information within the record. This is particularly relevant in the course of care to adolescent minors as EHRs may compromise the tenuous balance providers maintain between protecting confidentiality and effective documentation within the record. Copyright © 2017 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

A review of security of electronic health records.

PubMed

Win, Khin Than

The objective of this study is to answer the research question, "Are current information security technologies adequate for electronic health records (EHRs)?" In order to achieve this, the following matters have been addressed in this article: (i) What is information security in the context of EHRs? (ii) Why is information security important for EHRs? and (iii) What are the current technologies for information security available to EHRs? It is concluded that current EHR security technologies are inadequate and urgently require improvement. Further study regarding information security of EHRs is indicated.

Health information technology workforce needs of rural primary care practices.

PubMed

Skillman, Susan M; Andrilla, C Holly A; Patterson, Davis G; Fenton, Susan H; Ostergard, Stefanie J

2015-01-01

This study assessed electronic health record (EHR) and health information technology (HIT) workforce resources needed by rural primary care practices, and their workforce-related barriers to implementing and using EHRs and HIT. Rural primary care practices (1,772) in 13 states (34.2% response) were surveyed in 2012 using mailed and Web-based questionnaires. EHRs or HIT were used by 70% of respondents. Among practices using or intending to use the technology, most did not plan to hire new employees to obtain EHR/HIT skills and even fewer planned to hire consultants or vendors to fill gaps. Many practices had staff with some basic/entry, intermediate and/or advanced-level skills, but nearly two-thirds (61.4%) needed more staff training. Affordable access to vendors/consultants who understand their needs and availability of community college and baccalaureate-level training were the workforce-related barriers cited by the highest percentages of respondents. Accessing the Web/Internet challenged nearly a quarter of practices in isolated rural areas, and nearly a fifth in small rural areas. Finding relevant vendors/consultants and qualified staff were greater barriers in small and isolated rural areas than in large rural areas. Rural primary care practices mainly will rely on existing staff for continued implementation and use of EHR/HIT systems. Infrastructure and workforce-related barriers remain and must be overcome before practices can fully manage patient populations and exchange patient information among care system partners. Efforts to monitor adoption of these skills and ongoing support for continuing education will likely benefit rural populations. © 2014 National Rural Health Association.

Barriers to Retrieving Patient Information from Electronic Health Record Data: Failure Analysis from the TREC Medical Records Track

PubMed Central

Edinger, Tracy; Cohen, Aaron M.; Bedrick, Steven; Ambert, Kyle; Hersh, William

2012-01-01

Objective: Secondary use of electronic health record (EHR) data relies on the ability to retrieve accurate and complete information about desired patient populations. The Text Retrieval Conference (TREC) 2011 Medical Records Track was a challenge evaluation allowing comparison of systems and algorithms to retrieve patients eligible for clinical studies from a corpus of de-identified medical records, grouped by patient visit. Participants retrieved cohorts of patients relevant to 35 different clinical topics, and visits were judged for relevance to each topic. This study identified the most common barriers to identifying specific clinic populations in the test collection. Methods: Using the runs from track participants and judged visits, we analyzed the five non-relevant visits most often retrieved and the five relevant visits most often overlooked. Categories were developed iteratively to group the reasons for incorrect retrieval for each of the 35 topics. Results: Reasons fell into nine categories for non-relevant visits and five categories for relevant visits. Non-relevant visits were most often retrieved because they contained a non-relevant reference to the topic terms. Relevant visits were most often infrequently retrieved because they used a synonym for a topic term. Conclusions: This failure analysis provides insight into areas for future improvement in EHR-based retrieval with techniques such as more widespread and complete use of standardized terminology in retrieval and data entry systems. PMID:23304287

Barriers to retrieving patient information from electronic health record data: failure analysis from the TREC Medical Records Track.

PubMed

Edinger, Tracy; Cohen, Aaron M; Bedrick, Steven; Ambert, Kyle; Hersh, William

2012-01-01

Secondary use of electronic health record (EHR) data relies on the ability to retrieve accurate and complete information about desired patient populations. The Text Retrieval Conference (TREC) 2011 Medical Records Track was a challenge evaluation allowing comparison of systems and algorithms to retrieve patients eligible for clinical studies from a corpus of de-identified medical records, grouped by patient visit. Participants retrieved cohorts of patients relevant to 35 different clinical topics, and visits were judged for relevance to each topic. This study identified the most common barriers to identifying specific clinic populations in the test collection. Using the runs from track participants and judged visits, we analyzed the five non-relevant visits most often retrieved and the five relevant visits most often overlooked. Categories were developed iteratively to group the reasons for incorrect retrieval for each of the 35 topics. Reasons fell into nine categories for non-relevant visits and five categories for relevant visits. Non-relevant visits were most often retrieved because they contained a non-relevant reference to the topic terms. Relevant visits were most often infrequently retrieved because they used a synonym for a topic term. This failure analysis provides insight into areas for future improvement in EHR-based retrieval with techniques such as more widespread and complete use of standardized terminology in retrieval and data entry systems.

ORBDA: An openEHR benchmark dataset for performance assessment of electronic health record servers.

PubMed

Teodoro, Douglas; Sundvall, Erik; João Junior, Mario; Ruch, Patrick; Miranda Freire, Sergio

2018-01-01

The openEHR specifications are designed to support implementation of flexible and interoperable Electronic Health Record (EHR) systems. Despite the increasing number of solutions based on the openEHR specifications, it is difficult to find publicly available healthcare datasets in the openEHR format that can be used to test, compare and validate different data persistence mechanisms for openEHR. To foster research on openEHR servers, we present the openEHR Benchmark Dataset, ORBDA, a very large healthcare benchmark dataset encoded using the openEHR formalism. To construct ORBDA, we extracted and cleaned a de-identified dataset from the Brazilian National Healthcare System (SUS) containing hospitalisation and high complexity procedures information and formalised it using a set of openEHR archetypes and templates. Then, we implemented a tool to enrich the raw relational data and convert it into the openEHR model using the openEHR Java reference model library. The ORBDA dataset is available in composition, versioned composition and EHR openEHR representations in XML and JSON formats. In total, the dataset contains more than 150 million composition records. We describe the dataset and provide means to access it. Additionally, we demonstrate the usage of ORBDA for evaluating inserting throughput and query latency performances of some NoSQL database management systems. We believe that ORBDA is a valuable asset for assessing storage models for openEHR-based information systems during the software engineering process. It may also be a suitable component in future standardised benchmarking of available openEHR storage platforms.

ORBDA: An openEHR benchmark dataset for performance assessment of electronic health record servers

PubMed Central

Sundvall, Erik; João Junior, Mario; Ruch, Patrick; Miranda Freire, Sergio

2018-01-01

The openEHR specifications are designed to support implementation of flexible and interoperable Electronic Health Record (EHR) systems. Despite the increasing number of solutions based on the openEHR specifications, it is difficult to find publicly available healthcare datasets in the openEHR format that can be used to test, compare and validate different data persistence mechanisms for openEHR. To foster research on openEHR servers, we present the openEHR Benchmark Dataset, ORBDA, a very large healthcare benchmark dataset encoded using the openEHR formalism. To construct ORBDA, we extracted and cleaned a de-identified dataset from the Brazilian National Healthcare System (SUS) containing hospitalisation and high complexity procedures information and formalised it using a set of openEHR archetypes and templates. Then, we implemented a tool to enrich the raw relational data and convert it into the openEHR model using the openEHR Java reference model library. The ORBDA dataset is available in composition, versioned composition and EHR openEHR representations in XML and JSON formats. In total, the dataset contains more than 150 million composition records. We describe the dataset and provide means to access it. Additionally, we demonstrate the usage of ORBDA for evaluating inserting throughput and query latency performances of some NoSQL database management systems. We believe that ORBDA is a valuable asset for assessing storage models for openEHR-based information systems during the software engineering process. It may also be a suitable component in future standardised benchmarking of available openEHR storage platforms. PMID:29293556

Food entries in a large allergy data repository

PubMed Central

Plasek, Joseph M.; Goss, Foster R.; Lai, Kenneth H.; Lau, Jason J.; Seger,, Diane L.; Blumenthal, Kimberly G.; Wickner, Paige G.; Slight, Sarah P.; Chang, Frank Y.; Topaz, Maxim; Bates, David W.

2016-01-01

Objective Accurate food adverse sensitivity documentation in electronic health records (EHRs) is crucial to patient safety. This study examined, encoded, and grouped foods that caused any adverse sensitivity in a large allergy repository using natural language processing and standard terminologies. Methods Using the Medical Text Extraction, Reasoning, and Mapping System (MTERMS), we processed both structured and free-text entries stored in an enterprise-wide allergy repository (Partners’ Enterprise-wide Allergy Repository), normalized diverse food allergen terms into concepts, and encoded these concepts using the Systematized Nomenclature of Medicine – Clinical Terms (SNOMED-CT) and Unique Ingredient Identifiers (UNII) terminologies. Concept coverage also was assessed for these two terminologies. We further categorized allergen concepts into groups and calculated the frequencies of these concepts by group. Finally, we conducted an external validation of MTERMS’s performance when identifying food allergen terms, using a randomized sample from a different institution. Results We identified 158 552 food allergen records (2140 unique terms) in the Partners repository, corresponding to 672 food allergen concepts. High-frequency groups included shellfish (19.3%), fruits or vegetables (18.4%), dairy (9.0%), peanuts (8.5%), tree nuts (8.5%), eggs (6.0%), grains (5.1%), and additives (4.7%). Ambiguous, generic concepts such as “nuts” and “seafood” accounted for 8.8% of the records. SNOMED-CT covered more concepts than UNII in terms of exact (81.7% vs 68.0%) and partial (14.3% vs 9.7%) matches. Discussion Adverse sensitivities to food are diverse, and existing standard terminologies have gaps in their coverage of the breadth of allergy concepts. Conclusion New strategies are needed to represent and standardize food adverse sensitivity concepts, to improve documentation in EHRs. PMID:26384406

Food entries in a large allergy data repository.

PubMed

Plasek, Joseph M; Goss, Foster R; Lai, Kenneth H; Lau, Jason J; Seger, Diane L; Blumenthal, Kimberly G; Wickner, Paige G; Slight, Sarah P; Chang, Frank Y; Topaz, Maxim; Bates, David W; Zhou, Li

2016-04-01

Accurate food adverse sensitivity documentation in electronic health records (EHRs) is crucial to patient safety. This study examined, encoded, and grouped foods that caused any adverse sensitivity in a large allergy repository using natural language processing and standard terminologies. Using the Medical Text Extraction, Reasoning, and Mapping System (MTERMS), we processed both structured and free-text entries stored in an enterprise-wide allergy repository (Partners' Enterprise-wide Allergy Repository), normalized diverse food allergen terms into concepts, and encoded these concepts using the Systematized Nomenclature of Medicine - Clinical Terms (SNOMED-CT) and Unique Ingredient Identifiers (UNII) terminologies. Concept coverage also was assessed for these two terminologies. We further categorized allergen concepts into groups and calculated the frequencies of these concepts by group. Finally, we conducted an external validation of MTERMS's performance when identifying food allergen terms, using a randomized sample from a different institution. We identified 158 552 food allergen records (2140 unique terms) in the Partners repository, corresponding to 672 food allergen concepts. High-frequency groups included shellfish (19.3%), fruits or vegetables (18.4%), dairy (9.0%), peanuts (8.5%), tree nuts (8.5%), eggs (6.0%), grains (5.1%), and additives (4.7%). Ambiguous, generic concepts such as "nuts" and "seafood" accounted for 8.8% of the records. SNOMED-CT covered more concepts than UNII in terms of exact (81.7% vs 68.0%) and partial (14.3% vs 9.7%) matches. Adverse sensitivities to food are diverse, and existing standard terminologies have gaps in their coverage of the breadth of allergy concepts. New strategies are needed to represent and standardize food adverse sensitivity concepts, to improve documentation in EHRs. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Safety huddles to proactively identify and address electronic health record safety

PubMed Central

Menon, Shailaja; Singh, Hardeep; Giardina, Traber D; Rayburn, William L; Davis, Brenda P; Russo, Elise M

2017-01-01

Objective: Methods to identify and study safety risks of electronic health records (EHRs) are underdeveloped and largely depend on limited end-user reports. “Safety huddles” have been found useful in creating a sense of collective situational awareness that increases an organization’s capacity to respond to safety concerns. We explored the use of safety huddles for identifying and learning about EHR-related safety concerns. Design: Data were obtained from daily safety huddle briefing notes recorded at a single midsized tertiary-care hospital in the United States over 1 year. Huddles were attended by key administrative, clinical, and information technology staff. We conducted a content analysis of huddle notes to identify what EHR-related safety concerns were discussed. We expanded a previously developed EHR-related error taxonomy to categorize types of EHR-related safety concerns recorded in the notes. Results: On review of daily huddle notes spanning 249 days, we identified 245 EHR-related safety concerns. For our analysis, we defined EHR technology to include a specific EHR functionality, an entire clinical software application, or the hardware system. Most concerns (41.6%) involved “EHR technology working incorrectly,” followed by 25.7% involving “EHR technology not working at all.” Concerns related to “EHR technology missing or absent” accounted for 16.7%, whereas 15.9% were linked to “user errors.” Conclusions: Safety huddles promoted discussion of several technology-related issues at the organization level and can serve as a promising technique to identify and address EHR-related safety concerns. Based on our findings, we recommend that health care organizations consider huddles as a strategy to promote understanding and improvement of EHR safety. PMID:28031286

Measuring use of electronic health record functionality using system audit information.

PubMed

Bowes, Watson A

2010-01-01

Meaningful and efficient methods for measuring Electronic Health Record (EHR) adoption and functional usage patterns have recently become important for hospitals, clinics, and health care networks in the United State due to recent government initiatives to increase EHR use. To date, surveys have been the method of choice to measure EHR adoption. This paper describes another method for measuring EHR adoption which capitalizes on audit logs, which are often common components of modern EHRs. An Audit Data Mart is described which identified EHR functionality within 836 Departments, within 22 Hospitals and 170 clinics at Intermountain Healthcare, a large integrated delivery system. The Audit Data Mart successfully identified important and differing EHR functional usage patterns. These patterns were useful in strategic planning, tracking EHR implementations, and will likely be utilized to assist in documentation of "Meaningful Use" of EHR functionality.

Use of Electronic Health Records in sub-Saharan Africa: Progress and challenges

PubMed Central

Akanbi, Maxwell O.; Ocheke, Amaka N.; Agaba, Patricia A.; Daniyam, Comfort A.; Agaba, Emmanuel I.; Okeke, Edith N.; Ukoli, Christiana O.

2012-01-01

Background The Electronic Health Record (EHR) is a key component of medical informatics that is increasingly being utilized in industrialized nations to improve healthcare. There is limited information on the use of EHR in sub-Saharan Africa. This paper reviews availability of EHRs in sub-Saharan Africa. Methods Searches were performed on PubMed and Google Scholar databases using the terms ‘Electronic Health Records OR Electronic Medical Records OR e-Health and Africa’. References from identified publications were reviewed. Inclusion criterion was documented use of EHR in Africa. Results The search yielded 147 publications of which 21papers from 15 sub-Saharan African countries documented the use of EHR in Africa and were reviewed. About 91% reported use of Open Source healthcare software, with OpenMRS being the most widely used. Most reports were from HIV related health centers. Barriers to adoption of EHRs include high cost of procurement and maintenance, poor network infrastructure and lack of comfort among health workers with electronic medical records. Conclusion There has been an increase in the use of EHRs in sub-Saharan Africa, largely driven by utilization by HIV treatment programs. Penetration is still however very low. PMID:25243111

Definition, structure, content, use and impacts of electronic health records: a review of the research literature.

PubMed

Häyrinen, Kristiina; Saranto, Kaija; Nykänen, Pirkko

2008-05-01

This paper reviews the research literature on electronic health record (EHR) systems. The aim is to find out (1) how electronic health records are defined, (2) how the structure of these records is described, (3) in what contexts EHRs are used, (4) who has access to EHRs, (5) which data components of the EHRs are used and studied, (6) what is the purpose of research in this field, (7) what methods of data collection have been used in the studies reviewed and (8) what are the results of these studies. A systematic review was carried out of the research dealing with the content of EHRs. A literature search was conducted on four electronic databases: Pubmed/Medline, Cinalh, Eval and Cochrane. The concept of EHR comprised a wide range of information systems, from files compiled in single departments to longitudinal collections of patient data. Only very few papers offered descriptions of the structure of EHRs or the terminologies used. EHRs were used in primary, secondary and tertiary care. Data were recorded in EHRs by different groups of health care professionals. Secretarial staff also recorded data from dictation or nurses' or physicians' manual notes. Some information was also recorded by patients themselves; this information is validated by physicians. It is important that the needs and requirements of different users are taken into account in the future development of information systems. Several data components were documented in EHRs: daily charting, medication administration, physical assessment, admission nursing note, nursing care plan, referral, present complaint (e.g. symptoms), past medical history, life style, physical examination, diagnoses, tests, procedures, treatment, medication, discharge, history, diaries, problems, findings and immunization. In the future it will be necessary to incorporate different kinds of standardized instruments, electronic interviews and nursing documentation systems in EHR systems. The aspects of information quality most often explored in the studies reviewed were the completeness and accuracy of different data components. It has been shown in several studies that the use of an information system was conducive to more complete and accurate documentation by health care professionals. The quality of information is particularly important in patient care, but EHRs also provide important information for secondary purposes, such as health policy planning. Studies focusing on the content of EHRs are needed, especially studies of nursing documentation or patient self-documentation. One future research area is to compare the documentation of different health care professionals with the core information about EHRs which has been determined in national health projects. The challenge for ongoing national health record projects around the world is to take into account all the different types of EHRs and the needs and requirements of different health care professionals and consumers in the development of EHRs. A further challenge is the use of international terminologies in order to achieve semantic interoperability.

Open data models for smart health interconnected applications: the example of openEHR.

PubMed

Demski, Hans; Garde, Sebastian; Hildebrand, Claudia

2016-10-22

Smart Health is known as a concept that enhances networking, intelligent data processing and combining patient data with other parameters. Open data models can play an important role in creating a framework for providing interoperable data services that support the development of innovative Smart Health applications profiting from data fusion and sharing. This article describes a model-driven engineering approach based on standardized clinical information models and explores its application for the development of interoperable electronic health record systems. The following possible model-driven procedures were considered: provision of data schemes for data exchange, automated generation of artefacts for application development and native platforms that directly execute the models. The applicability of the approach in practice was examined using the openEHR framework as an example. A comprehensive infrastructure for model-driven engineering of electronic health records is presented using the example of the openEHR framework. It is shown that data schema definitions to be used in common practice software development processes can be derived from domain models. The capabilities for automatic creation of implementation artefacts (e.g., data entry forms) are demonstrated. Complementary programming libraries and frameworks that foster the use of open data models are introduced. Several compatible health data platforms are listed. They provide standard based interfaces for interconnecting with further applications. Open data models help build a framework for interoperable data services that support the development of innovative Smart Health applications. Related tools for model-driven application development foster semantic interoperability and interconnected innovative applications.

Technological trends in health care: electronic health record.

PubMed

Abraham, Sam

2010-01-01

The most relevant technological trend affecting health care organizations and physician services is the electronic health record (EHR). Billions of dollars from the federal government stimulus bill are available for investment toward EHR. Based on the government directives, it is evident EHR has to be a high-priority technological intervention in health care organizations. Addressed in the following pages are the effects of the EHR trend on financial and human resources; analysis of advantages and disadvantages of EHR; action steps involved in implementing EHR, and a timeline for implementation. Medical facilities that do not meet the timetable for using EHR will likely experience reduction of Medicare payments. This article also identifies the strengths, weaknesses, opportunities, and threats of the EHR and steps to be taken by hospitals and physician medical groups to receive stimulus payment.

Electronic Health Records and US Public Health: Current Realities and Future Promise

PubMed Central

Parrish, R. Gibson; Ross, David A.

2013-01-01

Electronic health records (EHRs) could contribute to improving population health in the United States. Realizing this potential will require understanding what EHRs can realistically offer to efforts to improve population health, the requirements for obtaining useful information from EHRs, and a plan for addressing these requirements. Potential contributions of EHRs to improving population health include better understanding of the level and distribution of disease, function, and well-being within populations. Requirements are improved population coverage of EHRs, standardized EHR content and reporting methods, and adequate legal authority for using EHRs, particularly for population health. A collaborative national effort to address the most pressing prerequisites for and barriers to the use of EHRs for improving population health is needed to realize the EHR’s potential. PMID:23865646

A student-centred electronic health record system for clinical education.

PubMed

Elliott, Kristine; Judd, Terry; McColl, Geoff

2011-01-01

Electronic Health Record (EHR) systems are an increasingly important feature of the national healthcare system [1]. However, little research has investigated the impact this will have on medical students' learning. As part of an innovative technology platform for a new masters level program in medicine, we are developing a student-centred EHR system for clinical education. A prototype was trialed with medical students over several weeks during 2010. This paper reports on the findings of the trial, which had the overall aim of assisting our understanding of how trainee doctors might use an EHR system for learning and communication in a clinical setting. In primary care and hospital settings, EHR systems offer potential benefits to medical students' learning: Longitudinal tracking of clinical progress towards established learning objectives [2]; Capacity to search across a substantial body of records [3]; Integration with online medical databases [3]; Development of expertise in creating, accessing and managing high quality EHRs [4]. While concerns have been raised that EHR systems may alter the interaction between teachers and students [3], and may negatively influence physician-patient communication [6], there is general consensus that the EHR is changing the current practice environment and teaching practice needs to respond. Final year medical students on clinical placement at a large university teaching hospital were recruited for the trial. Following a four-week period of use, semi-structured interviews were conducted with 10 participants. Audio-recorded interviews were transcribed and data analysed for emerging themes. Study participants were also surveyed about the importance of EHR systems in general, their familiarity with them, and general perceptions of sharing patient records. Medical students in this pilot study identified a number of educational, practical and administrative advantages that the student-centred EHR system offered over their existing ad-hoc procedures for recording patient encounters. Findings from this preliminary study point to the need to introduce and instruct students' on the use of EHR systems from their earliest clinical encounters, and to closely integrate learning activities based on the EHR system with established learning objectives. Further research is required to evaluate the impact of student-centred EHR systems on learning outcomes.

Prototype Development: Context-Driven Dynamic XML Ophthalmologic Data Capture Application.

PubMed

Peissig, Peggy; Schwei, Kelsey M; Kadolph, Christopher; Finamore, Joseph; Cancel, Efrain; McCarty, Catherine A; Okorie, Asha; Thomas, Kate L; Allen Pacheco, Jennifer; Pathak, Jyotishman; Ellis, Stephen B; Denny, Joshua C; Rasmussen, Luke V; Tromp, Gerard; Williams, Marc S; Vrabec, Tamara R; Brilliant, Murray H

2017-09-13

The capture and integration of structured ophthalmologic data into electronic health records (EHRs) has historically been a challenge. However, the importance of this activity for patient care and research is critical. The purpose of this study was to develop a prototype of a context-driven dynamic extensible markup language (XML) ophthalmologic data capture application for research and clinical care that could be easily integrated into an EHR system. Stakeholders in the medical, research, and informatics fields were interviewed and surveyed to determine data and system requirements for ophthalmologic data capture. On the basis of these requirements, an ophthalmology data capture application was developed to collect and store discrete data elements with important graphical information. The context-driven data entry application supports several features, including ink-over drawing capability for documenting eye abnormalities, context-based Web controls that guide data entry based on preestablished dependencies, and an adaptable database or XML schema that stores Web form specifications and allows for immediate changes in form layout or content. The application utilizes Web services to enable data integration with a variety of EHRs for retrieval and storage of patient data. This paper describes the development process used to create a context-driven dynamic XML data capture application for optometry and ophthalmology. The list of ophthalmologic data elements identified as important for care and research can be used as a baseline list for future ophthalmologic data collection activities. ©Peggy Peissig, Kelsey M Schwei, Christopher Kadolph, Joseph Finamore, Efrain Cancel, Catherine A McCarty, Asha Okorie, Kate L Thomas, Jennifer Allen Pacheco, Jyotishman Pathak, Stephen B Ellis, Joshua C Denny, Luke V Rasmussen, Gerard Tromp, Marc S Williams, Tamara R Vrabec, Murray H Brilliant. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 13.09.2017.

Writing and reading in the electronic health record: an entirely new world.

PubMed

Han, Heeyoung; Lopp, Lauri

2013-02-05

Electronic health records (EHRs) are structured, distributed documentation systems that differ from paper charts. These systems require skills not traditionally used to navigate a paper chart and to produce a written clinic note. Despite these differences, little attention has been given to physicians' electronic health record (EHR)-writing and -reading competence. This study aims to investigate physicians' self-assessed competence to document and to read EHR notes; writing and reading preferences in an EHR; and demographic characteristics associated with their perceived EHR ability and preference. Fourteen 5-point Likert scale items, based on EHR system characteristics and a literature review, were developed to measure EHR-writing and -reading competence and preference. Physicians in the midwest region of the United States were invited via e-mail to complete the survey online from February to April 2011. Factor analysis and reliability testing were conducted to provide validity and reliability of the instrument. Correlation and regression analysis were conducted to pursue answers to the research questions. Ninety-one physicians (12.5%), from general and specialty fields, working in inpatient and outpatient settings, participated in the survey. Despite over 3 years of EHR experience, respondents perceived themselves to be incompetent in EHR writing and reading (Mean = 2.74, SD = 0.76). They preferred to read succinct, narrative notes in EHR systems. However, physicians with higher perceived EHR-writing and -reading competence had less preference toward reading succinct (r= - 0.33, p<0.001) and narrative (r= - 0.36, p<0.001) EHR notes than physicians with lower perceived EHR competence. Physicians' perceived EHR-writing and -reading competence was strongly related to their EHR navigation skills (r=0.55, p<0.0001). Writing and reading EHR documentation is different for physicians. Maximizing navigation skills can optimize non-linear EHR writing and reading. Pedagogical questions remain related to how physicians and medical students are able to retrieve correct information effectively and to understand thought patterns in collectively lengthier and sometimes fragmented EHR chart notes.

Using ISO 25040 standard for evaluating electronic health record systems.

PubMed

Oliveira, Marília; Novaes, Magdala; Vasconcelos, Alexandre

2013-01-01

Quality of electronic health record systems (EHR-S) is one of the key points in the discussion about the safe use of this kind of system. It stimulates creation of technical standards and certifications in order to establish the minimum requirements expected for these systems. [1] In other side, EHR-S suppliers need to invest in evaluation of their products to provide systems according to these requirements. This work presents a proposal of use ISO 25040 standard, which focuses on the evaluation of software products, for define a model of evaluation of EHR-S in relation to Brazilian Certification for Electronic Health Record Systems - SBIS-CFM Certification. Proposal instantiates the process described in ISO 25040 standard using the set of requirements that is scope of the Brazilian certification. As first results, this research has produced an evaluation model and a scale for classify an EHR-S about its compliance level in relation to certification. This work in progress is part for the acquisition of the degree of master in Computer Science at the Federal University of Pernambuco.

Patient Perceptions of Electronic Health Records

ERIC Educational Resources Information Center

Lulejian, Armine

2011-01-01

Research objective. Electronic Health Records (EHR) are expected to transform the way medicine is delivered with patients/consumers being the intended beneficiaries. However, little is known regarding patient knowledge and attitudes about EHRs. This study examined patient perceptions about EHR. Study design. Surveys were administered following…

Evaluating a Dental Diagnostic Terminology in an Electronic Health Record

PubMed Central

White, Joel M.; Kalenderian, Elsbeth; Stark, Paul C.; Ramoni, Rachel L.; Vaderhobli, Ram; Walji, Muhammad F.

2011-01-01

Standardized treatment procedure codes and terms are routinely used in dentistry. Utilization of a diagnostic terminology is common in medicine, but there is not a satisfactory or commonly standardized dental diagnostic terminology available at this time. Recent advances in dental informatics have provided an opportunity for inclusion of diagnostic codes and terms as part of treatment planning and documentation in the patient treatment history. This article reports the results of the use of a diagnostic coding system in a large dental school’s predoctoral clinical practice. A list of diagnostic codes and terms, called Z codes, was developed by dental faculty members. The diagnostic codes and terms were implemented into an electronic health record (EHR) for use in a predoctoral dental clinic. The utilization of diagnostic terms was quantified. The validity of Z code entry was evaluated by comparing the diagnostic term entered to the procedure performed, where valid diagnosis-procedure associations were determined by consensus among three calibrated academically based dentists. A total of 115,004 dental procedures were entered into the EHR during the year sampled. Of those, 43,053 were excluded from this analysis because they represent diagnosis or other procedures unrelated to treatments. Among the 71,951 treatment procedures, 27,973 had diagnoses assigned to them with an overall utilization of 38.9 percent. Of the 147 available Z codes, ninety-three were used (63.3 percent). There were 335 unique procedures provided and 2,127 procedure/diagnosis pairs captured in the EHR. Overall, 76.7 percent of the diagnoses entered were valid. We conclude that dental diagnostic terminology can be incorporated within an electronic health record and utilized in an academic clinical environment. Challenges remain in the development of terms and implementation and ease of use that, if resolved, would improve the utilization. PMID:21546594

Taming the EHR (Electronic Health Record) - There is Hope

PubMed Central

DiAngi, YT; Longhurst, CA; Payne, TH

2016-01-01

With increasing diffusion of EHR technology over the last half decade, clinician burnout is rising. As healthcare is a complex and highly regulated field, the rapid and mass adoption of EHR technology has created disruption for highly skilled workers such as clinicians. Although, much has been written about dissatisfaction with the EHR (electronic health record), a paucity of immediate solutions exists in the literature. This article suggests three actionable steps health systems and clinicians can make to expedite gains from and mitigate the effect of the EHR on clinical practice. PMID:27830215

Access Control Model for Sharing Composite Electronic Health Records

NASA Astrophysics Data System (ADS)

Jin, Jing; Ahn, Gail-Joon; Covington, Michael J.; Zhang, Xinwen

The adoption of electronically formatted medical records, so called Electronic Health Records (EHRs), has become extremely important in healthcare systems to enable the exchange of medical information among stakeholders. An EHR generally consists of data with different types and sensitivity degrees which must be selectively shared based on the need-to-know principle. Security mechanisms are required to guarantee that only authorized users have access to specific portions of such critical record for legitimate purposes. In this paper, we propose a novel approach for modelling access control scheme for composite EHRs. Our model formulates the semantics and structural composition of an EHR document, from which we introduce a notion of authorized zones of the composite EHR at different granularity levels, taking into consideration of several important criteria such as data types, intended purposes and information sensitivities.

The Effect of a Learning Environment Using an Electronic Health Record (EHR) on Undergraduate Nursing Students' Behaviorial Intention to Use an EHR

ERIC Educational Resources Information Center

Foley, Shawn

2011-01-01

The purpose of this study was to explore the effect of a learning environment using an Electronic Health Record (EHR) on undergraduate nursing students' behavioral intention (BI) to use an EHR. BI is defined by Davis (1989) in the Technology Acceptance Model (TAM) as the degree to which a person has formulated conscious plans to perform or not…

Electronic health record systems in ophthalmology: impact on clinical documentation.

PubMed

Sanders, David S; Lattin, Daniel J; Read-Brown, Sarah; Tu, Daniel C; Wilson, David J; Hwang, Thomas S; Morrison, John C; Yackel, Thomas R; Chiang, Michael F

2013-09-01

To evaluate quantitative and qualitative differences in documentation of the ophthalmic examination between paper and electronic health record (EHR) systems. Comparative case series. One hundred fifty consecutive pairs of matched paper and EHR notes, documented by 3 attending ophthalmologist providers. An academic ophthalmology department implemented an EHR system in 2006. Database queries were performed to identify cases in which the same problems were documented by the same provider on different dates, using paper versus EHR methods. This was done for 50 consecutive pairs of examinations in 3 different diseases: age-related macular degeneration (AMD), glaucoma, and pigmented choroidal lesions (PCLs). Quantitative measures were used to compare completeness of documenting the complete ophthalmologic examination, as well as disease-specific critical findings using paper versus an EHR system. Qualitative differences in paper versus EHR documentation were illustrated by selecting representative paired examples. (1) Documentation score, defined as the number of examination elements recorded for the slit-lamp examination, fundus examination, and complete ophthalmologic examination and for critical clinical findings for each disease. (2) Paired comparison of qualitative differences in paper versus EHR documentation. For all 3 diseases (AMD, glaucoma, PCL), the number of complete examination findings recorded was significantly lower with paper than the EHR system (P ≤ 0.004). Among the 3 individual examination sections (general, slit lamp, fundus) for the 3 diseases, 5 of the 9 possible combinations had significantly lower mean documentation scores with paper than EHR notes. For 2 of the 3 diseases, the number of critical clinical findings recorded was significantly lower using paper versus EHR notes (P ≤ 0.022). All (150/150) paper notes relied on graphical representations using annotated hand-drawn sketches, whereas no (0/150) EHR notes contained drawings. Instead, the EHR systems documented clinical findings using textual descriptions and interpretations. There were quantitative and qualitative differences in the nature of paper versus EHR documentation of ophthalmic findings in this study. The EHR notes included more complete documentation of examination elements using structured textual descriptions and interpretations, whereas paper notes used graphical representations of findings. The author(s) have no proprietary or commercial interest in any materials discussed in this article. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

MedlinePlus Connect: Linking Patient Portals and Electronic Health Records to Health Information

MedlinePlus

... Patient portals, patient health record (PHR) systems, and electronic health record (EHR) systems can use MedlinePlus Connect ... patient portal, patient health record (PHR) system, or electronic health record (EHR) system sends a problem, medication, ...

Macro influencers of electronic health records adoption.

PubMed

Raghavan, Vijay V; Chinta, Ravi; Zhirkin, Nikita

2015-01-01

While adoption rates for electronic health records (EHRs) have improved, the reasons for significant geographical differences in EHR adoption within the USA have remained unclear. To understand the reasons for these variations across states, we have compiled from secondary sources a profile of different states within the USA, based on macroeconomic and macro health-environment factors. Regression analyses were performed using these indicator factors on EHR adoption. The results showed that internet usage and literacy are significantly associated with certain measures of EHR adoption. Income level was not significantly associated with EHR adoption. Per capita patient days (a proxy for healthcare need intensity within a state) is negatively correlated with EHR adoption rate. Health insurance coverage is positively correlated with EHR adoption rate. Older physicians (>60 years) tend to adopt EHR systems less than their younger counterparts. These findings have policy implications on formulating regionally focused incentive programs.

Strategies for Primary Care Stakeholders to Improve Electronic Health Records (EHRs).

PubMed

Olayiwola, J Nwando; Rubin, Ashley; Slomoff, Theo; Woldeyesus, Tem; Willard-Grace, Rachel

2016-01-01

The use of electronic health records (EHRs) and the vendors that develop them have increased exponentially in recent years. While there continues to emerge literature on the challenges EHRs have created related to primary care provider satisfaction and workflow, there is sparse literature on the perspective of the EHR vendors themselves. We examined the role of EHR vendors in optimizing primary care practice through a qualitative study of vendor leadership and developers representing 8 companies. We found that EHR vendors apply a range of strategies to elicit feedback from their clinical users and to engage selected users in their development and design process, but priorities are heavily influenced by the macroenvironment and government regulations. To improve the "marriage" between primary care and the EHR vendor community, we propose 6 strategies that may be most impactful for primary care stakeholders seeking to influence EHR development processes. © Copyright 2016 by the American Board of Family Medicine.

Technology versus humanism: how patients perceive the use of electronic health records in physicians' offices--a qualitative study.

PubMed

Mwachofi, Ari K; Khaliq, Amir A; Carrillo, Estevan R; Winfree, William

2016-01-01

Electronic Health Records (EHRs) have the potential to improve the quality of care. In view of the accelerated adoption of EHRs, there is a need to understand conditions necessary for their effective use. Patients are the focus of healthcare and their perceptions and expectations need to be included in developing and implementing EHRs. The purpose of this study was to gather exploratory qualitative information from patients about their experiences and perceptions regarding the effects of EHRs on healthcare quality in physicians' offices. We conducted five focus groups with patients representing a random mix of diverse socio-demographic backgrounds in Oklahoma. Related to EHRs, patients reported improvements on the technical side of care but no change on the human side. They expressed concerns about the potential for breach of confidentiality and security of medical records. They were also concerned about the possibility of governmental agencies or insurance companies having unauthorized access to patient records. Patients differentiated between the human and technical sides of care and reported no change or improvement in the doctor-patient interaction. Patients have an important perspective on the use of EHRs and their perceptions and experiences should be considered in the development, adoption and implementation of EHRs. Otherwise, the use of EHRs may not be fully effective. There is also a need to educate patients about the potential benefits and risks of EHRs and the steps being taken to mitigate such risks.

Assessing the Representation of Occupation Information in Free-Text Clinical Documents Across Multiple Sources

PubMed Central

Lindemann, Elizabeth A.; Chen, Elizabeth S.; Rajamani, Sripriya; Manohar, Nivedha; Wang, Yan; Melton, Genevieve B.

2017-01-01

There has been increasing recognition of the key role of social determinants like occupation on health. Given the relatively poor understanding of occupation information in electronic health records (EHRs), we sought to characterize occupation information within free-text clinical document sources. From six distinct clinical sources, 868 total occupation-related sentences were identified for the study corpus. Building off approaches from previous studies, refined annotation guidelines were created using the National Institute for Occupational Safety and Health Occupational Data for Health data model with elements added to increase granularity. Our corpus generated 2,005 total annotations representing 39 of 41 entity types from the enhanced data model. Highest frequency entities were: Occupation Description (17.7%); Employment Status – Not Specified (12.5%); Employer Name (11.0%); Subject (9.8%); Industry Description (6.2%). Our findings support the value for standardizing entry of EHR occupation information to improve data quality for improved patient care and secondary uses of this information. PMID:29295142

Electronic Health Records Data and Metadata: Challenges for Big Data in the United States.

PubMed

Sweet, Lauren E; Moulaison, Heather Lea

2013-12-01

This article, written by researchers studying metadata and standards, represents a fresh perspective on the challenges of electronic health records (EHRs) and serves as a primer for big data researchers new to health-related issues. Primarily, we argue for the importance of the systematic adoption of standards in EHR data and metadata as a way of promoting big data research and benefiting patients. EHRs have the potential to include a vast amount of longitudinal health data, and metadata provides the formal structures to govern that data. In the United States, electronic medical records (EMRs) are part of the larger EHR. EHR data is submitted by a variety of clinical data providers and potentially by the patients themselves. Because data input practices are not necessarily standardized, and because of the multiplicity of current standards, basic interoperability in EHRs is hindered. Some of the issues with EHR interoperability stem from the complexities of the data they include, which can be both structured and unstructured. A number of controlled vocabularies are available to data providers. The continuity of care document standard will provide interoperability in the United States between the EMR and the larger EHR, potentially making data input by providers directly available to other providers. The data involved is nonetheless messy. In particular, the use of competing vocabularies such as the Systematized Nomenclature of Medicine-Clinical Terms, MEDCIN, and locally created vocabularies inhibits large-scale interoperability for structured portions of the records, and unstructured portions, although potentially not machine readable, remain essential. Once EMRs for patients are brought together as EHRs, the EHRs must be managed and stored. Adequate documentation should be created and maintained to assure the secure and accurate use of EHR data. There are currently a few notable international standards initiatives for EHRs. Organizations such as Health Level Seven International and Clinical Data Interchange Standards Consortium are developing and overseeing implementation of interoperability standards. Denmark and Singapore are two countries that have successfully implemented national EHR systems. Future work in electronic health information initiatives should underscore the importance of standards and reinforce interoperability of EHRs for big data research and for the sake of patients.

Progress along developmental tracks for electronic health records implementation in the United States

PubMed Central

Hollar, David W

2009-01-01

The development and implementation of electronic health records (EHR) have occurred slowly in the United States. To date, these approaches have, for the most part, followed four developmental tracks: (a) Enhancement of immunization registries and linkage with other health records to produce Child Health Profiles (CHP), (b) Regional Health Information Organization (RHIO) demonstration projects to link together patient medical records, (c) Insurance company projects linked to ICD-9 codes and patient records for cost-benefit assessments, and (d) Consortia of EHR developers collaborating to model systems requirements and standards for data linkage. Until recently, these separate efforts have been conducted in the very silos that they had intended to eliminate, and there is still considerable debate concerning health professionals access to as well as commitment to using EHR if these systems are provided. This paper will describe these four developmental tracks, patient rights and the legal environment for EHR, international comparisons, and future projections for EHR expansion across health networks in the United States. PMID:19291284

Electronic Health Record (EHR) Organizational Change: Explaining Resistance Through Profession, Organizational Experience, and EHR Communication Quality.

PubMed

Barrett, Ashley K

2018-04-01

The American Recovery and Reinvestment Act passed by the U.S. government in 2009 mandates that all healthcare organizations adopt a certified electronic health record (EHR) system by 2015. Failure to comply will result in Medicare reimbursement penalties, which steadily increase with each year of delinquency. There are several repercussions of this seemingly top-down, rule-bound organizational change-one of which is employee resistance. Given the penalties for violating EHR meaningful use standards are ongoing, resistance to this mandate presents a serious issue for healthcare organizations. This study surveyed 345 employees in one healthcare organization that recently implemented an EHR. Analysis of variance results offer theoretical and pragmatic contributions by demonstrating physicians, nurses, and employees with more experience in their organization are the most resistant to EHR change. The job characteristics model is used to explain these findings. Hierarchical regression analyses also demonstrate the quality of communication surrounding EHR implementation-from both formal and informal sources-is negatively associated with EHR resistance and positively associated with perceived EHR implementation success and EHR's perceived relative advantage.

Electronic Health Record Adoption as a Function of Success: Implications for Meaningful Use

ERIC Educational Resources Information Center

Naser, Riyad J.

2012-01-01

Successful electronic health records (EHR) implementation has the potential to transform the entire care delivery process across the enterprise. However, the rate of EHR implementation and use among physicians has been slow. Different factors have been reported in the literature that may hinder adoption of EHR. Identifying and managing these…

Readiness of the Belgian network of sentinel general practitioners to deliver electronic health record data for surveillance purposes: results of survey study.

PubMed

Boffin, Nicole; Bossuyt, Nathalie; Vanthomme, Katrien; Van Casteren, Viviane

2010-06-25

In order to proceed from a paper based registration to a surveillance system that is based on extraction of electronic health records (EHR), knowledge is needed on the number and representativeness of sentinel GPs using a government-certified EHR system and the quality of EHR data for research, expressed in the compliance rate with three criteria: recording of home visits, use of prescription module and diagnostic subject headings. Data were collected by annual postal surveys between 2005 and 2009 among all sentinel GPs. We tested relations between four key GP characteristics (age, gender, language community, practice organisation) and use of a certified EHR system by multivariable logistic regression. The relation between EHR software package, GP characteristics and compliance with three quality criteria was equally measured by multivariable logistic regression. A response rate of 99% was obtained. Of 221 sentinel GPs, 55% participated in the surveillance without interruption from 2005 onwards, i.e. all five years, and 78% were participants in 2009. Sixteen certified EHR systems were used among 91% of the Dutch and 63% of the French speaking sentinel GPs. The EHR software package was strongly related to the community and only one EHR system was used by a comparable number of sentinel GPs in both communities. Overall, the prescription module was always used and home visits were usually recorded. Uniform subject headings were only sometimes used and the compliance with this quality criterion was almost exclusively related to the EHR software package in use. The challenge is to progress towards a sentinel network of GPs delivering care-based data that are (partly) extracted from well performing EHR systems and still representative for Belgian general practice.

Building a portable data and information interoperability infrastructure-framework for a standard Taiwan Electronic Medical Record Template.

PubMed

Jian, Wen-Shan; Hsu, Chien-Yeh; Hao, Te-Hui; Wen, Hsyien-Chia; Hsu, Min-Huei; Lee, Yen-Liang; Li, Yu-Chuan; Chang, Polun

2007-11-01

Traditional electronic health record (EHR) data are produced from various hospital information systems. They could not have existed independently without an information system until the incarnation of XML technology. The interoperability of a healthcare system can be divided into two dimensions: functional interoperability and semantic interoperability. Currently, no single EHR standard exists that provides complete EHR interoperability. In order to establish a national EHR standard, we developed a set of local EHR templates. The Taiwan Electronic Medical Record Template (TMT) is a standard that aims to achieve semantic interoperability in EHR exchanges nationally. The TMT architecture is basically composed of forms, components, sections, and elements. Data stored in the elements which can be referenced by the code set, data type, and narrative block. The TMT was established with the following requirements in mind: (1) transformable to international standards; (2) having a minimal impact on the existing healthcare system; (3) easy to implement and deploy, and (4) compliant with Taiwan's current laws and regulations. The TMT provides a basis for building a portable, interoperable information infrastructure for EHR exchange in Taiwan.

Review of information technology for surgical patient care.

PubMed

Robinson, Jamie R; Huth, Hannah; Jackson, Gretchen P

2016-06-01

Electronic health records (EHRs), computerized provider order entry (CPOE), and patient portals have experienced increased adoption by health care systems. The objective of this study was to review evidence regarding the impact of such health information technologies (HIT) on surgical practice. A search of Medline, EMBASE, CINAHL, and the Cochrane Library was performed to identify data-driven, nonsurvey studies about the effects of HIT on surgical care. Domain experts were queried for relevant articles. Two authors independently reviewed abstracts for inclusion criteria and analyzed full text of eligible articles. A total of 2890 citations were identified. Of them, 32 observational studies and two randomized controlled trials met eligibility criteria. EHR or CPOE improved appropriate antibiotic administration for surgical procedures in 13 comparative observational studies. Five comparative observational studies indicated that electronically generated operative notes had increased accuracy, completeness, and availability in the medical record. The Internet as an information resource about surgical procedures was generally inadequate. Surgical patients and providers demonstrated rapid adoption of patient portals, with increasing proportions of online versus inperson outpatient surgical encounters. The overall quality of evidence about the effects of HIT in surgical practice was low. Current data suggest an improvement in appropriate perioperative antibiotic administration and accuracy of operative reports from CPOE and EHR applications. Online consumer health educational resources and patient portals are popular among patients and families, but their impact has not been studied well in surgical populations. With increasing adoption of HIT, further research is needed to optimize the efficacy of such tools in surgical care. Copyright © 2016 Elsevier Inc. All rights reserved.

NOR-DMARD data management: implementation of data capture from electronic health records.

PubMed

Olsen, I C; Haavardsholm, E A; Moholt, E; Kvien, T K; Lie, E

2014-01-01

The use of electronic health records (EHR) is an essential part of modern health care, and electronic data capture (EDC) has become essential for managing clinical trials. Usually, these two entities are independent of each other, and transfer from one system to another is done manually. Our aim was to develop a method to capture data directly from the EHR system and transfer them into an EDC system for the NORwegian Disease-Modifying Anti-Rheumatic Drugs (NOR-DMARD) registry. All rheumatology departments contributing to NOR-DMARD had implemented a structured EHR system. Data are extracted locally and securely transferred to the study data management once a month. The study data management then parse the data into a readable format for the EDC and import the data. Once the data is in the EDC, they are available to all authorized researchers and downloadable in a preferred format. From May 2012 to August 2014 almost 6400 visits in 3400 patients treated with biologics have been successfully registered in the EDC system. Previously, NOR-DMARD used standard paper-based case report forms (CRFs), with a substantial cost for data entry. Setting up and maintaining the EDC system required some investments, but the amount saved from avoiding paper handling has made the shift into EDC profitable. In addition to this, gains have been made in administration and data quality. The transition from paper and pencil format to a fully electronic data management system in NOR-DMARD has had obvious advantages regarding feasibility, cost, data quality and accessibility of the data.

Assessing performance of an Electronic Health Record (EHR) using Cognitive Task Analysis.

PubMed

Saitwal, Himali; Feng, Xuan; Walji, Muhammad; Patel, Vimla; Zhang, Jiajie

2010-07-01

Many Electronic Health Record (EHR) systems fail to provide user-friendly interfaces due to the lack of systematic consideration of human-centered computing issues. Such interfaces can be improved to provide easy to use, easy to learn, and error-resistant EHR systems to the users. To evaluate the usability of an EHR system and suggest areas of improvement in the user interface. The user interface of the AHLTA (Armed Forces Health Longitudinal Technology Application) was analyzed using the Cognitive Task Analysis (CTA) method called GOMS (Goals, Operators, Methods, and Selection rules) and an associated technique called KLM (Keystroke Level Model). The GOMS method was used to evaluate the AHLTA user interface by classifying each step of a given task into Mental (Internal) or Physical (External) operators. This analysis was performed by two analysts independently and the inter-rater reliability was computed to verify the reliability of the GOMS method. Further evaluation was performed using KLM to estimate the execution time required to perform the given task through application of its standard set of operators. The results are based on the analysis of 14 prototypical tasks performed by AHLTA users. The results show that on average a user needs to go through 106 steps to complete a task. To perform all 14 tasks, they would spend about 22 min (independent of system response time) for data entry, of which 11 min are spent on more effortful mental operators. The inter-rater reliability analysis performed for all 14 tasks was 0.8 (kappa), indicating good reliability of the method. This paper empirically reveals and identifies the following finding related to the performance of AHLTA: (1) large number of average total steps to complete common tasks, (2) high average execution time and (3) large percentage of mental operators. The user interface can be improved by reducing (a) the total number of steps and (b) the percentage of mental effort, required for the tasks. 2010 Elsevier Ireland Ltd. All rights reserved.

Feasibility of real-time capture of routine clinical data in the electronic health record: a hospital-based, observational service-evaluation study

PubMed Central

Archbold, R Andrew; Weerackody, Roshan; Barnes, Michael R; Lee, Aaron M; Janjuha, Surjeet; Gutteridge, Charles; Robson, John; Timmis, Adam

2018-01-01

Objectives The electronic health record (EHR) is underused in the hospital setting. The aim of this service evaluation study was to respond to National Health Service (NHS) Digital’s ambition for a paperless NHS by capturing routinely collected cardiac outpatient data in the EHR to populate summary patient reports and provide a resource for audit and research. Design A PowerForm template was developed within the Cerner EHR, for real-time entry of routine clinical data by clinicians attending a cardiac outpatient clinic. Data captured within the PowerForm automatically populated a SmartTemplate to generate a view-only report that was immediately available for the patient and for electronic transmission to the referring general practitioner (GP). Results During the first 8 months, the PowerForm template was used in 61% (360/594) of consecutive outpatient referrals increasing from 42% to 77% during the course of the study. Structured patient reports were available for immediate sharing with the referring GP using Cerner Health Information Exchange technology while electronic transmission was successfully developed in a substudy of 64 cases, with direct delivery by the NHS Data Transfer Service in 29 cases and NHS mail in the remainder. In feedback, the report’s immediate availability was considered very or extremely important by >80% of the patients and GPs who were surveyed. Both groups reported preference of the patient report to the conventional typed letter. Deidentified template data for all 360 patients were successfully captured within the Trust system, confirming availability of these routinely collected outpatient data for audit and research. Conclusion Electronic template development tailored to the requirements of a specialist outpatient clinic facilitates capture of routinely collected data within the Cerner EHR. These data can be made available for audit and research. They can also be used to enhance communication by populating structured reports for immediate delivery to patients and GPs. PMID:29523565

Data extraction from electronic health records (EHRs) for quality measurement of the physical therapy process: comparison between EHR data and survey data.

PubMed

Scholte, Marijn; van Dulmen, Simone A; Neeleman-Van der Steen, Catherina W M; van der Wees, Philip J; Nijhuis-van der Sanden, Maria W G; Braspenning, Jozé

2016-11-08

With the emergence of the electronic health records (EHRs) as a pervasive healthcare information technology, new opportunities and challenges for use of clinical data for quality measurements arise with respect to data quality, data availability and comparability. The objective of this study is to test whether data extracted from electronic health records (EHRs) was of comparable quality as survey data for the calculation of quality indicators. Data from surveys describing patient cases and filled out by physiotherapists in 2009-2010 were used to calculate scores on eight quality indicators (QIs) to measure the quality of physiotherapy care. In 2011, data was extracted directly from EHRs. The data collection methods were evaluated for comparability. EHR data was compared to survey data on completeness and correctness. Five of the eight QIs could be extracted from the EHRs. Three were omitted from the indicator set, as they proved too difficult to be extracted from the EHRs. Another QI proved incomparable due to errors in the extraction software of some of the EHRs. Three out of four comparable QIs performed better (p < 0.001) in EHR data on completeness. EHR data also proved to be correct; the relative change in indicator scores between EHR and survey data were small (<5 %) in three out of four QIs. Data quality of EHRs was sufficient to be used for the calculation of QIs, although comparability to survey data was problematic. Standardization is needed, not only to be able to compare different data collection methods properly, but also to compare between practices with different EHRs. EHRs have the option to administrate narrative data, but natural language processing tools are needed to quantify these text boxes. Such development, can narrow the comparability gap between scoring QIs based on EHR data and based on survey data. EHRs have the potential to provide real time feedback to professionals and quality measurements for research, but more effort is needed to create unambiguous and uniform information and to unlock written text in a standardized manner.

SemEHR: A general-purpose semantic search system to surface semantic data from clinical notes for tailored care, trial recruitment, and clinical research.

PubMed

Wu, Honghan; Toti, Giulia; Morley, Katherine I; Ibrahim, Zina M; Folarin, Amos; Jackson, Richard; Kartoglu, Ismail; Agrawal, Asha; Stringer, Clive; Gale, Darren; Gorrell, Genevieve; Roberts, Angus; Broadbent, Matthew; Stewart, Robert; Dobson, Richard J B

2018-05-01

Unlocking the data contained within both structured and unstructured components of electronic health records (EHRs) has the potential to provide a step change in data available for secondary research use, generation of actionable medical insights, hospital management, and trial recruitment. To achieve this, we implemented SemEHR, an open source semantic search and analytics tool for EHRs. SemEHR implements a generic information extraction (IE) and retrieval infrastructure by identifying contextualized mentions of a wide range of biomedical concepts within EHRs. Natural language processing annotations are further assembled at the patient level and extended with EHR-specific knowledge to generate a timeline for each patient. The semantic data are serviced via ontology-based search and analytics interfaces. SemEHR has been deployed at a number of UK hospitals, including the Clinical Record Interactive Search, an anonymized replica of the EHR of the UK South London and Maudsley National Health Service Foundation Trust, one of Europe's largest providers of mental health services. In 2 Clinical Record Interactive Search-based studies, SemEHR achieved 93% (hepatitis C) and 99% (HIV) F-measure results in identifying true positive patients. At King's College Hospital in London, as part of the CogStack program (github.com/cogstack), SemEHR is being used to recruit patients into the UK Department of Health 100 000 Genomes Project (genomicsengland.co.uk). The validation study suggests that the tool can validate previously recruited cases and is very fast at searching phenotypes; time for recruitment criteria checking was reduced from days to minutes. Validated on open intensive care EHR data, Medical Information Mart for Intensive Care III, the vital signs extracted by SemEHR can achieve around 97% accuracy. Results from the multiple case studies demonstrate SemEHR's efficiency: weeks or months of work can be done within hours or minutes in some cases. SemEHR provides a more comprehensive view of patients, bringing in more and unexpected insight compared to study-oriented bespoke IE systems. SemEHR is open source, available at https://github.com/CogStack/SemEHR.

Openness of patients' reporting with use of electronic records: psychiatric clinicians' views

PubMed Central

Blackford, Jennifer Urbano; Rosenbloom, S Trent; Seidel, Sandra; Clayton, Ellen Wright; Dilts, David M; Finder, Stuart G

2010-01-01

Objectives Improvements in electronic health record (EHR) system development will require an understanding of psychiatric clinicians' views on EHR system acceptability, including effects on psychotherapy communications, data-recording behaviors, data accessibility versus security and privacy, data quality and clarity, communications with medical colleagues, and stigma. Design Multidisciplinary development of a survey instrument targeting psychiatric clinicians who recently switched to EHR system use, focus group testing, data analysis, and data reliability testing. Measurements Survey of 120 university-based, outpatient mental health clinicians, with 56 (47%) responding, conducted 18 months after transition from a paper to an EHR system. Results Factor analysis gave nine item groupings that overlapped strongly with five a priori domains. Respondents both praised and criticized the EHR system. A strong majority (81%) felt that open therapeutic communications were preserved. Regarding data quality, content, and privacy, clinicians (63%) were less willing to record highly confidential information and disagreed (83%) with including their own psychiatric records among routinely accessed EHR systems. Limitations single time point; single academic medical center clinic setting; modest sample size; lack of prior instrument validation; survey conducted in 2005. Conclusions In an academic medical center clinic, the presence of electronic records was not seen as a dramatic impediment to therapeutic communications. Concerns regarding privacy and data security were significant, and may contribute to reluctances to adopt electronic records in other settings. Further study of clinicians' views and use patterns may be helpful in guiding development and deployment of electronic records systems. PMID:20064802

Unintended adverse consequences of electronic health record introduction to a mature universal HIV screening program.

PubMed

Medford-Davis, Laura N; Yang, Katharine; Pasalar, Siavash; Pillow, M Tyson; Miertschin, Nancy P; Peacock, William F; Giordano, Thomas P; Hoxhaj, Shkelzen

2016-01-01

Early HIV detection and treatment decreases morbidity and mortality and reduces high-risk behaviors. Many Emergency Departments (EDs) have HIV screening programs as recommended by the Centers for Disease Control and Prevention. Recent federal legislation includes incentives for electronic health record (EHR) adoption. Our objective was to analyze the impact of conversion to EHR on a mature ED-based HIV screening program. A retrospective pre- and post-EHR implementation cohort study was conducted in a large urban, academic ED. Medical records were reviewed for HIV screening rates from August 2008 through October 2013. On 1 November 2010, a comprehensive EHR system was implemented throughout the hospital. Before EHR implementation, labs were requested by providers by paper orders with HIV-1/2 automatically pre-selected on every form. This universal ordering protocol was not duplicated in the new EHR; rather it required a provider to manually enter the order. Using a chi-squared test, we compared HIV testing in the 6 months before and after EHR implementation; 55,054 patients presented before, and 50,576 after EHR implementation. Age, sex, race, acuity of presenting condition, and HIV seropositivity rates were similar pre- and post-EHR, and there were no major patient or provider changes during this period. Average HIV testing rate was 37.7% of all ED patients pre-, and 22.3% post-EHR, a 41% decline (p < 0.0001), leading to 167 missed new diagnoses after EHR. The rate of HIV screening in the ED decreased after EHR implementation, and could have been improved with more thoughtful inclusion of existing human processes in its design.

Communication and the electronic health record training: a comparison of three healthcare systems.

PubMed

Lynott, Michelle H; Kooienga, Sarah A; Stewart, Valerie T

2012-01-01

The electronic health record (EHR) used in the examination room, is becoming the primary method of medical data storage in primary care practice in the USA. One of the challenges in using EHRs is maintaining effective patient-provider communication. Many studies have focused on communication in the examination room. Scant research exists on the best methods in educating nurse practitioners and other primary care providers (clinicians). The purpose of this study was to explore various health record training programmes for clinicians. One researcher participated in and observed three health systems' EHR training programmes for ambulatory care providers in the Pacific Northwest. A focused ethnographic approach was used, emphasising patient-provider communication. Only one system had formalised communication training in their class, the other two systems emphasised only the software and data aspects of the EHR. The fact that clinicians are expected to use EHRs in the examination room necessitates the inclusion of communication training in EHR training programmes and/or as a part of primary care nurse practitioner education programmes.

The current state of electronic health record (EHR) use in Oklahoma.

PubMed

Khaliq, Amir A; Mwachofi, Ari K; Hughes, Danny R; Broyles, Robert W; Wheeler, Denna; Roswell, Robert H

2013-02-01

There is ample evidence of the positive impact of electronic health records (EHR) on operational efficiencies and quality of care. Yet, growth in the adoption of EHR and sharing of information among providers has been slow. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 provides financial incentives for eligible providers to adopt and implement EHR. Until now, little information was available regarding the use of EHR in Oklahoma. Sponsored by the Oklahoma Health Information Exchange Trust (OHIET), this study reveals that the frequency of use of EHR among Oklahoma providers is near the national average. Although a large number of Oklahoma physicians have received Medicaid incentive payments for planned adoption, implementation, or upgrade of EHR systems, relatively few eligible providers in Oklahoma have been certified to receive Medicare incentive payments through the Centers for Medicare and Medicaid Services (CMS) and even fewer have actually received these incentive payments.

Electronic Health Record Use a Bitter Pill for Many Physicians.

PubMed

Meigs, Stephen L; Solomon, Michael

2016-01-01

Electronic health record (EHR) adoption among office-based physician practices in the United States has increased significantly in the past decade. However, the challenges of using EHRs have resulted in growing dissatisfaction with the systems among many of these physicians. The purpose of this qualitative multiple-case study was to increase understanding of physician perceptions regarding the value of using EHR technology. Important findings included the belief among physicians that EHR systems need to be more user-friendly and adaptable to individual clinic workflow preferences, physician beliefs that lack of interoperability among EHRs is a major barrier to meaningful use of the systems, and physician beliefs that EHR use does not improve the quality of care provided to patients. These findings suggest that although government initiatives to encourage EHR adoption among office-based physician practices have produced positive results, additional support may be required in the future to maintain this momentum.

Care Coordination and Electronic Health Records: Connecting Clinicians

PubMed Central

Graetz, Ilana; Reed, Mary; Rundall, Thomas; Bellows, Jim; Brand, Richard; Hsu, John

2009-01-01

Objective: To examine the association between use of electronic health records (EHR) and care coordination. Study Design: Two surveys, in 2005 and again in 2006, of primary care clinicians working in a prepaid integrated delivery system during the staggered implementation of an EHR system. Using multivariate logistic regression to adjust for clinician characteristics, we examined the association between EHR use and clinicians’ perceptions of three dimensions of care coordination: timely access to complete information; treatment goal agreement; and role/responsibility agreement. Results: Compared to clinicians without EHR, clinicians with 6+ months of EHR use more frequently reported timely access to complete information, and being in agreement on treatment goals with other involved clinicians. There was no significant association between EHR use and being in agreement on roles and responsibilities with other clinicians. Conclusions: EHR use is associated with aspects of care coordination involving information transfer and communication of treatment goals. PMID:20351851

Protection of electronic health records (EHRs) in cloud.

PubMed

Alabdulatif, Abdulatif; Khalil, Ibrahim; Mai, Vu

2013-01-01

EHR technology has come into widespread use and has attracted attention in healthcare institutions as well as in research. Cloud services are used to build efficient EHR systems and obtain the greatest benefits of EHR implementation. Many issues relating to building an ideal EHR system in the cloud, especially the tradeoff between flexibility and security, have recently surfaced. The privacy of patient records in cloud platforms is still a point of contention. In this research, we are going to improve the management of access control by restricting participants' access through the use of distinct encrypted parameters for each participant in the cloud-based database. Also, we implement and improve an existing secure index search algorithm to enhance the efficiency of information control and flow through a cloud-based EHR system. At the final stage, we contribute to the design of reliable, flexible and secure access control, enabling quick access to EHR information.

Risk assessment of integrated electronic health records.

PubMed

Bjornsson, Bjarni Thor; Sigurdardottir, Gudlaug; Stefansson, Stefan Orri

2010-01-01

The paper describes the security concerns related to Electronic Health Records (EHR) both in registration of data and integration of systems. A description of the current state of EHR systems in Iceland is provided, along with the Ministry of Health's future vision and plans. New legislation provides the opportunity for increased integration of EHRs and further collaboration between institutions. Integration of systems, along with greater availability and access to EHR data, requires increased security awareness since additional risks are introduced. The paper describes the core principles of information security as it applies to EHR systems and data. The concepts of confidentiality, integrity, availability, accountability and traceability are introduced and described. The paper discusses the legal requirements and importance of performing risk assessment for EHR data. Risk assessment methodology according to the ISO/IEC 27001 information security standard is described with examples on how it is applied to EHR systems.

Bridging informatics and implementation science: evaluating a framework to assess electronic health record implementations in community settings.

PubMed

Richardson, Joshua E; Abramson, Erika L; Pfoh, Elizabeth R; Kaushal, Rainu

2012-01-01

Effective electronic health record (EHR) implementations in community settings are critical to promoting safe and reliable EHR use as well as mitigating provider dissatisfaction that often results. The implementation challenge is compounded given the scale and scope of EHR installations that are occurring and will continue to occur over the next five years. However, when compared to EHR evaluations relatively few biomedical informatics researchers have published on evaluating EHR implementations. Fewer still have evaluated EHR implementations in community settings. We report on the methods we used to achieve a novel application of an implementation science framework in informatics to qualitatively evaluate community-based EHR implementations. We briefly provide an overview of the implementation science framework, our methods for adapting it to informatics, the effects the framework had on our qualitative methods of inquiry and analysis, and discuss its potential value for informatics research.

Electronic Health Record Use a Bitter Pill for Many Physicians

PubMed Central

Meigs, Stephen L.; Solomon, Michael

2016-01-01

Electronic health record (EHR) adoption among office-based physician practices in the United States has increased significantly in the past decade. However, the challenges of using EHRs have resulted in growing dissatisfaction with the systems among many of these physicians. The purpose of this qualitative multiple-case study was to increase understanding of physician perceptions regarding the value of using EHR technology. Important findings included the belief among physicians that EHR systems need to be more user-friendly and adaptable to individual clinic workflow preferences, physician beliefs that lack of interoperability among EHRs is a major barrier to meaningful use of the systems, and physician beliefs that EHR use does not improve the quality of care provided to patients. These findings suggest that although government initiatives to encourage EHR adoption among office-based physician practices have produced positive results, additional support may be required in the future to maintain this momentum. PMID:26903782

Making Electronic Health Records (EHRs) Work: Informal Talk and Workarounds in Healthcare Organizations.

PubMed

Barrett, Ashley K; Stephens, Keri K

2017-08-01

A key provision of the American Recovery and Reinvestment Act of 2009 mandated that electronic health records (EHR) be adopted in US healthcare organizations by 2015. The purpose of this study is to examine the communicative processes involved as healthcare workers implement an EHR and make changes, known as workarounds. Guided by theories in social influence, and diffusion of innovations, we conducted a survey of healthcare professionals using an EHR system in an organization. Our structural equation modeling (SEM) and multiple regression results reveal coworker communication, in the form of informal social support and feedback, play an important role in whether people engage in workarounds. Understanding this relationship is important because our study also demonstrates that workarounds predict healthcare employees' overall satisfaction with the EHR system. Specifically, workarounds are associated with higher perceptions of the EHR's relative advantage, higher perceptions of EHR implementation success, and lower levels of resistance to EHR change. This study offers a health communication contribution to the growing research on EHR systems and demonstrates the persuasive effects that coworkers have on new technology use in healthcare organizations.

Changes to the electronic health records market in light of health information technology certification and meaningful use.

PubMed

Vest, Joshua R; Yoon, Jangho; Bossak, Brian H

2013-01-01

Health information technology (HIT) certification and meaningful use are interventions encouraging the adoption of electronic health records (EHRs) in the USA. However, these initiatives also constitute a significant intervention which will change the structure of the EHR market. To describe quantitatively recent changes to both the demand and supply sides of the EHR market. A cohort of 3447 of hospitals from the HIMSS Analytics Database (2006-10) was created. Using hospital referral regions to define the local market, we determined the percentage of hospitals using paper records, the number of vendors, and local EHR vendor competition using the Herfindahl-Hirschman Index. Changes over time were assessed using a series of regression equations and geographic information systems analyses. Overall, there was movement away from paper records, upward trends in the number of EHR vendors, and greater competition. However, changes differed according to hospital size and region of the country. Changes were greatest for small hospitals, whereas competition and the number of vendors did not change dramatically for large hospitals. The EHR market is changing most dramatically for those least equipped to handle broad technological transformation, which underscores the need for continued targeted support. Furthermore, wide variations across the nation indicate a continued role for states in the support of EHR utilization. The structure of the EHR market is undergoing substantial changes as desired by the proponents and architects of HIT certification and meaningful use. However, these transformations are not uniform for all hospitals or all the country.

The challenge of electronic health records (EHRs) design and implementation: responses of health workers to drawing a 'big and rich picture' of a future EHR programme using animated tools.

PubMed

Jenkings, K Neil; Wilson, Robert G

2007-01-01

To investigate the use of animation tools to aid visualisation of problems for discussion within focus groups, in the context of healthcare workers discussing electronic health records (EHRs). Ten healthcare staff focus groups, held in a range of organisational contexts. Each focus group was in four stages: baseline discussion, animator presentation, post-animator discussion and questionnaire. Audio recordings of the focus groups were transcribed and coded and the emergent analytic themes analysed for issues relating to EHR design and implementation. The data allowed a comparison of baseline and post-animator discussion. The animator facilitated discussion about EHR issues and these were thematically coded as: Workload; Sharing Information; Access to Information; Record Content; Confidentiality; Patient Consent; and Implementation. We illustrate that use of the animator in focus groups is one means to raise understanding about a proposed EHR development. The animator provided a visual 'probe' to support a more proactive and discursive localised approach to end-user concerns, which could be part of an effective stakeholder engagement and communication strategy crucial in any EHR or health informatics implementation programme. The results of the focus groups were to raise salient issues and concerns, many of which anticipated those that have emerged in the current NHS Connecting for Health Care Records programme in England. Potentially, animator-type technologies may facilitate the user ownership which other forms of dissemination appear to be failing to achieve.

Security challenges in integration of a PHR-S into a standards based national EHR.

PubMed

Mense, Alexander; Hoheiser Pförtner, Franz; Sauermann, Stefan

2014-01-01

Health related data provided by patients themselves is expected to play a major role in future healthcare. Data from personal health devices, vaccination records, health diaries or observations of daily living, for instance, is stored in personal health records (PHR) which are maintained by personal health record systems (PHR-S). Combining this information with medical records provided by healthcare providers in electronic health records (EHR) is one of the next steps towards "personal care". Austria currently sets up a nationwide EHR system that incorporates all healthcare providers and is technically based on international standards (IHE, HL7, OASIS, ...). Looking at the expected potential of merging PHR and EHR data it is worth to analyse integration approaches. Although knowing that an integration requires the coordination of processes, information models and technical architectures, this paper specifically focuses on security issues by evaluating general security requirements for a PHR-S (based on HL7 PHR-S FM), comparing them with the information security specifications for the Austrian's national EHR (based on ISO/IES 27000 series) and identifying the main challenges as well as possible approaches.

International developments in openEHR archetypes and templates.

PubMed

Leslie, Heather

Electronic Health Records (EHRs) are a complex knowledge domain. The ability to design EHRs to cope with the changing nature of health knowledge, and to be shareable, has been elusive. A recent pilot study1 tested the applicability of the CEN 13606 as an electronic health record standard. Using openEHR archetypes and tools2, 650 clinical content specifi cations (archetypes) were created (e.g. for blood pressure) and re-used across all clinical specialties and contexts. Groups of archetypes were aggregated in templates to support clinical information gathering or viewing (e.g. 80 separate archetypes make up the routine antenatal visit record). Over 60 templates were created for use in the emergency department, antenatal care and delivery of an infant, and paediatric hearing loss assessment. The primary goal is to define a logical clinical record architecture for the NHS but potentially, with archetypes as the keystone, shareable EHRs will also be attainable. Archetype and template development work is ongoing, with associated evaluation occurring in parallel.

Effects of automated immunization registry reporting via an electronic health record deployed in community practice settings.

PubMed

Merrill, J; Phillips, A; Keeling, J; Kaushal, R; Senathirajah, Y

2013-01-01

Among the expected benefits of electronic health records (EHRs) is increased reporting of public health information, such as immunization status. State and local immunization registries aid control of vaccine-preventable diseases and help offset fragmentation in healthcare, but reporting is often slow and incomplete. The Primary Care Information Project (PCIP), an initiative of the NYC Department of Health and Mental Hygiene, has implemented EHRs with immunization reporting capability in community settings. To evaluate the effect of automated reporting via an EHR on use and efficiency of reporting to the NY Citywide Immunization Registry, we conducted a secondary analysis of 1.7 million de-identified records submitted between January 2007 and June 2011 by 217 primary care practices enrolled in PCIP, pre and post launch of automated reporting via an EHR. We examined differences in records submitted per day, lag time, and documentation of eligibility for subsidized vaccines. Mean submissions per day did not change. Automated submissions of new and historical records increased by 18% and 98% respectively. Submissions within 14 days increased from 84% to 87%, and within 2 days increased from 60% to 77%. Median lag time decreased from 13 to 10 days. Documentation of eligibility decreased. Results are significant at p<0.001. Significant improvements in registry use and efficiency of reporting were found after launch of automated reporting via an EHR. A decrease in eligibility documentation was attributed to EHR workflow. The limitations to comprehensive evaluation found in these data, which were extracted from a registry initiated prior to widespread EHR implementation suggests that reliable evaluation of immunization reporting via the EHR may require modifications to legacy registry databases.

Understanding Providers' Interaction with Graphical User Interface Pertaining to Clinical Document Usage in an Electronic Health Record System

ERIC Educational Resources Information Center

Rizvi, Rubina Fatima

2017-01-01

Despite high Electronic Health Record (EHR) system adoption rates by hospital and office-based practices, many users remain highly dissatisfied with the current state of EHRs. Sub-optimal EHR usability as a result of insufficient incorporation of User-Centered Design (UCD) approach during System Development Life Cycle process (SDLC) is considered…

Implementation of an Electronic Health Records System in a Small Clinic: The Viewpoint of Clinic Staff

ERIC Educational Resources Information Center

Carayon, Pascale; Smith, Paul; Hundt, Ann Schoofs; Kuruchittham, Vipat; Li, Qian

2009-01-01

In this study, we examined the implementation of an electronic health records (EHR) system in a small family practice clinic. We used three data collection instruments to evaluate user experience, work pattern changes, and organisational changes related to the implementation and use of the EHR system: (1) an EHR user survey, (2) interviews with…

Evaluation of Electronic Health Record Implementation in Ophthalmology at an Academic Medical Center (An American Ophthalmological Society Thesis)

PubMed Central

Chiang, Michael F.; Read-Brown, Sarah; Tu, Daniel C.; Choi, Dongseok; Sanders, David S.; Hwang, Thomas S.; Bailey, Steven; Karr, Daniel J.; Cottle, Elizabeth; Morrison, John C.; Wilson, David J.; Yackel, Thomas R.

2013-01-01

Purpose: To evaluate three measures related to electronic health record (EHR) implementation: clinical volume, time requirements, and nature of clinical documentation. Comparison is made to baseline paper documentation. Methods: An academic ophthalmology department implemented an EHR in 2006. A study population was defined of faculty providers who worked the 5 months before and after implementation. Clinical volumes, as well as time length for each patient encounter, were collected from the EHR reporting system. To directly compare time requirements, two faculty providers who utilized both paper and EHR systems completed time-motion logs to record the number of patients, clinic time, and nonclinic time to complete documentation. Faculty providers and databases were queried to identify patient records containing both paper and EHR notes, from which three cases were identified to illustrate representative documentation differences. Results: Twenty-three faculty providers completed 120,490 clinical encounters during a 3-year study period. Compared to baseline clinical volume from 3 months pre-implementation, the post-implementation volume was 88% in quarter 1, 93% in year 1, 97% in year 2, and 97% in year 3. Among all encounters, 75% were completed within 1.7 days after beginning documentation. The mean total time per patient was 6.8 minutes longer with EHR than paper (P<.01). EHR documentation involved greater reliance on textual interpretation of clinical findings, whereas paper notes used more graphical representations, and EHR notes were longer and included automatically generated text. Conclusion: This EHR implementation was associated with increased documentation time, little or no increase in clinical volume, and changes in the nature of ophthalmic documentation. PMID:24167326

Understanding differences in electronic health record (EHR) use: linking individual physicians' perceptions of uncertainty and EHR use patterns in ambulatory care.

PubMed

Lanham, Holly Jordan; Sittig, Dean F; Leykum, Luci K; Parchman, Michael L; Pugh, Jacqueline A; McDaniel, Reuben R

2014-01-01

Electronic health records (EHR) hold great promise for managing patient information in ways that improve healthcare delivery. Physicians differ, however, in their use of this health information technology (IT), and these differences are not well understood. The authors study the differences in individual physicians' EHR use patterns and identify perceptions of uncertainty as an important new variable in understanding EHR use. Qualitative study using semi-structured interviews and direct observation of physicians (n=28) working in a multispecialty outpatient care organization. We identified physicians' perceptions of uncertainty as an important variable in understanding differences in EHR use patterns. Drawing on theories from the medical and organizational literatures, we identified three categories of perceptions of uncertainty: reduction, absorption, and hybrid. We used an existing model of EHR use to categorize physician EHR use patterns as high, medium, and low based on degree of feature use, level of EHR-enabled communication, and frequency that EHR use patterns change. Physicians' perceptions of uncertainty were distinctly associated with their EHR use patterns. Uncertainty reductionists tended to exhibit high levels of EHR use, uncertainty absorbers tended to exhibit low levels of EHR use, and physicians demonstrating both perspectives of uncertainty (hybrids) tended to exhibit medium levels of EHR use. We find evidence linking physicians' perceptions of uncertainty with EHR use patterns. Study findings have implications for health IT research, practice, and policy, particularly in terms of impacting health IT design and implementation efforts in ways that consider differences in physicians' perceptions of uncertainty.

How the provenance of electronic health record data matters for research: a case example using system mapping.

PubMed

Johnson, Karin E; Kamineni, Aruna; Fuller, Sharon; Olmstead, Danielle; Wernli, Karen J

2014-01-01

The use of electronic health records (EHRs) for research is proceeding rapidly, driven by computational power, analytical techniques, and policy. However, EHR-based research is limited by the complexity of EHR data and a lack of understanding about data provenance, meaning the context under which the data were collected. This paper presents system flow mapping as a method to help researchers more fully understand the provenance of their EHR data as it relates to local workflow. We provide two specific examples of how this method can improve data identification, documentation, and processing. EHRs store clinical and administrative data, often in unstructured fields. Each clinical system has a unique and dynamic workflow, as well as an EHR customized for local use. The EHR customization may be influenced by a broader context such as documentation required for billing. We present a case study with two examples of using system flow mapping to characterize EHR data for a local colorectal cancer screening process. System flow mapping demonstrated that information entered into the EHR during clinical practice required interpretation and transformation before it could be accurately applied to research. We illustrate how system flow mapping shaped our knowledge of the quality and completeness of data in two examples: (1) determining colonoscopy indication as recorded in the EHR, and (2) discovering a specific EHR form that captured family history. Researchers who do not consider data provenance risk compiling data that are systematically incomplete or incorrect. For example, researchers who are not familiar with the clinical workflow under which data were entered might miss or misunderstand patient information or procedure and diagnostic codes. Data provenance is a fundamental characteristic of research data from EHRs. Given the diversity of EHR platforms and system workflows, researchers need tools for evaluating and reporting data availability, quality, and transformations. Our case study illustrates how system mapping can inform researchers about the provenance of their data as it pertains to local workflows.

Evaluating the data completeness in the Electronic Health Record after the Implementation of an Outpatient Electronic Health Record.

PubMed

Soto, Mauricio; Capurro, Daniel; Catalán, Silvia

2015-01-01

Electronic health records (EHRs) present an opportunity for quality improvement in health organitations, particularly at the primary health level. However, EHR implementation impacts clinical workflows, and physicians frequently prefer to document in a non-structured way, which ultimately hinders the ability to measure quality indicators. We present an assessment of data completeness-a key data quality indicator-during the first 12 months after the implementation of an EHR at a teaching outpatient center in Santiago, Chile.

Guide to the NITRD Program FY 2004-FY 2005. Supplement to the President’s Budget for FY 2005

DTIC Science & Technology

2004-12-01

electronic medical records systems . At the core of such systems is the concept of a secure, patient-centered electronic health record ( EHR ) that: 1...support the development of an NHII that includes an Electronic Health Record System ( EHRS ). The EHRS will be a longitudinal collection of electronic... health information for and about persons. It will allow electronic access to person- and population-level information by authorized users. The system

Impact of electronic health records on malpractice claims in a sample of physician offices in Colorado: a retrospective cohort study.

PubMed

Victoroff, Michael S; Drury, Barbara M; Campagna, Elizabeth J; Morrato, Elaine H

2013-05-01

Electronic health records (EHRs) might reduce medical liability claims and potentially justify premium credits from liability insurers, but the evidence is limited. To evaluate the association between EHR use and medical liability claims in a population of office-based physicians, including claims that could potentially be directly prevented by features available in EHRs ("EHR-sensitive" claims). Retrospective cohort study of medical liability claims and analysis of claim abstracts. The 26 % of Colorado office-based physicians insured through COPIC Insurance Company who responded to a survey on EHR use (894 respondents out of 3,502 invitees). Claims incidence rate ratio (IRR); prevalence of "EHR-sensitive" claims. 473 physicians (53 % of respondents) used an office-based EHR. After adjustment for sex, birth cohort, specialty, practice setting and use of an EHR in settings other than an office, IRR for all claims was not significantly different between EHR users and non-users (0.88, 95 % CI 0.52-1.46; p = 0.61), or for users after EHR implementation as compared to before (0.73, 95 % CI 0.41-1.29; p = 0.28). Of 1,569 claim abstracts reviewed, 3 % were judged "Plausibly EHR-sensitive," 82 % "Unlikely EHR-sensitive," and 15 % "Unable to determine." EHR-sensitive claims occurred in six out of 633 non-users and two out of 251 EHR users. Incidence rate ratios were 0.01 for both groups. Colorado physicians using office-based EHRs did not have significantly different rates of liability claims than non-EHR users; nor were rates different for EHR users before and after EHR implementation. The lack of significant effect may be due to a low prevalence of EHR-sensitive claims. Further research on EHR use and medical liability across a larger population of physicians is warranted.

Linking guidelines to Electronic Health Record design for improved chronic disease management.

PubMed

Barretto, Sistine A; Warren, Jim; Goodchild, Andrew; Bird, Linda; Heard, Sam; Stumptner, Markus

2003-01-01

The promise of electronic decision support to promote evidence based practice remains elusive in the context of chronic disease management. We examine the problem of achieving a close relationship of Electronic Health Record (EHR) content to other components of a clinical information system (guidelines, decision support and workflow), particularly linking the decisions made by providers back to the guidelines. We use the openEHR architecture, which allows extension of a core Reference Model via Archetypes to refine the detailed information recording options for specific classes of encounter. We illustrate the use of openEHR for tracking the relationship of a series of clinical encounters to a guideline via a case study of guideline-compliant treatment of hypertension in diabetes. This case study shows the contribution guideline content can have on problem-specific EHR structure and demonstrates the potential for a constructive interaction of electronic decision support and the EHR.

Linking Guidelines to Electronic Health Record Design for Improved Chronic Disease Management

PubMed Central

Barretto, Sistine A.; Warren, Jim; Goodchild, Andrew; Bird, Linda; Heard, Sam; Stumptner, Markus

2003-01-01

The promise of electronic decision support to promote evidence based practice remains elusive in the context of chronic disease management. We examine the problem of achieving a close relationship of Electronic Health Record (EHR) content to other components of a clinical information system (guidelines, decision support and work-flow), particularly linking the decisions made by providers back to the guidelines. We use the openEHR architecture, which allows extension of a core Reference Model via Archetypes to refine the detailed information recording options for specific classes of encounter. We illustrate the use of openEHR for tracking the relationship of a series of clinical encounters to a guideline via a case study of guideline-compliant treatment of hypertension in diabetes. This case study shows the contribution guideline content can have on problem-specific EHR structure and demonstrates the potential for a constructive interaction of electronic decision support and the EHR. PMID:14728135

Are physicians' perceptions of healthcare quality and practice satisfaction affected by errors associated with electronic health record use?

PubMed Central

Wright, Adam; Simon, Steven R; Jenter, Chelsea A; Soran, Christine S; Volk, Lynn A; Bates, David W; Poon, Eric G

2011-01-01

Background Electronic health record (EHR) adoption is a national priority in the USA, and well-designed EHRs have the potential to improve quality and safety. However, physicians are reluctant to implement EHRs due to financial constraints, usability concerns, and apprehension about unintended consequences, including the introduction of medical errors related to EHR use. The goal of this study was to characterize and describe physicians' attitudes towards three consequences of EHR implementation: (1) the potential for EHRs to introduce new errors; (2) improvements in healthcare quality; and (3) changes in overall physician satisfaction. Methods Using data from a 2007 statewide survey of Massachusetts physicians, we conducted multivariate regression analysis to examine relationships between practice characteristics, perceptions of EHR-related errors, perceptions of healthcare quality, and overall physician satisfaction. Results 30% of physicians agreed that EHRs create new opportunities for error, but only 2% believed their EHR has created more errors than it prevented. With respect to perceptions of quality, there was no significant association between perceptions of EHR-associated errors and perceptions of EHR-associated changes in healthcare quality. Finally, physicians who believed that EHRs created new opportunities for error were less likely be satisfied with their practice situation (adjusted OR 0.49, p=0.001). Conclusions Almost one third of physicians perceived that EHRs create new opportunities for error. This perception was associated with lower levels of physician satisfaction. PMID:22199017

The impact of electronic health record use on physician productivity.

PubMed

Adler-Milstein, Julia; Huckman, Robert S

2013-11-01

To examine the impact of the degree of electronic health record (EHR) use and delegation of EHR tasks on clinician productivity in ambulatory settings. We examined EHR use in primary care practices that implemented a web-based EHR from athenahealth (n = 42) over 3 years (695 practice-month observations). Practices were predominantly small and spread throughout the country. Data came from athenahealth practice management system and EHR task logs. We developed monthly measures of EHR use and delegation to support staff from task logs. Productivity was measured using work relative value units (RVUs). Using fixed effects models, we assessed the independent impacts on productivity of EHR use and delegation. We then explored the interaction between these 2 strategies and the role of practice size. Greater EHR use and greater delegation were independently associated with higher levels of productivity. An increase in EHR use of 1 standard deviation resulted in a 5.3% increase in RVUs per clinician workday; an increase in delegation of EHR tasks of 1 standard deviation resulted in an 11.0% increase in RVUs per clinician workday (P <.05 for both). Further, EHR use and delegation had a positive joint impact on productivity in large practices (coefficient, 0.058; P <.05), but a negative joint impact on productivity in small practices (coefficient, -0.142; P <.01). Clinicians in practices that increased EHR use and delegated EHR tasks were more productive, but practice size determined whether the 2 strategies were complements or substitutes.

-Omic and Electronic Health Record Big Data Analytics for Precision Medicine.

PubMed

Wu, Po-Yen; Cheng, Chih-Wen; Kaddi, Chanchala D; Venugopalan, Janani; Hoffman, Ryan; Wang, May D

2017-02-01

Rapid advances of high-throughput technologies and wide adoption of electronic health records (EHRs) have led to fast accumulation of -omic and EHR data. These voluminous complex data contain abundant information for precision medicine, and big data analytics can extract such knowledge to improve the quality of healthcare. In this paper, we present -omic and EHR data characteristics, associated challenges, and data analytics including data preprocessing, mining, and modeling. To demonstrate how big data analytics enables precision medicine, we provide two case studies, including identifying disease biomarkers from multi-omic data and incorporating -omic information into EHR. Big data analytics is able to address -omic and EHR data challenges for paradigm shift toward precision medicine. Big data analytics makes sense of -omic and EHR data to improve healthcare outcome. It has long lasting societal impact.

Applied nursing informatics research - state-of-the-art methodologies using electronic health record data.

PubMed

Park, Jung In; Pruinelli, Lisiane; Westra, Bonnie L; Delaney, Connie W

2014-01-01

With the pervasive implementation of electronic health records (EHR), new opportunities arise for nursing research through use of EHR data. Increasingly, comparative effectiveness research within and across health systems is conducted to identify the impact of nursing for improving health, health care, and lowering costs of care. Use of EHR data for this type of research requires use of national and internationally recognized nursing terminologies to normalize data. Research methods are evolving as large data sets become available through EHRs. Little is known about the types of research and analytic methods for applied to nursing research using EHR data normalized with nursing terminologies. The purpose of this paper is to report on a subset of a systematic review of peer reviewed studies related to applied nursing informatics research involving EHR data using standardized nursing terminologies.

Changes to the electronic health records market in light of health information technology certification and meaningful use

PubMed Central

Yoon, Jangho; Bossak, Brian H

2013-01-01

Background Health information technology (HIT) certification and meaningful use are interventions encouraging the adoption of electronic health records (EHRs) in the USA. However, these initiatives also constitute a significant intervention which will change the structure of the EHR market. Objective To describe quantitatively recent changes to both the demand and supply sides of the EHR market. Materials and methods A cohort of 3447 of hospitals from the HIMSS Analytics Database (2006–10) was created. Using hospital referral regions to define the local market, we determined the percentage of hospitals using paper records, the number of vendors, and local EHR vendor competition using the Herfindahl–Hirschman Index. Changes over time were assessed using a series of regression equations and geographic information systems analyses. Results Overall, there was movement away from paper records, upward trends in the number of EHR vendors, and greater competition. However, changes differed according to hospital size and region of the country. Changes were greatest for small hospitals, whereas competition and the number of vendors did not change dramatically for large hospitals. Discussion The EHR market is changing most dramatically for those least equipped to handle broad technological transformation, which underscores the need for continued targeted support. Furthermore, wide variations across the nation indicate a continued role for states in the support of EHR utilization. Conclusion The structure of the EHR market is undergoing substantial changes as desired by the proponents and architects of HIT certification and meaningful use. However, these transformations are not uniform for all hospitals or all the country. PMID:22917839

ResearchEHR: use of semantic web technologies and archetypes for the description of EHRs.

PubMed

Robles, Montserrat; Fernández-Breis, Jesualdo Tomás; Maldonado, Jose A; Moner, David; Martínez-Costa, Catalina; Bosca, Diego; Menárguez-Tortosa, Marcos

2010-01-01

In this paper, we present the ResearchEHR project. It focuses on the usability of Electronic Health Record (EHR) sources and EHR standards for building advanced clinical systems. The aim is to support healthcare professional, institutions and authorities by providing a set of generic methods and tools for the capture, standardization, integration, description and dissemination of health related information. ResearchEHR combines several tools to manage EHR at two different levels. The internal level that deals with the normalization and semantic upgrading of exiting EHR by using archetypes and the external level that uses Semantic Web technologies to specify clinical archetypes for advanced EHR architectures and systems.

The SAFER guides: empowering organizations to improve the safety and effectiveness of electronic health records.

PubMed

Sittig, Dean F; Ash, Joan S; Singh, Hardeep

2014-05-01

Electronic health records (EHRs) have potential to improve quality and safety of healthcare. However, EHR users have experienced safety concerns from EHR design and usability features that are not optimally adapted for the complex work flow of real-world practice. Few strategies exist to address unintended consequences from implementation of EHRs and other health information technologies. We propose that organizations equipped with EHRs should consider the strategy of "proactive risk assessment" of their EHR-enabled healthcare system to identify and address EHR-related safety concerns. In this paper, we describe the conceptual underpinning of an EHR-related self-assessment strategy to provide institutions a foundation upon which they could build their safety efforts. With support from the Office of the National Coordinator for Health Information Technology (ONC), we used a rigorous, iterative process to develop a set of 9 self-assessment tools to optimize the safety and safe use of EHRs. These tools, referred to as the Safety Assurance Factors for EHR Resilience (SAFER) guides, could be used to self-assess safety and effectiveness of EHR implementations, identify specific areas of vulnerability, and create solutions and culture change to mitigate risks. A variety of audiences could conduct these assessments, including frontline clinicians or care teams in different practices, or clinical, quality, or administrative leaders within larger institutions. The guides use a multifaceted systems-based approach to assess risk and empower organizations to work with internal or external stakeholders (eg, EHR developers) on optimizing EHR functionality and using EHRs to drive improvements in the quality and safety of healthcare.

Simulated electronic health record (Sim-EHR) curriculum: teaching EHR skills and use of the EHR for disease management and prevention.

PubMed

Milano, Christina E; Hardman, Joseph A; Plesiu, Adeline; Rdesinski, Rebecca E; Biagioli, Frances E

2014-03-01

Electronic health records (EHRs) can improve many aspects of patient care, yet few formal EHR curricula exist to teach optimal use to students and other trainees. The Simulated EHR (Sim-EHR) curriculum was introduced in January 2011 at Oregon Health & Science University (OHSU) to provide learners with a safe hands-on environment in which to apply evidence-based guidelines while learning EHR skills. Using an EHR training platform identical to the OHSU EHR system, learners review and correct a simulated medical chart for a complex virtual patient with chronic diseases and years of fragmented care. They write orders and prescriptions, create an evidence-based plan of care for indicated disease prevention and management, and review their work in a small-group setting. Third-year students complete the Sim-EHR curriculum as part of the required family medicine clerkship; their chart work is assessed using a rubric tied to the curriculum's general and specific objectives. As of January 2014, 406 third-year OHSU medical students, on campus or at remote clerkship sites, and 21 OHSU internal medicine interns had completed simulated charts.In this article, the authors describe the development and implementation of the Sim-EHR curriculum, with a focus on use of the curriculum in the family medicine clerkship. They also share preliminary findings and lessons learned. They suggest that the Sim-EHR curriculum is an effective, interactive method for providing learners with EHR skills education while demonstrating how a well-organized chart helps ensure safe, efficient, and quality patient care.

The Evaluation of SEPAS National Project Based on Electronic Health Record System (EHRS) Coordinates in Iran.

PubMed

Asadi, Farkhondeh; Moghaddasi, Hamid; Rabiei, Reza; Rahimi, Forough; Mirshekarlou, Soheila Jahangiri

2015-12-01

Electronic Health Records (EHRs) are secure private lifetime records that can be shared by using interoperability standards between different organizations and units. These records are created by the productive system that is called EHR system. Implementing EHR systems has a number of advantages such as facilitating access to medical records, supporting patient care, and improving the quality of care and health care decisions. The project of electronic health record system in Iran, which is the goal of this study, is called SEPAS. With respect to the importance of EHR and EHR systems the researchers investigated the project from two perspectives: determining the coordinates of the project and how it evolved, and incorporating the coordinates of EHR system in this project. In this study two evaluation tools, a checklist and a questionnaire, were developed based on texts and reliable documentation. The questionnaire and the checklist were validated using content validity by receiving the experts' comments and the questionnaire's reliability was estimated through Test-retest(r =87%). Data were collected through study, observation, and interviews with experts and specialists of SEPAS project. This research showed that SEPAS project, like any other project, could be evaluated. It has some aims; steps, operational phases and certain start and end time, but all the resources and required facilities for the project have not been considered. Therefore it could not satisfy its specified objective and the useful and unique changes which are the other characteristics of any project have not been achieved. In addition, the findings of EHR system coordinates can be determined in 4 categories as Standards and rules, Telecommunication-Communication facilities, Computer equipment and facilities and Stakeholders. The findings indicated that SEPAS has the ability to use all standards of medical terminology and health classification systems in the case of Maksa approval (The reference health coding of Iran). ISO13606 was used as the main standard in this project. Regarding the telecommunication-communication facilities of the project, the findings showed that its link is restricted to health care centers which does not cover other institutions and organizations involved in public health. The final result showed that SEPAS is in the early stages of execution. And the full implementation of EHR needs the provision of the infrastructure of the National Health Information Network that is the same as EHR system.

Electronic Health Records

MedlinePlus

... Doctors and hospitals are turning to new health information technology, and while these changes won't happen overnight, they are coming. Understanding EHRs Electronic health records (EHR) — ... information like your age, gender, ethnicity, health history, medications, ...

The business end of health information technology. Can a fully integrated electronic health record increase provider productivity in a large community practice?

PubMed

De Leon, Samantha; Connelly-Flores, Alison; Mostashari, Farzad; Shih, Sarah C

2010-01-01

Electronic health records (EHRs) are expected to transform and improve the way medicine is practiced. However, providers perceive many barriers toward implementing new health information technology. Specifically, they are most concerned about the potentially negative impact on their practice finances and productivity. This study compares the productivity of 75 providers at a large urban primary care practice from January 2005 to February 2009, before and after implementing an EHR system, using longitudinal mixed model analyses. While decreases in productivity were observed at the time the EHR system was implemented, most providers quickly recovered, showing increases in productivity per month shortly after EHR implementation. Overall, providers had significant productivity increases of 1.7% per month per provider from pre- to post-EHR adoption. The majority of the productivity gains occurred after the practice instituted a pay-for-performance program, enabled by the data capture of the EHRs. Coupled with pay-for-performance, EHRs can spur rapid gains in provider productivity.

The role of electronic health records in clinical reasoning.

PubMed

Berndt, Markus; Fischer, Martin R

2018-05-16

Electronic health records (eHRs) play an increasingly important role in documentation and exchange of information in multi-and interdisciplinary patient care. Although eHRs are associated with mixed evidence in terms of effectiveness, they are undeniably the health record form of the future. This poses several learning opportunities and challenges for medical education. This review aims to connect the concept of eHRs to key competencies of physicians and elaborates current learning science perspectives on diagnostic and clinical reasoning based on a theoretical framework of scientific reasoning and argumentation. It concludes with an integrative vision of the use of eHRs, and the special role of the patient, for teaching and learning in medicine. © 2018 New York Academy of Sciences.

Quality Requirements for Electronic Health Record Systems*. A Japanese-German Information Management Perspective.

PubMed

Winter, Alfred; Takabayashi, Katsuhiko; Jahn, Franziska; Kimura, Eizen; Engelbrecht, Rolf; Haux, Reinhold; Honda, Masayuki; Hübner, Ursula H; Inoue, Sozo; Kohl, Christian D; Matsumoto, Takehiro; Matsumura, Yasushi; Miyo, Kengo; Nakashima, Naoki; Prokosch, Hans-Ulrich; Staemmler, Martin

2017-08-07

For more than 30 years, there has been close cooperation between Japanese and German scientists with regard to information systems in health care. Collaboration has been formalized by an agreement between the respective scientific associations. Following this agreement, two joint workshops took place to explore the similarities and differences of electronic health record systems (EHRS) against the background of the two national healthcare systems that share many commonalities. To establish a framework and requirements for the quality of EHRS that may also serve as a basis for comparing different EHRS. Donabedian's three dimensions of quality of medical care were adapted to the outcome, process, and structural quality of EHRS and their management. These quality dimensions were proposed before the first workshop of EHRS experts and enriched during the discussions. The Quality Requirements Framework of EHRS (QRF-EHRS) was defined and complemented by requirements for high quality EHRS. The framework integrates three quality dimensions (outcome, process, and structural quality), three layers of information systems (processes and data, applications, and physical tools) and three dimensions of information management (strategic, tactical, and operational information management). Describing and comparing the quality of EHRS is in fact a multidimensional problem as given by the QRF-EHRS framework. This framework will be utilized to compare Japanese and German EHRS, notably those that were presented at the second workshop.

[Views of health system administrators, professionals, and users concerning the electronic health record and facilitators and obstacles to its implementation].

PubMed

Costa, Jose Felipe Riani; Portela, Margareth Crisóstomo

2018-02-05

The design and deployment of complex technologies like the electronic health record (EHR) involve technical, personal, social, and organizational issues. The Brazilian public and private scenario includes different local and regional initiatives for implementation of the electronic health record. The Brazilian Ministry of Health also has a proposal to develop a national EHR. The current study aimed to provide a comprehensive view of perceptions by health system administrators, professionals, and users concerning their experiences with the electronic health record and their opinions of the possibility of developing a national EHR. This qualitative study involved 28 semi-structured interviews. The results revealed both the diversity of factors that can influence the implementation of an electronic health record and the existence of convergences and aspects that tend to be valued differently according to the different points of view. Key aspects include discussions on the electronic health record's attributes and it impact on healthcare, especially in the case of local electronic health records, concerns over costs and confidentiality and privacy pertaining to electronic health records in general, and the possible implications of centralized versus decentralized data storage in the case of a national EHR. The interviews clearly showed the need to establish more effective communication among the various stakeholders, and that the different perspectives should be considered when drafting and deploying an EHR at the local, regional, and national levels.

Evaluating the Usability of a Free Electronic Health Record for Training

PubMed Central

Hoyt, Robert; Adler, Kenneth; Ziesemer, Brandy; Palombo, Georgina

2013-01-01

The United States will need to train a large workforce of skilled health information technology (HIT) professionals in order to meet the US government's goal of universal electronic health records (EHRs) for all patients and widespread health information exchange. The Health Information Technology for Economic and Clinical Health (HITECH) Act established several HIT workforce educational programs to accomplish this goal. Recent studies have shown that EHR usability is a significant concern of physicians and is a potential obstacle to EHR adoption. It is important to have a highly usable EHR to train both clinicians and students. In this article, we report a qualitative-quantitative usability analysis of a web-based EHR for training health informatics and health information management students. PMID:23805062

Rapid Development of Specialty Population Registries and Quality Measures from Electronic Health Record Data*. An Agile Framework.

PubMed

Kannan, Vaishnavi; Fish, Jason S; Mutz, Jacqueline M; Carrington, Angela R; Lai, Ki; Davis, Lisa S; Youngblood, Josh E; Rauschuber, Mark R; Flores, Kathryn A; Sara, Evan J; Bhat, Deepa G; Willett, DuWayne L

2017-06-14

Creation of a new electronic health record (EHR)-based registry often can be a "one-off" complex endeavor: first developing new EHR data collection and clinical decision support tools, followed by developing registry-specific data extractions from the EHR for analysis. Each development phase typically has its own long development and testing time, leading to a prolonged overall cycle time for delivering one functioning registry with companion reporting into production. The next registry request then starts from scratch. Such an approach will not scale to meet the emerging demand for specialty registries to support population health and value-based care. To determine if the creation of EHR-based specialty registries could be markedly accelerated by employing (a) a finite core set of EHR data collection principles and methods, (b) concurrent engineering of data extraction and data warehouse design using a common dimensional data model for all registries, and (c) agile development methods commonly employed in new product development. We adopted as guiding principles to (a) capture data as a byproduct of care of the patient, (b) reinforce optimal EHR use by clinicians, (c) employ a finite but robust set of EHR data capture tool types, and (d) leverage our existing technology toolkit. Registries were defined by a shared condition (recorded on the Problem List) or a shared exposure to a procedure (recorded on the Surgical History) or to a medication (recorded on the Medication List). Any EHR fields needed - either to determine registry membership or to calculate a registry-associated clinical quality measure (CQM) - were included in the enterprise data warehouse (EDW) shared dimensional data model. Extract-transform-load (ETL) code was written to pull data at defined "grains" from the EHR into the EDW model. All calculated CQM values were stored in a single Fact table in the EDW crossing all registries. Registry-specific dashboards were created in the EHR to display both (a) real-time patient lists of registry patients and (b) EDW-generated CQM data. Agile project management methods were employed, including co-development, lightweight requirements documentation with User Stories and acceptance criteria, and time-boxed iterative development of EHR features in 2-week "sprints" for rapid-cycle feedback and refinement. Using this approach, in calendar year 2015 we developed a total of 43 specialty chronic disease registries, with 111 new EHR data collection and clinical decision support tools, 163 new clinical quality measures, and 30 clinic-specific dashboards reporting on both real-time patient care gaps and summarized and vetted CQM measure performance trends. This study suggests concurrent design of EHR data collection tools and reporting can quickly yield useful EHR structured data for chronic disease registries, and bodes well for efforts to migrate away from manual abstraction. This work also supports the view that in new EHR-based registry development, as in new product development, adopting agile principles and practices can help deliver valued, high-quality features early and often.

Rapid Development of Specialty Population Registries and Quality Measures from Electronic Health Record Data.

PubMed

Kannan, Vaishnavi; Fish, Jason S; Mutz, Jacqueline M; Carrington, Angela R; Lai, Ki; Davis, Lisa S; Youngblood, Josh E; Rauschuber, Mark R; Flores, Kathryn A; Sara, Evan J; Bhat, Deepa G; Willett, DuWayne L

2017-01-01

Creation of a new electronic health record (EHR)-based registry often can be a "one-off" complex endeavor: first developing new EHR data collection and clinical decision support tools, followed by developing registry-specific data extractions from the EHR for analysis. Each development phase typically has its own long development and testing time, leading to a prolonged overall cycle time for delivering one functioning registry with companion reporting into production. The next registry request then starts from scratch. Such an approach will not scale to meet the emerging demand for specialty registries to support population health and value-based care. To determine if the creation of EHR-based specialty registries could be markedly accelerated by employing (a) a finite core set of EHR data collection principles and methods, (b) concurrent engineering of data extraction and data warehouse design using a common dimensional data model for all registries, and (c) agile development methods commonly employed in new product development. We adopted as guiding principles to (a) capture data as a byproduct of care of the patient, (b) reinforce optimal EHR use by clinicians, (c) employ a finite but robust set of EHR data capture tool types, and (d) leverage our existing technology toolkit. Registries were defined by a shared condition (recorded on the Problem List) or a shared exposure to a procedure (recorded on the Surgical History) or to a medication (recorded on the Medication List). Any EHR fields needed - either to determine registry membership or to calculate a registry-associated clinical quality measure (CQM) - were included in the enterprise data warehouse (EDW) shared dimensional data model. Extract-transform-load (ETL) code was written to pull data at defined "grains" from the EHR into the EDW model. All calculated CQM values were stored in a single Fact table in the EDW crossing all registries. Registry-specific dashboards were created in the EHR to display both (a) real-time patient lists of registry patients and (b) EDW-gener-ated CQM data. Agile project management methods were employed, including co-development, lightweight requirements documentation with User Stories and acceptance criteria, and time-boxed iterative development of EHR features in 2-week "sprints" for rapid-cycle feedback and refinement. Using this approach, in calendar year 2015 we developed a total of 43 specialty chronic disease registries, with 111 new EHR data collection and clinical decision support tools, 163 new clinical quality measures, and 30 clinic-specific dashboards reporting on both real-time patient care gaps and summarized and vetted CQM measure performance trends. This study suggests concurrent design of EHR data collection tools and reporting can quickly yield useful EHR structured data for chronic disease registries, and bodes well for efforts to migrate away from manual abstraction. This work also supports the view that in new EHR-based registry development, as in new product development, adopting agile principles and practices can help deliver valued, high-quality features early and often. Schattauer GmbH.

Patient and public attitudes towards informed consent models and levels of awareness of Electronic Health Records in the UK

PubMed Central

Riordan, Fiona; Papoutsi, Chrysanthi; Reed, Julie E.; Marston, Cicely; Bell, Derek; Majeed, Azeem

2015-01-01

Background The development of Electronic Health Records (EHRs) forms an integral part of the information strategy for the National Health Service (NHS) in the UK, with the aim of facilitating health information exchange for patient care and secondary use, including research and healthcare planning. Implementing EHR systems requires an understanding of patient expectations for consent mechanisms and consideration of public awareness towards information sharing as might be made possible through integrated EHRs across primary and secondary health providers. Objectives To explore levels of public awareness about EHRs and to examine attitudes towards different consent models with respect to sharing identifiable and de-identified records for healthcare provision, research and planning. Methods A cross-sectional questionnaire survey was administered to adult patients and members of the public in primary and secondary care clinics in West London, UK in 2011. In total, 5331 individuals participated in the survey, and 3157 were included in the final analysis. Results The majority (91%) of respondents expected to be explicitly asked for consent for their identifiable records to be accessed for health provision, research or planning. Half the respondents (49%) did not expect to be asked for consent before their de-identified records were accessed. Compared with White British respondents, those from all other ethnic groups were more likely to anticipate their permission would be obtained before their de-identified records were used. Of the study population, 59% reported already being aware of EHRs before the survey. Older respondents and individuals with complex patterns of interaction with healthcare services were more likely to report prior awareness of EHRs. Individuals self-identifying as belonging to ethnic groups other than White British, and those with lower educational qualifications were less likely to report being aware of EHRs than White British respondents and respondents with degree-level education, respectively. Those who reported being aware of EHRs were less likely to say they expected explicit consent to be sought before use of their de-identified record. Conclusions A large number of patients remain unaware of EHRs, while preference for implicit consent is stronger among those who report previous awareness. Differences in awareness levels and consent expectations between groups with different socio-demographic characteristics suggest that public education and information campaigns should target specific groups to increase public awareness and ensure meaningful informed consent mechanisms. PMID:25649841

Missing clinical and behavioral health data in a large electronic health record (EHR) system.

PubMed

Madden, Jeanne M; Lakoma, Matthew D; Rusinak, Donna; Lu, Christine Y; Soumerai, Stephen B

2016-11-01

Recent massive investment in electronic health records (EHRs) was predicated on the assumption of improved patient safety, research capacity, and cost savings. However, most US health systems and health records are fragmented and do not share patient information. Our study compared information available in a typical EHR with more complete data from insurance claims, focusing on diagnoses, visits, and hospital care for depression and bipolar disorder. We included insurance plan members aged 12 and over, assigned throughout 2009 to a large multispecialty medical practice in Massachusetts, with diagnoses of depression (N = 5140) or bipolar disorder (N = 462). We extracted insurance claims and EHR data from the primary care site and compared diagnoses of interest, outpatient visits, and acute hospital events (overall and behavioral) between the 2 sources. Patients with depression and bipolar disorder, respectively, averaged 8.4 and 14.0 days of outpatient behavioral care per year; 60% and 54% of these, respectively, were missing from the EHR because they occurred offsite. Total outpatient care days were 20.5 for those with depression and 25.0 for those with bipolar disorder, with 45% and 46% missing, respectively, from the EHR. The EHR missed 89% of acute psychiatric services. Study diagnoses were missing from the EHR's structured event data for 27.3% and 27.7% of patients. EHRs inadequately capture mental health diagnoses, visits, specialty care, hospitalizations, and medications. Missing clinical information raises concerns about medical errors and research integrity. Given the fragmentation of health care and poor EHR interoperability, information exchange, and usability, priorities for further investment in health IT will need thoughtful reconsideration. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Locating relevant patient information in electronic health record data using representations of clinical concepts and database structures.

PubMed

Pan, Xuequn; Cimino, James J

2014-01-01

Clinicians and clinical researchers often seek information in electronic health records (EHRs) that are relevant to some concept of interest, such as a disease or finding. The heterogeneous nature of EHRs can complicate retrieval, risking incomplete results. We frame this problem as the presence of two gaps: 1) a gap between clinical concepts and their representations in EHR data and 2) a gap between data representations and their locations within EHR data structures. We bridge these gaps with a knowledge structure that comprises relationships among clinical concepts (including concepts of interest and concepts that may be instantiated in EHR data) and relationships between clinical concepts and the database structures. We make use of available knowledge resources to develop a reproducible, scalable process for creating a knowledge base that can support automated query expansion from a clinical concept to all relevant EHR data.

How to integrate the electronic health record and patient-centered communication into the medical visit: a skills-based approach.

PubMed

Duke, Pamela; Frankel, Richard M; Reis, Shmuel

2013-01-01

Implementation of the electronic health record (EHR) has changed the dynamics of doctor-patient communication. Physicians train to use EHRs from a technical standpoint, giving only minimal attention to integrating the human dimensions of the doctor-patient relationship into the computer-accompanied medical visit. This article reviews the literature and proposes a model to help clinicians, residents, and students improve physician-patient communication while using the EHR. We conducted a literature search on use of communication skills when interfacing with the EHR. We observed an instructional gap and developed a model using evidence-based communication skills. This model integrates patient-centered interview skills and aims to empower physicians to remain patient centered while effectively using EHRs. It may also serve as a template for future educational and practice interventions for use of the EHR in the examination room.

-Omic and Electronic Health Records Big Data Analytics for Precision Medicine

PubMed Central

Wu, Po-Yen; Cheng, Chih-Wen; Kaddi, Chanchala D.; Venugopalan, Janani; Hoffman, Ryan; Wang, May D.

2017-01-01

Objective Rapid advances of high-throughput technologies and wide adoption of electronic health records (EHRs) have led to fast accumulation of -omic and EHR data. These voluminous complex data contain abundant information for precision medicine, and big data analytics can extract such knowledge to improve the quality of health care. Methods In this article, we present -omic and EHR data characteristics, associated challenges, and data analytics including data pre-processing, mining, and modeling. Results To demonstrate how big data analytics enables precision medicine, we provide two case studies, including identifying disease biomarkers from multi-omic data and incorporating -omic information into EHR. Conclusion Big data analytics is able to address –omic and EHR data challenges for paradigm shift towards precision medicine. Significance Big data analytics makes sense of –omic and EHR data to improve healthcare outcome. It has long lasting societal impact. PMID:27740470

Enabling Cross-Platform Clinical Decision Support through Web-Based Decision Support in Commercial Electronic Health Record Systems: Proposal and Evaluation of Initial Prototype Implementations

PubMed Central

Zhang, Mingyuan; Velasco, Ferdinand T.; Musser, R. Clayton; Kawamoto, Kensaku

2013-01-01

Enabling clinical decision support (CDS) across multiple electronic health record (EHR) systems has been a desired but largely unattained aim of clinical informatics, especially in commercial EHR systems. A potential opportunity for enabling such scalable CDS is to leverage vendor-supported, Web-based CDS development platforms along with vendor-supported application programming interfaces (APIs). Here, we propose a potential staged approach for enabling such scalable CDS, starting with the use of custom EHR APIs and moving towards standardized EHR APIs to facilitate interoperability. We analyzed three commercial EHR systems for their capabilities to support the proposed approach, and we implemented prototypes in all three systems. Based on these analyses and prototype implementations, we conclude that the approach proposed is feasible, already supported by several major commercial EHR vendors, and potentially capable of enabling cross-platform CDS at scale. PMID:24551426

Improving Service Coordination and Reducing Mental Health Disparities Through Adoption of Electronic Health Records.

PubMed

McGregor, Brian; Mack, Dominic; Wrenn, Glenda; Shim, Ruth S; Holden, Kisha; Satcher, David

2015-09-01

Despite widespread support for removing barriers to the use of electronic health records (EHRs) in behavioral health care, adoption of EHRs in behavioral health settings lags behind adoption in other areas of health care. The authors discuss barriers to use of EHRs among behavioral health care practitioners, suggest solutions to overcome these barriers, and describe the potential benefits of EHRs to reduce behavioral health care disparities. Thoughtful and comprehensive strategies will be needed to design EHR systems that address concerns about policy, practice, costs, and stigma and that protect patients' privacy and confidentiality. However, these goals must not detract from continuing to challenge the notion that behavioral health and general medical health should be treated as separate and distinct. Ultimately, utilization of EHRs among behavioral health care providers will improve the coordination of services and overall patient care, which is essential to reducing mental health disparities.

Making electronic health records support quality management: A narrative review.

PubMed

Triantafillou, Peter

2017-08-01

Since the 1990s many hospitals in the OECD countries have introduced electronic health record (EHR) systems. A number of studies have examined the factors impinging on EHR implementation. Others have studied the clinical efficacy of EHR. However, only few studies have explored the (intermediary) factors that make EHR systems conducive to quality management (QM). Undertake a narrative review of existing studies in order to identify and discuss the factors conducive to making EHR support three dimensions of QM: clinical outcomes, managerial monitoring and cost-effectiveness. A narrative review of Web of Science, Cochrane, EBSCO, ProQuest, Scopus and three Nordic research databases. most studies do not specify the type of EHR examined. 39 studies were identified for analysis. 10 factors were found to be conducive to make EHR support QM. However, the contribution of EHR to the three specific dimensions of QM varied substantially. Most studies (29) included clinical outcomes. However, only half of these reported EHR to have a positive impact. Almost all the studies (36) dealt with the ability of EHR to enhance managerial monitoring of clinical activities, the far majority of which showed a positive relationship. Finally, only five dealt with cost-effectiveness of which two found positive effects. The findings resonates well with previous reviews, though two factors making EHR support QM seem new, namely: political goals and strategies, and integration of guidelines for clinical conduct. Lacking EHR type specification and diversity in study method imply that there is a strong need for further research on the factors that may make EHR may support QM. Copyright © 2017 Elsevier B.V. All rights reserved.

A Novel Approach to Supporting Relationship-Centered Care Through Electronic Health Record Ergonomic Training in Preclerkship Medical Education

PubMed Central

Silverman, Howard; Ho, Yun-Xian; Kaib, Susan; Ellis, Wendy Danto; Moffitt, Marícela P.; Chen, Qingxia; Nian, Hui; Gadd, Cynthia S.

2014-01-01

Problem How can physicians incorporate the electronic health record (EHR) into clinical practice in a relationship-enhancing fashion (“EHR ergonomics”)? Approach Three convenience samples of 40 second-year medical students with varying levels of EHR ergonomic training were compared in the 2012 spring semester. All participants first received basic EHR training and completed a pre-survey. Two study groups were then instructed to use the EHR during the standardized patient (SP) encounter in each of four regularly scheduled Doctoring (clinical skills) course sessions. One group received additional ergonomic training in each session. Ergonomic assessment data were collected from students, faculty, and SPs in each session. A post-survey was administered to all students, and data were compared across all three groups to assess the impact of EHR use and ergonomic training. Outcomes There was a significant positive effect of EHR ergonomics skills training on students’ relationship-centered EHR use (P < .005). Students who received training reported that they were able to use the EHR to engage with patients more effectively, better articulate the benefits of using the EHR, better address patient concerns, more appropriately position the EHR device, and more effectively integrate the EHR into patient encounters. Additionally, students’ self-assessments were strongly corroborated by SP and faculty assessments. A minimum of three ergonomic training sessions was needed to see an overall improvement in EHR use. Next Steps In addition to replication of these results, further effectiveness studies of this educational intervention need to be carried out in GME, practice, and other environments. PMID:24826851

A novel approach to supporting relationship-centered care through electronic health record ergonomic training in preclerkship medical education.

PubMed

Silverman, Howard; Ho, Yun-Xian; Kaib, Susan; Ellis, Wendy Danto; Moffitt, Marícela P; Chen, Qingxia; Nian, Hui; Gadd, Cynthia S

2014-09-01

How can physicians incorporate the electronic health record (EHR) into clinical practice in a relationship-enhancing fashion ("EHR ergonomics")? Three convenience samples of 40 second-year medical students with varying levels of EHR ergonomic training were compared in the 2012 spring semester. All participants first received basic EHR training and completed a presurvey. Two study groups were then instructed to use the EHR during the standardized patient (SP) encounter in each of four regularly scheduled Doctoring (clinical skills) course sessions. One group received additional ergonomic training in each session. Ergonomic assessment data were collected from students, faculty, and SPs in each session. A postsurvey was administered to all students, and data were compared across all three groups to assess the impact of EHR use and ergonomic training. There was a significant positive effect of EHR ergonomics skills training on students' relationship-centered EHR use (P<.005). Students who received training reported that they were able to use the EHR to engage with patients more effectively, better articulate the benefits of using the EHR, better address patient concerns, more appropriately position the EHR device, and more effectively integrate the EHR into patient encounters. Additionally, students' self-assessments were strongly corroborated by SP and faculty assessments. A minimum of three ergonomic training sessions were needed to see an overall improvement in EHR use. In addition to replication of these results, further effectiveness studies of this educational intervention need to be carried out in GME, practice, and other environments.

Electronic health records improve clinical note quality.

PubMed

Burke, Harry B; Sessums, Laura L; Hoang, Albert; Becher, Dorothy A; Fontelo, Paul; Liu, Fang; Stephens, Mark; Pangaro, Louis N; O'Malley, Patrick G; Baxi, Nancy S; Bunt, Christopher W; Capaldi, Vincent F; Chen, Julie M; Cooper, Barbara A; Djuric, David A; Hodge, Joshua A; Kane, Shawn; Magee, Charles; Makary, Zizette R; Mallory, Renee M; Miller, Thomas; Saperstein, Adam; Servey, Jessica; Gimbel, Ronald W

2015-01-01

The clinical note documents the clinician's information collection, problem assessment, clinical management, and its used for administrative purposes. Electronic health records (EHRs) are being implemented in clinical practices throughout the USA yet it is not known whether they improve the quality of clinical notes. The goal in this study was to determine if EHRs improve the quality of outpatient clinical notes. A five and a half year longitudinal retrospective multicenter quantitative study comparing the quality of handwritten and electronic outpatient clinical visit notes for 100 patients with type 2 diabetes at three time points: 6 months prior to the introduction of the EHR (before-EHR), 6 months after the introduction of the EHR (after-EHR), and 5 years after the introduction of the EHR (5-year-EHR). QNOTE, a validated quantitative instrument, was used to assess the quality of outpatient clinical notes. Its scores can range from a low of 0 to a high of 100. Sixteen primary care physicians with active practices used QNOTE to determine the quality of the 300 patient notes. The before-EHR, after-EHR, and 5-year-EHR grand mean scores (SD) were 52.0 (18.4), 61.2 (16.3), and 80.4 (8.9), respectively, and the change in scores for before-EHR to after-EHR and before-EHR to 5-year-EHR were 18% (p<0.0001) and 55% (p<0.0001), respectively. All the element and grand mean quality scores significantly improved over the 5-year time interval. The EHR significantly improved the overall quality of the outpatient clinical note and the quality of all its elements, including the core and non-core elements. To our knowledge, this is the first study to demonstrate that the EHR significantly improves the quality of clinical notes. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Reducing Misses and Near Misses Related to Multitasking on the Electronic Health Record: Observational Study and Qualitative Analysis

PubMed Central

Matta, George Y; Bohsali, Fuad B; Chisolm, Margaret S

2018-01-01

Background Clinicians’ use of electronic health record (EHR) systems while multitasking may increase the risk of making errors, but silent EHR system use may lower patient satisfaction. Delaying EHR system use until after patient visits may increase clinicians’ EHR workload, stress, and burnout. Objective We aimed to describe the perspectives of clinicians, educators, administrators, and researchers about misses and near misses that they felt were related to clinician multitasking while using EHR systems. Methods This observational study was a thematic analysis of perspectives elicited from 63 continuing medical education (CME) participants during 2 workshops and 1 interactive lecture about challenges and strategies for relationship-centered communication during clinician EHR system use. The workshop elicited reflection about memorable times when multitasking EHR use was associated with “misses” (errors that were not caught at the time) or “near misses” (mistakes that were caught before leading to errors). We conducted qualitative analysis using an editing analysis style to identify codes and then select representative themes and quotes. Results All workshop participants shared stories of misses or near misses in EHR system ordering and documentation or patient-clinician communication, wondering about “misses we don’t even know about.” Risk factors included the computer’s position, EHR system usability, note content and style, information overload, problematic workflows, systems issues, and provider and patient communication behaviors and expectations. Strategies to reduce multitasking EHR system misses included clinician transparency when needing silent EHR system use (eg, for prescribing), narrating EHR system use, patient activation during EHR system use, adapting visit organization and workflow, improving EHR system design, and improving team support and systems. Conclusions CME participants shared numerous stories of errors and near misses in EHR tasks and communication that they felt related to EHR multitasking. However, they brainstormed diverse strategies for using EHR systems safely while preserving patient relationships. PMID:29410388

Reducing Misses and Near Misses Related to Multitasking on the Electronic Health Record: Observational Study and Qualitative Analysis.

PubMed

Ratanawongsa, Neda; Matta, George Y; Bohsali, Fuad B; Chisolm, Margaret S

2018-02-06

Clinicians' use of electronic health record (EHR) systems while multitasking may increase the risk of making errors, but silent EHR system use may lower patient satisfaction. Delaying EHR system use until after patient visits may increase clinicians' EHR workload, stress, and burnout. We aimed to describe the perspectives of clinicians, educators, administrators, and researchers about misses and near misses that they felt were related to clinician multitasking while using EHR systems. This observational study was a thematic analysis of perspectives elicited from 63 continuing medical education (CME) participants during 2 workshops and 1 interactive lecture about challenges and strategies for relationship-centered communication during clinician EHR system use. The workshop elicited reflection about memorable times when multitasking EHR use was associated with "misses" (errors that were not caught at the time) or "near misses" (mistakes that were caught before leading to errors). We conducted qualitative analysis using an editing analysis style to identify codes and then select representative themes and quotes. All workshop participants shared stories of misses or near misses in EHR system ordering and documentation or patient-clinician communication, wondering about "misses we don't even know about." Risk factors included the computer's position, EHR system usability, note content and style, information overload, problematic workflows, systems issues, and provider and patient communication behaviors and expectations. Strategies to reduce multitasking EHR system misses included clinician transparency when needing silent EHR system use (eg, for prescribing), narrating EHR system use, patient activation during EHR system use, adapting visit organization and workflow, improving EHR system design, and improving team support and systems. CME participants shared numerous stories of errors and near misses in EHR tasks and communication that they felt related to EHR multitasking. However, they brainstormed diverse strategies for using EHR systems safely while preserving patient relationships. ©Neda Ratanawongsa, George Y Matta, Fuad B Bohsali, Margaret S Chisolm. Originally published in JMIR Human Factors (http://humanfactors.jmir.org), 06.02.2018.

Association between Electronic Health Records and Health Care Utilization

PubMed Central

Edwards, A.; Kern, L.M.

2015-01-01

Summary Background The federal government is investing approximately $20 billion in electronic health records (EHRs), in part to address escalating health care costs. However, empirical evidence that provider use of EHRs decreases health care costs is limited. Objective To determine any association between EHRs and health care utilization. Methods We conducted a cohort study (2008–2009) in the Hudson Valley, a multi-payer, multiprovider community in New York State. We included 328 primary care physicians in predominantly small practices (median practice size four primary care physicians), who were caring for 223,772 patients. Data from an independent practice association was used to determine adoption of EHRs. Claims data aggregated across five commercial health plans was used to characterize seven types of health care utilization: primary care visits, specialist visits, radiology tests, laboratory tests, emergency department visits, hospital admissions, and readmissions. We used negative binomial regression to determine associations between EHR adoption and each utilization outcome, adjusting for ten physician characteristics. Results Approximately half (48%) of the physicians were using paper records and half (52%) were using EHRs. For every 100 patients seen by physicians using EHRs, there were 14 fewer specialist visits (adjusted p < 0.01) and 9 fewer radiology tests (adjusted p = 0.01). There were no significant differences in rates of primary care visits, laboratory tests, emergency department visits, hospitalizations or readmissions. Conclusions Patients of primary care providers who used EHRs were less likely to have specialist visits and radiology tests than patients of primary care providers who did not use EHRs. PMID:25848412

The Impact of Electronic Health Records on Risk Management of Information Systems in Australian Residential Aged Care Homes.

PubMed

Jiang, Tao; Yu, Ping; Hailey, David; Ma, Jun; Yang, Jie

2016-09-01

To obtain indications of the influence of electronic health records (EHR) in managing risks and meeting information system accreditation standard in Australian residential aged care (RAC) homes. The hypothesis to be tested is that the RAC homes using EHR have better performance in meeting information system standards in aged care accreditation than their counterparts only using paper records for information management. Content analysis of aged care accreditation reports from the Aged Care Standards and Accreditation Agency produced between April 2011 and December 2013. Items identified included types of information systems, compliance with accreditation standards, and indicators of failure to meet an expected outcome for information systems. The Chi-square test was used to identify difference between the RAC homes that used EHR systems and those that used paper records in not meeting aged care accreditation standards. 1,031 (37.4%) of 2,754 RAC homes had adopted EHR systems. Although the proportion of homes that met all accreditation standards was significantly higher for those with EHR than for homes with paper records, only 13 RAC homes did not meet one or more expected outcomes. 12 used paper records and nine of these failed the expected outcome for information systems. The overall contribution of EHR to meeting aged care accreditation standard in Australia was very small. Risk indicators for not meeting information system standard were no access to accurate and appropriate information, failure in monitoring mechanisms, not reporting clinical incidents, insufficient recording of residents' clinical changes, not providing accurate care plans, and communication processes failure. The study has provided indications that use of EHR provides small, yet significant advantages for RAC homes in Australia in managing risks for information management and in meeting accreditation requirements. The implication of the study for introducing technology innovation in RAC in Australia is discussed.

Fear of e-Health records implementation?

PubMed

Laur, Audrey

2015-03-01

As our world is dominated by Information Communication and Technologies (ICT), governments of many leading countries have decided to implement ICT in their health systems. The first step is the digitalisation of medical records (e-Health Records or EHRs). In order to reduce concerns that health systems encountered, EHRs are supposed to prevent duplicated prescriptions and hospitalisations, ineffective transferability of medical records, lack of communication in clinical assessments, etc. They are also expected to improve the relationship between health providers and patients. At first sight, EHR seems to offer considerable potential for assisting health policies, enabling the development of new tools to facilitate coordination and cooperation among health professionals and promoting a new approach to sharing medical information. However, as discussed in this article, recent debates have shown that EHR presents pros and cons (technical, financial, social) that governments need to clarify urgently. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Use of electronic health records by child primary healthcare providers in Europe.

PubMed

Grossman, Z; Del Torso, S; van Esso, D; Ehrich, J H H; Altorjai, P; Mazur, A; Wyder, C; Neves, A M; Dornbusch, H J; Jaeger Roman, E; Santucci, A; Hadjipanayis, A

2016-11-01

There is limited data on the use and functionality level of electronic health records (EHRs) supporting primary child health care in Europe. Our objective was to determine European primary child healthcare providers' use of EHRs, and functionality level of the systems used. European primary care paediatricians, paediatric subspecialists and family doctors were invited by European Academy of Paediatrics Research in Ambulatory Setting Network (EAPRASnet) country coordinators to complete a web-based survey on the use of EHRs and the systems' functionalities. Binomial logistic analysis has been used to evaluate the effect of specialty and type of practice on the use of EHRs. The survey was completed by 679 child primary healthcare providers (response rate 53%). Five hundred and fifty four responses coming from 10 predominant countries were taken for further analysis. EHR use by respondents varied widely between countries, all electronic type use ranging between 7% and 97%. There was no significant difference in EHR use between group practice and solo practitioners, or between family doctors and primary care paediatricians. History and physical examination can be properly recorded by respondents in most countries. However, growth chart plotting capacity in some countries ranges between 22% and 50%. Vaccination recording capacity varies between 50% and 100%, and data exchange capacity with immunization databases is mostly limited, ranging between 0% and 54%. There is marked heterogeneity in the use and functionalities of EHRs used among child primary child healthcare providers in Europe. More importantly, lack of critical paediatric supportive functionalities like growth tracking and vaccination status has been documented in some countries. There is a need to explore the reasons for these findings, and to develop a cross European paediatric EHR standards. © 2016 John Wiley & Sons Ltd.

Does adoption of electronic health records improve the quality of care management in France? Results from the French e-SI (PREPS-SIPS) study.

PubMed

Plantier, Morgane; Havet, Nathalie; Durand, Thierry; Caquot, Nicolas; Amaz, Camille; Biron, Pierre; Philip, Irène; Perrier, Lionel

2017-06-01

Electronic health records (EHR) are increasingly being adopted by healthcare systems worldwide. In France, the "Hôpital numérique 2012-2017" program was implemented as part of a strategic plan to modernize health information technology (HIT), including the promotion of widespread EHR use. With significant upfront investment costs as well as ongoing operational expenses, it is important to assess this system in terms of its ability to result in improvements in hospital performances. The aim of this study was to evaluate the impact of EHR use on the quality of care management in acute care hospitals throughout France. This retrospective study was based on data derived from three national databases for the year 2011: IPAQSS (indicators of improvement in the quality and the management of healthcare, "IPAQSS"), Hospi-Diag (French hospital performance indicators), and the national accreditation database. Several multivariate models were used to examine the association between the use of EHRs and specific EHR features with four quality indicators: the quality of patient record, the delay in sending information at hospital discharge, the pain status evaluation, and the nutritional status evaluation, while also adjusting for hospital characteristics. The models revealed a significant positive impact of EHR use on the four quality indicators. Additionally, they showed a differential impact according to the functionality of the element of the health record that was computerized. All four quality indicators were also impacted by the type of hospital, the geographical region, and the severity of the pathology. These results suggest that, to improve the quality of care management in hospitals, EHR adoption represents an important lever. They complete previous work dealing with EHR and the organizational performance of hospital surgical units. Copyright © 2017 Elsevier B.V. All rights reserved.

Implementing EHRs: An Exploratory Study to Examine Current Practices in Migrating Physician Practice

PubMed Central

Dolezel, Diane; Moczygemba, Jackie

2015-01-01

Implementation of electronic health record (EHR) systems in physician practices is challenging and complex. In the past, physicians had little incentive to move from paper-based records. With the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, Medicare and Medicaid incentive payments are now available for physicians who implement EHRs for meaningful use. The Office of the National Coordinator for Health Information Technology (ONC) has ample detail on clinical data needed for meaningful use in order to assess the quality of patient care. Details are lacking, however, on how much clinical data, if any, should be transferred from the old paper records during an EHR implementation project. The purpose of this exploratory study was to investigate and document the elements of longitudinal clinical data that are essential for inclusion in the EHR of physicians in a clinical practice setting, as reported by the office managers of the physicians in the study group. PMID:26807077

Accessing personal medical records online: a means to what ends?

PubMed

Shah, Syed Ghulam Sarwar; Fitton, Richard; Hannan, Amir; Fisher, Brian; Young, Terry; Barnett, Julie

2015-02-01

Initiatives in the UK to enable patients to access their electronic health records (EHRs) are gathering momentum. All citizens of the European Union should have access to their records by 2015, a target that the UK has endorsed. To identify the ways in which patients used their access to their EHRs, what they sought to achieve, and the extent to which EHR access was related to the concept of making savings. An audit of patients' online access to medical records was conducted in July-August 2011 using a survey questionnaire. Two hundred and twenty six patients who were registered with two general practices in the National Health Service (NHS) located in the UK and who had accessed their personal EHRs at least twice in the preceding 12 months i.e. from July 2010 to July 2011, completed the questionnaire. Data analysis A thematic analysis of the comments that patients gave in response to the open ended questions on the questionnaire. Overall, evaluations of record access were positive. Four main themes relating to the ways in which patients accessed their records were identified: making savings, checking past activity, preparation for future action, and setting new expectations. Quite apart from any benefits of savings in healthcare resources, this study has provided qualitative evidence of the active ways in which patients may make use of access to their EHRs, many of which are in line with proportionate health management strategies. Access to personal EHRs may contribute to the development of new expectations among patients. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Big biomedical data and cardiovascular disease research: opportunities and challenges.

PubMed

Denaxas, Spiros C; Morley, Katherine I

2015-07-01

Electronic health records (EHRs), data generated and collected during normal clinical care, are increasingly being linked and used for translational cardiovascular disease research. Electronic health record data can be structured (e.g. coded diagnoses) or unstructured (e.g. clinical notes) and increasingly encapsulate medical imaging, genomic and patient-generated information. Large-scale EHR linkages enable researchers to conduct high-resolution observational and interventional clinical research at an unprecedented scale. A significant amount of preparatory work and research, however, is required to identify, obtain, and transform raw EHR data into research-ready variables that can be statistically analysed. This study critically reviews the opportunities and challenges that EHR data present in the field of cardiovascular disease clinical research and provides a series of recommendations for advancing and facilitating EHR research.

A Scalable Data Access Layer to Manage Structured Heterogeneous Biomedical Data.

PubMed

Delussu, Giovanni; Lianas, Luca; Frexia, Francesca; Zanetti, Gianluigi

2016-01-01

This work presents a scalable data access layer, called PyEHR, designed to support the implementation of data management systems for secondary use of structured heterogeneous biomedical and clinical data. PyEHR adopts the openEHR's formalisms to guarantee the decoupling of data descriptions from implementation details and exploits structure indexing to accelerate searches. Data persistence is guaranteed by a driver layer with a common driver interface. Interfaces for two NoSQL Database Management Systems are already implemented: MongoDB and Elasticsearch. We evaluated the scalability of PyEHR experimentally through two types of tests, called "Constant Load" and "Constant Number of Records", with queries of increasing complexity on synthetic datasets of ten million records each, containing very complex openEHR archetype structures, distributed on up to ten computing nodes.

Do family physicians electronic health records support meaningful use?

PubMed

Peterson, Lars E; Blackburn, Brenna; Ivins, Douglas; Mitchell, Jason; Matson, Christine; Phillips, Robert L

2015-03-01

Spurred by government incentives, the use of electronic health records (EHRs) in the United States has increased; however, whether these EHRs have the functionality necessary to meet meaningful use (MU) criteria remains unknown. Our objective was to characterize family physician access to MU functionality when using a MU-certified EHR. Data were obtained from a convenience survey of family physicians accessing their American Board of Family Medicine online portfolio in 2011. A brief survey queried MU functionality. We used descriptive statistics to characterize the responses and bivariate statistics to test associations between MU and patient communication functions by presence of a MU-certified EHR. Out of 3855 respondents, 60% reported having an EHR that supports MU. Physicians with MU-certified EHRs were more likely than physicians without MU-certified EHRs to report patient registry activities (49.7% vs. 32.3%, p-value<0.01), tracking quality measures (74.1% vs. 56.4%, p-value<0.01), access to labs or consultation notes, and electronic prescribing; but electronic communication abilities were low regardless of EHR capabilities. Family physicians with MU-certified EHRs are more likely to report MU functionality; however, a sizeable minority does not report MU functions. Many family physicians with MU-certified EHRs may not successfully meet the successively stringent MU criteria and may face significant upgrade costs to do so. Cross sectional survey. Copyright © 2014 Elsevier Inc. All rights reserved.

Satisfaction of health-care providers with electronic health records and perceived barriers to its implementation in the United Arab Emirates.

PubMed

Bani-Issa, Wegdan; Al Yateem, Nabeel; Al Makhzoomy, Ibtihal Khalaf; Ibrahim, Ali

2016-08-01

The integration of electronic health records (EHRs) has shown promise in improving health-care quality. In the United Arab Emirates, EHRs have been recently adopted to improve the quality and safety of patient care. A cross-sectional survey of 680 health-care providers (HCPs) was conducted to assess the satisfaction of HCPs in the United Arab Emirates with EHRs' impact on access/viewing, documentation and medication administration and to explore the barriers encountered in their use. Data were collected over 6 months from April to September 2014. High overall satisfaction with EHRs was reported by HCPs, suggesting their acceptance. Physicians reported the greatest overall satisfaction with EHRs, although nurses showed significantly higher satisfaction with the impact on medication administration compared with other HCPs. The most significant barriers reported by nurses were lack of belief in the value of EHRs for patients and lack of adequate computer skills. Given the large investment in technology, additional research is necessary to promote the full utilization of EHRs. Nurses need to be aware of the value of EHRs for patient care and be involved in all stages of EHR implementations to maximize its meaningful use for better clinical outcomes. © 2016 John Wiley & Sons Australia, Ltd.

Towards semantic interoperability for electronic health records.

PubMed

Garde, Sebastian; Knaup, Petra; Hovenga, Evelyn; Heard, Sam

2007-01-01

In the field of open electronic health records (EHRs), openEHR as an archetype-based approach is being increasingly recognised. It is the objective of this paper to shortly describe this approach, and to analyse how openEHR archetypes impact on health professionals and semantic interoperability. Analysis of current approaches to EHR systems, terminology and standards developments. In addition to literature reviews, we organised face-to-face and additional telephone interviews and tele-conferences with members of relevant organisations and committees. The openEHR archetypes approach enables syntactic interoperability and semantic interpretability -- both important prerequisites for semantic interoperability. Archetypes enable the formal definition of clinical content by clinicians. To enable comprehensive semantic interoperability, the development and maintenance of archetypes needs to be coordinated internationally and across health professions. Domain knowledge governance comprises a set of processes that enable the creation, development, organisation, sharing, dissemination, use and continuous maintenance of archetypes. It needs to be supported by information technology. To enable EHRs, semantic interoperability is essential. The openEHR archetypes approach enables syntactic interoperability and semantic interpretability. However, without coordinated archetype development and maintenance, 'rank growth' of archetypes would jeopardize semantic interoperability. We therefore believe that openEHR archetypes and domain knowledge governance together create the knowledge environment required to adopt EHRs.

Cost-benefit assessment of using electronic health records data for clinical research versus current practices: Contribution of the Electronic Health Records for Clinical Research (EHR4CR) European Project.

PubMed

Beresniak, Ariel; Schmidt, Andreas; Proeve, Johann; Bolanos, Elena; Patel, Neelam; Ammour, Nadir; Sundgren, Mats; Ericson, Mats; Karakoyun, Töresin; Coorevits, Pascal; Kalra, Dipak; De Moor, Georges; Dupont, Danielle

2016-01-01

The widespread adoption of electronic health records (EHR) provides a new opportunity to improve the efficiency of clinical research. The European EHR4CR (Electronic Health Records for Clinical Research) 4-year project has developed an innovative technological platform to enable the re-use of EHR data for clinical research. The objective of this cost-benefit assessment (CBA) is to assess the value of EHR4CR solutions compared to current practices, from the perspective of sponsors of clinical trials. A CBA model was developed using an advanced modeling approach. The costs of performing three clinical research scenarios (S) applied to a hypothetical Phase II or III oncology clinical trial workflow (reference case) were estimated under current and EHR4CR conditions, namely protocol feasibility assessment (S1), patient identification for recruitment (S2), and clinical study execution (S3). The potential benefits were calculated considering that the estimated reduction in actual person-time and costs for performing EHR4CR S1, S2, and S3 would accelerate time to market (TTM). Probabilistic sensitivity analyses using Monte Carlo simulations were conducted to manage uncertainty. Should the estimated efficiency gains achieved with the EHR4CR platform translate into faster TTM, the expected benefits for the global pharmaceutical oncology sector were estimated at €161.5m (S1), €45.7m (S2), €204.5m (S1+S2), €1906m (S3), and up to €2121.8m (S1+S2+S3) when the scenarios were used sequentially. The results suggest that optimizing clinical trial design and execution with the EHR4CR platform would generate substantial added value for pharmaceutical industry, as main sponsors of clinical trials in Europe, and beyond. Copyright © 2015 Elsevier Inc. All rights reserved.

Effects of exam room EHR use on doctor-patient communication: a systematic literature review.

PubMed

Kazmi, Zainab

2013-01-01

High levels of funding have been invested in health information technologies, especially electronic health records (EHRs), in an effect to coordinate and organize patient health data. However, the effect of EHRs in the exam room on doctor-patient communication has not been sufficiently explored. Objective The purpose of this systematic review was to determine how physician use of EHRs in medical consultations affects doctor-patient communication, both in terms of patient perceptions and actual physician behaviours. The reviewer conducted a comprehensive online database search in March 2013 of EMBASE, MEDLINE, and SCOPUS, using a combination of synonyms of the terms "patient", "doctor", "communication", and "EHR" or "computing". For inclusion in this review, articles had to be published in English, take place in an outpatient setting and demonstrate an empirical investigation into whether EHR affects doctor-patient communication. The reviewer then analysed 13 articles that met the inclusion criteria. Studies showed EHR use encouraged biomedical questioning of the patient, and encouraged patient-led questioning and doctor-led information provision. EHR-related behaviours such as keyboarding and screen gaze impaired relationships with patients, by reducing eye contact, rapport, and provision of emotional support. EHRs negatively affected physician-led patient-centred communication. Computer use may have amplified existing physician behaviours regarding medical record use. We noted both positive and negative effects of EHR use. This review highlights the need for increased EHR-specific communication training to mitigate adverse effects and for continued acknowledgement of patient perspectives.

Funding alternatives in EHR adoption: beyond HITECH incentives and traditional approaches.

PubMed

Wang, Tiankai; Wang, Yangmei; Biedermann, Sue

2013-05-01

The meaningful use incentives under HITECH may be inadequate to address the financial challenges many hospitals face in implementing electronic health records (EHRs). Hospitals can fill the capital gap between EHR costs and available funds by exploring other potential funding sources. These sources include additional grants, funding permissible under EHR regulations, vendor financing, and tax benefits under IRS Section 179.

Applying representational state transfer (REST) architecture to archetype-based electronic health record systems

PubMed Central

2013-01-01

Background The openEHR project and the closely related ISO 13606 standard have defined structures supporting the content of Electronic Health Records (EHRs). However, there is not yet any finalized openEHR specification of a service interface to aid application developers in creating, accessing, and storing the EHR content. The aim of this paper is to explore how the Representational State Transfer (REST) architectural style can be used as a basis for a platform-independent, HTTP-based openEHR service interface. Associated benefits and tradeoffs of such a design are also explored. Results The main contribution is the formalization of the openEHR storage, retrieval, and version-handling semantics and related services into an implementable HTTP-based service interface. The modular design makes it possible to prototype, test, replicate, distribute, cache, and load-balance the system using ordinary web technology. Other contributions are approaches to query and retrieval of the EHR content that takes caching, logging, and distribution into account. Triggering on EHR change events is also explored. A final contribution is an open source openEHR implementation using the above-mentioned approaches to create LiU EEE, an educational EHR environment intended to help newcomers and developers experiment with and learn about the archetype-based EHR approach and enable rapid prototyping. Conclusions Using REST addressed many architectural concerns in a successful way, but an additional messaging component was needed to address some architectural aspects. Many of our approaches are likely of value to other archetype-based EHR implementations and may contribute to associated service model specifications. PMID:23656624

Applying representational state transfer (REST) architecture to archetype-based electronic health record systems.

PubMed

Sundvall, Erik; Nyström, Mikael; Karlsson, Daniel; Eneling, Martin; Chen, Rong; Örman, Håkan

2013-05-09

The openEHR project and the closely related ISO 13606 standard have defined structures supporting the content of Electronic Health Records (EHRs). However, there is not yet any finalized openEHR specification of a service interface to aid application developers in creating, accessing, and storing the EHR content.The aim of this paper is to explore how the Representational State Transfer (REST) architectural style can be used as a basis for a platform-independent, HTTP-based openEHR service interface. Associated benefits and tradeoffs of such a design are also explored. The main contribution is the formalization of the openEHR storage, retrieval, and version-handling semantics and related services into an implementable HTTP-based service interface. The modular design makes it possible to prototype, test, replicate, distribute, cache, and load-balance the system using ordinary web technology. Other contributions are approaches to query and retrieval of the EHR content that takes caching, logging, and distribution into account. Triggering on EHR change events is also explored.A final contribution is an open source openEHR implementation using the above-mentioned approaches to create LiU EEE, an educational EHR environment intended to help newcomers and developers experiment with and learn about the archetype-based EHR approach and enable rapid prototyping. Using REST addressed many architectural concerns in a successful way, but an additional messaging component was needed to address some architectural aspects. Many of our approaches are likely of value to other archetype-based EHR implementations and may contribute to associated service model specifications.

Assessing the cost of electronic health records: a review of cost indicators.

PubMed

Gallego, Ana Isabel; Gagnon, Marie-Pierre; Desmartis, Marie

2010-11-01

We systematically reviewed PubMed and EBSCO business, looking for cost indicators of electronic health record (EHR) implementations and their associated benefit indicators. We provide a set of the most common cost and benefit (CB) indicators used in the EHR literature, as well as an overall estimate of the CB related to EHR implementation. Overall, CB evaluation of EHR implementation showed a rapid capital-recovering process. On average, the annual benefits were 76.5% of the first-year costs and 308.6% of the annual costs. However, the initial investments were not recovered in a few studied implementations. Distinctions in reporting fixed and variable costs are suggested.

“Meaningful use” of electronic health records and its relevance to laboratories and pathologists

PubMed Central

Henricks, Walter H.

2011-01-01

Electronic health records (EHRs) have emerged as a major topic in health care and are central to the federal government’s strategy for transforming healthcare delivery in the United States. Recent federal actions that aim to promote the use of EHRs promise to have significant implications for laboratories and for pathology practices. Under the HITECH (Health Information Technology Economic and Clinical Health) Act, an EHR incentive program has been established through which individual physicians and hospitals can qualify to receive incentive payments if they achieve “meaningful use” of “certified” EHR technology. The rule also establishes payment penalties in future years for eligible providers who have not met the requirements for meaningful use of EHRs. Meaningful use must be achieved using EHR technology that has been certified in accordance with functional and technical criteria that are set forth a regulation that parallels the meaningful use criteria in the incentive program. These actions and regulations are important to laboratories and pathologists for a number of reasons. Several of the criteria and requirements in the meaningful use rules and EHR certification criteria relate directly or indirectly to laboratory testing and laboratory information management, and future stage requirements are expected to impact the laboratory as well. Furthermore, as EHR uptake expands, there will be greater expectations for electronic interchange of laboratory information and laboratory information system (LIS)-EHR interfaces. Laboratories will need to be aware of the technical, operational, and business challenges that they may face as expectations for LIS-EHR increase. This paper reviews the important recent federal efforts aimed at accelerating EHR use, including the incentive program for EHR meaningful use, provider eligibility, and EHR certification criteria, from a perspective of their relevance for laboratories and pathology practices. PMID:21383931

Finding Meaning in Medication Reconciliation Using Electronic Health Records: Qualitative Analysis in Safety Net Primary and Specialty Care

PubMed Central

Matta, George Yaccoub; Khoong, Elaine C; Lyles, Courtney R; Schillinger, Dean

2018-01-01

Background Safety net health systems face barriers to effective ambulatory medication reconciliation for vulnerable populations. Although some electronic health record (EHR) systems offer safety advantages, EHR use may affect the quality of patient-provider communication. Objective This mixed-methods observational study aimed to develop a conceptual framework of how clinicians balance the demands and risks of EHR and communication tasks during medication reconciliation discussions in a safety net system. Methods This study occurred 3 to 16 (median 9) months after new EHR implementation in five academic public hospital clinics. We video recorded visits between English-/Spanish-speaking patients and their primary/specialty care clinicians. We analyzed the proportion of medications addressed and coded time spent on nonverbal tasks during medication reconciliation as “multitasking EHR use,” “silent EHR use,” “non-EHR multitasking,” and “focused patient-clinician talk.” Finally, we analyzed communication patterns to develop a conceptual framework. Results We examined 35 visits (17%, 6/35 Spanish) between 25 patients (mean age 57, SD 11 years; 44%, 11/25 women; 48%, 12/25 Hispanic; and 20%, 5/25 with limited health literacy) and 25 clinicians (48%, 12/25 primary care). Patients had listed a median of 7 (IQR 5-12) relevant medications, and clinicians addressed a median of 3 (interquartile range [IQR] 1-5) medications. The median duration of medication reconciliation was 2.1 (IQR 1.0-4.2) minutes, comprising a median of 10% (IQR 3%-17%) of visit time. Multitasking EHR use occurred in 47% (IQR 26%-70%) of the medication reconciliation time. Silent EHR use and non-EHR multitasking occurred a smaller proportion of medication reconciliation time, with a median of 0% for both. Focused clinician-patient talk occurred a median of 24% (IQR 0-39%) of medication reconciliation time. Five communication patterns with EHR medication reconciliation were observed: (1) typical EHR multitasking for medication reconciliation, (2) dynamic EHR use to negotiate medication discrepancies, (3) focused patient-clinician talk for medication counseling and addressing patient concerns, (4) responding to patient concerns while maintaining EHR use, and (5) using EHRs to engage patients during medication reconciliation. We developed a conceptual diagram representing the dilemma of the multitasking clinician during medication reconciliation. Conclusions Safety net visits involve multitasking EHR use during almost half of medication reconciliation time. The multitasking clinician balances the cognitive and emotional demands posed by incoming information from multiple sources, attempts to synthesize and act on this information through EHR and communication tasks, and adopts strategies of silent EHR use and focused patient-clinician talk that may help mitigate the risks of multitasking. Future studies should explore diverse patient perspectives about clinician EHR multitasking, clinical outcomes related to EHR multitasking, and human factors and systems engineering interventions to improve the safety of EHR use during the complex process of medication reconciliation. PMID:29735477

Rapid Development of Specialty Population Registries and Quality Measures from Electronic Health Record Data: An Agile Framework

PubMed Central

Kannan, V; Fish, JS; Mutz, JM; Carrington, AR; Lai, K; Davis, LS; Youngblood, JE; Rauschuber, MR; Flores, KA; Sara, EJ; Bhat, DG; Willett, DL

2017-01-01

Summary Background Creation of a new electronic health record (EHR)-based registry often can be a "one-off" complex endeavor: first developing new EHR data collection and clinical decision support tools, followed by developing registry-specific data extractions from the EHR for analysis. Each development phase typically has its own long development and testing time, leading to a prolonged overall cycle time for delivering one functioning registry with companion reporting into production. The next registry request then starts from scratch. Such an approach will not scale to meet the emerging demand for specialty registries to support population health and value-based care. Objective To determine if the creation of EHR-based specialty registries could be markedly accelerated by employing (a) a finite core set of EHR data collection principles and methods, (b) concurrent engineering of data extraction and data warehouse design using a common dimensional data model for all registries, and (c) agile development methods commonly employed in new product development. Methods We adopted as guiding principles to (a) capture data as a by product of care of the patient, (b) reinforce optimal EHR use by clinicians, (c) employ a finite but robust set of EHR data capture tool types, and (d) leverage our existing technology toolkit. Registries were defined by a shared condition (recorded on the Problem List) or a shared exposure to a procedure (recorded on the Surgical History) or to a medication (recorded on the Medication List). Any EHR fields needed—either to determine registry membership or to calculate a registry-associated clinical quality measure (CQM)—were included in the enterprise data warehouse (EDW) shared dimensional data model. Extract-transform-load (ETL) code was written to pull data at defined “grains” from the EHR into the EDW model. All calculated CQM values were stored in a single Fact table in the EDW crossing all registries. Registry-specific dashboards were created in the EHR to display both (a) real-time patient lists of registry patients and (b) EDW-generated CQM data. Agile project management methods were employed, including co-development, lightweight requirements documentation with User Stories and acceptance criteria, and time-boxed iterative development of EHR features in 2-week “sprints” for rapid-cycle feedback and refinement. Results Using this approach, in calendar year 2015 we developed a total of 43 specialty chronic disease registries, with 111 new EHR data collection and clinical decision support tools, 163 new clinical quality measures, and 30 clinic-specific dashboards reporting on both real-time patient care gaps and summarized and vetted CQM measure performance trends. Conclusions This study suggests concurrent design of EHR data collection tools and reporting can quickly yield useful EHR structured data for chronic disease registries, and bodes well for efforts to migrate away from manual abstraction. This work also supports the view that in new EHR-based registry development, as in new product development, adopting agile principles and practices can help deliver valued, high-quality features early and often. PMID:28930362

Nurses' Perceptions of Nursing Care Documentation in the Electronic Health Record

ERIC Educational Resources Information Center

Jensen, Tracey A.

2013-01-01

Electronic health records (EHRs) will soon become the standard for documenting nursing care. The EHR holds the promise of rapid access to complete records of a patient's encounter with the healthcare system. It is the expectation that healthcare providers input essential data that communicates important patient information to support quality…

Physician Interaction with Electronic Medical Records: A Qualitative Study

ERIC Educational Resources Information Center

Noteboom, Cherie Bakker

2010-01-01

The integration of EHR (Electronic Health Records) in IT infrastructures supporting organizations enable improved access to and recording of patient data, enhanced ability to make better and more-timely decisions, and improved quality and reduced errors. Despite these benefits, there are mixed results as to the use of EHR. The literature suggests…

An Enterprise Architecture Perspective to Electronic Health Record Based Care Governance.

PubMed

Motoc, Bogdan

2017-01-01

This paper proposes an Enterprise Architecture viewpoint of Electronic Health Record (EHR) based care governance. The improvements expected are derived from the collaboration framework and the clinical health model proposed as foundation for the concept of EHR.

National electronic medical records integration on cloud computing system.

PubMed

Mirza, Hebah; El-Masri, Samir

2013-01-01

Few Healthcare providers have an advanced level of Electronic Medical Record (EMR) adoption. Others have a low level and most have no EMR at all. Cloud computing technology is a new emerging technology that has been used in other industry and showed a great success. Despite the great features of Cloud computing, they haven't been utilized fairly yet in healthcare industry. This study presents an innovative Healthcare Cloud Computing system for Integrating Electronic Health Record (EHR). The proposed Cloud system applies the Cloud Computing technology on EHR system, to present a comprehensive EHR integrated environment.

Professional and interprofessional differences in electronic health records use and recognition of safety issues in critically ill patients

PubMed Central

Sakata, Knewton K.; Stephenson, Laurel S.; Mulanax, Ashley; Bierman, Jesse; Mcgrath, Karess; Scholl, Gretchen; McDougal, Adrienne; Bearden, David T.; Mohan, Vishnu; Gold, Jeffrey A.

2018-01-01

During interprofessional intensive care unit (ICU) rounds each member of the interprofessional team is responsible for gathering and interpreting information from the electronic health records (EHR) to facilitate effective team decision-making. This study was conducted to determine how each professional group reviews EHR data in preparation for rounds and their ability to identify patient safety issues. Twenty-five physicians, 29 nurses, and 20 pharmacists participated. Individual participants were given verbal and written sign-out and then asked to review a simulated record in our institution’s EHR, which contained 14 patient safety items. After reviewing the chart, subjects presented the patient and the number of safety items recognised was recorded. About 40%, 30%, and 26% of safety issues were recognised by physicians, nurses, and pharmacists, respectively (p = 0.0006) and no item recognised 100% of the time. There was little overlap between the three groups with only 50% of items predicted to be recognised 100% of the time by the team. Differential recognition was associated with marked differences in EHR use, with only 3/152 EHR screens utilised by all three groups and the majority of screens used exclusively only by one group. There were significant and non-overlapping differences in individual profession recognition of patient safety issues in the EHR. Preferential identification of safety issues by certain professional groups may be attributed to differences in EHR use. Future studies will be needed to determine if shared decision-making during rounds can improve recognition of safety issues. PMID:27341177

Electronic health record interoperability as realized in the Turkish health information system.

PubMed

Dogac, A; Yuksel, M; Avci, A; Ceyhan, B; Hülür, U; Eryilmaz, Z; Mollahaliloglu, S; Atbakan, E; Akdag, R

2011-01-01

The objective of this paper is to describe the techniques used in developing the National Health Information System of Turkey (NHIS-T), a nation-wide infrastructure for sharing electronic health records (EHRs). The UN/CEFACT Core Components Technical Specification (CCTS) methodology was applied to design the logical EHR structure and to increase the reuse of common information blocks in EHRs. The NHIS-T became operational on January 15, 2009. By June 2010, 99% of the public hospitals and 71% of the private and university hospitals were connected to NHIS-T with daily feeds of their patients' EHRs. Out of the 72 million citizens of Turkey, electronic healthcare records of 43 million citizens have already been created in NHIS-T. Currently, only the general practitioners can access the EHRs of their patients. In the second phase of the implementation and once the legal framework is completed, the proper patient consent mechanisms will be available through the personal health record system that is under development. At this time authorized healthcare professionals in secondary and tertiary healthcare systems can access the patients' EHRs. A number of factors affected the successful implementation of NHIS-T. First, all stakeholders have to adopt the specified standards. Second, the UN/CEFACT CCTS approach was applied which facilitated the development and understanding of rather complex EHR schemas. Finally, the comprehensive testing of vendor-based hospital information systems for their conformance to and interoperability with NHIS-T through an automated testing platform enhanced substantially the fast integration of vendor-based solutions with the NHIS-T.

Leveraging electronic healthcare record standards and semantic web technologies for the identification of patient cohorts

PubMed Central

Fernández-Breis, Jesualdo Tomás; Maldonado, José Alberto; Marcos, Mar; Legaz-García, María del Carmen; Moner, David; Torres-Sospedra, Joaquín; Esteban-Gil, Angel; Martínez-Salvador, Begoña; Robles, Montserrat

2013-01-01

Background The secondary use of electronic healthcare records (EHRs) often requires the identification of patient cohorts. In this context, an important problem is the heterogeneity of clinical data sources, which can be overcome with the combined use of standardized information models, virtual health records, and semantic technologies, since each of them contributes to solving aspects related to the semantic interoperability of EHR data. Objective To develop methods allowing for a direct use of EHR data for the identification of patient cohorts leveraging current EHR standards and semantic web technologies. Materials and methods We propose to take advantage of the best features of working with EHR standards and ontologies. Our proposal is based on our previous results and experience working with both technological infrastructures. Our main principle is to perform each activity at the abstraction level with the most appropriate technology available. This means that part of the processing will be performed using archetypes (ie, data level) and the rest using ontologies (ie, knowledge level). Our approach will start working with EHR data in proprietary format, which will be first normalized and elaborated using EHR standards and then transformed into a semantic representation, which will be exploited by automated reasoning. Results We have applied our approach to protocols for colorectal cancer screening. The results comprise the archetypes, ontologies, and datasets developed for the standardization and semantic analysis of EHR data. Anonymized real data have been used and the patients have been successfully classified by the risk of developing colorectal cancer. Conclusions This work provides new insights in how archetypes and ontologies can be effectively combined for EHR-driven phenotyping. The methodological approach can be applied to other problems provided that suitable archetypes, ontologies, and classification rules can be designed. PMID:23934950

Building a robust, scalable and standards-driven infrastructure for secondary use of EHR data: the SHARPn project.

PubMed

Rea, Susan; Pathak, Jyotishman; Savova, Guergana; Oniki, Thomas A; Westberg, Les; Beebe, Calvin E; Tao, Cui; Parker, Craig G; Haug, Peter J; Huff, Stanley M; Chute, Christopher G

2012-08-01

The Strategic Health IT Advanced Research Projects (SHARP) Program, established by the Office of the National Coordinator for Health Information Technology in 2010 supports research findings that remove barriers for increased adoption of health IT. The improvements envisioned by the SHARP Area 4 Consortium (SHARPn) will enable the use of the electronic health record (EHR) for secondary purposes, such as care process and outcomes improvement, biomedical research and epidemiologic monitoring of the nation's health. One of the primary informatics problem areas in this endeavor is the standardization of disparate health data from the nation's many health care organizations and providers. The SHARPn team is developing open source services and components to support the ubiquitous exchange, sharing and reuse or 'liquidity' of operational clinical data stored in electronic health records. One year into the design and development of the SHARPn framework, we demonstrated end to end data flow and a prototype SHARPn platform, using thousands of patient electronic records sourced from two large healthcare organizations: Mayo Clinic and Intermountain Healthcare. The platform was deployed to (1) receive source EHR data in several formats, (2) generate structured data from EHR narrative text, and (3) normalize the EHR data using common detailed clinical models and Consolidated Health Informatics standard terminologies, which were (4) accessed by a phenotyping service using normalized data specifications. The architecture of this prototype SHARPn platform is presented. The EHR data throughput demonstration showed success in normalizing native EHR data, both structured and narrative, from two independent organizations and EHR systems. Based on the demonstration, observed challenges for standardization of EHR data for interoperable secondary use are discussed. Copyright © 2012 Elsevier Inc. All rights reserved.

Building a robust, scalable and standards-driven infrastructure for secondary use of EHR data: The SHARPn project

PubMed Central

Rea, Susan; Pathak, Jyotishman; Savova, Guergana; Oniki, Thomas A.; Westberg, Les; Beebe, Calvin E.; Tao, Cui; Parker, Craig G.; Haug, Peter J.; Huff, Stanley M.; Chute, Christopher G.

2016-01-01

The Strategic Health IT Advanced Research Projects (SHARP) Program, established by the Office of the National Coordinator for Health Information Technology in 2010 supports research findings that remove barriers for increased adoption of health IT. The improvements envisioned by the SHARP Area 4 Consortium (SHARPn) will enable the use of the electronic health record (EHR) for secondary purposes, such as care process and outcomes improvement, biomedical research and epidemiologic monitoring of the nation’s health. One of the primary informatics problem areas in this endeavor is the standardization of disparate health data from the nation’s many health care organizations and providers. The SHARPn team is developing open source services and components to support the ubiquitous exchange, sharing and reuse or ‘liquidity’ of operational clinical data stored in electronic health records. One year into the design and development of the SHARPn framework, we demonstrated end to end data flow and a prototype SHARPn platform, using thousands of patient electronic records sourced from two large healthcare organizations: Mayo Clinic and Intermountain Healthcare. The platform was deployed to (1) receive source EHR data in several formats, (2) generate structured data from EHR narrative text, and (3) normalize the EHR data using common detailed clinical models and Consolidated Health Informatics standard terminologies, which were (4) accessed by a phenotyping service using normalized data specifications. The architecture of this prototype SHARPn platform is presented. The EHR data throughput demonstration showed success in normalizing native EHR data, both structured and narrative, from two independent organizations and EHR systems. Based on the demonstration, observed challenges for standardization of EHR data for interoperable secondary use are discussed. PMID:22326800

Leveraging electronic healthcare record standards and semantic web technologies for the identification of patient cohorts.

PubMed

Fernández-Breis, Jesualdo Tomás; Maldonado, José Alberto; Marcos, Mar; Legaz-García, María del Carmen; Moner, David; Torres-Sospedra, Joaquín; Esteban-Gil, Angel; Martínez-Salvador, Begoña; Robles, Montserrat

2013-12-01

The secondary use of electronic healthcare records (EHRs) often requires the identification of patient cohorts. In this context, an important problem is the heterogeneity of clinical data sources, which can be overcome with the combined use of standardized information models, virtual health records, and semantic technologies, since each of them contributes to solving aspects related to the semantic interoperability of EHR data. To develop methods allowing for a direct use of EHR data for the identification of patient cohorts leveraging current EHR standards and semantic web technologies. We propose to take advantage of the best features of working with EHR standards and ontologies. Our proposal is based on our previous results and experience working with both technological infrastructures. Our main principle is to perform each activity at the abstraction level with the most appropriate technology available. This means that part of the processing will be performed using archetypes (ie, data level) and the rest using ontologies (ie, knowledge level). Our approach will start working with EHR data in proprietary format, which will be first normalized and elaborated using EHR standards and then transformed into a semantic representation, which will be exploited by automated reasoning. We have applied our approach to protocols for colorectal cancer screening. The results comprise the archetypes, ontologies, and datasets developed for the standardization and semantic analysis of EHR data. Anonymized real data have been used and the patients have been successfully classified by the risk of developing colorectal cancer. This work provides new insights in how archetypes and ontologies can be effectively combined for EHR-driven phenotyping. The methodological approach can be applied to other problems provided that suitable archetypes, ontologies, and classification rules can be designed.

Same organization, same electronic health records (EHRs) system, different use: exploring the linkage between practice member communication patterns and EHR use patterns in an ambulatory care setting

PubMed Central

Leykum, Luci K; McDaniel, Reuben R

2011-01-01

Objective Despite efforts made by ambulatory care organizations to standardize the use of electronic health records (EHRs), practices often incorporate these systems into their work differently from each other. One potential factor contributing to these differences is within-practice communication patterns. The authors explore the linkage between within-practice communication patterns and practice-level EHR use patterns. Design Qualitative study of six practices operating within the same multi-specialty ambulatory care organization using the same EHR system. Semistructured interviews and direct observation were conducted with all physicians, nurses, medical assistants, practice managers, and non-clinical staff from each practice. Measurements An existing model of practice relationships was used to analyze communication patterns within the practices. Practice-level EHR use was defined and analyzed as the ways in which a practice uses an EHR as a collective or a group—including the degree of feature use, level of EHR-enabled communication, and frequency that EHR use changes in a practice. Interview and observation data were analyzed for themes. Based on these themes, within-practice communication patterns were categorized as fragmented or cohesive, and practice-level EHR use patterns were categorized as heterogeneous or homogeneous. Practices where EHR use was uniformly high across all users were further categorized as having standardized EHR use. Communication patterns and EHR use patterns were compared across the six practices. Results Within-practice communication patterns were associated with practice-level EHR use patterns. In practices where communication patterns were fragmented, EHR use was heterogeneous. In practices where communication patterns were cohesive, EHR use was homogeneous. Additional analysis revealed that practices that had achieved standardized EHR use (uniformly high EHR use across all users) exhibited high levels of mindfulness and respectful interaction, whereas practices that were furthest from achieving standardized EHR use exhibited low levels of mindfulness and respectful interaction. Conclusion Within-practice communication patterns provide a unique perspective for exploring the issue of standardization in EHR use. A major fallacy of setting homogeneous EHR use as the goal for practice-level EHR use is that practices with uniformly low EHR use could be considered successful. Achieving uniformly high EHR use across all users in a practice is more consistent with the goals of current EHR adoption and use efforts. It was found that some communication patterns among practice members may enable more standardized EHR use than others. Understanding the linkage between communication patterns and EHR use can inform understanding of the human element in EHR use and may provide key lessons for the implementation of EHRs and other health information technologies. PMID:21846780

Same organization, same electronic health records (EHRs) system, different use: exploring the linkage between practice member communication patterns and EHR use patterns in an ambulatory care setting.

PubMed

Lanham, Holly Jordan; Leykum, Luci K; McDaniel, Reuben R

2012-01-01

Despite efforts made by ambulatory care organizations to standardize the use of electronic health records (EHRs), practices often incorporate these systems into their work differently from each other. One potential factor contributing to these differences is within-practice communication patterns. The authors explore the linkage between within-practice communication patterns and practice-level EHR use patterns. Qualitative study of six practices operating within the same multi-specialty ambulatory care organization using the same EHR system. Semistructured interviews and direct observation were conducted with all physicians, nurses, medical assistants, practice managers, and non-clinical staff from each practice. An existing model of practice relationships was used to analyze communication patterns within the practices. Practice-level EHR use was defined and analyzed as the ways in which a practice uses an EHR as a collective or a group-including the degree of feature use, level of EHR-enabled communication, and frequency that EHR use changes in a practice. Interview and observation data were analyzed for themes. Based on these themes, within-practice communication patterns were categorized as fragmented or cohesive, and practice-level EHR use patterns were categorized as heterogeneous or homogeneous. Practices where EHR use was uniformly high across all users were further categorized as having standardized EHR use. Communication patterns and EHR use patterns were compared across the six practices. Within-practice communication patterns were associated with practice-level EHR use patterns. In practices where communication patterns were fragmented, EHR use was heterogeneous. In practices where communication patterns were cohesive, EHR use was homogeneous. Additional analysis revealed that practices that had achieved standardized EHR use (uniformly high EHR use across all users) exhibited high levels of mindfulness and respectful interaction, whereas practices that were furthest from achieving standardized EHR use exhibited low levels of mindfulness and respectful interaction. Within-practice communication patterns provide a unique perspective for exploring the issue of standardization in EHR use. A major fallacy of setting homogeneous EHR use as the goal for practice-level EHR use is that practices with uniformly low EHR use could be considered successful. Achieving uniformly high EHR use across all users in a practice is more consistent with the goals of current EHR adoption and use efforts. It was found that some communication patterns among practice members may enable more standardized EHR use than others. Understanding the linkage between communication patterns and EHR use can inform understanding of the human element in EHR use and may provide key lessons for the implementation of EHRs and other health information technologies.

Modest Associations Between Electronic Health Record Use and Acute Myocardial Infarction Quality of Care and Outcomes: Results From the National Cardiovascular Data Registry.

PubMed

Enriquez, Jonathan R; de Lemos, James A; Parikh, Shailja V; Simon, DaJuanicia N; Thomas, Laine E; Wang, Tracy Y; Chan, Paul S; Spertus, John A; Das, Sandeep R

2015-11-01

In 2009, national legislation promoted wide-spread adoption of electronic health records (EHRs) across US hospitals; however, the association of EHR use with quality of care and outcomes after acute myocardial infarction (AMI) remains unclear. Data on EHR use were collected from the American Hospital Association Annual Surveys (2007-2010) and data on AMI care and outcomes from the National Cardiovascular Data Registry Acute Coronary Treatment and Interventions Outcomes Network Registry-Get With The Guidelines. Comparisons were made between patients treated at hospitals with fully implemented EHR (n=43 527), partially implemented EHR (n=72 029), and no EHR (n=9270). Overall EHR use increased from 82.1% (183/223) hospitals in 2007 to 99.3% (275/277) hospitals in 2010. Patients treated at hospitals with fully implemented EHRs had fewer heparin overdosing errors (45.7% versus 72.8%; P<0.01) and a higher likelihood of guideline-recommended care (adjusted odds ratio, 1.40 [confidence interval, 1.07-1.84]) compared with patients treated at hospitals with no EHR. In non-ST-segment-elevation AMI, fully implemented EHR use was associated with lower risk of major bleeding (adjusted odds ratio, 0.78 [confidence interval, 0.67-0.91]) and mortality (adjusted odds ratio, 0.82 [confidence interval, 0.69-0.97]) compared with no EHR. In ST-segment-elevation MI, outcomes did not significantly differ by EHR status. EHR use has risen to high levels among hospitals in the National Cardiovascular Data Registry. EHR use was associated with less frequent heparin overdosing and modestly greater adherence to acute MI guideline-recommended therapies. In non-ST-segment-elevation MI, slightly lower adjusted risk of major bleeding and mortality were seen in hospitals implemented with full EHRs; however, in ST-segment-elevation MI, differences in outcomes were not seen. © 2015 American Heart Association, Inc.

Electronic Health Record Design and Implementation for Pharmacogenomics: a Local Perspective

PubMed Central

Peterson, Josh F.; Bowton, Erica; Field, Julie R.; Beller, Marc; Mitchell, Jennifer; Schildcrout, Jonathan; Gregg, William; Johnson, Kevin; Jirjis, Jim N; Roden, Dan M.; Pulley, Jill M.; Denny, Josh C.

2014-01-01

Purpose The design of electronic health records (EHR) to translate genomic medicine into clinical care is crucial to successful introduction of new genomic services, yet there are few published guides to implementation. Methods The design, implemented features, and evolution of a locally developed EHR that supports a large pharmacogenomics program at a tertiary care academic medical center was tracked over a 4-year development period. Results Developers and program staff created EHR mechanisms for ordering a pharmacogenomics panel in advance of clinical need (preemptive genotyping) and in response to a specific drug indication. Genetic data from panel-based genotyping were sequestered from the EHR until drug-gene interactions (DGIs) met evidentiary standards and deemed clinically actionable. A service to translate genotype to predicted drug response phenotype populated a summary of DGIs, triggered inpatient and outpatient clinical decision support, updated laboratory records, and created gene results within online personal health records. Conclusion The design of a locally developed EHR supporting pharmacogenomics has generalizable utility. The challenge of representing genomic data in a comprehensible and clinically actionable format is discussed along with reflection on the scalability of the model to larger sets of genomic data. PMID:24009000

Patient and public attitudes towards informed consent models and levels of awareness of Electronic Health Records in the UK.

PubMed

Riordan, Fiona; Papoutsi, Chrysanthi; Reed, Julie E; Marston, Cicely; Bell, Derek; Majeed, Azeem

2015-04-01

The development of Electronic Health Records (EHRs) forms an integral part of the information strategy for the National Health Service (NHS) in the UK, with the aim of facilitating health information exchange for patient care and secondary use, including research and healthcare planning. Implementing EHR systems requires an understanding of patient expectations for consent mechanisms and consideration of public awareness towards information sharing as might be made possible through integrated EHRs across primary and secondary health providers. To explore levels of public awareness about EHRs and to examine attitudes towards different consent models with respect to sharing identifiable and de-identified records for healthcare provision, research and planning. A cross-sectional questionnaire survey was administered to adult patients and members of the public in primary and secondary care clinics in West London, UK in 2011. In total, 5331 individuals participated in the survey, and 3157 were included in the final analysis. The majority (91%) of respondents expected to be explicitly asked for consent for their identifiable records to be accessed for health provision, research or planning. Half the respondents (49%) did not expect to be asked for consent before their de-identified records were accessed. Compared with White British respondents, those from all other ethnic groups were more likely to anticipate their permission would be obtained before their de-identified records were used. Of the study population, 59% reported already being aware of EHRs before the survey. Older respondents and individuals with complex patterns of interaction with healthcare services were more likely to report prior awareness of EHRs. Individuals self-identifying as belonging to ethnic groups other than White British, and those with lower educational qualifications were less likely to report being aware of EHRs than White British respondents and respondents with degree-level education, respectively. Those who reported being aware of EHRs were less likely to say they expected explicit consent to be sought before use of their de-identified record. A large number of patients remain unaware of EHRs, while preference for implicit consent is stronger among those who report previous awareness. Differences in awareness levels and consent expectations between groups with different socio-demographic characteristics suggest that public education and information campaigns should target specific groups to increase public awareness and ensure meaningful informed consent mechanisms. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

You and me and the computer makes three: variations in exam room use of the electronic health record

PubMed Central

Saleem, Jason J; Flanagan, Mindy E; Russ, Alissa L; McMullen, Carmit K; Elli, Leora; Russell, Scott A; Bennett, Katelyn J; Matthias, Marianne S; Rehman, Shakaib U; Schwartz, Mark D; Frankel, Richard M

2014-01-01

Challenges persist on how to effectively integrate the electronic health record (EHR) into patient visits and clinical workflow, while maintaining patient-centered care. Our goal was to identify variations in, barriers to, and facilitators of the use of the US Department of Veterans Affairs (VA) EHR in ambulatory care workflow in order better to understand how to integrate the EHR into clinical work. We observed and interviewed 20 ambulatory care providers across three geographically distinct VA medical centers. Analysis revealed several variations in, associated barriers to, and facilitators of EHR use corresponding to different units of analysis: computer interface, team coordination/workflow, and organizational. We discuss our findings in the context of different units of analysis and connect variations in EHR use to various barriers and facilitators. Findings from this study may help inform the design of the next generation of EHRs for the VA and other healthcare systems. PMID:24001517

Adoption of electronic health records and barriers

PubMed Central

Palabindala, Venkataraman; Pamarthy, Amaleswari; Jonnalagadda, Nageshwar Reddy

2016-01-01

Electronic health records (EHR) are not a new idea in the U.S. medical system, but surprisingly there has been very slow adoption of fully integrated EHR systems in practice in both primary care settings and within hospitals. For those who have invested in EHR, physicians report high levels of satisfaction and confidence in the reliability of their system. There is also consensus that EHR can improve patient care, promote safe practice, and enhance communication between patients and multiple providers, reducing the risk of error. As EHR implementation continues in hospitals, administrative and physician leadership must actively investigate all of the potential risks for medical error, system failure, and legal responsibility before moving forward. Ensuring that physicians are aware of their responsibilities in relation to their charting practices and the depth of information available within an EHR system is crucial for minimizing the risk of malpractice and lawsuit. Hospitals must commit to regular system upgrading and corresponding training for all users to reduce the risk of error and adverse events. PMID:27802857

Documentation of Sexual Partner Gender Is Low in Electronic Health Records: Observations, Predictors, and Recommendations to Improve Population Health Management in Primary Care

PubMed Central

Yehia, Baligh R.

2015-01-01

Abstract The 2011 Institute of Medicine report on LGBT health recommended that sexual orientation and gender identity (SO/GI) be documented in electronic health records (EHRs). Most EHRs cannot document all aspects of SO/GI, but some can record gender of sexual partners. This study sought to determine the proportion of patients who have the gender of sexual partners recorded in the EHR and to identify factors associated with documentation. A retrospective analysis was done of EHR data for 40 family medicine (FM) and general internal medicine (IM) practices, comprising 170,570 adult patients seen in 2012. The primary outcome was EHR documentation of sexual partner gender. Multivariate logistic regression assessed the impact of patient, provider, and practice factors on documentation. In all, 76,767 patients (45%) had the gender of sexual partners recorded, 4.3% of whom had same-gender partners (3.5% of females, 5.6% of males). Likelihood of documentation was independently higher for women; blacks; those with a preventive visit; those with a physician assistant, nurse practitioner, or resident primary care provider (vs. attending); those at urban practices; those at smaller practices; and those at a residency FM practice. Older age and Medicare insurance were associated with lower documentation. Sexual partner gender documentation is important to identify patients for targeted prevention and support, and holds great potential for population health management, yet documentation in the EHR currently is low. Primary care practices should routinely record the gender of sexual partners, and additional work is needed to identify best practices for collecting and using SO/GI data in this setting. (Population Health Management 2015;18:217–222). PMID:25290634

Exploring the business case for ambulatory electronic health record system adoption.

PubMed

Song, Paula H; McAlearney, Ann Scheck; Robbins, Julie; McCullough, Jeffrey S

2011-01-01

Widespread implementation and use of electronic health record (EHR) systems has been recognized by healthcare leaders as a cornerstone strategy for systematically reducing medical errors and improving clinical quality. However, EHR adoption requires a significant capital investment for healthcare providers, and cost is often cited as a barrier. Despite the capital requirements, a true business case for EHR system adoption and implementation has not been made. This is of concern, as the lack of a business case can influence decision making about EHR investments. The purpose of this study was to examine the role of business case analysis in healthcare organizations' decisions to invest in ambulatory EHR systems, and to identify what factors organizations considered when justifying an ambulatory EHR. Using a qualitative case study approach, we explored how five organizations that are considered to have best practices in ambulatory EHR system implementation had evaluated the business case for EHR adoption. We found that although the rigor of formal business case analysis was highly variable, informants across these organizations consistently reported perceiving that a positive business case for EHR system adoption existed, especially when they considered both financial and non-financial benefits. While many consider EHR system adoption inevitable in healthcare, this viewpoint should not deter managers from conducting a business case analysis. Results of such an analysis can inform healthcare organizations' understanding about resource allocation needs, help clarify expectations about financial and clinical performance metrics to be monitored through EHR systems, and form the basis for ongoing organizational support to ensure successful system implementation.

Electronic health records: use, barriers and satisfaction among physicians who care for black and Hispanic patients.

PubMed

Jha, Ashish K; Bates, David W; Jenter, Chelsea; Orav, E John; Zheng, Jie; Cleary, Paul; Simon, Steven R

2009-02-01

Electronic health records (EHRs) are a promising tool to improve the quality of health care, although it remains unclear who will benefit from this new technology. Given that a small group of providers care for most racial/ethnic minorities, we sought to determine whether minority-serving providers adopt EHR systems at comparable rates to other providers. We used survey data from stratified random sample of all medical practices in Massachusetts in 2005. We determined rates of EHR adoption, perceived barriers to adoption, and satisfaction with EHR systems. Physicians who reported patient panels of more than 40% black or Hispanic had comparable levels of EHR adoption than other physicians (27.9% and 21.8%, respectively, P = 0.46). Physicians from minority-serving practices identified financial and other barriers to implementing EHR systems at similar rates, although these physicians were less likely to be concerned with privacy and security concerns of EHRs (47.1% vs. 64.4%, P = 0.01). Finally, physicians from high-minority practices had similar perceptions about the positive impact of EHRs on quality (73.7% vs. 76.6%, P = 0.43) and costs (46.9% vs. 51.5%, P = 0.17) of care. In a state with a diverse minority population, we found no evidence that minority-serving providers had lower EHR adoption rates, faced different barriers to adoption or were less satisfied with EHRs. Given the importance of ensuring that minority-serving providers have equal access to EHR systems, we failed to find evidence of a new digital divide.

Attending Physician Remote Access of the Electronic Health Record and Implications for Resident Supervision: A Mixed Methods Study.

PubMed

Martin, Shannon K; Tulla, Kiara; Meltzer, David O; Arora, Vineet M; Farnan, Jeanne M

2017-12-01

Advances in information technology have increased remote access to the electronic health record (EHR). Concurrently, standards defining appropriate resident supervision have evolved. How often and under what circumstances inpatient attending physicians remotely access the EHR for resident supervision is unknown. We described a model of attending remote EHR use for resident supervision, and quantified the frequency and magnitude of use. Using a mixed methods approach, general medicine inpatient attendings were surveyed and interviewed about their remote EHR use. Frequency of use and supervisory actions were quantitatively examined via survey. Transcripts from semistructured interviews were analyzed using grounded theory to identify codes and themes. A total of 83% (59 of 71) of attendings participated. Fifty-seven (97%) reported using the EHR remotely, with 54 (92%) reporting they discovered new clinical information not relayed by residents via remote EHR use. A majority (93%, 55 of 59) reported that this resulted in management changes, and 54% (32 of 59) reported making immediate changes by contacting cross-covering teams. Six major factors around remote EHR use emerged: resident, clinical, educational, personal, technical, and administrative. Attendings described resident and clinical factors as facilitating "backstage" supervision via remote EHR use. In our study to assess attending remote EHR use for resident supervision, attendings reported frequent remote use with resulting supervisory actions, describing a previously uncharacterized form of "backstage" oversight supervision. Future work should explore best practices in remote EHR use to provide effective supervision and ultimately improve patient safety.

EHRs in primary care practices: benefits, challenges, and successful strategies.

PubMed

Goetz Goldberg, Debora; Kuzel, Anton J; Feng, Lisa Bo; DeShazo, Jonathan P; Love, Linda E

2012-02-01

To understand the current use of electronic health records (EHRs) in small primary care practices and to explore experiences and perceptions of physicians and staff toward the benefits, challenges, and successful strategies for implementation and meaningful use of advanced EHR functions. Qualitative case study of 6 primary care practices in Virginia. We performed surveys and in-depth interviews with clinicians and administrative staff (N = 38) and observed interpersonal relations and use of EHR functions over a 16-month period. Practices with an established EHR were selected based on a maximum variation of quality activities, location, and ownership. Physicians and staff report increased efficiency in retrieving medical records, storing patient information, coordination of care, and office operations. Costs, lack of knowledge of EHR functions, and problems transforming office operations were barriers reported for meaningful use of EHRs. Major disruption to patient care during upgrades and difficulty utilizing performance tracking and quality functions were also reported. Facilitators for adopting and using advanced EHR functions include team-based care, adequate technical support, communication and training for employees and physicians, alternative strategies for patient care during transition, and development of new processes and work flow procedures. Small practices experience difficulty with implementation and utilization of advanced EHR functions. Federal and state policies should continue to support practices by providing technical assistance and financial incentives, grants, and/or loans. Small practices should consider using regional extension center services and reaching out to colleagues and other healthcare organizations with similar EHR systems for advice and guidance.

Analysis of the process of representing clinical statements for decision-support applications: a comparison of openEHR archetypes and HL7 virtual medical record.

PubMed

González-Ferrer, A; Peleg, M; Marcos, M; Maldonado, J A

2016-07-01

Delivering patient-specific decision-support based on computer-interpretable guidelines (CIGs) requires mapping CIG clinical statements (data items, clinical recommendations) into patients' data. This is most effectively done via intermediate data schemas, which enable querying the data according to the semantics of a shared standard intermediate schema. This study aims to evaluate the use of HL7 virtual medical record (vMR) and openEHR archetypes as intermediate schemas for capturing clinical statements from CIGs that are mappable to electronic health records (EHRs) containing patient data and patient-specific recommendations. Using qualitative research methods, we analyzed the encoding of ten representative clinical statements taken from two CIGs used in real decision-support systems into two health information models (openEHR archetypes and HL7 vMR instances) by four experienced informaticians. Discussion among the modelers about each case study example greatly increased our understanding of the capabilities of these standards, which we share in this educational paper. Differing in content and structure, the openEHR archetypes were found to contain a greater level of representational detail and structure while the vMR representations took fewer steps to complete. The use of openEHR in the encoding of CIG clinical statements could potentially facilitate applications other than decision-support, including intelligent data analysis and integration of additional properties of data items from existing EHRs. On the other hand, due to their smaller size and fewer details, the use of vMR potentially supports quicker mapping of EHR data into clinical statements.

Early Experiences with Mobile Electronic Health Records Application in a Tertiary Hospital in Korea

PubMed Central

Park, Minah; Hong, Eunseok; Kim, Sunhyu; Ahn, Ryeok; Hong, Jungseok; Song, Seungyeol; Kim, Tak; Kim, Jeongkeun; Yeo, Seongwoon

2015-01-01

Objectives Recent advances in mobile technology have opened up possibilities to provide strongly integrated mobile-based services in healthcare and telemedicine. Although the number of mobile Electronic Health Record (EHR) applications is large and growing, there is a paucity of evidence demonstrating the usage patterns of these mobile applications by healthcare providers. This study aimed to illustrate the deployment process for an integrated mobile EHR application and to analyze usage patterns after provision of the mobile EHR service. Methods We developed an integrated mobile application that aimed to enhance the mobility of healthcare providers by improving access to patient- and hospital-related information during their daily medical activities. The study included mobile EHR users who accessed patient healthcare records between May 2013 and May 2014. We performed a data analysis using a web server log file analyzer from the integrated EHR system. Cluster analysis was applied to longitudinal user data based on their application usage pattern. Results The mobile EHR service named M-UMIS has been in service since May 2013. Every healthcare provider in the hospital could access the mobile EHR service and view the medical charts of their patients. The frequency of using services and network packet transmission on the M-UMIS increased gradually during the study period. The most frequently accessed service in the menu was the patient list. Conclusions A better understanding regarding the adoption of mobile EHR applications by healthcare providers in patient-centered care provides useful information to guide the design and implementation of future applications. PMID:26618036

A Document-Based EHR System That Controls the Disclosure of Clinical Documents Using an Access Control List File Based on the HL7 CDA Header.

PubMed

Takeda, Toshihiro; Ueda, Kanayo; Nakagawa, Akito; Manabe, Shirou; Okada, Katsuki; Mihara, Naoki; Matsumura, Yasushi

2017-01-01

Electronic health record (EHR) systems are necessary for the sharing of medical information between care delivery organizations (CDOs). We developed a document-based EHR system in which all of the PDF documents that are stored in our electronic medical record system can be disclosed to selected target CDOs. An access control list (ACL) file was designed based on the HL7 CDA header to manage the information that is disclosed.

Fundamental Components For The Realization of a Federated Integrated Electronic Health Record Environment

DTIC Science & Technology

2001-10-25

for the deployment of the I- EHR at a regional level, and a large number of CISs systems have been supported, ranging from primary health care and...1 of 4 Abstract - The Integrated Electronic Health Record (I- EHR ) is a term used to describe the whole set of information that exists in...electronic form and is related to the personal health of an indi- vidual. Any approach towards I- EHR focuses on the needs of professionals or citizens who

Electronic Health Records: Then, Now, and in the Future

PubMed Central

2016-01-01

Summary Objectives Describe the state of Electronic Health Records (EHRs) in 1992 and their evolution by 2015 and where EHRs are expected to be in 25 years. Further to discuss the expectations for EHRs in 1992 and explore which of them were realized and what events accelerated or disrupted/derailed how EHRs evolved. Methods Literature search based on “Electronic Health Record”, “Medical Record”, and “Medical Chart” using Medline, Google, Wikipedia Medical, and Cochrane Libraries resulted in an initial review of 2,356 abstracts and other information in papers and books. Additional papers and books were identified through the review of references cited in the initial review. Results By 1992, hardware had become more affordable, powerful, and compact and the use of personal computers, local area networks, and the Internet provided faster and easier access to medical information. EHRs were initially developed and used at academic medical facilities but since most have been replaced by large vendor EHRs. While EHR use has increased and clinicians are being prepared to practice in an EHR-mediated world, technical issues have been overshadowed by procedural, professional, social, political, and especially ethical issues as well as the need for compliance with standards and information security. There have been enormous advancements that have taken place, but many of the early expectations for EHRs have not been realized and current EHRs still do not meet the needs of today’s rapidly changing healthcare environment. Conclusion The current use of EHRs initiated by new technology would have been hard to foresee. Current and new EHR technology will help to provide international standards for interoperable applications that use health, social, economic, behavioral, and environmental data to communicate, interpret, and act intelligently upon complex healthcare information to foster precision medicine and a learning health system. PMID:27199197

Do service innovations influence the adoption of electronic health records in long-term care organizations? Results from the U.S. National Survey of Residential Care Facilities.

PubMed

Bhuyan, Soumitra S; Zhu, He; Chandak, Aastha; Kim, Jungyoon; Stimpson, Jim P

2014-12-01

Healthcare organizations including residential care facilities (RCFs) are diversifying their services to meet market demands. Service innovations have been linked to the changes in the way that healthcare organizations organize their work. The objective of this study is to explore the relationship between organizational service innovations and Electronic Health Record (EHR) adoption in the RCFs. We used the data from the 2010 National Survey of Residential Care Facilities conducted by the Centers for Disease Control and Prevention. The outcome was whether an RCF adopted EHR or not, and the predictors were the organizational service innovations including provision of skilled nursing care and medication review. We also added facility characteristics as control variables. Weighted multivariate logistic regressions were used to estimate the relationship between service innovation factors and EHR adoption in the RCFs. In 2010, about 17.4% of the RCFs were estimated to use EHR. Multivariate analysis showed that RCFs employing service innovations were more likely to adopt EHR. The residential care facilities that provide skilled nursing services to their residents are more likely (OR: 1.42; 95% CI: 1.09-1.87) to adopt EHR. Similarly, RCFs with a provision of medication review were also more likely to adopt EHR (OR: 1.40; 95% CI: 1.00-1.95). Among the control variables, facility size, chain affiliation, ownership type, and Medicaid certification were significantly associated with EHR adoption. Our findings suggest that service innovations may drive EHR adoption in the RCFs in the United States. This can be viewed as a strategic attempt by RCFs to engage in a new business arrangement with hospitals and other health care organizations, where quality of care and interoperability of patients' records might play a vital role under the current healthcare reform. Future research could examine the relationship between service innovations and use of different EHR functionality in RCFs. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

77 FR 8217 - Evaluating the Usability of Electronic Health Record (EHR) Systems

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-14

... interface design guidelines for EHRs. Manufacturers interested in participating in this research will be... the usability of health information technology (HIT) systems. NIST research is designed to: (1... develop performance-oriented user interface design guidelines for EHRs, and a framework for assessing the...

Use of large electronic health record databases for environmental epidemiology studies.

EPA Science Inventory

Background: Electronic health records (EHRs) are a ubiquitous component of the United States healthcare system and capture nearly all data collected in a clinic or hospital setting. EHR databases are attractive for secondary data analysis as they may contain detailed clinical rec...

42 CFR 495.2 - Basis and purpose.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM General... certified electronic health record (EHR) technology. (b) Section 1853(1) of the Act to provide incentive... certified EHR technology and meet certain other requirements. (c) Section 1886(n) of the Act by establishing...

42 CFR 495.2 - Basis and purpose.

Code of Federal Regulations, 2012 CFR

2012-10-01

...) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM General... certified electronic health record (EHR) technology. (b) Section 1853(1) of the Act to provide incentive... certified EHR technology and meet certain other requirements. (c) Section 1886(n) of the Act by establishing...

42 CFR 495.2 - Basis and purpose.

Code of Federal Regulations, 2013 CFR

2013-10-01

...) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM General... certified electronic health record (EHR) technology. (b) Section 1853(1) of the Act to provide incentive... certified EHR technology and meet certain other requirements. (c) Section 1886(n) of the Act by establishing...

42 CFR 495.2 - Basis and purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM General... certified electronic health record (EHR) technology. (b) Section 1853(1) of the Act to provide incentive... certified EHR technology and meet certain other requirements. (c) Section 1886(n) of the Act by establishing...

42 CFR 495.2 - Basis and purpose.

Code of Federal Regulations, 2014 CFR

2014-10-01

...) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM General... certified electronic health record (EHR) technology. (b) Section 1853(1) of the Act to provide incentive... certified EHR technology and meet certain other requirements. (c) Section 1886(n) of the Act by establishing...

Electronic Health Records in the Cloud: Improving Primary Health Care Delivery in South Africa.

PubMed

Cilliers, Liezel; Wright, Graham

2017-01-01

In South Africa, the recording of health data is done manually in a paper-based file, while attempts to digitize healthcare records have had limited success. In many countries, Electronic Health Records (EHRs) has developed in silos, with little or no integration between different operational systems. Literature has provided evidence that the cloud can be used to 'leapfrog' some of these implementation issues, but the adoption of this technology in the public health care sector has been very limited. This paper aims to identify the major reasons why the cloud has not been used to implement EHRs for the South African public health care system, and to provide recommendations of how to overcome these challenges. From the literature, it is clear that there are technology, environmental and organisational challenges affecting the implementation of EHRs in the cloud. Four recommendations are provided that can be used by the National Department of Health to implement EHRs making use of the cloud.

Advance Care Planning Documentation in Electronic Health Records: Current Challenges and Recommendations for Change.

PubMed

Lamas, Daniela; Panariello, Natalie; Henrich, Natalie; Hammes, Bernard; Hanson, Laura C; Meier, Diane E; Guinn, Nancy; Corrigan, Janet; Hubber, Sean; Luetke-Stahlman, Hannah; Block, Susan

2018-04-01

To develop a set of clinically relevant recommendations to improve the state of advance care planning (ACP) documentation in the electronic health record (EHR). Advance care planning (ACP) is a key process that supports goal-concordant care. For preferences to be honored, clinicians must be able to reliably record, find, and use ACP documentation. However, there are no standards to guide ACP documentation in the electronic health record (EHR). We interviewed 21 key informants to understand the strengths and weaknesses of EHR documentation systems for ACP and identify best practices. We analyzed these interviews using a qualitative content analysis approach and subsequently developed a preliminary set of recommendations. These recommendations were vetted and refined in a second round of input from a national panel of content experts. Informants identified six themes regarding current inadequacies in documentation and accessibility of ACP information and opportunities for improvement. We offer a set of concise, clinically relevant recommendations, informed by expert opinion, to improve the state of ACP documentation in the EHR.

An HL7/CDA Framework for the Design and Deployment of Telemedicine Services

DTIC Science & Technology

2001-10-25

schemes and prescription databases. Furthermore, interoperability with the Electronic Health Re- cord ( EHR ) facilitates automatic retrieval of relevant...local EHR system or the integrated electronic health record (I- EHR ) [9], which indexes all medical contacts of a patient in the regional net- work...suspected medical problem. Interoperability with middleware services of the HII and other data sources such as the local EHR sys- tem affects

Public and physician's expectations and ethical concerns about electronic health record: Benefits outweigh risks except for information security.

PubMed

Entzeridou, Eleni; Markopoulou, Evgenia; Mollaki, Vasiliki

2018-02-01

Electronic Health Record systems (EHRs) offer numerous benefits in health care but also pose certain risks. As we progress toward the implementation of EHRs, a more in-depth understanding of attitudes that influence overall levels of EHR support is required. To record public and physicians' awareness, expectations for, and ethical concerns about the use of EHRs. A convenience sample was surveyed for both the public and physicians. The Public's Questionnaire was distributed to the public in a printed and an online version. The Physicians' Questionnaire was distributed to physicians in an online version. The questionnaires requested demographic characteristics followed by close-ended questions enquiring about awareness, perceived impact, perceived risks, and ethical issues raised by EHR use. In total, 46% of the public and 91% of physicians were aware of EHRs. Physicians' and public opinions were comparable concerning the positive impact of EHRs on better, more effective, and faster decisions on the patients' health, on better coordination between hospitals/clinics and on quality and reduced cost of health care. However, physicians were concerned that an EHR system would be a burden for their finances, for their time concerning training on the system, for their everyday workload and workflow. The majority of the public generally agreed that they would worry about the possibility that a non-authorized, third party might gain access to their personal health information (48.8%), and that they would worry about future discriminations due to possible disclosure of their health information (48.8%). Most physicians disagreed that EHRs will disrupt the doctor-patient relationship (58.1%) but they would worry about the safety of their patients' information (53.1%). Overall, both the public and physicians were in favor of the implementation of an EHR system, evaluating that possible benefits are more important than possible risks. The majority of the public believed that physicians should have full access to an EHR (90.9%), whereas nursing staff, pharmacists, laboratory staff, and other healthcare professional should have partial access. The factors identified in the present study present actionable insights that may increase awareness about EHRs. The survey illustrates that both the public and physicians acknowledge the benefits and support EHRs on the condition that sufficient guarantees are provided about privacy and security. Copyright © 2017 Elsevier B.V. All rights reserved.

Genetic data and electronic health records: a discussion of ethical, logistical and technological considerations

PubMed Central

Shoenbill, Kimberly; Fost, Norman; Tachinardi, Umberto; Mendonca, Eneida A

2014-01-01

Objective The completion of sequencing the human genome in 2003 has spurred the production and collection of genetic data at ever increasing rates. Genetic data obtained for clinical purposes, as is true for all results of clinical tests, are expected to be included in patients’ medical records. With this explosion of information, questions of what, when, where and how to incorporate genetic data into electronic health records (EHRs) have reached a critical point. In order to answer these questions fully, this paper addresses the ethical, logistical and technological issues involved in incorporating these data into EHRs. Materials and methods This paper reviews journal articles, government documents and websites relevant to the ethics, genetics and informatics domains as they pertain to EHRs. Results and discussion The authors explore concerns and tasks facing health information technology (HIT) developers at the intersection of ethics, genetics, and technology as applied to EHR development. Conclusions By ensuring the efficient and effective incorporation of genetic data into EHRs, HIT developers will play a key role in facilitating the delivery of personalized medicine. PMID:23771953

Electronic health record usability: analysis of the user-centered design processes of eleven electronic health record vendors.

PubMed

Ratwani, Raj M; Fairbanks, Rollin J; Hettinger, A Zachary; Benda, Natalie C

2015-11-01

The usability of electronic health records (EHRs) continues to be a point of dissatisfaction for providers, despite certification requirements from the Office of the National Coordinator that require EHR vendors to employ a user-centered design (UCD) process. To better understand factors that contribute to poor usability, a research team visited 11 different EHR vendors in order to analyze their UCD processes and discover the specific challenges that vendors faced as they sought to integrate UCD with their EHR development. Our analysis demonstrates a diverse range of vendors' UCD practices that fall into 3 categories: well-developed UCD, basic UCD, and misconceptions of UCD. Specific challenges to practicing UCD include conducting contextually rich studies of clinical workflow, recruiting participants for usability studies, and having support from leadership within the vendor organization. The results of the study provide novel insights for how to improve usability practices of EHR vendors. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Electronic health systems: challenges faced by hospital-based providers.

PubMed

Agno, Christina Farala; Guo, Kristina L

2013-01-01

The purpose of this article is to discuss specific challenges faced by hospitals adopting the use of electronic medical records and implementing electronic health record (EHR) systems. Challenges include user and information technology support; ease of technical use and software interface capabilities; compliance; and financial, legal, workforce training, and development issues. Electronic health records are essential to preventing medical errors, increasing consumer trust and use of the health system, and improving quality and overall efficiency. Government efforts are focused on ways to accelerate the adoption and use of EHRs as a means of facilitating data sharing, protecting health information privacy and security, quickly identifying emerging public health threats, and reducing medical errors and health care costs and increasing quality of care. This article will discuss physician and nonphysician staff training before, during, and after implementation; the effective use of EHR systems' technical features; the selection of a capable and secure EHR system; and the development of collaborative system implementation. Strategies that are necessary to help health care providers achieve successful implementation of EHR systems will be addressed.

Legal, ethical, and financial dilemmas in electronic health record adoption and use.

PubMed

Sittig, Dean F; Singh, Hardeep

2011-04-01

Electronic health records (EHRs) facilitate several innovations capable of reforming health care. Despite their promise, many currently unanswered legal, ethical, and financial questions threaten the widespread adoption and use of EHRs. Key legal dilemmas that must be addressed in the near-term pertain to the extent of clinicians' responsibilities for reviewing the entire computer-accessible clinical synopsis from multiple clinicians and institutions, the liabilities posed by overriding clinical decision support warnings and alerts, and mechanisms for clinicians to publically report potential EHR safety issues. Ethical dilemmas that need additional discussion relate to opt-out provisions that exclude patients from electronic record storage, sale of deidentified patient data by EHR vendors, adolescent control of access to their data, and use of electronic data repositories to redesign the nation's health care delivery and payment mechanisms on the basis of statistical analyses. Finally, one overwhelming financial question is who should pay for EHR implementation because most users and current owners of these systems will not receive the majority of benefits. The authors recommend that key stakeholders begin discussing these issues in a national forum. These actions can help identify and prioritize solutions to the key legal, ethical, and financial dilemmas discussed, so that widespread, safe, effective, interoperable EHRs can help transform health care.

We are bitter, but we are better off: case study of the implementation of an electronic health record system into a mental health hospital in England

PubMed Central

2012-01-01

Background In contrast to the acute hospital sector, there have been relatively few implementations of integrated electronic health record (EHR) systems into specialist mental health settings. The National Programme for Information Technology (NPfIT) in England was the most expensive IT-based transformation of public services ever undertaken, which aimed amongst other things, to implement integrated EHR systems into mental health hospitals. This paper describes the arrival, the process of implementation, stakeholders’ experiences and the local consequences of the implementation of an EHR system into a mental health hospital. Methods Longitudinal, real-time, case study-based evaluation of the implementation and adoption of an EHR software (RiO) into an English mental health hospital known here as Beta. We conducted 48 in-depth interviews with a wide range of internal and external stakeholders, undertook 26 hours of on-site observations, and obtained 65 sets of relevant documents from various types relating to Beta. Analysis was both inductive and deductive, the latter being informed by the ‘sociotechnical changing’ theoretical framework. Results Many interviewees perceived the implementation of the EHR system as challenging and cumbersome. During the early stages of the implementation, some clinicians felt that using the software was time-consuming leading to the conclusion that the EHR was not fit for purpose. Most interviewees considered the chain of deployment of the EHR–which was imposed by NPfIT–as bureaucratic and obstructive, which restricted customization and as a result limited adoption and use. The low IT literacy among users at Beta was a further barrier to the implementation of the EHR. This along with inadequate training in using the EHR software led to resistance to the significant cultural and work environment changes initiated by EHR. Despite the many challenges, Beta achieved some early positive results. These included: the ability to check progress notes and monitor staff activities; improving quality of care as a result of real-time, more accurate and shared patient records across the hospital; and potentially improving the safety of care through increasing the legibility of the clinical record. Conclusions Notwithstanding what was seen as a turbulent, painful and troublesome implementation of the EHR system, Beta achieved some early clinical and managerial benefits from implementing EHRs. The ‘sociotechnical changing’ framework helped us go beyond the dichotomy of success versus failure, when conducting the evaluation and interpreting findings. Given the scope for continued development, there are good reasons, we argue, to scale up the intake of EHR systems by mental health care settings. Software customization and appropriate support are essential to work EHR out in such organizations. PMID:23272770

EHR Safety: The Way Forward to Safe and Effective Systems

PubMed Central

Walker, James M.; Carayon, Pascale; Leveson, Nancy; Paulus, Ronald A.; Tooker, John; Chin, Homer; Bothe, Albert; Stewart, Walter F.

2008-01-01

Diverse stakeholders—clinicians, researchers, business leaders, policy makers, and the public—have good reason to believe that the effective use of electronic health care records (EHRs) is essential to meaningful advances in health care quality and patient safety. However, several reports have documented the potential of EHRs to contribute to health care system flaws and patient harm. As organizations (including small hospitals and physician practices) with limited resources for care-process transformation, human-factors engineering, software safety, and project management begin to use EHRs, the chance of EHR-associated harm may increase. The authors propose a coordinated set of steps to advance the practice and theory of safe EHR design, implementation, and continuous improvement. These include setting EHR implementation in the context of health care process improvement, building safety into the specification and design of EHRs, safety testing and reporting, and rapid communication of EHR-related safety flaws and incidents. PMID:18308981

Increasing EHR system usability through standards: Conformance criteria in the HL7 EHR-system functional model.

PubMed

Meehan, Rebecca A; Mon, Donald T; Kelly, Kandace M; Rocca, Mitra; Dickinson, Gary; Ritter, John; Johnson, Constance M

2016-10-01

Though substantial work has been done on the usability of health information technology, improvements in electronic health record system (EHR) usability have been slow, creating frustration, distrust of EHRs and the use of potentially unsafe work-arounds. Usability standards could be part of the solution for improving EHR usability. EHR system functional requirements and standards have been used successfully in the past to specify system behavior, the criteria of which have been gradually implemented in EHR systems through certification programs and other national health IT strategies. Similarly, functional requirements and standards for usability can help address the multitude of sequelae associated with poor usability. This paper describes the evidence-based functional requirements for usability contained in the Health Level Seven (HL7) EHR System Functional Model, and the benefits of open and voluntary EHR system usability standards. Copyright © 2016 Elsevier Inc. All rights reserved.

A secure EHR system based on hybrid clouds.

PubMed

Chen, Yu-Yi; Lu, Jun-Chao; Jan, Jinn-Ke

2012-10-01

Consequently, application services rendering remote medical services and electronic health record (EHR) have become a hot topic and stimulating increased interest in studying this subject in recent years. Information and communication technologies have been applied to the medical services and healthcare area for a number of years to resolve problems in medical management. Sharing EHR information can provide professional medical programs with consultancy, evaluation, and tracing services can certainly improve accessibility to the public receiving medical services or medical information at remote sites. With the widespread use of EHR, building a secure EHR sharing environment has attracted a lot of attention in both healthcare industry and academic community. Cloud computing paradigm is one of the popular healthIT infrastructures for facilitating EHR sharing and EHR integration. In this paper, we propose an EHR sharing and integration system in healthcare clouds and analyze the arising security and privacy issues in access and management of EHRs.

Disease Heritability Inferred from Familial Relationships Reported in Medical Records.

PubMed

Polubriaginof, Fernanda C G; Vanguri, Rami; Quinnies, Kayla; Belbin, Gillian M; Yahi, Alexandre; Salmasian, Hojjat; Lorberbaum, Tal; Nwankwo, Victor; Li, Li; Shervey, Mark M; Glowe, Patricia; Ionita-Laza, Iuliana; Simmerling, Mary; Hripcsak, George; Bakken, Suzanne; Goldstein, David; Kiryluk, Krzysztof; Kenny, Eimear E; Dudley, Joel; Vawdrey, David K; Tatonetti, Nicholas P

2018-05-15

Heritability is essential for understanding the biological causes of disease but requires laborious patient recruitment and phenotype ascertainment. Electronic health records (EHRs) passively capture a wide range of clinically relevant data and provide a resource for studying the heritability of traits that are not typically accessible. EHRs contain next-of-kin information collected via patient emergency contact forms, but until now, these data have gone unused in research. We mined emergency contact data at three academic medical centers and identified 7.4 million familial relationships while maintaining patient privacy. Identified relationships were consistent with genetically derived relatedness. We used EHR data to compute heritability estimates for 500 disease phenotypes. Overall, estimates were consistent with the literature and between sites. Inconsistencies were indicative of limitations and opportunities unique to EHR research. These analyses provide a validation of the use of EHRs for genetics and disease research. Copyright © 2018 Elsevier Inc. All rights reserved.

Electronic health records: postadoption physician satisfaction and continued use.

PubMed

Wright, Edward; Marvel, Jon

2012-01-01

One goal of public-policy makers in general and health care managers in particular is the adoption and efficient utilization of electronic health record (EHR) systems throughout the health care industry. Consequently, this investigation focused on the effects of known antecedents of technology adoption on physician satisfaction with EHR technology and the continued use of such systems. The American Academy of Family Physicians provided support in the survey of 453 physicians regarding their satisfaction with their EHR use experience. A conceptual model merging technology adoption and computer user satisfaction models was tested using structural equation modeling. Results indicate that effort expectancy (ease of use) has the most substantive effect on physician satisfaction and the continued use of EHR systems. As such, health care managers should be especially sensitive to the user and computer interface of prospective EHR systems to avoid costly and disruptive system selection mistakes.

2015 Edition Health Information Technology (Health IT) Certification Criteria, 2015 Edition Base Electronic Health Record (EHR) Definition, and ONC Health IT Certification Program Modifications. Final rule.

PubMed

2015-10-16

This final rule finalizes a new edition of certification criteria (the 2015 Edition health IT certification criteria or "2015 Edition'') and a new 2015 Edition Base Electronic Health Record (EHR) definition, while also modifying the ONC Health IT Certification Program to make it open and accessible to more types of health IT and health IT that supports various care and practice settings. The 2015 Edition establishes the capabilities and specifies the related standards and implementation specifications that Certified Electronic Health Record Technology (CEHRT) would need to include to, at a minimum, support the achievement of meaningful use by eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) under the Medicare and Medicaid EHR Incentive Programs (EHR Incentive Programs) when such edition is required for use under these programs.

Business analysis for a sustainable, multi-stakeholder ecosystem for leveraging the Electronic Health Records for Clinical Research (EHR4CR) platform in Europe.

PubMed

Dupont, Danielle; Beresniak, Ariel; Sundgren, Mats; Schmidt, Andreas; Ainsworth, John; Coorevits, Pascal; Kalra, Dipak; Dewispelaere, Marc; De Moor, Georges

2017-01-01

The Electronic Health Records for Clinical Research (EHR4CR) technological platform has been developed to enable the trustworthy reuse of hospital electronic health records data for clinical research. The EHR4CR platform can enhance and speed up clinical research scenarios: protocol feasibility assessment, patient identification for recruitment in clinical trials, and clinical data exchange, including for reporting serious adverse events. Our objective was to seed a multi-stakeholder ecosystem to enable the scalable exploitation of the EHR4CR platform in Europe, and to assess its economic sustainability. Market analyses were conducted by a multidisciplinary task force to define an EHR4CR emerging ecosystem and multi-stakeholder value chain. This involved mapping stakeholder groups and defining their unmet needs, incentives, potential barriers for adopting innovative solutions, roles and interdependencies. A comprehensive business model, value propositions, and sustainability strategies were developed accordingly. Using simulation modelling (including Monte Carlo simulations) and a 5-year horizon, the potential financial outcomes of the business model were forecasted from the perspective of an EHR4CR service provider. A business ecosystem was defined to leverage the EHR4CR multi-stakeholder value chain. Value propositions were developed describing the expected benefits of EHR4CR solutions for all stakeholders. From an EHR4CR service provider's viewpoint, the business model simulation estimated that a profitability ratio of up to 1.8 could be achieved at year 1, with potential for growth in subsequent years depending on projected market uptake. By enhancing and speeding up existing processes, EHR4CR solutions promise to transform the clinical research landscape. The ecosystem defined provides the organisational framework for optimising the value and benefits for all stakeholders involved, in a sustainable manner. Our study suggests that the exploitation of EHR4CR solutions appears profitable and sustainable in Europe, with a growth potential depending on the rates of market and hospital adoption. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Designing a system for patients controlling providers' access to their electronic health records: organizational and technical challenges.

PubMed

Leventhal, Jeremy C; Cummins, Jonathan A; Schwartz, Peter H; Martin, Douglas K; Tierney, William M

2015-01-01

Electronic health records (EHRs) are proliferating, and financial incentives encourage their use. Applying Fair Information Practice principles to EHRs necessitates balancing patients' rights to control their personal information with providers' data needs to deliver safe, high-quality care. We describe the technical and organizational challenges faced in capturing patients' preferences for patient-controlled EHR access and applying those preferences to an existing EHR. We established an online system for capturing patients' preferences for who could view their EHRs (listing all participating clinic providers individually and categorically-physicians, nurses, other staff) and what data to redact (none, all, or by specific categories of sensitive data or patient age). We then modified existing data-viewing software serving a state-wide health information exchange and a large urban health system and its primary care clinics to allow patients' preferences to guide data displays to providers. Patients could allow or restrict data displays to all clinicians and staff in a demonstration primary care clinic, categories of providers (physicians, nurses, others), or individual providers. They could also restrict access to all EHR data or any or all of five categories of sensitive data (mental and reproductive health, sexually transmitted diseases, HIV/AIDS, and substance abuse) and for specific patient ages. The EHR viewer displayed data via reports, data flowsheets, and coded and free text data displayed by Google-like searches. Unless patients recorded restrictions, by default all requested data were displayed to all providers. Data patients wanted restricted were not displayed, with no indication they were redacted. Technical barriers prevented redacting restricted information in free textnotes. The program allowed providers to hit a "Break the Glass" button to override patients' restrictions, recording the date, time, and next screen viewed. Establishing patient-control over EHR data displays was complex and required ethical, clinical, database, and programming expertise and difficult choices to overcome technical and health system constraints. Assessing patients' preferences for access to their EHRs and applying them in clinical practice requires wide-ranging technical, clinical, and bioethical expertise, to make tough choices to overcome significant technical and organization challenges.

Patient and public views about the security and privacy of Electronic Health Records (EHRs) in the UK: results from a mixed methods study.

PubMed

Papoutsi, Chrysanthi; Reed, Julie E; Marston, Cicely; Lewis, Ruth; Majeed, Azeem; Bell, Derek

2015-10-14

Although policy discourses frame integrated Electronic Health Records (EHRs) as essential for contemporary healthcare systems, increased information sharing often raises concerns among patients and the public. This paper examines patient and public views about the security and privacy of EHRs used for health provision, research and policy in the UK. Sequential mixed methods study with a cross-sectional survey (in 2011) followed by focus group discussions (in 2012-2013). Survey participants (N = 5331) were recruited from primary and secondary care settings in West London (UK). Complete data for 2761 (51.8 %) participants were included in the final analysis for this paper. The survey results were discussed in 13 focus groups with people living with a range of different health conditions, and in 4 mixed focus groups with patients, health professionals and researchers (total N = 120). Qualitative data were analysed thematically. In the survey, 79 % of participants reported that they would worry about the security of their record if this was part of a national EHR system and 71 % thought the National Health Service (NHS) was unable to guarantee EHR safety at the time this work was carried out. Almost half (47 %) responded that EHRs would be less secure compared with the way their health record was held at the time of the survey. Of those who reported being worried about EHR security, many would nevertheless support their development (55 %), while 12 % would not support national EHRs and a sizeable proportion (33 %) were undecided. There were also variations by age, ethnicity and education. In focus group discussions participants weighed up perceived benefits against potential security and privacy threats from wider sharing of information, as well as discussing other perceived risks: commercial exploitation, lack of accountability, data inaccuracies, prejudice and inequalities in health provision. Patient and public worries about the security risks associated with integrated EHRs highlight the need for intensive public awareness and engagement initiatives, together with the establishment of trustworthy security and privacy mechanisms for health information sharing.

Relational machine learning for electronic health record-driven phenotyping.

PubMed

Peissig, Peggy L; Santos Costa, Vitor; Caldwell, Michael D; Rottscheit, Carla; Berg, Richard L; Mendonca, Eneida A; Page, David

2014-12-01

Electronic health records (EHR) offer medical and pharmacogenomics research unprecedented opportunities to identify and classify patients at risk. EHRs are collections of highly inter-dependent records that include biological, anatomical, physiological, and behavioral observations. They comprise a patient's clinical phenome, where each patient has thousands of date-stamped records distributed across many relational tables. Development of EHR computer-based phenotyping algorithms require time and medical insight from clinical experts, who most often can only review a small patient subset representative of the total EHR records, to identify phenotype features. In this research we evaluate whether relational machine learning (ML) using inductive logic programming (ILP) can contribute to addressing these issues as a viable approach for EHR-based phenotyping. Two relational learning ILP approaches and three well-known WEKA (Waikato Environment for Knowledge Analysis) implementations of non-relational approaches (PART, J48, and JRIP) were used to develop models for nine phenotypes. International Classification of Diseases, Ninth Revision (ICD-9) coded EHR data were used to select training cohorts for the development of each phenotypic model. Accuracy, precision, recall, F-Measure, and Area Under the Receiver Operating Characteristic (AUROC) curve statistics were measured for each phenotypic model based on independent manually verified test cohorts. A two-sided binomial distribution test (sign test) compared the five ML approaches across phenotypes for statistical significance. We developed an approach to automatically label training examples using ICD-9 diagnosis codes for the ML approaches being evaluated. Nine phenotypic models for each ML approach were evaluated, resulting in better overall model performance in AUROC using ILP when compared to PART (p=0.039), J48 (p=0.003) and JRIP (p=0.003). ILP has the potential to improve phenotyping by independently delivering clinically expert interpretable rules for phenotype definitions, or intuitive phenotypes to assist experts. Relational learning using ILP offers a viable approach to EHR-driven phenotyping. Copyright © 2014 Elsevier Inc. All rights reserved.

Orders on file but no labs drawn: investigation of machine and human errors caused by an interface idiosyncrasy.

PubMed

Schreiber, Richard; Sittig, Dean F; Ash, Joan; Wright, Adam

2017-09-01

In this report, we describe 2 instances in which expert use of an electronic health record (EHR) system interfaced to an external clinical laboratory information system led to unintended consequences wherein 2 patients failed to have laboratory tests drawn in a timely manner. In both events, user actions combined with the lack of an acknowledgment message describing the order cancellation from the external clinical system were the root causes. In 1 case, rapid, near-simultaneous order entry was the culprit; in the second, astute order management by a clinician, unaware of the lack of proper 2-way interface messaging from the external clinical system, led to the confusion. Although testing had shown that the laboratory system would cancel duplicate laboratory orders, it was thought that duplicate alerting in the new order entry system would prevent such events. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Area-level factors associated with electronic health record adoption and meaningful use in the Regional Extension Center Program.

PubMed

Samuel, Cleo A

2014-01-01

To identify area-level correlates of electronic health record (EHR) adoption and meaningful use (MU) among primary care providers (PCPs) enrolled in the Regional Extension Center (REC) Program. County-level data on 2013 EHR adoption and MU among REC-enrolled PCPs were obtained from the Office of the National Coordinator for Health Information Technology and linked with other county-level data sources including the Area Resource File, American Community Survey, and Federal Communications Commission's broadband availability database. Hierarchical models with random intercepts for RECs were employed to assess associations between a broad set of area-level factors and county-level rates of EHR adoption and MU. Among the 2715 counties examined, the average county-level EHR adoption and MU rates for REC-enrolled PCPs were 87.5% and 54.2%, respectively. Community health center presence and Medicaid enrollment concentration were positively associated with EHR adoption, while metropolitan status and Medicare Advantage enrollment concentration were positively associated with MU. Health professional shortage area status and minority concentration were negatively associated with EHR adoption and MU. Increased financial incentives in areas with greater concentrations of Medicaid and Medicare enrollees may be encouraging EHR adoption and MU among REC-enrolled PCPs. Disparities in EHR adoption and MU in some low-resource and underserved areas remain a concern. Federal efforts to spur EHR adoption and MU have demonstrated some early success; however, some geographic variations in EHR diffusion indicate that greater attention needs to be paid to ensuring equitable uptake and use of EHRs throughout the US. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Area-level factors associated with electronic health record adoption and meaningful use in the Regional Extension Center Program

PubMed Central

Samuel, Cleo A

2014-01-01

Objective To identify area-level correlates of electronic health record (EHR) adoption and meaningful use (MU) among primary care providers (PCPs) enrolled in the Regional Extension Center (REC) Program. Materials and methods County-level data on 2013 EHR adoption and MU among REC-enrolled PCPs were obtained from the Office of the National Coordinator for Health Information Technology and linked with other county-level data sources including the Area Resource File, American Community Survey, and Federal Communications Commission's broadband availability database. Hierarchical models with random intercepts for RECs were employed to assess associations between a broad set of area-level factors and county-level rates of EHR adoption and MU. Results Among the 2715 counties examined, the average county-level EHR adoption and MU rates for REC-enrolled PCPs were 87.5% and 54.2%, respectively. Community health center presence and Medicaid enrollment concentration were positively associated with EHR adoption, while metropolitan status and Medicare Advantage enrollment concentration were positively associated with MU. Health professional shortage area status and minority concentration were negatively associated with EHR adoption and MU. Discussion Increased financial incentives in areas with greater concentrations of Medicaid and Medicare enrollees may be encouraging EHR adoption and MU among REC-enrolled PCPs. Disparities in EHR adoption and MU in some low-resource and underserved areas remain a concern. Conclusions Federal efforts to spur EHR adoption and MU have demonstrated some early success; however, some geographic variations in EHR diffusion indicate that greater attention needs to be paid to ensuring equitable uptake and use of EHRs throughout the US. PMID:24798687

Nurses' Perceptions of the Electronic Health Record

ERIC Educational Resources Information Center

Crawley, Rocquel Devonne

2013-01-01

The implementation of electronic health records (EHR) by health care organizations has been limited. Despite the broad consensus on the potential benefits of EHRs, health care organizations have been slow to adopt the technology. The purpose of this qualitative phenomenological study was to explore licensed practical and registered nurses'…

Toward Improved Security and Privacy in Modern Healthcare

ERIC Educational Resources Information Center

Pagano, Matthew Wallach

2013-01-01

The conversion of paper-based medical records into electronic formats is set to bring many benefits to healthcare. This includes creating a more seamless exchange of electronic health records (EHRs) between providers, improving healthcare while lowering its costs, and providing patients with increased access to their EHRs. As more medical…

Examining the Relationship between Electronic Health Record Interoperability and Quality Management

ERIC Educational Resources Information Center

Purcell, Bernice M.

2013-01-01

A lack of interoperability impairs data quality among health care providers' electronic health record (EHR) systems. The problem is whether the International Organization for Standardization (ISO) 9000 principles relate to the problem of interoperability in implementation of EHR systems. The purpose of the nonexperimental quantitative research…

Improving the quality of EHR recording in primary care: a data quality feedback tool.

PubMed

van der Bij, Sjoukje; Khan, Nasra; Ten Veen, Petra; de Bakker, Dinny H; Verheij, Robert A

2017-01-01

Electronic health record (EHR) data are used to exchange information among health care providers. For this purpose, the quality of the data is essential. We developed a data quality feedback tool that evaluates differences in EHR data quality among practices and software packages as part of a larger intervention. The tool was applied in 92 practices in the Netherlands using different software packages. Practices received data quality feedback in 2010 and 2012. We observed large differences in the quality of recording. For example, the percentage of episodes of care that had a meaningful diagnostic code ranged from 30% to 100%. Differences were highly related to the software package. A year after the first measurement, the quality of recording had improved significantly and differences decreased, with 67% of the physicians indicating that they had actively changed their recording habits based on the results of the first measurement. About 80% found the feedback helpful in pinpointing recording problems. One of the software vendors made changes in functionality as a result of the feedback. Our EHR data quality feedback tool is capable of highlighting differences among practices and software packages. As such, it also stimulates improvements. As substantial variability in recording is related to the software package, our study strengthens the evidence that data quality can be improved substantially by standardizing the functionalities of EHR software packages. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Exploring the sociotechnical intersection of patient safety and electronic health record implementation

PubMed Central

Meeks, Derek W; Takian, Amirhossein; Sittig, Dean F; Singh, Hardeep; Barber, Nick

2014-01-01

Objective The intersection of electronic health records (EHR) and patient safety is complex. To examine the applicability of two previously developed conceptual models comprehensively to understand safety implications of EHR implementation in the English National Health Service (NHS). Methods We conducted a secondary analysis of interview data from a 30-month longitudinal, prospective, case study-based evaluation of EHR implementation in 12 NHS hospitals. We used a framework analysis approach to apply conceptual models developed by Sittig and Singh to understand better EHR implementation and use: an eight-dimension sociotechnical model and a three-phase patient safety model (safe technology, safe use of technology, and use of technology to improve safety). Results The intersection of patient safety and EHR implementation and use was characterized by risks involving technology (hardware and software, clinical content, and human–computer interfaces), the interaction of technology with non-technological factors, and improper or unsafe use of technology. Our data support that patient safety improvement activities as well as patient safety hazards change as an organization evolves from concerns about safe EHR functionality, ensuring safe and appropriate EHR use, to using the EHR itself to provide ongoing surveillance and monitoring of patient safety. Discussion We demonstrate the face validity of two models for understanding the sociotechnical aspects of safe EHR implementation and the complex interactions of technology within a healthcare system evolving from paper to integrated EHR. Conclusions Using sociotechnical models, including those presented in this paper, may be beneficial to help stakeholders understand, synthesize, and anticipate risks at the intersection of patient safety and health information technology. PMID:24052536

Exploring the sociotechnical intersection of patient safety and electronic health record implementation.

PubMed

Meeks, Derek W; Takian, Amirhossein; Sittig, Dean F; Singh, Hardeep; Barber, Nick

2014-02-01

The intersection of electronic health records (EHR) and patient safety is complex. To examine the applicability of two previously developed conceptual models comprehensively to understand safety implications of EHR implementation in the English National Health Service (NHS). We conducted a secondary analysis of interview data from a 30-month longitudinal, prospective, case study-based evaluation of EHR implementation in 12 NHS hospitals. We used a framework analysis approach to apply conceptual models developed by Sittig and Singh to understand better EHR implementation and use: an eight-dimension sociotechnical model and a three-phase patient safety model (safe technology, safe use of technology, and use of technology to improve safety). The intersection of patient safety and EHR implementation and use was characterized by risks involving technology (hardware and software, clinical content, and human-computer interfaces), the interaction of technology with non-technological factors, and improper or unsafe use of technology. Our data support that patient safety improvement activities as well as patient safety hazards change as an organization evolves from concerns about safe EHR functionality, ensuring safe and appropriate EHR use, to using the EHR itself to provide ongoing surveillance and monitoring of patient safety. We demonstrate the face validity of two models for understanding the sociotechnical aspects of safe EHR implementation and the complex interactions of technology within a healthcare system evolving from paper to integrated EHR. Using sociotechnical models, including those presented in this paper, may be beneficial to help stakeholders understand, synthesize, and anticipate risks at the intersection of patient safety and health information technology.

Electronic Health Record Impacts on Family Medicine Teachers: Survey of Third-Year Medical Student Clerkship Preceptors at an Academic Medical Center.

PubMed

Curry, Elizabeth; Oser, Tamara K; Oser, Sean M

2017-10-01

Electronic Health Record (EHR) use in clinical practice has accelerated in recent years. While several aspects of EHR use have been extensively studied, there is little data on EHR impacts on medical student educators, especially those involved in outpatient family medicine. This study evaluated perceived impacts of EHR use on clinician teachers of outpatient family medicine. The study used a mixed methods survey of clinicians who teach third-year medical students during the required family and community medicine outpatient clerkship at a Mid-Atlantic medical school. Among 50 completed surveys, most respondents reported that the EHR had impacted their teaching (70% reported at least one negative effect; 84% reported at least one positive effect). Positive impacts included more easily viewing information, more effectively teaching evidence-based medicine, and teaching about EHR use itself. Negative impacts included less time teaching or interacting with students, and a perception that EHR use impedes development of students' critical thinking and clinical integration skills. Providers who have taught medical students both with and without EHR in place (>P=.024), those over 50 years old (>P=.019), and those with at least 5 years teaching experience (>P=.006) were more likely to report negative impacts. Most preceptors reported that EHR use had both positive and negative impacts on their teaching of medical students, though the negative effects were perceived by respondents as more substantial, consistent with a theme of decreased enthusiasm for teaching due to EHR use. These findings can be used to help inform faculty development and education initiatives.

Effects of electronic health record use on the exam room communication skills of resident physicians: a randomized within-subjects study.

PubMed

Taft, Teresa; Lenert, Leslie; Sakaguchi, Farrant; Stoddard, Gregory; Milne, Caroline

2015-01-01

The effects of electronic health records (EHRs) on doctor-patient communication are unclear. To evaluate the effects of EHR use compared with paper chart use, on novice physicians' communication skills. Within-subjects randomized controlled trial using observed structured clinical examination methods to assess the impact of use of an EHR on communication. A large academic internal medicine training program. First-year internal medicine residents. Residents interviewed, diagnosed, and initiated treatment of simulated patients using a paper chart or an EHR on a laptop computer. Video recordings of interviews were rated by three trained observers using the Four Habits scale. Thirty-two residents completed the study and had data available for review (61.5% of those enrolled in the residency program). In most skill areas in the Four Habits model, residents performed at least as well using the EHR and were statistically better in six of 23 skills areas (p<0.05). The overall average communication score was better when using an EHR: mean difference 0.254 (95% CI 0.05 to 0.45), p = 0.012, Cohen's d of 0.47 (a moderate effect). Residents scoring poorly (>3 average score) with paper methods (n = 8) had clinically important improvement when using the EHR. This study was conducted in first-year residents in a training environment using simulated patients at a single institution. Use of an EHR on a laptop computer appears to improve the ability of first-year residents to communicate with patients relative to using a paper chart. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Effects of electronic health record use on the exam room communication skills of resident physicians: a randomized within-subjects study

PubMed Central

Taft, Teresa; Lenert, Leslie; Sakaguchi, Farrant; Stoddard, Gregory; Milne, Caroline

2015-01-01

Background The effects of electronic health records (EHRs) on doctor–patient communication are unclear. Objective To evaluate the effects of EHR use compared with paper chart use, on novice physicians’ communication skills. Design Within-subjects randomized controlled trial using observed structured clinical examination methods to assess the impact of use of an EHR on communication. Setting A large academic internal medicine training program. Population First-year internal medicine residents. Intervention Residents interviewed, diagnosed, and initiated treatment of simulated patients using a paper chart or an EHR on a laptop computer. Video recordings of interviews were rated by three trained observers using the Four Habits scale. Results Thirty-two residents completed the study and had data available for review (61.5% of those enrolled in the residency program). In most skill areas in the Four Habits model, residents performed at least as well using the EHR and were statistically better in six of 23 skills areas (p<0.05). The overall average communication score was better when using an EHR: mean difference 0.254 (95% CI 0.05 to 0.45), p = 0.012, Cohen's d of 0.47 (a moderate effect). Residents scoring poorly (>3 average score) with paper methods (n = 8) had clinically important improvement when using the EHR. Limitations This study was conducted in first-year residents in a training environment using simulated patients at a single institution. Conclusions Use of an EHR on a laptop computer appears to improve the ability of first-year residents to communicate with patients relative to using a paper chart. PMID:25336596

Electronic health records and support for primary care teamwork.

PubMed

O'Malley, Ann S; Draper, Kevin; Gourevitch, Rebecca; Cross, Dori A; Scholle, Sarah Hudson

2015-03-01

Consensus that enhanced teamwork is necessary for efficient and effective primary care delivery is growing. We sought to identify how electronic health records (EHRs) facilitate and pose challenges to primary care teams as well as how practices are overcoming these challenges. Practices in this qualitative study were selected from those recognized as patient-centered medical homes via the National Committee for Quality Assurance 2011 tool, which included a section on practice teamwork. We interviewed 63 respondents, ranging from physicians to front-desk staff, from 27 primary care practices ranging in size, type, geography, and population size. EHRs were found to facilitate communication and task delegation in primary care teams through instant messaging, task management software, and the ability to create evidence-based templates for symptom-specific data collection from patients by medical assistants and nurses (which can offload work from physicians). Areas where respondents felt that electronic medical record EHR functionalities were weakest and posed challenges to teamwork included the lack of integrated care manager software and care plans in EHRs, poor practice registry functionality and interoperability, and inadequate ease of tracking patient data in the EHR over time. Practices developed solutions for some of the challenges they faced when attempting to use EHRs to support teamwork but wanted more permanent vendor and policy solutions for other challenges. EHR vendors in the United States need to work alongside practicing primary care teams to create more clinically useful EHRs that support dynamic care plans, integrated care management software, more functional and interoperable practice registries, and greater ease of data tracking over time. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association.

New Paradigms for Patient-Centered Outcomes Research in Electronic Medical Records: An Example of Detecting Urinary Incontinence Following Prostatectomy.

PubMed

Hernandez-Boussard, Tina; Tamang, Suzanne; Blayney, Douglas; Brooks, Jim; Shah, Nigam

2016-01-01

National initiatives to develop quality metrics emphasize the need to include patient-centered outcomes. Patient-centered outcomes are complex, require documentation of patient communications, and have not been routinely collected by healthcare providers. The widespread implementation of electronic medical records (EHR) offers opportunities to assess patient-centered outcomes within the routine healthcare delivery system. The objective of this study was to test the feasibility and accuracy of identifying patient centered outcomes within the EHR. Data from patients with localized prostate cancer undergoing prostatectomy were used to develop and test algorithms to accurately identify patient-centered outcomes in post-operative EHRs - we used urinary incontinence as the use case. Standard data mining techniques were used to extract and annotate free text and structured data to assess urinary incontinence recorded within the EHRs. A total 5,349 prostate cancer patients were identified in our EHR-system between 1998-2013. Among these EHRs, 30.3% had a text mention of urinary incontinence within 90 days post-operative compared to less than 1.0% with a structured data field for urinary incontinence (i.e. ICD-9 code). Our workflow had good precision and recall for urinary incontinence (positive predictive value: 0.73 and sensitivity: 0.84). Our data indicate that important patient-centered outcomes, such as urinary incontinence, are being captured in EHRs as free text and highlight the long-standing importance of accurate clinician documentation. Standard data mining algorithms can accurately and efficiently identify these outcomes in existing EHRs; the complete assessment of these outcomes is essential to move practice into the patient-centered realm of healthcare.

Identifying Barriers in the Use of Electronic Health Records in Hawai‘i

PubMed Central

Hamamura, Faith D; Hughes, Kira

2017-01-01

Hawai‘i faces unique challenges to Electronic Health Record (EHR) adoption due to physician shortages, a widespread distribution of Medically Underserved Areas and Populations (MUA/P), and a higher percentage of small independent practices. However, research on EHR adoption in Hawai‘i is limited. To address this gap, this article examines the current state of EHR in Hawai‘i, the barriers to adoption, and the future of Health Information Technology (HIT) initiatives to improve the health of Hawai‘i's people. Eight focus groups were conducted on Lana‘i, Maui, Hawai‘i Island, Kaua‘i, Moloka‘i, and O‘ahu. In these groups, a total of 51 diverse health professionals were asked about the functionality of EHR systems, barriers to use, facilitators of use, and what EHRs would look like in a perfect world. Responses were summarized and analyzed based on constant comparative analysis techniques. Responses were then clustered into thirteen themes: system compatibility, loss of productivity, poor interface, IT support, hardware/software, patient factors, education/training, noise in the system, safety, data quality concerns, quality metrics, workflow, and malpractice concerns. Results show that every group mentioned system compatibility. In response to these findings, the Health eNet Community Health Record initiative — which allows providers web-based access to patient health information from the patient's provider network— was developed as a step toward alleviating some of the barriers to sharing information between different EHRs. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) legislation will introduce a new payment model in 2017 that is partially based on EHR utilization. Therefore, more research should be done to understand EHR adoption and how this ruling will affect providers in Hawai‘i. PMID:28435756

"It's like texting at the dinner table": A qualitative analysis of the impact of electronic health records on patient-physician interaction in hospitals.

PubMed

Pelland, Kimberly D; Baier, Rosa R; Gardner, Rebekah L

2017-06-30

nBACKGROUND: Electronic health records (EHRs) may reduce medical errors and improve care, but can complicate clinical encounters. To describe hospital-based physicians' perceptions of the impact of EHRs on patient-physician interactions and contrast these findings against office-based physicians' perceptionsMethods: We performed a qualitative analysis of comments submitted in response to the 2014 Rhode Island Health Information Technology Survey. Office- and hospital-based physicians licensed in Rhode Island, in active practice, and located in Rhode Island or neighboring states completed the survey about their Electronic Health Record use. The survey's response rate was 68.3% and 2,236 (87.1%) respondents had EHRs. Among survey respondents, 27.3% of hospital-based and 37.8% of office-based physicians with EHRs responded to the question about patient interaction. Five main themes emerged for hospital-based physicians, with respondents generally perceiving EHRs as negatively altering patient interactions. We noted the same five themes among office-based physicians, but the rank-order of the top two responses differed by setting: hospital-based physicians commented most frequently that they spend less time with patients because they have to spend more time on computers; office-based physicians commented most frequently on EHRs worsening the quality of their interactions and relationships with patients. In our analysis of a large sample of physicians, hospital-based physicians generally perceived EHRs as negatively altering patient interactions, although they emphasized different reasons than their office-based counterparts. These findings add to the prior literature, which focuses on outpatient physicians, and can shape interventions to improve how EHRs are used in inpatient settings.

Identifying Barriers in the Use of Electronic Health Records in Hawai'i.

PubMed

Hamamura, Faith D; Withy, Kelley; Hughes, Kira

2017-03-01

Hawai'i faces unique challenges to Electronic Health Record (EHR) adoption due to physician shortages, a widespread distribution of Medically Underserved Areas and Populations (MUA/P), and a higher percentage of small independent practices. However, research on EHR adoption in Hawai'i is limited. To address this gap, this article examines the current state of EHR in Hawai'i, the barriers to adoption, and the future of Health Information Technology (HIT) initiatives to improve the health of Hawai'i's people. Eight focus groups were conducted on Lana'i, Maui, Hawai'i Island, Kaua'i, Moloka'i, and O'ahu. In these groups, a total of 51 diverse health professionals were asked about the functionality of EHR systems, barriers to use, facilitators of use, and what EHRs would look like in a perfect world. Responses were summarized and analyzed based on constant comparative analysis techniques. Responses were then clustered into thirteen themes: system compatibility, loss of productivity, poor interface, IT support, hardware/software, patient factors, education/training, noise in the system, safety, data quality concerns, quality metrics, workflow, and malpractice concerns. Results show that every group mentioned system compatibility. In response to these findings, the Health eNet Community Health Record initiative - which allows providers web-based access to patient health information from the patient's provider network- was developed as a step toward alleviating some of the barriers to sharing information between different EHRs. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) legislation will introduce a new payment model in 2017 that is partially based on EHR utilization. Therefore, more research should be done to understand EHR adoption and how this ruling will affect providers in Hawai'i.

Cross-vendor evaluation of key user-defined clinical decision support capabilities: a scenario-based assessment of certified electronic health records with guidelines for future development

PubMed Central

Wright, Adam; Sittig, Dean F

2015-01-01

Objective Clinical decision support (CDS) is essential for delivery of high-quality, cost-effective, and safe healthcare. The authors sought to evaluate the CDS capabilities across electronic health record (EHR) systems. Methods We evaluated the CDS implementation capabilities of 8 Office of the National Coordinator for Health Information Technology Authorized Certification Body (ONC-ACB)-certified EHRs. Within each EHR, the authors attempted to implement 3 user-defined rules that utilized the various data and logic elements expected of typical EHRs and that represented clinically important evidenced-based care. The rules were: 1) if a patient has amiodarone on his or her active medication list and does not have a thyroid-stimulating hormone (TSH) result recorded in the last 12 months, suggest ordering a TSH; 2) if a patient has a hemoglobin A1c result >7% and does not have diabetes on his or her problem list, suggest adding diabetes to the problem list; and 3) if a patient has coronary artery disease on his or her problem list and does not have aspirin on the active medication list, suggest ordering aspirin. Results Most evaluated EHRs lacked some CDS capabilities; 5 EHRs were able to implement all 3 rules, and the remaining 3 EHRs were unable to implement any of the rules. One of these did not allow users to customize CDS rules at all. The most frequently found shortcomings included the inability to use laboratory test results in rules, limit rules by time, use advanced Boolean logic, perform actions from the alert interface, and adequately test rules. Conclusion Significant improvements in the EHR certification and implementation procedures are necessary. PMID:26104739

Electronic health records in four community physician practices: impact on quality and cost of care.

PubMed

Welch, W Pete; Bazarko, Dawn; Ritten, Kimberly; Burgess, Yo; Harmon, Robert; Sandy, Lewis G

2007-01-01

To assess the impact of the electronic health record (EHR) on cost (i.e., payments to providers) and process measures of quality of care. Retrospective before-after-study-control. From the database of a large managed care organization (MCO), we obtained the claims of patients from four community physician practices that implemented the EHR and from about 50 comparison practices without the EHR in the same counties. The diverse patient and practice populations were chosen to be a sample more representative of typical private practices than has previously been studied. For four chronic conditions, we used commercially-available software to analyze cost per episode over a year and the rate of adherence to clinical guidelines as a measure of quality. The implementation of the EHR had a modest positive impact on the quality measure of guideline adherence for hypertension and hyperlipidemia, but no significant impact for diabetes and coronary artery disease. No measurable impact on the short-term cost per episode was found. Discussions with the study practices revealed that the timing and comprehensiveness of EHR implementation varied across practices, creating an intervention variable that was heterogeneous. Guideline adherence increased across practices without EHRs and slightly faster in practices with EHRs. Measuring the impact of EHRs on cost per episode was challenging, because of the difficulty of completely capturing the long-term episodic costs of a chronic condition. Few practices associated with the study MCO had implemented EHRs in any form, much less utilizing standardized protocols.

The long-term financial impact of electronic health record implementation.

PubMed

Howley, Michael J; Chou, Edgar Y; Hansen, Nancy; Dalrymple, Prudence W

2015-03-01

To examine the financial impact of electronic health record (EHR) implementation on ambulatory practices. We tracked the practice productivity (ie, number of patient visits) and reimbursement of 30 ambulatory practices for 2 years after EHR implementation and compared each practice to their pre-EHR implementation baseline. Reimbursements significantly increased after EHR implementation even though practice productivity (ie, the number of patient visits) decreased over the 2-year observation period. We saw no evidence of upcoding or increased reimbursement rates to explain the increased revenues. Instead, they were associated with an increase in ancillary office procedures (eg, drawing blood, immunizations, wound care, ultrasounds). The bottom line result-that EHR implementation is associated with increased revenues-is reassuring and offers a basis for further EHR investment. While the productivity losses are consistent with field reports, they also reflect a type of efficiency-the practices are receiving more reimbursement for fewer seeing patients. For the practices still seeing fewer patients after 2 years, the solution likely involves advancing their EHR functionality to include analytics. Although they may still see fewer patients, with EHR analytics, they can focus on seeing the right patients. Practice reimbursements increased after EHR implementation, but there was a long-term decrease in the number of patient visits seen in this ambulatory practice context. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

42 CFR 495.6 - Meaningful use objectives and measures for EPs, eligible hospitals, and CAHs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM General Provisions § 495.6 Meaningful use objectives and... their first payment year. For Medicaid EPs who adopt, implement, or upgrade certified EHR technology in... first payment year. (4) Flexible options for using certified EHR technology in 2014. For an EHR...

Meaningful Use of School Health Data

ERIC Educational Resources Information Center

Johnson, Kathleen Hoy; Bergren, Martha Dewey

2011-01-01

Meaningful use (MU) of Electronic Health Records (EHRs) is an important development in the safety and security of health care delivery in the United States. Advancement in the use of EHRs occurred with the passage of the American Recovery and Reinvestment Act of 2009, which provides incentives for providers to support adoption and use of EHRs.…

Using the landmark method for creating prediction models in large datasets derived from electronic health records.

PubMed

Wells, Brian J; Chagin, Kevin M; Li, Liang; Hu, Bo; Yu, Changhong; Kattan, Michael W

2015-03-01

With the integration of electronic health records (EHRs), health data has become easily accessible and abounded. The EHR has the potential to provide important healthcare information to researchers by creating study cohorts. However, accessing this information comes with three major issues: 1) Predictor variables often change over time, 2) Patients have various lengths of follow up within the EHR, and 3) the size of the EHR data can be computationally challenging. Landmark analyses provide a perfect complement to EHR data and help to alleviate these three issues. We present two examples that utilize patient birthdays as landmark times for creating dynamic datasets for predicting clinical outcomes. The use of landmark times help to solve these three issues by incorporating information that changes over time, by creating unbiased reference points that are not related to a patient's exposure within the EHR, and reducing the size of a dataset compared to true time-varying analysis. These techniques are shown using two example cohort studies from the Cleveland Clinic that utilized 4.5 million and 17,787 unique patients, respectively.

Barriers to comparing the usability of electronic health records.

PubMed

Ratwani, Raj M; Hettinger, A Zachary; Fairbanks, Rollin J

2017-04-01

Despite the widespread adoption of electronic health records (EHRs), usability of many EHRs continues to be suboptimal, with some vendors failing to meet usability standards, resulting in clinician frustration and patient safety hazards. In an effort to increase EHR vendor competition on usability, recommendations have been made and legislation drafted to develop comparison tools that would allow purchasers to better understand the usability of EHR products prior to purchase. Usability comparison can be based on EHR vendor design and development processes, vendor usability testing as part of the Office of the National Coordinator for Health Information Technology certification program, and usability of implemented products. Barriers exist within the current certified health technology program that prevent effective comparison of usability during each of these stages. We describe the importance of providing purchasers with improved information about EHR usability, barriers to making usability comparisons, and solutions to overcome these barriers. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A qualitative study of Swedes' opinions about shared electronic health records.

PubMed

Lehnbom, Elin C; McLachlan, Andrew J; Brien, Jo-anne E

2013-01-01

European countries are world-leading in the development and implementation of e-Health. In Sweden, all primary healthcare centres and most hospitals use digital records. Some regions use the same software which allows for clinical information to be shared (regionally shared EHRs), but there is a movement towards making all EHRs inter-operable to allow for a National Patient Summary (NPS). The aim of this study was to explore the opinions of Swedish consumers and health professionals about shared EHRs and the NPS. Semi-structered phone interviews were conducted with consumers and health professionals. The majority of interviewed health professionals were currently using regionally shared EHRs. In their experience, having access to regionally shared EHRs facilitated a holistic patient approach, assisted in patient follow-up, and reduced inappropriate (over)prescribing. Consumers had a poor level of knowledge about shared EHRs and the NPS. Unlike health professionals, consumers perceived a NPS to be of great value. The findings indicate that there was a discrepancy between health professionals and consumers' knowledge of, and the perceived need for, a NPS.

Estimating Wisconsin asthma prevalence using clinical electronic health records and public health data.

PubMed

Tomasallo, Carrie D; Hanrahan, Lawrence P; Tandias, Aman; Chang, Timothy S; Cowan, Kelly J; Guilbert, Theresa W

2014-01-01

We compared a statewide telephone health survey with electronic health record (EHR) data from a large Wisconsin health system to estimate asthma prevalence in Wisconsin. We developed frequency tables and logistic regression models using Wisconsin Behavioral Risk Factor Surveillance System and University of Wisconsin primary care clinic data. We compared adjusted odds ratios (AORs) from each model. Between 2007 and 2009, the EHR database contained 376,000 patients (30,000 with asthma), and 23,000 (1850 with asthma) responded to the Behavioral Risk Factor Surveillance System telephone survey. AORs for asthma were similar in magnitude and direction for the majority of covariates, including gender, age, and race/ethnicity, between survey and EHR models. The EHR data had greater statistical power to detect associations than did survey data, especially in pediatric and ethnic populations, because of larger sample sizes. EHRs can be used to estimate asthma prevalence in Wisconsin adults and children. EHR data may improve public health chronic disease surveillance using high-quality data at the local level to better identify areas of disparity and risk factors and guide education and health care interventions.

Electronic Health Record-Related Safety Concerns: A Cross-Sectional Survey of Electronic Health Record Users

PubMed Central

Pajunen, Tuuli; Saranto, Kaija; Lehtonen, Lasse

2016-01-01

Background The rapid expansion in the use of electronic health records (EHR) has increased the number of medical errors originating in health information systems (HIS). The sociotechnical approach helps in understanding risks in the development, implementation, and use of EHR and health information technology (HIT) while accounting for complex interactions of technology within the health care system. Objective This study addresses two important questions: (1) “which of the common EHR error types are associated with perceived high- and extreme-risk severity ratings among EHR users?”, and (2) “which variables are associated with high- and extreme-risk severity ratings?” Methods This study was a quantitative, non-experimental, descriptive study of EHR users. We conducted a cross-sectional web-based questionnaire study at the largest hospital district in Finland. Statistical tests included the reliability of the summative scales tested with Cronbach’s alpha. Logistic regression served to assess the association of the independent variables to each of the eight risk factors examined. Results A total of 2864 eligible respondents provided the final data. Almost half of the respondents reported a high level of risk related to the error type “extended EHR unavailability”. The lowest overall risk level was associated with “selecting incorrectly from a list of items”. In multivariate analyses, profession and clinical unit proved to be the strongest predictors for high perceived risk. Physicians perceived risk levels to be the highest (P<.001 in six of eight error types), while emergency departments, operating rooms, and procedure units were associated with higher perceived risk levels (P<.001 in four of eight error types). Previous participation in eLearning courses on EHR-use was associated with lower risk for some of the risk factors. Conclusions Based on a large number of Finnish EHR users in hospitals, this study indicates that HIT safety hazards should be taken very seriously, particularly in operating rooms, procedure units, emergency departments, and intensive care units/critical care units. Health care organizations should use proactive and systematic assessments of EHR risks before harmful events occur. An EHR training program should be compulsory for all EHR users in order to address EHR safety concerns resulting from the failure to use HIT appropriately. PMID:27154599

Return on Investment in Electronic Health Records in Primary Care Practices: A Mixed-Methods Study

PubMed Central

Sanche, Steven

2014-01-01

Background The use of electronic health records (EHR) in clinical settings is considered pivotal to a patient-centered health care delivery system. However, uncertainty in cost recovery from EHR investments remains a significant concern in primary care practices. Objective Guided by the question of “When implemented in primary care practices, what will be the return on investment (ROI) from an EHR implementation?”, the objectives of this study are two-fold: (1) to assess ROI from EHR in primary care practices and (2) to identify principal factors affecting the realization of positive ROI from EHR. We used a break-even point, that is, the time required to achieve cost recovery from an EHR investment, as an ROI indicator of an EHR investment. Methods Given the complexity exhibited by most EHR implementation projects, this study adopted a retrospective mixed-method research approach, particularly a multiphase study design approach. For this study, data were collected from community-based primary care clinics using EHR systems. Results We collected data from 17 primary care clinics using EHR systems. Our data show that the sampled primary care clinics recovered their EHR investments within an average period of 10 months (95% CI 6.2-17.4 months), seeing more patients with an average increase of 27% in the active-patients-to-clinician-FTE (full time equivalent) ratio and an average increase of 10% in the active-patients-to-clinical-support-staff-FTE ratio after an EHR implementation. Our analysis suggests, with a 95% confidence level, that the increase in the number of active patients (P=.006), the increase in the active-patients-to-clinician-FTE ratio (P<.001), and the increase in the clinic net revenue (P<.001) are positively associated with the EHR implementation, likely contributing substantially to an average break-even point of 10 months. Conclusions We found that primary care clinics can realize a positive ROI with EHR. Our analysis of the variances in the time required to achieve cost recovery from EHR investments suggests that a positive ROI does not appear automatically upon implementing an EHR and that a clinic’s ability to leverage EHR for process changes seems to play a role. Policies that provide support to help primary care practices successfully make EHR-enabled changes, such as support of clinic workflow optimization with an EHR system, could facilitate the realization of positive ROI from EHR in primary care practices. PMID:25600508

Impact of an electronic health record operating room management system in ophthalmology on documentation time, surgical volume, and staffing.

PubMed

Sanders, David S; Read-Brown, Sarah; Tu, Daniel C; Lambert, William E; Choi, Dongseok; Almario, Bella M; Yackel, Thomas R; Brown, Anna S; Chiang, Michael F

2014-05-01

Although electronic health record (EHR) systems have potential benefits, such as improved safety and quality of care, most ophthalmology practices in the United States have not adopted these systems. Concerns persist regarding potential negative impacts on clinical workflow. In particular, the impact of EHR operating room (OR) management systems on clinical efficiency in the ophthalmic surgery setting is unknown. To determine the impact of an EHR OR management system on intraoperative nursing documentation time, surgical volume, and staffing requirements. For documentation time and circulating nurses per procedure, a prospective cohort design was used between January 10, 2012, and January 10, 2013. For surgical volume and overall staffing requirements, a case series design was used between January 29, 2011, and January 28, 2013. This study involved ophthalmic OR nurses (n = 13) and surgeons (n = 25) at an academic medical center. Electronic health record OR management system implementation. (1) Documentation time (percentage of operating time documenting [POTD], absolute documentation time in minutes), (2) surgical volume (procedures/time), and (3) staffing requirements (full-time equivalents, circulating nurses/procedure). Outcomes were measured during a baseline period when paper documentation was used and during the early (first 3 months) and late (4-12 months) periods after EHR implementation. There was a worsening in total POTD in the early EHR period (83%) vs paper baseline (41%) (P < .001). This improved to baseline levels by the late EHR period (46%, P = .28), although POTD in the cataract group remained worse than at baseline (64%, P < .001). There was a worsening in absolute mean documentation time in the early EHR period (16.7 minutes) vs paper baseline (7.5 minutes) (P < .001). This improved in the late EHR period (9.2 minutes) but remained worse than in the paper baseline (P < .001). While cataract procedures required more circulating nurses in the early EHR (mean, 1.9 nurses/procedure) and late EHR (mean, 1.5 nurses/procedure) periods than in the paper baseline (mean, 1.0 nurses/procedure) (P < .001), overall staffing requirements and surgical volume were not significantly different between the periods. Electronic health record OR management system implementation was associated with worsening of intraoperative nursing documentation time especially in shorter procedures. However, it is possible to implement an EHR OR management system without serious negative impacts on surgical volume and staffing requirements.

The influence of institutional pressures on hospital electronic health record presence.

PubMed

Fareed, Naleef; Bazzoli, Gloria J; Farnsworth Mick, Stephen S; Harless, David W

2015-05-01

Electronic health records (EHR) are a promising form of health information technology that could help US hospitals improve on their quality of care and costs. During the study period explored (2005-2009), high expectations for EHR diffused across institutional stakeholders in the healthcare environment, which may have pressured hospitals to have EHR capabilities even in the presence of weak technical rationale for the technology. Using an extensive set of organizational theory-specific predictors, this study explored whether five factors - cause, constituents, content, context, and control - that reflect the nature of institutional pressures for EHR capabilities motivated hospitals to comply with these pressures. Using information from several national data bases, an ordered probit regression model was estimated. The resulting predicted probabilities of EHR capabilities from the empirical model's estimates were used to test the study's five hypotheses, of which three were supported. When the underlying cause, dependence on constituents, or influence of control were high and potential countervailing forces were low, hospitals were more likely to employ strategic responses that were compliant with the institutional pressures for EHR capabilities. In light of these pressures, hospitals may have acquiesced, by having comprehensive EHR capabilities, or compromised, by having intermediate EHR capabilities, in order to maintain legitimacy in their environment. The study underscores the importance of our assessment for theory and policy development, and provides suggestions for future research. Copyright © 2015 Elsevier Ltd. All rights reserved.

Leveraging electronic health records for clinical research.

PubMed

Raman, Sudha R; Curtis, Lesley H; Temple, Robert; Andersson, Tomas; Ezekowitz, Justin; Ford, Ian; James, Stefan; Marsolo, Keith; Mirhaji, Parsa; Rocca, Mitra; Rothman, Russell L; Sethuraman, Barathi; Stockbridge, Norman; Terry, Sharon; Wasserman, Scott M; Peterson, Eric D; Hernandez, Adrian F

2018-04-30

Electronic health records (EHRs) can be a major tool in the quest to decrease costs and timelines of clinical trial research, generate better evidence for clinical decision making, and advance health care. Over the past decade, EHRs have increasingly offered opportunities to speed up, streamline, and enhance clinical research. EHRs offer a wide range of possible uses in clinical trials, including assisting with prestudy feasibility assessment, patient recruitment, and data capture in care delivery. To fully appreciate these opportunities, health care stakeholders must come together to face critical challenges in leveraging EHR data, including data quality/completeness, information security, stakeholder engagement, and increasing the scale of research infrastructure and related governance. Leaders from academia, government, industry, and professional societies representing patient, provider, researcher, industry, and regulator perspectives convened the Leveraging EHR for Clinical Research Now! Think Tank in Washington, DC (February 18-19, 2016), to identify barriers to using EHRs in clinical research and to generate potential solutions. Think tank members identified a broad range of issues surrounding the use of EHRs in research and proposed a variety of solutions. Recognizing the challenges, the participants identified the urgent need to look more deeply at previous efforts to use these data, share lessons learned, and develop a multidisciplinary agenda for best practices for using EHRs in clinical research. We report the proceedings from this think tank meeting in the following paper. Copyright © 2018 Elsevier, Inc. All rights reserved.

Real-time database drawn from an electronic health record for a thoracic surgery unit: high-quality clinical data saving time and human resources.

PubMed

Salati, Michele; Pompili, Cecilia; Refai, Majed; Xiumè, Francesco; Sabbatini, Armando; Brunelli, Alessandro

2014-06-01

The aim of the present study was to verify whether the implementation of an electronic health record (EHR) in our thoracic surgery unit allows creation of a high-quality clinical database saving time and costs. Before August 2011, multiple individuals compiled the on-paper documents/records and a single data manager inputted selected data into the database (traditional database, tDB). Since the adoption of an EHR in August 2011, multiple individuals have been responsible for compiling the EHR, which automatically generates a real-time database (EHR-based database, eDB), without the need for a data manager. During the initial period of implementation of the EHR, periodic meetings were held with all physicians involved in the use of the EHR in order to monitor and standardize the data registration process. Data quality of the first 100 anatomical lung resections recorded in the eDB was assessed by measuring the total number of missing values (MVs: existing non-reported value) and inaccurate values (wrong data) occurring in 95 core variables. The average MV of the eDB was compared with the one occurring in the same variables of the last 100 records registered in the tDB. A learning curve was constructed by plotting the number of MVs in the electronic database and tDB with the patients arranged by the date of registration. The tDB and eDB had similar MVs (0.74 vs 1, P = 0.13). The learning curve showed an initial phase including about 35 records, where MV in the eDB was higher than that in the tDB (1.9 vs 0.74, P = 0.03), and a subsequent phase, where the MV was similar in the two databases (0.7 vs 0.74, P = 0.6). The inaccuracy rate of these two phases in the eDB was stable (0.5 vs 0.3, P = 0.3). Using EHR saved an average of 9 min per patient, totalling 15 h saved for obtaining a dataset of 100 patients with respect to the tDB. The implementation of EHR allowed streamlining the process of clinical data recording. It saved time and human resource costs, without compromising the quality of data. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

The Association of Electronic Health Record Adoption with Staffing Mix in Community Health Centers.

PubMed

Frogner, Bianca K; Wu, Xiaoli; Park, Jeongyoung; Pittman, Patricia

2017-02-01

To assess how medical staffing mix changed over time in association with the adoption of electronic health records (EHRs) in community health centers (CHCs). Community health centers within the 50 states and Washington, DC. Estimated how the change in the share of total medical staff full-time equivalents (FTE) by provider category between 2007 and 2013 was associated with EHR adoption using fractional multinomial logit. 2007-2013 Uniform Data System, an administrative data set of Section 330 federal grant recipients; and Readiness for Meaningful Use and HIT and Patient Centered Medical Home Recognition Survey responses collected from Section 330 recipients between December 2010 and February 2011. Having an EHR system did significantly shift the share of workers over time between physicians and each of the other categories of health care workers. While an EHR system significantly shifted the share of physician and other medical staff, this effect did not significantly vary over time. CHCs with EHRs by the end of the study period had a relatively greater proportion of other medical staff compared to the proportion of physicians. Electronic health records appeared to influence staffing allocation in CHCs such that other medical staff may be used to support adoption of EHRs as well as be leveraged as an important care provider. © Health Research and Educational Trust.

Open source electronic health records and chronic disease management.

PubMed

Goldwater, Jason C; Kwon, Nancy J; Nathanson, Ashley; Muckle, Alison E; Brown, Alexa; Cornejo, Kerri

2014-02-01

To study and report on the use of open source electronic health records (EHR) to assist with chronic care management within safety net medical settings, such as community health centers (CHC). The study was conducted by NORC at the University of Chicago from April to September 2010. The NORC team undertook a comprehensive environmental scan, including a literature review, a dozen key informant interviews using a semistructured protocol, and a series of site visits to CHC that currently use an open source EHR. Two of the sites chosen by NORC were actively using an open source EHR to assist in the redesign of their care delivery system to support more effective chronic disease management. This included incorporating the chronic care model into an CHC and using the EHR to help facilitate its elements, such as care teams for patients, in addition to maintaining health records on indigent populations, such as tuberculosis status on homeless patients. The ability to modify the open-source EHR to adapt to the CHC environment and leverage the ecosystem of providers and users to assist in this process provided significant advantages in chronic care management. Improvements in diabetes management, controlled hypertension and increases in tuberculosis vaccinations were assisted through the use of these open source systems. The flexibility and adaptability of open source EHR demonstrated its utility and viability in the provision of necessary and needed chronic disease care among populations served by CHC.

Analysis and evaluation of the Electronic Health Record standard in China: a comparison with the American national standard ASTM E 1384.

PubMed

Xu, Wei; Guan, Zhiyu; Cao, Hongxin; Zhang, Haiyan; Lu, Min; Li, Tiejun

2011-08-01

To analyze and evaluate the newly issued Electronic Health Record (EHR) Architecture and Data Standard of China (Chinese EHR Standard) and identify areas of improvement for future revisions. We compared the Chinese EHR Standard with the standard of the American Society for Testing and Materials Standard Practice for Content and Structure of Electronic Health Records in the United States (ASTM E 1384 Standard). The comparison comprised two steps: (1) comparing the conformance of the two standards to the international standard: Health Informatics-Requirements for an Electronic Health Record Architecture (ISO/TS 18308), and showing how the architectures of the two standards satisfy or deviate from the ISO requirements and (2) comparing the detailed data structures between the two standards. Of the 124 requirement items in ISO/TS 18308, the Chinese EHR Standard and the ASTM E 1384 Standard conformed to 77 (62.1%) and 111 (89.5%), respectively. The Chinese EHR Standard conformed to 34 of 50 Structure requirements (68.0%), 22 of 24 Process requirements (91.7%), and 21 of 50 Other requirements (42.0%). The ASTM E 1384 Standard conformed to 49 of 50 Structure requirements (98.0%), 23 of 24 Process requirements (95.8%), and 39 of 40 Other requirements (78.0%). Further development of the Chinese EHR Standard should focus on supporting privacy and security mechanism, diverse data types, more generic and extensible lower level data structures, and relational attributes for data elements. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Hospital Electronic Health Record Adoption and Its Influence on Postoperative Sepsis

ERIC Educational Resources Information Center

Fareed, Naleef

2013-01-01

Electronic Health Record (EHR) systems could make healthcare delivery safer by providing benefits such as timely access to accurate and complete patient information, advances in diagnosis and coordination of care, and enhancements for monitoring patient vitals. This study explored the nature of EHR adoption in U.S. hospitals and their patient…

Facilitating Ambulatory Electronic Health Record System Implementation: Evidence from a Qualitative Study

PubMed Central

Hefner, Jennifer; Robbins, Julie; Huerta, Timothy R.

2013-01-01

Background. Ambulatory care practices have increasing interest in leveraging the capabilities of electronic health record (EHR) systems, but little information is available documenting how organizations have successfully implemented these systems. Objective. To characterize elements of successful electronic health record (EHR) system implementation and to synthesize the key informants' perspectives about successful implementation practices. Methods. Key informant interviews and focus groups were conducted with a purposive sample of individuals from US healthcare organizations identified for their success with ambulatory EHR implementation. Rigorous qualitative data analyses used both deductive and inductive methods. Results. Participants identified personal and system-related barriers, at both the individual and organization levels, including poor computer skills, productivity losses, resistance to change, and EHR system failure. Implementation success was reportedly facilitated by careful planning and consistent communication throughout distinct stages of the implementation process. A significant element of successful implementation was an emphasis on optimization, both during “go-live” and, subsequently, when users had more experience with the system. Conclusion. Successful EHR implementation requires both detailed planning and clear mechanisms to deal with unforeseen or unintended consequences. Focusing on user buy-in early and including plans for optimization can facilitate greater success. PMID:24228257

Patient and Public Views on Electronic Health Records and Their Uses in the United Kingdom: Cross-Sectional Survey

PubMed Central

Luchenski, Serena A; Reed, Julie E; Marston, Cicely; Papoutsi, Chrysanthi; Majeed, Azeem

2013-01-01

Background The development and implementation of electronic health records (EHRs) remains an international challenge. Better understanding of patient and public attitudes and the factors that influence overall levels of support toward EHRs is needed to inform policy. Objective To explore patient and public attitudes toward integrated EHRs used simultaneously for health care provision, planning and policy, and health research. Methods Cross-sectional questionnaire survey administered to patients and members of the public who were recruited from a stratified cluster random sample of 8 outpatient clinics of a major teaching hospital and 8 general practices in London (United Kingdom). Results 5331 patients and members of the public responded to the survey, with 2857 providing complete data for the analysis presented here. There were moderately high levels of support for integrated EHRs used simultaneously for health care provision, planning and policy, and health research (1785/2857, 62.47%), while 27.93% (798/2857) of participants reported being undecided about whether or not they would support EHR use. There were higher levels of support for specific uses of EHRs. Most participants were in favor of EHRs for personal health care provision (2563/2857, 89.71%), with 66.75% (1907/2857) stating that they would prefer their complete, rather than limited, medical history to be included. Of those “undecided” about integrated EHRs, 87.2% (696/798) were nevertheless in favor of sharing their full (373/798, 46.7%) or limited (323/798, 40.5%) records for health provision purposes. There were similar high levels of support for use of EHRs in health services policy and planning (2274/2857, 79.59%) and research (2325/2857, 81.38%), although 59.75% (1707/2857) and 67.10% (1917/2857) of respondents respectively would prefer their personal identifiers to be removed. Multivariable analysis showed levels of overall support for EHRs decreasing with age. Respondents self-identifying as Black British were more likely to report being undecided or unsupportive of national EHRs. Frequent health services users were more likely to report being supportive than undecided. Conclusions Despite previous difficulties with National Health Service (NHS) technology projects, patients and the public generally support the development of integrated EHRs for health care provision, planning and policy, and health research. This support, however, varies between social groups and is not unqualified; relevant safeguards must be in place and patients should be guided in their decision-making process, including increased awareness about the benefits of EHRs for secondary uses. PMID:23975239

Patient and public views on electronic health records and their uses in the United kingdom: cross-sectional survey.

PubMed

Luchenski, Serena A; Reed, Julie E; Marston, Cicely; Papoutsi, Chrysanthi; Majeed, Azeem; Bell, Derek

2013-08-23

The development and implementation of electronic health records (EHRs) remains an international challenge. Better understanding of patient and public attitudes and the factors that influence overall levels of support toward EHRs is needed to inform policy. To explore patient and public attitudes toward integrated EHRs used simultaneously for health care provision, planning and policy, and health research. Cross-sectional questionnaire survey administered to patients and members of the public who were recruited from a stratified cluster random sample of 8 outpatient clinics of a major teaching hospital and 8 general practices in London (United Kingdom). 5331 patients and members of the public responded to the survey, with 2857 providing complete data for the analysis presented here. There were moderately high levels of support for integrated EHRs used simultaneously for health care provision, planning and policy, and health research (1785/2857, 62.47%), while 27.93% (798/2857) of participants reported being undecided about whether or not they would support EHR use. There were higher levels of support for specific uses of EHRs. Most participants were in favor of EHRs for personal health care provision (2563/2857, 89.71%), with 66.75% (1907/2857) stating that they would prefer their complete, rather than limited, medical history to be included. Of those "undecided" about integrated EHRs, 87.2% (696/798) were nevertheless in favor of sharing their full (373/798, 46.7%) or limited (323/798, 40.5%) records for health provision purposes. There were similar high levels of support for use of EHRs in health services policy and planning (2274/2857, 79.59%) and research (2325/2857, 81.38%), although 59.75% (1707/2857) and 67.10% (1917/2857) of respondents respectively would prefer their personal identifiers to be removed. Multivariable analysis showed levels of overall support for EHRs decreasing with age. Respondents self-identifying as Black British were more likely to report being undecided or unsupportive of national EHRs. Frequent health services users were more likely to report being supportive than undecided. Despite previous difficulties with National Health Service (NHS) technology projects, patients and the public generally support the development of integrated EHRs for health care provision, planning and policy, and health research. This support, however, varies between social groups and is not unqualified; relevant safeguards must be in place and patients should be guided in their decision-making process, including increased awareness about the benefits of EHRs for secondary uses.

Electronic health record adoption in US hospitals: the emergence of a digital "advanced use" divide.

PubMed

Adler-Milstein, Julia; Holmgren, A Jay; Kralovec, Peter; Worzala, Chantal; Searcy, Talisha; Patel, Vaishali

2017-11-01

While most hospitals have adopted electronic health records (EHRs), we know little about whether hospitals use EHRs in advanced ways that are critical to improving outcomes, and whether hospitals with fewer resources - small, rural, safety-net - are keeping up. Using 2008-2015 American Hospital Association Information Technology Supplement survey data, we measured "basic" and "comprehensive" EHR adoption among hospitals to provide the latest national numbers. We then used new supplement questions to assess advanced use of EHRs and EHR data for performance measurement and patient engagement functions. To assess a digital "advanced use" divide, we ran logistic regression models to identify hospital characteristics associated with high adoption in each advanced use domain. We found that 80.5% of hospitals adopted at least a basic EHR system, a 5.3 percentage point increase from 2014. Only 37.5% of hospitals adopted at least 8 (of 10) EHR data for performance measurement functions, and 41.7% of hospitals adopted at least 8 (of 10) patient engagement functions. Critical access hospitals were less likely to have adopted at least 8 performance measurement functions (odds ratio [OR] = 0.58; P < .001) and at least 8 patient engagement functions (OR = 0.68; P = 0.02). While the Health Information Technology for Economic and Clinical Health Act resulted in widespread hospital EHR adoption, use of advanced EHR functions lags and a digital divide appears to be emerging, with critical-access hospitals in particular lagging behind. This is concerning, because EHR-enabled performance measurement and patient engagement are key contributors to improving hospital performance. Hospital EHR adoption is widespread and many hospitals are using EHRs to support performance measurement and patient engagement. However, this is not happening across all hospitals. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Eliciting end-user expectations to guide the implementation process of a new electronic health record: A case study using concept mapping.

PubMed

Joukes, Erik; Cornet, Ronald; de Bruijne, Martine C; de Keizer, Nicolette F

2016-03-01

To evaluate the usability of concept mapping to elicit the expectations of healthcare professionals regarding the implementation of a new electronic health record (EHR). These expectations need to be taken into account during the implementation process to maximize the chance of success of the EHR. Two university hospitals in Amsterdam, The Netherlands, in the preparation phase of jointly implementing a new EHR. During this study the hospitals had different methods of documenting patient information (legacy EHR vs. paper-based records). Concept mapping was used to determine and classify the expectations of healthcare professionals regarding the implementation of a new EHR. A multidisciplinary group of 46 healthcare professionals from both university hospitals participated in this study. Expectations were elicited in focus groups, their relevance and feasibility were assessed through a web-questionnaire. Nonmetric multidimensional scaling and clustering methods were used to identify clusters of expectations. We found nine clusters of expectations, each covering an important topic to enable the healthcare professionals to work properly with the new EHR once implemented: usability, data use and reuse, facility conditions, data registration, support, training, internal communication, patients, and collaboration. Average importance and feasibility of each of the clusters was high. Concept mapping is an effective method to find topics that, according to healthcare professionals, are important to consider during the implementation of a new EHR. The method helps to combine the input of a large group of stakeholders at limited efforts. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Comprehensive electronic medical record implementation levels not associated with 30-day all-cause readmissions within Medicare beneficiaries with heart failure.

PubMed

Patterson, M E; Marken, P; Zhong, Y; Simon, S D; Ketcherside, W

2014-01-01

Regulatory standards for 30-day readmissions incentivize hospitals to improve quality of care. Implementing comprehensive electronic health record systems potentially decreases readmission rates by improving medication reconciliation at discharge, demonstrating the additional benefits of inpatient EHRs beyond improved safety and decreased errors. To compare 30-day all-cause readmission incidence rates within Medicare fee-for-service with heart failure discharged from hospitals with full implementation levels of comprehensive EHR systems versus those without. This retrospective cohort study uses data from the American Hospital Association Health IT survey and Medicare Part A claims to measure associations between hospital EHR implementation levels and beneficiary readmissions. Multivariable Cox regressions estimate the hazard ratio of 30-day all-cause readmissions within beneficiaries discharged from hospitals implementing comprehensive EHRs versus those without, controlling for beneficiary health status and hospital organizational factors. Propensity scores are used to account for selection bias. The proportion of heart failure patients with 30-day all-cause readmissions was 30%, 29%, and 32% for those discharged from hospitals with full, some, and no comprehensive EHR systems. Heart failure patients discharged from hospitals with fully implemented comprehensive EHRs compared to those with no comprehensive EHR systems had equivalent 30-day readmission incidence rates (HR = 0.97, 95% CI 0.73 - 1.3). Implementation of comprehensive electronic health record systems does not necessarily improve a hospital's ability to decrease 30-day readmission rates. Improving the efficiency of post-acute care will require more coordination of information systems between inpatient and ambulatory providers.

Leveraging electronic health record documentation for Failure Mode and Effects Analysis team identification

PubMed Central

Carson, Matthew B; Lee, Young Ji; Benacka, Corrine; Mutharasan, R. Kannan; Ahmad, Faraz S; Kansal, Preeti; Yancy, Clyde W; Anderson, Allen S; Soulakis, Nicholas D

2017-01-01

Objective: Using Failure Mode and Effects Analysis (FMEA) as an example quality improvement approach, our objective was to evaluate whether secondary use of orders, forms, and notes recorded by the electronic health record (EHR) during daily practice can enhance the accuracy of process maps used to guide improvement. We examined discrepancies between expected and observed activities and individuals involved in a high-risk process and devised diagnostic measures for understanding discrepancies that may be used to inform quality improvement planning. Methods: Inpatient cardiology unit staff developed a process map of discharge from the unit. We matched activities and providers identified on the process map to EHR data. Using four diagnostic measures, we analyzed discrepancies between expectation and observation. Results: EHR data showed that 35% of activities were completed by unexpected providers, including providers from 12 categories not identified as part of the discharge workflow. The EHR also revealed sub-components of process activities not identified on the process map. Additional information from the EHR was used to revise the process map and show differences between expectation and observation. Conclusion: Findings suggest EHR data may reveal gaps in process maps used for quality improvement and identify characteristics about workflow activities that can identify perspectives for inclusion in an FMEA. Organizations with access to EHR data may be able to leverage clinical documentation to enhance process maps used for quality improvement. While focused on FMEA protocols, findings from this study may be applicable to other quality activities that require process maps. PMID:27589944

Advanced Proficiency EHR Training: Effect on Physicians’ EHR Efficiency, EHR Satisfaction and Job Satisfaction

PubMed Central

Dastagir, M. Tariq; Chin, Homer L.; McNamara, Michael; Poteraj, Kathy; Battaglini, Sarah; Alstot, Lauren

2012-01-01

The best way to train clinicians to optimize their use of the Electronic Health Record (EHR) remains unclear. Approaches range from web-based training, class-room training, EHR functionality training, case-based training, role-based training, process-based training, mock-clinic training and “on the job” training. Similarly, the optimal timing of training remains unclear--whether to engage in extensive pre go-live training vs. minimal pre go-live training followed by more extensive post go-live training. In addition, the effectiveness of non-clinician trainers, clinician trainers, and peer-trainers, remains unclearly defined. This paper describes a program in which relatively experienced clinician users of an EHR underwent an intensive 3-day Peer-Led EHR advanced proficiency training, and the results of that training based on participant surveys. It highlights the effectiveness of Peer-Led Proficiency Training of existing experienced clinician EHR users in improving self-reported efficiency and satisfaction with an EHR and improvements in perceived work-life balance and job satisfaction. PMID:23304282

Advanced proficiency EHR training: effect on physicians' EHR efficiency, EHR satisfaction and job satisfaction.

PubMed

Dastagir, M Tariq; Chin, Homer L; McNamara, Michael; Poteraj, Kathy; Battaglini, Sarah; Alstot, Lauren

2012-01-01

The best way to train clinicians to optimize their use of the Electronic Health Record (EHR) remains unclear. Approaches range from web-based training, class-room training, EHR functionality training, case-based training, role-based training, process-based training, mock-clinic training and "on the job" training. Similarly, the optimal timing of training remains unclear--whether to engage in extensive pre go-live training vs. minimal pre go-live training followed by more extensive post go-live training. In addition, the effectiveness of non-clinician trainers, clinician trainers, and peer-trainers, remains unclearly defined. This paper describes a program in which relatively experienced clinician users of an EHR underwent an intensive 3-day Peer-Led EHR advanced proficiency training, and the results of that training based on participant surveys. It highlights the effectiveness of Peer-Led Proficiency Training of existing experienced clinician EHR users in improving self-reported efficiency and satisfaction with an EHR and improvements in perceived work-life balance and job satisfaction.

The openEHR Java reference implementation project.

PubMed

Chen, Rong; Klein, Gunnar

2007-01-01

The openEHR foundation has developed an innovative design for interoperable and future-proof Electronic Health Record (EHR) systems based on a dual model approach with a stable reference information model complemented by archetypes for specific clinical purposes.A team from Sweden has implemented all the stable specifications in the Java programming language and donated the source code to the openEHR foundation. It was adopted as the openEHR Java Reference Implementation in March 2005 and released under open source licenses. This encourages early EHR implementation projects around the world and a number of groups have already started to use this code. The early Java implementation experience has also led to the publication of the openEHR Java Implementation Technology Specification. A number of design changes to the specifications and important minor corrections have been directly initiated by the implementation project over the last two years. The Java Implementation has been important for the validation and improvement of the openEHR design specifications and provides building blocks for future EHR systems.

Resilient Practices in Maintaining Safety of Health Information Technologies

PubMed Central

Ash, Joan S.; Sittig, Dean F.; Singh, Hardeep

2014-01-01

Electronic health record systems (EHRs) can improve safety and reliability of health care, but they can also introduce new vulnerabilities by failing to accommodate changes within a dynamic EHR-enabled health care system. Continuous assessment and improvement is thus essential for achieving resilience in EHR-enabled health care systems. Given the rapid adoption of EHRs by many organizations that are still early in their experiences with EHR safety, it is important to understand practices for maintaining resilience used by organizations with a track record of success in EHR use. We conducted interviews about safety practices with 56 key informants (including information technology managers, chief medical information officers, physicians, and patient safety officers) at two large health care systems recognized as leaders in EHR use. We identified 156 references to resilience-related practices from 41 informants. Framework analysis generated five categories of resilient practices: (a) sensitivity to dynamics and interdependencies affecting risks, (b) basic monitoring and responding practices, (c) management of practices and resources for monitoring and responding, (d) sensitivity to risks beyond the horizon, and (e) reflecting on risks with the safety and quality control process itself. The categories reflect three functions that facilitate resilience: reflection, transcending boundaries, and involving sharp-end practitioners in safety management. PMID:25866492

Developing Electronic Health Record (EHR) Strategies Related to Health Center Patients' Social Determinants of Health.

PubMed

Gold, Rachel; Cottrell, Erika; Bunce, Arwen; Middendorf, Mary; Hollombe, Celine; Cowburn, Stuart; Mahr, Peter; Melgar, Gerardo

2017-01-01

"Social determinants of heath" (SDHs) are nonclinical factors that profoundly affect health. Helping community health centers (CHCs) document patients' SDH data in electronic health records (EHRs) could yield substantial health benefits, but little has been reported about CHCs' development of EHR-based tools for SDH data collection and presentation. We worked with 27 diverse CHC stakeholders to develop strategies for optimizing SDH data collection and presentation in their EHR, and approaches for integrating SDH data collection and the use of those data (eg, through referrals to community resources) into CHC workflows. We iteratively developed a set of EHR-based SDH data collection, summary, and referral tools for CHCs. We describe considerations that arose while developing the tools and present some preliminary lessons learned. Standardizing SDH data collection and presentation in EHRs could lead to improved patient and population health outcomes in CHCs and other care settings. We know of no previous reports of processes used to develop similar tools. This article provides an example of 1 such process. Lessons from our process may be useful to health care organizations interested in using EHRs to collect and act on SDH data. Research is needed to empirically test the generalizability of these lessons. © Copyright 2017 by the American Board of Family Medicine.

The total cost of EHR ownership.

PubMed

Eastaugh, Steven R

2013-02-01

Consider total cost of ownership, not just initial cost of acquisition and annual maintenance, when reviewing electronic health record (EHR) system bids. Support costs--a key part of total cost of ownership--include FTEs dedicated to the system. The long-term costs of an EHR system can vary dramatically (up to 200 percent) depending on which system is selected.

Automated integration of continuous glucose monitor data in the electronic health record using consumer technology

PubMed Central

Kumar, Rajiv B; Goren, Nira D; Stark, David E; Wall, Dennis P; Longhurst, Christopher A

2016-01-01

The diabetes healthcare provider plays a key role in interpreting blood glucose trends, but few institutions have successfully integrated patient home glucose data in the electronic health record (EHR). Published implementations to date have required custom interfaces, which limit wide-scale replication. We piloted automated integration of continuous glucose monitor data in the EHR using widely available consumer technology for 10 pediatric patients with insulin-dependent diabetes. Establishment of a passive data communication bridge via a patient’s/parent’s smartphone enabled automated integration and analytics of patient device data within the EHR between scheduled clinic visits. It is feasible to utilize available consumer technology to assess and triage home diabetes device data within the EHR, and to engage patients/parents and improve healthcare provider workflow. PMID:27018263

Electronic health records and disease registries to support integrated care in a health neighbourhood: an ontology-based methodology.

PubMed

Liaw, Siaw-Teng; Taggart, Jane; Yu, Hairong; Rahimi, Alireza

2014-01-01

Disease registries derived from Electronic Health Records (EHRs) are widely used for chronic disease management (CDM). However, unlike national registries which are specialised data collections, they are usually specific to an EHR or organization such as a medical home. We approached registries from the perspective of integrated care in a health neighbourhood, considering data quality issues such as semantic interoperability (consistency), accuracy, completeness and duplication. Our proposition is that a realist ontological approach is required to systematically and accurately identify patients in an EHR or data repository of EHRs, assess intrinsic data quality and fitness for use by members of the multidisciplinary integrated care team. We report on this approach as applied to routinely collected data in an electronic practice based research network in Australia.

The Relationship between Using Electronic Health Records and Meeting Accreditation Standards for Client Safety in Residential Aged Care Homes.

PubMed

Jiang, Tao; Yu, Ping

2015-01-01

This study aims to identify the benefits of using electronic health records (EHR) for client safety in residential aged care (RAC) homes. The aged care accreditation reports published between 27 April 2011 and 3 December 2013 were downloaded and analysed. It could be seen from these reports that only 1,031(37.45%) RAC homes in Australia had adopted an EHR system by 2013. 13 RAC homes failed one or more accreditation standards. Only one of these was using an EHR system and this one met the accreditation standards on information systems. Our study provides empirical evidence to suggest that adopting and using EHR can be one of the effective organisational mechanisms to meeting accreditation standards in RAC homes.

The double-edged sword of electronic health records: implications for patient disclosure.

PubMed

Campos-Castillo, Celeste; Anthony, Denise L

2015-04-01

Electronic health record (EHR) systems are linked to improvements in quality of care, yet also privacy and security risks. Results from research studies are mixed about whether patients withhold personal information from their providers to protect against the perceived EHR privacy and security risks. This study seeks to reconcile the mixed findings by focusing on whether accounting for patients' global ratings of care reveals a relationship between EHR provider-use and patient non-disclosure. A nationally representative sample from the 2012 Health Information National Trends Survey was analyzed using bivariate and multivariable logit regressions to examine whether global ratings of care suppress the relationship between EHR provider-use and patient non-disclosure. 13% of respondents reported having ever withheld information from a provider because of privacy/security concerns. Bivariate analysis showed that withholding information was unrelated to whether respondents' providers used an EHR. Multivariable analysis showed that accounting for respondents' global ratings of care revealed a positive relationship between having a provider who uses an EHR and withholding information. After accounting for global ratings of care, findings suggest that patients may non-disclose to providers to protect against the perceived EHR privacy and security risks. Despite evidence that EHRs inhibit patient disclosure, their advantages for promoting quality of care may outweigh the drawbacks. Clinicians should leverage the EHR's value in quality of care and discuss patients' privacy concerns during clinic visits, while policy makers should consider how to address the real and perceived privacy and security risks of EHRs. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Predictors of Success for Electronic Health Record Implementation in Small Physician Practices

PubMed Central

Ancker, J.S.; Singh, M.P.; Thomas, R.; Edwards, A.; Snyder, A.; Kashyap, A.; Kaushal, R.

2013-01-01

Background The federal government is promoting adoption of electronic health records (EHRs) through financial incentives for EHR use and implementation support provided by regional extension centers. Small practices have been slow to adopt EHRs. Objectives Our objective was to measure time to EHR implementation and identify factors associated with successful implementation in small practices receiving financial incentives and implementation support. This study is unique in exploiting quantitative implementation time data collected prospectively as part of routine project management. Methods This mixed-methods study includes interviews of key informants and a cohort study of 544 practices that had worked with the Primary Care Information Project (PCIP), a publicly funded organization that since 2007 has subsidized EHRs and provided implementation support similar to that supplied by the new regional extension centers. Data from a project management database were used for a cohort study to assess time to implementation and predictors of implementation success. Results Four hundred and thirty practices (79%) implemented EHRs within the analysis period, with a median project time of 24.7 weeks (95% CI: 23.3 – 26.4). Factors associated with implementation success were: fewer providers, practice sites, and patients; fewer Medicaid and uninsured patients; having previous experience with scheduling software; enrolling in 2010 rather than earlier; and selecting an integrated EHR plus practice management product rather than two products. Interviews identified positive attitude toward EHRs, resources, and centralized leadership as additional practice-level predictors of success. Conclusions A local initiative similar to current federal programs successfully implemented EHRs in primary care practices by offsetting software costs and providing implementation assistance. Nevertheless, implementation success was affected by practice size and other characteristics, suggesting that the federal programs can reduce barriers to EHR implementation but may not eliminate them. PMID:23650484

Electronic Health Record Effects on Work-Life Balance and Burnout Within the I3 Population Collaborative.

PubMed

Robertson, Sandy L; Robinson, Mark D; Reid, Alfred

2017-08-01

Physician burnout is a problem that often is attributed to the use of the electronic health record (EHR). To estimate the prevalence of burnout and work-life balance satisfaction in primary care residents and teaching physicians, and to examine the relationship between these outcomes, EHR use, and other practice and individual factors. Residents and faculty in 19 primary care programs were anonymously surveyed about burnout, work-life balance satisfaction, and EHR use. Additional items included practice size, specialty, EHR characteristics, and demographics. A logistic regression model identified independent factors associated with burnout and work-life balance satisfaction. In total, 585 of 866 surveys (68%) were completed, and 216 (37%) respondents indicated 1 or more symptoms of burnout, with 162 (75%) attributing burnout to the EHR. A total of 310 of 585 (53%) reported dissatisfaction with work-life balance, and 497 (85%) indicated that use of the EHR affected their work-life balance. Respondents who spent more than 6 hours weekly after hours in EHR work were 2.9 times (95% confidence interval [CI] 1.9-4.4) more likely to report burnout and 3.9 times (95% CI 1.9-8.2) more likely to attribute burnout to the EHR. They were 0.33 times (95% CI 0.22-0.49) as likely to report work-life balance satisfaction, and 3.7 times (95% CI 2.1-6.7) more likely to attribute their work-life balance satisfaction to the EHR. More after-hours time spent on the EHR was associated with burnout and less work-life satisfaction in primary care residents and faculty.

integrated Electronic Health Record Increment 1 (iEHR Inc 1)

DTIC Science & Technology

2016-03-01

Executive DoD - Department of Defense DoDAF - DoD Architecture Framework FD - Full Deployment FDD - Full Deployment Decision FY - Fiscal Year IA...Acronyms and Abbreviations ADM - Acquisition Decision Memorandum FD - Full Deployment FDD - Full Deployment Decision iEHR Inc 1 2016 MAR UNCLASSIFIED...iEHR Increment 1 APB for FDD achieved in November 2014 was signed by the MDA March 2, 2015. Current estimate is consistent with the FDD APB. iEHR Inc 1 2016 MAR UNCLASSIFIED 11

Consumers Are Ready to Accept the Transition to Online and Electronic Records If They Can Be Assured of the Security Measures

PubMed Central

Chhanabhai, Prajesh; Holt, Alec

2007-01-01

Background Healthcare has entered the electronic domain. This domain has improved data collection and storage abilities while allowing almost instantaneous access and results to data queries. Furthermore, it allows direct communication between healthcare providers and health consumers. The development of privacy, confidentiality, and security principles are necessary to protect consumers' interests against inappropriate access. Studies have shown that the health consumer is the important stakeholder in this process. With the international push toward electronic health records (EHRs), this article presents the importance of secure EHR systems from the public's perspective. Objective To examine the public's perception of the security of electronic systems and report on how their perceptions can shape the building of stronger systems. Methods A cross-sectional survey (September-November 2005) of people attending healthcare providers (n = 400) was conducted in the 4 major cities in New Zealand. Participants were surveyed on computer use, knowledge of EHR-proposed benefits and issues, security issues, and demographics. Results A total of 300 surveys were completed and returned (a 75% response rate), with 180 (60%) being women. One hundred eighty-eight (62.6%) had not heard of EHRs, with those who had heard of them indicating that they were a positive innovation in the health sector. However, 202 (73.3%) participants were highly concerned about the security and privacy of their health records. This feeling was further accentuated when participants were asked about security of electronic systems. Participants were worried about hackers (79.4%), vendor access (72.7%), and malicious software (68%). Participants were also introduced to various security systems, and in each case, over 80% of participants believed that these would make EHR systems more secure. A number of chi-square tests were carried out with each variable, and it was found that there were strong relationships between age, location, computer use, EHR knowledge, and the concern for privacy and the security of medical records (P < .05). The survey also showed that there was a very small difference (9.8%) between health consumers who believed that paper records are more secure than EHRs and those who believed otherwise. Conclusions The findings showed that for the EHR to be fully integrating in the health sector, there are 2 main issues that need to be addressed: The security of the EHR system has to be of the highest level, and needs to be constantly monitored and updated.The involvement of the health consumer in the ownership and maintenance of their health record needs to be more proactive. The EHR aims to collect information to allow for “cradle to the grave” treatment; thus, the health consumer has to be seen as a major player in ensuring that this can happen correctly. The results from this study indicated that the consumer is ready to accept the transition, as long as one can be assured of the security of the system. PMID:17435617

Consumers are ready to accept the transition to online and electronic records if they can be assured of the security measures.

PubMed

Chhanabhai, Prajesh; Holt, Alec

2007-01-11

Healthcare has entered the electronic domain. This domain has improved data collection and storage abilities while allowing almost instantaneous access and results to data queries. Furthermore, it allows direct communication between healthcare providers and health consumers. The development of privacy, confidentiality, and security principles are necessary to protect consumers' interests against inappropriate access. Studies have shown that the health consumer is the important stakeholder in this process. With the international push toward electronic health records (EHRs), this article presents the importance of secure EHR systems from the public's perspective. To examine the public's perception of the security of electronic systems and report on how their perceptions can shape the building of stronger systems. A cross-sectional survey (September-November 2005) of people attending healthcare providers (n = 400) was conducted in the 4 major cities in New Zealand. Participants were surveyed on computer use, knowledge of EHR-proposed benefits and issues, security issues, and demographics. A total of 300 surveys were completed and returned (a 75% response rate), with 180 (60%) being women. One hundred eighty-eight (62.6%) had not heard of EHRs, with those who had heard of them indicating that they were a positive innovation in the health sector. However, 202 (73.3%) participants were highly concerned about the security and privacy of their health records. This feeling was further accentuated when participants were asked about security of electronic systems. Participants were worried about hackers (79.4%), vendor access (72.7%), and malicious software (68%). Participants were also introduced to various security systems, and in each case, over 80% of participants believed that these would make EHR systems more secure. A number of chi-square tests were carried out with each variable, and it was found that there were strong relationships between age, location, computer use, EHR knowledge, and the concern for privacy and the security of medical records (P < .05). The survey also showed that there was a very small difference (9.8%) between health consumers who believed that paper records are more secure than EHRs and those who believed otherwise. The findings showed that for the EHR to be fully integrating in the health sector, there are 2 main issues that need to be addressed: The security of the EHR system has to be of the highest level, and needs to be constantly monitored and updated. The involvement of the health consumer in the ownership and maintenance of their health record needs to be more proactive. The EHR aims to collect information to allow for "cradle to the grave" treatment; thus, the health consumer has to be seen as a major player in ensuring that this can happen correctly. The results from this study indicated that the consumer is ready to accept the transition, as long as one can be assured of the security of the system.

Evaluating a scalable model for implementing electronic health records in resource-limited settings.

PubMed

Were, Martin C; Emenyonu, Nneka; Achieng, Marion; Shen, Changyu; Ssali, John; Masaba, John P M; Tierney, William M

2010-01-01

Current models for implementing electronic health records (EHRs) in resource-limited settings may not be scalable because they fail to address human-resource and cost constraints. This paper describes an implementation model which relies on shared responsibility between local sites and an external three-pronged support infrastructure consisting of: (1) a national technical expertise center, (2) an implementer's community, and (3) a developer's community. This model was used to implement an open-source EHR in three Ugandan HIV-clinics. Pre-post time-motion study at one site revealed that Primary Care Providers spent a third less time in direct and indirect care of patients (p<0.001) and 40% more time on personal activities (p=0.09) after EHRs implementation. Time spent by previously enrolled patients with non-clinician staff fell by half (p=0.004) and with pharmacy by 63% (p<0.001). Surveyed providers were highly satisfied with the EHRs and its support infrastructure. This model offers a viable approach for broadly implementing EHRs in resource-limited settings.

Method to integrate clinical guidelines into the electronic health record (EHR) by applying the archetypes approach.

PubMed

Garcia, Diego; Moro, Claudia Maria Cabral; Cicogna, Paulo Eduardo; Carvalho, Deborah Ribeiro

2013-01-01

Clinical guidelines are documents that assist healthcare professionals, facilitating and standardizing diagnosis, management, and treatment in specific areas. Computerized guidelines as decision support systems (DSS) attempt to increase the performance of tasks and facilitate the use of guidelines. Most DSS are not integrated into the electronic health record (EHR), ordering some degree of rework especially related to data collection. This study's objective was to present a method for integrating clinical guidelines into the EHR. The study developed first a way to identify data and rules contained in the guidelines, and then incorporate rules into an archetype-based EHR. The proposed method tested was anemia treatment in the Chronic Kidney Disease Guideline. The phases of the method are: data and rules identification; archetypes elaboration; rules definition and inclusion in inference engine; and DSS-EHR integration and validation. The main feature of the proposed method is that it is generic and can be applied toany type of guideline.

Primary Care Practices' Abilities And Challenges In Using Electronic Health Record Data For Quality Improvement.

PubMed

Cohen, Deborah J; Dorr, David A; Knierim, Kyle; DuBard, C Annette; Hemler, Jennifer R; Hall, Jennifer D; Marino, Miguel; Solberg, Leif I; McConnell, K John; Nichols, Len M; Nease, Donald E; Edwards, Samuel T; Wu, Winfred Y; Pham-Singer, Hang; Kho, Abel N; Phillips, Robert L; Rasmussen, Luke V; Duffy, F Daniel; Balasubramanian, Bijal A

2018-04-01

Federal value-based payment programs require primary care practices to conduct quality improvement activities, informed by the electronic reports on clinical quality measures that their electronic health records (EHRs) generate. To determine whether EHRs produce reports adequate to the task, we examined survey responses from 1,492 practices across twelve states, supplemented with qualitative data. Meaningful-use participation, which requires the use of a federally certified EHR, was associated with the ability to generate reports-but the reports did not necessarily support quality improvement initiatives. Practices reported numerous challenges in generating adequate reports, such as difficulty manipulating and aligning measurement time frames with quality improvement needs, lack of functionality for generating reports on electronic clinical quality measures at different levels, discordance between clinical guidelines and measures available in reports, questionable data quality, and vendors that were unreceptive to changing EHR configuration beyond federal requirements. The current state of EHR measurement functionality may be insufficient to support federal initiatives that tie payment to clinical quality measures.

Primary Care Practices’ Abilities And Challenges In Using Electronic Health Record Data For Quality Improvement

PubMed Central

Cohen, Deborah J.; Dorr, David A.; Knierim, Kyle; DuBard, C. Annette; Hemler, Jennifer R.; Hall, Jennifer D.; Marino, Miguel; Solberg, Leif I.; McConnell, K. John; Nichols, Len M.; Nease, Donald E.; Edwards, Samuel T.; Wu, Winfred Y.; Pham-Singer, Hang; Kho, Abel N.; Phillips, Robert L.; Rasmussen, Luke V.; Duffy, F. Daniel; Balasubramanian, Bijal A.

2018-01-01

Federal value-based payment programs require primary care practices to conduct quality improvement activities, informed by the electronic reports on clinical quality measures that their electronic health records (EHRs) generate. To determine whether EHRs produce reports adequate to the task, we examined survey responses from 1,492 practices across twelve states, supplemented with qualitative data. Meaningful-use participation, which requires the use of a federally certified EHR, was associated with the ability to generate reports—but the reports did not necessarily support quality improvement initiatives. Practices reported numerous challenges in generating adequate reports, such as difficulty manipulating and aligning measurement time frames with quality improvement needs, lack of functionality for generating reports on electronic clinical quality measures at different levels, discordance between clinical guidelines and measures available in reports, questionable data quality, and vendors that were unreceptive to changing EHR configuration beyond federal requirements. The current state of EHR measurement functionality may be insufficient to support federal initiatives that tie payment to clinical quality measures. PMID:29608365

Communication Patterns in the Perioperative Environment During Epic Electronic Health Record System Implementation.

PubMed

Friend, Tynan H; Jennings, Samantha J; Levine, Wilton C

2017-02-01

In April 2016, Massachusetts General Hospital (MGH) went live with the Epic electronic health records (EHR) system, replacing a variety of EHRs that previously existed in different departments throughout the hospital. At the time of implementation, the Vocera® Badge Communication System, a wireless hands-free communication device distributed to perioperative team members, had increased perioperative communication flow and efficiency. As a quality improvement effort to better understand communication patterns during an EHR go-live, we monitored our Vocera call volume and user volume before, during and after our go-live. We noticed that call volume and user volume significantly increased during our immediate go-live period and quickly returned to baseline levels. We also noticed that call volume increased during periods of unplanned EHR downtime long after our immediate go-live period. When planning the implementation of a new EHR, leadership must plan for and support this critical communication need at the time of the go-live and must also be aware of these needs during unplanned downtime.

Process-aware EHR BPM systems: two prototypes and a conceptual framework.

PubMed

Webster, Charles; Copenhaver, Mark

2010-01-01

Systematic methods to improve the effectiveness and efficiency of electronic health record-mediated processes will be key to EHRs playing an important role in the positive transformation of healthcare. Business process management (BPM) systematically optimizes process effectiveness, efficiency, and flexibility. Therefore BPM offers relevant ideas and technologies. We provide a conceptual model based on EHR productivity and negative feedback control that links EHR and BPM domains, describe two EHR BPM prototype modules, and close with the argument that typical EHRs must become more process-aware if they are to take full advantage of BPM ideas and technology. A prediction: Future extensible clinical groupware will coordinate delivery of EHR functionality to teams of users by combining modular components with executable process models whose usability (effectiveness, efficiency, and user satisfaction) will be systematically improved using business process management techniques.

Electronic health record usage behaviors in primary care medical practices: A survey of family physicians in Canada.

PubMed

Paré, Guy; Raymond, Louis; Guinea, Ana Ortiz de; Poba-Nzaou, Placide; Trudel, Marie-Claude; Marsan, Josianne; Micheneau, Thomas

2015-10-01

The importance and potential value of office-based electronic health record (EHR) systems is being recognized internationally. We thus sought to better understand how EHRs are actually being used by family physicians and what they perceive to be the main performance outcomes for themselves and their medical practices. We conducted a survey of family physicians practicing in medical practices in Quebec, Canada (n =331). Bivariate and multivariate statistical analyses were conducted to characterize EHR usage behaviors and assess the perceived performance outcomes of these systems. EHR systems "as-used" vary substantively from one family physician to another in terms of the capabilities that are actually mobilized by them. Significant differences between "basic" and "advanced" users were observed in terms of the EHR system's characteristics and perceived performance outcomes. Physicians were also clustered under three profiles that could be clearly distinguished from one another, in terms of the extent to which their performance and their practice's performance was impacted by their EHR usage. Physicians that are "highly impacted" by their EHR system are those who have the longest usage experience and make the most extended use of their system's capabilities. Our study indicates that only a minority of family physicians in our sample use most of the features available in their EHR system. Consequently, few physicians perceive gaining significant performance improvements from such systems. Future research must identify the factors that motivate primary care physicians to assimilate EHR systems in a more extensive manner. Copyright © 2015. Published by Elsevier Ireland Ltd.

Why sub-Saharan Africa lags in electronic health record adoption and possible strategies to increase its adoption in this region

PubMed Central

Odekunle, Florence Femi; Odekunle, Raphael Oluseun; Shankar, Srinivasan

2017-01-01

Poor health information system has been identified as a major challenge in the health-care system in many developing countries including sub-Saharan African countries. Electronic health record (EHR) has been shown as an important tool to improve access to patient information with attendance improved quality of care. However, EHR has not been widely implemented/adopted in sub-Saharan Africa. This study sought to identify factors that affect the adoption of an EHR in sub-Saharan Africa and strategies to improve its adoption in this region. A comprehensive literature search was conducted on three electronic databases: PubMed, Medline, and Google Scholar. Articles of interest were those published in English that contained information on factors that limit the adoption of an EHR as well as strategies that improve its adoption in sub-Saharan African countries. The available evidence indicated that there were many factors that hindered the widespread adoption of an EHR in sub-Saharan Africa. These were high costs of procurement and maintenance of the EHR system, lack of financial incentives and priorities, poor electricity supply and internet connectivity, and primary user’s limited computer skills. However, strategies such as implementation planning, financial supports, appropriate EHR system selection, training of primary users, and the adoption of the phased implementation process have been identified to facilitate the use of an EHR. Wide adoption of an EHR in sub-Saharan Africa region requires a lot more effort than what is assumed because of the current poor level of technological development, lack of required computer skills, and limited resources. PMID:29085270

Use of Electronic Health Record Simulation to Understand the Accuracy of Intern Progress Notes

PubMed Central

March, Christopher A.; Scholl, Gretchen; Dversdal, Renee K.; Richards, Matthew; Wilson, Leah M.; Mohan, Vishnu; Gold, Jeffrey A.

2016-01-01

Background With the widespread adoption of electronic health records (EHRs), there is a growing awareness of problems in EHR training for new users and subsequent problems with the quality of information present in EHR-generated progress notes. By standardizing the case, simulation allows for the discovery of EHR patterns of use as well as a modality to aid in EHR training. Objective To develop a high-fidelity EHR training exercise for internal medicine interns to understand patterns of EHR utilization in the generation of daily progress notes. Methods Three months after beginning their internship, 32 interns participated in an EHR simulation designed to assess patterns in note writing and generation. Each intern was given a simulated chart and instructed to create a daily progress note. Notes were graded for use of copy-paste, macros, and accuracy of presented data. Results A total of 31 out of 32 interns (97%) completed the exercise. There was wide variance in use of macros to populate data, with multiple macro types used for the same data category. Three-quarters of notes contained either copy-paste elements or the elimination of active medical problems from the prior days' notes. This was associated with a significant number of quality issues, including failure to recognize a lack of deep vein thrombosis prophylaxis, medications stopped on admission, and issues in prior discharge summary. Conclusions Interns displayed wide variation in the process of creating progress notes. Additional studies are being conducted to determine the impact EHR-based simulation has on standardization of note content. PMID:27168894

Use of Electronic Health Record Simulation to Understand the Accuracy of Intern Progress Notes.

PubMed

March, Christopher A; Scholl, Gretchen; Dversdal, Renee K; Richards, Matthew; Wilson, Leah M; Mohan, Vishnu; Gold, Jeffrey A

2016-05-01

Background With the widespread adoption of electronic health records (EHRs), there is a growing awareness of problems in EHR training for new users and subsequent problems with the quality of information present in EHR-generated progress notes. By standardizing the case, simulation allows for the discovery of EHR patterns of use as well as a modality to aid in EHR training. Objective To develop a high-fidelity EHR training exercise for internal medicine interns to understand patterns of EHR utilization in the generation of daily progress notes. Methods Three months after beginning their internship, 32 interns participated in an EHR simulation designed to assess patterns in note writing and generation. Each intern was given a simulated chart and instructed to create a daily progress note. Notes were graded for use of copy-paste, macros, and accuracy of presented data. Results A total of 31 out of 32 interns (97%) completed the exercise. There was wide variance in use of macros to populate data, with multiple macro types used for the same data category. Three-quarters of notes contained either copy-paste elements or the elimination of active medical problems from the prior days' notes. This was associated with a significant number of quality issues, including failure to recognize a lack of deep vein thrombosis prophylaxis, medications stopped on admission, and issues in prior discharge summary. Conclusions Interns displayed wide variation in the process of creating progress notes. Additional studies are being conducted to determine the impact EHR-based simulation has on standardization of note content.

Creating an Oversight Infrastructure for Electronic Health Record-Related Patient Safety Hazards

PubMed Central

Singh, Hardeep; Classen, David C.; Sittig, Dean F.

2013-01-01

Electronic health records (EHRs) have potential quality and safety benefits. However, reports of EHR-related safety hazards are now emerging. The Office of the National Coordinator (ONC) for Health Information Technology (HIT) recently sponsored an Institute of Medicine committee to evaluate how HIT use affects patient safety. In this paper, we propose the creation of a national EHR oversight program to provide dedicated surveillance of EHR-related safety hazards and to promote learning from identified errors, close calls, and adverse events. The program calls for data gathering, investigation/analysis and regulatory components. The first two functions will depend on institution-level EHR safety committees that will investigate all known EHR-related adverse events and near-misses and report them nationally using standardized methods. These committees should also perform routine safety self-assessments to proactively identify new risks. Nationally, we propose the long-term creation of a centralized, non-partisan board with an appropriate legal and regulatory infrastructure to ensure the safety of EHRs. We discuss the rationale of the proposed oversight program and its potential organizational components and functions. These include mechanisms for robust data collection and analyses of all safety concerns using multiple methods that extend beyond reporting; multidisciplinary investigation of selected high-risk safety events; and enhanced coordination with other national agencies in order to facilitate broad dissemination of hazards information. Implementation of this proposed infrastructure can facilitate identification of EHR-related adverse events and errors and potentially create a safer and more effective EHR-based health care delivery system. PMID:22080284

Assessing the impact of electronic health records as an enabler of hospital quality and patient satisfaction.

PubMed

Jarvis, Benjamin; Johnson, Tricia; Butler, Peter; O'Shaughnessy, Kathryn; Fullam, Francis; Tran, Lac; Gupta, Richa

2013-10-01

To assess the impact of using an advanced electronic health record (EHR) on hospital quality and patient satisfaction. This retrospective, cross-sectional analysis was conducted in 2012 to evaluate the association between advanced EHR use (Healthcare Information Management Systems Society [HIMSS] Stage 6 or 7 as of December 2012) and estimated process and experience of care scores for hospitals under the Medicare Hospital Value-Based Purchasing Program, using data from the American Hospital Association for 2008 to 2010. Generalized linear regression models were fit to test the association between advanced EHR use with process of care and experience of care, controlling for hospital characteristics. In a second analysis, the models included variables to account for HIMSS stage of advanced EHR use. The study included 2,988 hospitals, with 248 (8.3%) classified as advanced EHR users (HIMSS Stage 6 or 7). After controlling for hospital characteristics, advanced EHR use was associated with a 4.2-point-higher process of care score (P < .001). Hospitals with Stage 7 EHRs had 11.7 points higher process of care scores, but Stage 6 users had scores that were not substantially different from those of nonadvanced users. There was no significant difference in estimated experience of care scores by level of advanced EHR use. This study evaluated the effectiveness of the U.S. federal government's investment in hospital information technology infrastructure. Results suggest that the most advanced EHRs have the greatest payoff in improving clinical process of care scores, without detrimentally impacting the patient experience.

Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA.

PubMed

Middleton, Blackford; Bloomrosen, Meryl; Dente, Mark A; Hashmat, Bill; Koppel, Ross; Overhage, J Marc; Payne, Thomas H; Rosenbloom, S Trent; Weaver, Charlotte; Zhang, Jiajie

2013-06-01

In response to mounting evidence that use of electronic medical record systems may cause unintended consequences, and even patient harm, the AMIA Board of Directors convened a Task Force on Usability to examine evidence from the literature and make recommendations. This task force was composed of representatives from both academic settings and vendors of electronic health record (EHR) systems. After a careful review of the literature and of vendor experiences with EHR design and implementation, the task force developed 10 recommendations in four areas: (1) human factors health information technology (IT) research, (2) health IT policy, (3) industry recommendations, and (4) recommendations for the clinician end-user of EHR software. These AMIA recommendations are intended to stimulate informed debate, provide a plan to increase understanding of the impact of usability on the effective use of health IT, and lead to safer and higher quality care with the adoption of useful and usable EHR systems.

Collecting psychosocial "vital signs" in electronic health records: Why now? What are they? What's new for psychology?

PubMed

Matthews, Karen A; Adler, Nancy E; Forrest, Christopher B; Stead, William W

2016-09-01

Social, psychological, and behavioral factors are recognized as key contributors to health, but they are rarely measured in a systematic way in health care settings. Electronic health records (EHRs) can be used in these settings to routinely collect a standardized set of social, psychological, and behavioral determinants of health. The expanded use of EHRs provides opportunities to improve individual and population health, and offers new ways for the psychological community to engage in health promotion and disease prevention efforts. This article addresses 3 issues. First, it discusses what led to current efforts to include measures of psychosocial and behavioral determinants of health in EHRs. Second, it presents recommendations of an Institute of Medicine committee regarding inclusion in EHRS of a panel of measures that meet a priori criteria. Third, it identifies new opportunities and challenges these recommendations present for psychologists in practice and research. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA

PubMed Central

Middleton, Blackford; Bloomrosen, Meryl; Dente, Mark A; Hashmat, Bill; Koppel, Ross; Overhage, J Marc; Payne, Thomas H; Rosenbloom, S Trent; Weaver, Charlotte; Zhang, Jiajie

2013-01-01

In response to mounting evidence that use of electronic medical record systems may cause unintended consequences, and even patient harm, the AMIA Board of Directors convened a Task Force on Usability to examine evidence from the literature and make recommendations. This task force was composed of representatives from both academic settings and vendors of electronic health record (EHR) systems. After a careful review of the literature and of vendor experiences with EHR design and implementation, the task force developed 10 recommendations in four areas: (1) human factors health information technology (IT) research, (2) health IT policy, (3) industry recommendations, and (4) recommendations for the clinician end-user of EHR software. These AMIA recommendations are intended to stimulate informed debate, provide a plan to increase understanding of the impact of usability on the effective use of health IT, and lead to safer and higher quality care with the adoption of useful and usable EHR systems. PMID:23355463

EHR Big Data Deep Phenotyping

PubMed Central

Lenert, L.; Lopez-Campos, G.

2014-01-01

Summary Objectives Given the quickening speed of discovery of variant disease drivers from combined patient genotype and phenotype data, the objective is to provide methodology using big data technology to support the definition of deep phenotypes in medical records. Methods As the vast stores of genomic information increase with next generation sequencing, the importance of deep phenotyping increases. The growth of genomic data and adoption of Electronic Health Records (EHR) in medicine provides a unique opportunity to integrate phenotype and genotype data into medical records. The method by which collections of clinical findings and other health related data are leveraged to form meaningful phenotypes is an active area of research. Longitudinal data stored in EHRs provide a wealth of information that can be used to construct phenotypes of patients. We focus on a practical problem around data integration for deep phenotype identification within EHR data. The use of big data approaches are described that enable scalable markup of EHR events that can be used for semantic and temporal similarity analysis to support the identification of phenotype and genotype relationships. Conclusions Stead and colleagues’ 2005 concept of using light standards to increase the productivity of software systems by riding on the wave of hardware/processing power is described as a harbinger for designing future healthcare systems. The big data solution, using flexible markup, provides a route to improved utilization of processing power for organizing patient records in genotype and phenotype research. PMID:25123744

Integrating electronic healthcare records of armed forces personnel: Developing a framework for evaluating health outcomes in England, Scotland and Wales.

PubMed

Leightley, Daniel; Chui, Zoe; Jones, Margaret; Landau, Sabine; McCrone, Paul; Hayes, Richard D; Wessely, Simon; Fear, Nicola T; Goodwin, Laura

2018-05-01

Electronic Healthcare Records (EHRs) are created to capture summaries of care and contact made to healthcare services. EHRs offer a means to analyse admissions to hospitals for epidemiological research. In the United Kingdom (UK), England, Scotland and Wales maintain separate data stores, which are administered and managed exclusively by devolved Government. This independence results in harmonisation challenges, not least lack of uniformity, making it difficult to evaluate care, diagnoses and treatment across the UK. To overcome this lack of uniformity, it is important to develop methods to integrate EHRs to provide a multi-nation dataset of health. To develop and describe a method which integrates the EHRs of Armed Forces personnel in England, Scotland and Wales based on variable commonality to produce a multi-nation dataset of secondary health care. An Armed Forces cohort was used to extract and integrate three EHR datasets, using commonality as the linkage point. This was achieved by evaluating and combining variables which shared the same characteristics. EHRs representing Accident and Emergency (A&E), Admitted Patient Care (APC) and Outpatient care were combined to create a patient-level history spanning three nations. Patient-level EHRs were examined to ascertain admission differences, common diagnoses and record completeness. A total of 6,336 Armed Forces personnel were matched, of which 5,460 personnel had 7,510 A&E visits, 9,316 APC episodes and 45,005 Outpatient appointments. We observed full completeness for diagnoses in APC, whereas Outpatient admissions were sparsely coded; with 88% of diagnoses coded as "Unknown/unspecified cause of morbidity". In addition, A&E records were sporadically coded; we found five coding systems for identifying reason for admission. At present, EHRs are designed to monitor the cost of treatment, enable administrative oversight, and are not currently suited to epidemiological research. However, only small changes may be needed to take advantage of what should be a highly cost-effective means of delivering important research for the benefit of the NHS. Copyright © 2018 The Author(s). Published by Elsevier B.V. All rights reserved.

Electronic Health Records: Overcoming Obstacles to Improve Acceptance and Utilization for Mental Health Clinicians

ERIC Educational Resources Information Center

Odom, Stephen A.

2017-01-01

The dynamics and progress of the integration of the electronic health record (EHR) into health-care disciplines have been described and examined using theories related to technology adoption. Previous studies have examined health-care clinician resistance to the EHR in primary care, hospital, and urgent care medical settings, but few studies have…

A Correlational Analysis: Electronic Health Records (EHR) and Quality of Care in Critical Access Hospitals

ERIC Educational Resources Information Center

Khan, Arshia A.

2012-01-01

Driven by the compulsion to improve the evident paucity in quality of care, especially in critical access hospitals in the United States, policy makers, healthcare providers, and administrators have taken the advise of researchers suggesting the integration of technology in healthcare. The Electronic Health Record (EHR) System composed of multiple…

Automated Methods to Extract Patient New Information from Clinical Notes in Electronic Health Record Systems

ERIC Educational Resources Information Center

Zhang, Rui

2013-01-01

The widespread adoption of Electronic Health Record (EHR) has resulted in rapid text proliferation within clinical care. Clinicians' use of copying and pasting functions in EHR systems further compounds this by creating a large amount of redundant clinical information in clinical documents. A mixture of redundant information (especially outdated…

Behavioral Health Providers and Electronic Health Records: An Exploratory Beliefs Elicitation and Segmentation Study

ERIC Educational Resources Information Center

Shank, Nancy

2011-01-01

The widespread adoption of electronic health records (EHRs) is a public policy strategy to improve healthcare quality and reduce accelerating health care costs. Much research has focused on medical providers' perceptions of EHRs, but little is known about those of behavioral health providers. This research was informed by the theory of reasoned…

UCare navigator: A dynamic guide to the hybrid electronic and paper medical record in transition.

PubMed

Bokser, Seth J; Cucina, Russell J; Love, Jeffrey S; Blum, Michael S

2007-10-11

During the phased transition from a paper-based record to an electronic health record (EHR), we found that clinicians had difficulty remembering where to find important clinical documents. We describe our experience with the design and use of a web-based map of the hybrid medical record. With between 50 to 75 unique visits per day, the UCare Navigator has served as an important aid to clinicians practicing in the transitional environment of a large EHR implementation.

Factors affecting electronic health record adoption in long-term care facilities.

PubMed

Cherry, Barbara; Carter, Michael; Owen, Donna; Lockhart, Carol

2008-01-01

Electronic health records (EHRs) hold the potential to significantly improve the quality of care in long-term care (LTC) facilities, yet limited research has been done on how facilities decide to adopt these records. This study was conducted to identify factors that hinder and facilitate EHR adoption in LTC facilities. Study participants were LTC nurses, administrators, and corporate executives. Primary barriers identified were costs, the need for training, and the culture change required to embrace technology. Primary facilitators were training programs, well-defined implementation plans, government assistance with implementation costs, evidence that EHRs will improve care outcomes, and support from state regulatory agencies. These results offer a framework of action for policy makers, LTC Leaders, and researchers.

Rural primary care practices and meaningful use of electronic health records: the role of Regional Extension Centers.

PubMed

Casey, Michelle M; Moscovice, Ira; McCullough, Jeffrey

2014-01-01

To examine the role of Regional Extension Centers (RECs) in helping rural physician practices adopt electronic health records (EHRs) and achieve meaningful use. Using data from the Office of the National Coordinator for Health Information Technology, we conducted a county-level regression analysis using ordinary least squares to better understand rural-urban differences in REC participation, EHR implementation, and meaningful use, controlling for counties' economic conditions. We prepared case studies of 2 RECs that are serving a large number of rural practices, based on interviews with key individuals at the RECs, their partner organizations, and rural primary care practices that received assistance from the RECs. RECs are largely achieving their objective of targeting providers in communities that face barriers to EHRs. REC participants are disproportionately rural and more likely to come from high poverty and low employment communities. The case study RECs had long-standing relationships with rural providers, as well as extensive staff expertise in quality improvement and EHR implementation, and employed a variety of strategies to successfully assist rural providers. Rural providers report that REC assistance was invaluable in helping them implement EHRs and achieve meaningful use status. Modifying the criteria for Medicare and Medicaid EHR incentives could help additional rural providers pay for EHRs. REC federal funding is scheduled to end in 2014, but practices that have not yet adopted EHRs may need significant, ongoing assistance to receive meaningful use. © 2013 National Rural Health Association.

Incorporating personalized gene sequence variants, molecular genetics knowledge, and health knowledge into an EHR prototype based on the Continuity of Care Record standard.

PubMed

Jing, Xia; Kay, Stephen; Marley, Thomas; Hardiker, Nicholas R; Cimino, James J

2012-02-01

The current volume and complexity of genetic tests, and the molecular genetics knowledge and health knowledge related to interpretation of the results of those tests, are rapidly outstripping the ability of individual clinicians to recall, understand and convey to their patients information relevant to their care. The tailoring of molecular genetics knowledge and health knowledge in clinical settings is important both for the provision of personalized medicine and to reduce clinician information overload. In this paper we describe the incorporation, customization and demonstration of molecular genetic data (mainly sequence variants), molecular genetics knowledge and health knowledge into a standards-based electronic health record (EHR) prototype developed specifically for this study. We extended the CCR (Continuity of Care Record), an existing EHR standard for representing clinical data, to include molecular genetic data. An EHR prototype was built based on the extended CCR and designed to display relevant molecular genetics knowledge and health knowledge from an existing knowledge base for cystic fibrosis (OntoKBCF). We reconstructed test records from published case reports and represented them in the CCR schema. We then used the EHR to dynamically filter molecular genetics knowledge and health knowledge from OntoKBCF using molecular genetic data and clinical data from the test cases. The molecular genetic data were successfully incorporated in the CCR by creating a category of laboratory results called "Molecular Genetics" and specifying a particular class of test ("Gene Mutation Test") in this category. Unlike other laboratory tests reported in the CCR, results of tests in this class required additional attributes ("Molecular Structure" and "Molecular Position") to support interpretation by clinicians. These results, along with clinical data (age, sex, ethnicity, diagnostic procedures, and therapies) were used by the EHR to filter and present molecular genetics knowledge and health knowledge from OntoKBCF. This research shows a feasible model for delivering patient sequence variants and presenting tailored molecular genetics knowledge and health knowledge via a standards-based EHR system prototype. EHR standards can be extended to include the necessary patient data (as we have demonstrated in the case of the CCR), while knowledge can be obtained from external knowledge bases that are created and maintained independently from the EHR. This approach can form the basis for a personalized medicine framework, a more comprehensive standards-based EHR system and a potential platform for advancing translational research by both disseminating results and providing opportunities for new insights into phenotype-genotype relationships. Copyright © 2011 Elsevier Inc. All rights reserved.

A tutorial on activity-based costing of electronic health records.

PubMed

Federowicz, Marie H; Grossman, Mila N; Hayes, Bryant J; Riggs, Joseph

2010-01-01

As the American Recovery and Restoration Act of 2009 allocates $19 billion to health information technology, it will be useful for health care managers to project the true cost of implementing an electronic health record (EHR). This study presents a step-by-step guide for using activity-based costing (ABC) to estimate the cost of an EHR. ABC is a cost accounting method with a "top-down" approach for estimating the cost of a project or service within an organization. The total cost to implement an EHR includes obvious costs, such as licensing fees, and hidden costs, such as impact on productivity. Unlike other methods, ABC includes all of the organization's expenditures and is less likely to miss hidden costs. Although ABC is used considerably in manufacturing and other industries, it is a relatively new phenomenon in health care. ABC is a comprehensive approach that the health care field can use to analyze the cost-effectiveness of implementing EHRs. In this article, ABC is applied to a health clinic that recently implemented an EHR, and the clinic is found to be more productive after EHR implementation. This methodology can help health care administrators assess the impact of a stimulus investment on organizational performance.

The Effect of Electronic Health Record Use and Patient-Centered Communication on Cancer Screening Behavior: An Analysis of the Health Information National Trends Survey.

PubMed

Totzkay, Daniel; Silk, Kami J; Sheff, Sarah E

2017-07-01

The present study used the 2013 Health Information National Trends Survey (N = 3185) to examine the effects of patient-centered communication (PCC) and the use of electronic health records (EHRs) on the likelihood of patients receiving a recommended screening for cancer (i.e., mammogram, PSA test). Self-determination theory, a framework of self-initiated extrinsic behaviors, was applied to test mediation models of PCC and EHR use, respectively, through patient activation. The results demonstrated that PCC and EHR use predicted cancer screening (mediated through patient activation), but only for women recommended for biannual mammograms. The aforementioned relationship was not found for men who are recommended for prostate cancer screening. PCC and EHRs do appear to facilitate a patient's ability to take care of their own health, but only under certain circumstances. It was additionally found that men were more likely to report higher degrees of physician PCC when their physicians maintained an EHR, whereas women reported no difference. Future research should examine more nuanced personality factors that affect the perception of PCC in the presence of EHRs and the relationship between men's activation and likelihood of receiving a cancer screen.

In emergency departments, radiologists' access to EHRs may influence interpretations and medical management.

PubMed

Franczak, Michael J; Klein, Madeline; Raslau, Flavius; Bergholte, Jo; Mark, Leighton P; Ulmer, John L

2014-05-01

The adoption of electronic health records (EHRs) that meet federal meaningful-use standards is a major US national policy priority. Policy makers recognize the potential of electronic communication in delivering high-quality health care, particularly in an environment of expanding remote access to medical care and the ever-increasing need to transmit health care records across institutions. To demonstrate this principle, we sought to estimate the significance of EHR access in emergent neuroradiologic interpretations. Three neuroradiologists conducted a prospective expert-rater analysis of 2,000 consecutive head computed tomography (CT) exams ordered by emergency department (ED) physicians. For each head CT exam, the neuroradiologists compared medical information generated by ED physicians to information generated by the interpreting radiologists who had access to additional EHR-derived patient data. In 6.1 percent of the head CT exams, the neuroradiologists reached consensus--meaning two out of three agreed--that the additional clinical data derived from the EHR was "very likely" to influence radiological interpretations and that the lack of that data would have adversely affected medical management in those patients. Health care providers must recognize the value of implementing EHRs and foster their widespread adoption.

Estimating Wisconsin Asthma Prevalence Using Clinical Electronic Health Records and Public Health Data

PubMed Central

Tomasallo, Carrie D.; Hanrahan, Lawrence P.; Tandias, Aman; Chang, Timothy S.; Cowan, Kelly J.

2014-01-01

Objectives. We compared a statewide telephone health survey with electronic health record (EHR) data from a large Wisconsin health system to estimate asthma prevalence in Wisconsin. Methods. We developed frequency tables and logistic regression models using Wisconsin Behavioral Risk Factor Surveillance System and University of Wisconsin primary care clinic data. We compared adjusted odds ratios (AORs) from each model. Results. Between 2007 and 2009, the EHR database contained 376 000 patients (30 000 with asthma), and 23 000 (1850 with asthma) responded to the Behavioral Risk Factor Surveillance System telephone survey. AORs for asthma were similar in magnitude and direction for the majority of covariates, including gender, age, and race/ethnicity, between survey and EHR models. The EHR data had greater statistical power to detect associations than did survey data, especially in pediatric and ethnic populations, because of larger sample sizes. Conclusions. EHRs can be used to estimate asthma prevalence in Wisconsin adults and children. EHR data may improve public health chronic disease surveillance using high-quality data at the local level to better identify areas of disparity and risk factors and guide education and health care interventions. PMID:24228643

A systematic literature review on security and privacy of electronic health record systems: technical perspectives.

PubMed

Rezaeibagha, Fatemeh; Win, Khin Than; Susilo, Willy

Even though many safeguards and policies for electronic health record (EHR) security have been implemented, barriers to the privacy and security protection of EHR systems persist. This article presents the results of a systematic literature review regarding frequently adopted security and privacy technical features of EHR systems. Our inclusion criteria were full articles that dealt with the security and privacy of technical implementations of EHR systems published in English in peer-reviewed journals and conference proceedings between 1998 and 2013; 55 selected studies were reviewed in detail. We analysed the review results using two International Organization for Standardization (ISO) standards (29100 and 27002) in order to consolidate the study findings. Using this process, we identified 13 features that are essential to security and privacy in EHRs. These included system and application access control, compliance with security requirements, interoperability, integration and sharing, consent and choice mechanism, policies and regulation, applicability and scalability and cryptography techniques. This review highlights the importance of technical features, including mandated access control policies and consent mechanisms, to provide patients' consent, scalability through proper architecture and frameworks, and interoperability of health information systems, to EHR security and privacy requirements.

Comparison of electronic health record system functionalities to support the patient recruitment process in clinical trials.

PubMed

Schreiweis, Björn; Trinczek, Benjamin; Köpcke, Felix; Leusch, Thomas; Majeed, Raphael W; Wenk, Joachim; Bergh, Björn; Ohmann, Christian; Röhrig, Rainer; Dugas, Martin; Prokosch, Hans-Ulrich

2014-11-01

Reusing data from electronic health records for clinical and translational research and especially for patient recruitment has been tackled in a broader manner since about a decade. Most projects found in the literature however focus on standalone systems and proprietary implementations at one particular institution often for only one singular trial and no generic evaluation of EHR systems for their applicability to support the patient recruitment process does yet exist. Thus we sought to assess whether the current generation of EHR systems in Germany provides modules/tools, which can readily be applied for IT-supported patient recruitment scenarios. We first analysed the EHR portfolio implemented at German University Hospitals and then selected 5 sites with five different EHR implementations covering all major commercial systems applied in German University Hospitals. Further, major functionalities required for patient recruitment support have been defined and the five sample EHRs and their standard tools have been compared to the major functionalities. In our analysis of the site's hospital information system environments (with four commercial EHR systems and one self-developed system) we found that - even though no dedicated module for patient recruitment has been provided - most EHR products comprise generic tools such as workflow engines, querying capabilities, report generators and direct SQL-based database access which can be applied as query modules, screening lists and notification components for patient recruitment support. A major limitation of all current EHR products however is that they provide no dedicated data structures and functionalities for implementing and maintaining a local trial registry. At the five sites with standard EHR tools the typical functionalities of the patient recruitment process could be mostly implemented. However, no EHR component is yet directly dedicated to support research requirements such as patient recruitment. We recommend for future developments that EHR customers and vendors focus much more on the provision of dedicated patient recruitment modules. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Market effects on electronic health record adoption by physicians.

PubMed

Abdolrasulnia, Maziar; Menachemi, Nir; Shewchuk, Richard M; Ginter, Peter M; Duncan, W Jack; Brooks, Robert G

2008-01-01

Despite the advantages of electronic health record (EHR) systems, the adoption of these systems has been slow among community-based physicians. Current studies have examined organizational and personal barriers to adoption; however, the influence of market characteristics has not been studied. The purpose of this study was to measure the effects of market characteristics on EHR adoption by physicians. Generalized hierarchal linear modeling was used to analyze EHR survey data from Florida which were combined with data from the Area Resource File and the Florida Office of Insurance Regulation. The main outcome variable was self-reported use of EHR by physicians. A total of 2,926 physicians from practice sizes of 20 or less were included in the sample. Twenty-one percent (n = 613) indicated that they personally and routinely use an EHR system in their practice. Physicians located in counties with higher physician concentration were found to be more likely to adopt EHRs. For every one-unit increase in nonfederal physicians per 10,000 in the county, there was a 2.0% increase in likelihood of EHR adoption by physicians (odds ratio = 1.02, confidence interval = 1.00-1.03). Health maintenance organization penetration rate and poverty level were not found to be significantly related to EHR adoption. However, practice size, years in practice, Medicare payer mix, and measures of technology readiness were found to independently influence physician adoption. Market factors play an important role in the diffusion of EHRs in small medical practices. Policy makers interested in furthering the adoption of EHRs must consider strategies that would enhance the confidence of users as well as provide financial support in areas with the highest concentration of small medical practices and Medicare beneficiaries. Health care leaders should be cognizant of the market forces that enable or constrain the adoption of EHR among their practices and those of their competitors.

Provider responses to patients controlling access to their electronic health records: a prospective cohort study in primary care.

PubMed

Tierney, William M; Alpert, Sheri A; Byrket, Amy; Caine, Kelly; Leventhal, Jeremy C; Meslin, Eric M; Schwartz, Peter H

2015-01-01

Applying Fair Information Practice principles to electronic health records (EHRs) requires allowing patient control over who views their data. We designed a program that captures patients' preferences for provider access to an urban health system's EHR. Patients could allow or restrict providers' access to all data (diagnoses, medications, test results, reports, etc.) or only highly sensitive data (sexually transmitted infections, HIV/AIDS, drugs/alcohol, mental or reproductive health). Except for information in free-text reports, we redacted EHR data shown to providers according to patients' preferences. Providers could "break the glass" to display redacted information. We prospectively studied this system in one primary care clinic, noting redactions and when users "broke the glass," and surveyed providers about their experiences and opinions. Eight of nine eligible clinic physicians and all 23 clinic staff participated. All 105 patients who enrolled completed the preference program. Providers did not know which of their patients were enrolled, nor their preferences for accessing their EHRs. During the 6-month prospective study, 92 study patients (88 %) returned 261 times, during which providers viewed their EHRs 126 times (48 %). Providers "broke the glass" 102 times, 92 times for patients not in the study and ten times for six returning study patients, all of whom had restricted EHR access. Providers "broke the glass" for six (14 %) of 43 returning study patients with redacted data vs. zero among 49 study patients without redactions (p = 0.01). Although 54 % of providers agreed that patients should have control over who sees their EHR information, 58 % believed restricting EHR access could harm provider-patient relationships and 71 % felt quality of care would suffer. Patients frequently preferred restricting provider access to their EHRs. Providers infrequently overrode patients' preferences to view hidden data. Providers believed that restricting EHR access would adversely impact patient care. Applying Fair Information Practice principles to EHRs will require balancing patient preferences, providers' needs, and health care quality.

Using OpenEHR in SICTI an electronic health record system for critical medicine

NASA Astrophysics Data System (ADS)

Filgueira, R.; Odriazola, A.; Simini, F.

2007-11-01

SICTI is a software tool for registering health records in critical medicine environments. Version 1.0 has been in use since 2003. The Biomedical Engineering Group (Núcleo de Ingeniería Biomédica), with support from the Technological Development Programme (Programa de Desarrollo Tecnológico), decided to develop a new version, to provide an aid for more critical medicine processes, based on a framework which would make the application domain change oriented. The team analyzed three alternatives: to develop an original product based on new research, to base the development on OpenEHR framework, or to use HL7 RIM as the reference model for SICTI. The team opted for OpenEHR. This work describes the use of OpenEHR, its strong and weak points, and states future work perspectives.

Open source electronic health records and chronic disease management

PubMed Central

Goldwater, Jason C; Kwon, Nancy J; Nathanson, Ashley; Muckle, Alison E; Brown, Alexa; Cornejo, Kerri

2014-01-01

Objective To study and report on the use of open source electronic health records (EHR) to assist with chronic care management within safety net medical settings, such as community health centers (CHC). Methods and Materials The study was conducted by NORC at the University of Chicago from April to September 2010. The NORC team undertook a comprehensive environmental scan, including a literature review, a dozen key informant interviews using a semistructured protocol, and a series of site visits to CHC that currently use an open source EHR. Results Two of the sites chosen by NORC were actively using an open source EHR to assist in the redesign of their care delivery system to support more effective chronic disease management. This included incorporating the chronic care model into an CHC and using the EHR to help facilitate its elements, such as care teams for patients, in addition to maintaining health records on indigent populations, such as tuberculosis status on homeless patients. Discussion The ability to modify the open-source EHR to adapt to the CHC environment and leverage the ecosystem of providers and users to assist in this process provided significant advantages in chronic care management. Improvements in diabetes management, controlled hypertension and increases in tuberculosis vaccinations were assisted through the use of these open source systems. Conclusions The flexibility and adaptability of open source EHR demonstrated its utility and viability in the provision of necessary and needed chronic disease care among populations served by CHC. PMID:23813566

Evaluating Primary Care Providers' Views on Survivorship Care Plans Generated by an Electronic Health Record System

PubMed Central

Donohue, SarahMaria; Sesto, Mary E.; Hahn, David L.; Buhr, Kevin A.; Jacobs, Elizabeth A.; Sosman, James M.; Andreason, Molly J.; Wiegmann, Douglas A.; Tevaarwerk, Amye J.

2015-01-01

Purpose: Survivorship care plans for cancer survivors may facilitate provider-to-provider communication. Primary care provider (PCP) perspectives on care plan provision and use are limited, especially when care plans are generated by an electronic health record (EHR) system. We sought to examine PCPs' perspectives regarding EHR-generated care plans. Methods: PCPs (N = 160) who were members of the Wisconsin Research and Education Network listserv received a sample 10-page plan (WREN cohort). PCPs (n = 81) who had or were currently seeing survivors enrolled onto one of our survivorship clinical trials received a copy of the survivor's personalized care plan (University of Wisconsin [UW] cohort). Both cohorts received a survey after reviewing the plan. All plans were generated within an EHR. Results: Forty-six and 26 PCPs participated in the WREN and UW cohorts, respectively. PCPs regarded EHR-generated plans as useful in coordinating care (88%), understanding treatments (94%), understanding treatment adverse effects (89%), and supporting clinical decisions (82%). Few felt using EHR-generated plans would disrupt clinic workflow (14%) or take too much time (11%). Most (89%) preferred receiving the plan via EHR. PCPs reported consistent provision (81%) and standard location in the medical record (89%) as key factors facilitating their use of survivorship care plans. Important facilitators of care plan use included a more abbreviated plan, ideally one to three pages (32%), and/or a plan specifically tailored to PCP use (57%). Conclusion: Plans were viewed as useful for coordinating care and making clinical decisions. However, PCPs desired shorter, clinician-oriented plans, accessible within an EHR and delivered and located in a standardized manner. PMID:25804989

Development of Hospital-based Data Sets as a Vehicle for Implementation of a National Electronic Health Record

PubMed Central

Keikha, Leila; Farajollah, Seyede Sedigheh Seied; Safdari, Reza; Ghazisaeedi, Marjan; Mohammadzadeh, Niloofar

2018-01-01

Background In developing countries such as Iran, international standards offer good sources to survey and use for appropriate planning in the domain of electronic health records (EHRs). Therefore, in this study, HL7 and ASTM standards were considered as the main sources from which to extract EHR data. Objective The objective of this study was to propose a hospital data set for a national EHR consisting of data classes and data elements by adjusting data sets extracted from the standards and paper-based records. Method This comparative study was carried out in 2017 by studying the contents of the paper-based records approved by the health ministry in Iran and the international ASTM and HL7 standards in order to extract a minimum hospital data set for a national EHR. Results As a result of studying the standards and paper-based records, a total of 526 data elements in 174 classes were extracted. An examination of the data indicated that the highest number of extracted data came from the free text elements, both in the paper-based records and in the standards related to the administrative data. The major sources of data extracted from ASTM and HL7 were the E1384 and Hl7V.x standards, respectively. In the paper-based records, data were extracted from 19 forms sporadically. Discussion By declaring the confidentiality of information, the ASTM standards acknowledge the issue of confidentiality of information as one of the main challenges of EHR development, and propose new types of admission, such as teleconference, tele-video, and home visit, which are inevitable with the advent of new technology for providing healthcare and treating diseases. Data related to finance and insurance, which were scattered in different categories by three organizations, emerged as the financial category. Documenting the role and responsibility of the provider by adding the authenticator/signature data element was deemed essential. Conclusion Not only using well-defined and standardized data, but also adapting EHR systems to the local facilities and the existing social and cultural conditions, will facilitate the development of structured data sets. PMID:29618962

Development of Hospital-based Data Sets as a Vehicle for Implementation of a National Electronic Health Record.

PubMed

Keikha, Leila; Farajollah, Seyede Sedigheh Seied; Safdari, Reza; Ghazisaeedi, Marjan; Mohammadzadeh, Niloofar

2018-01-01

In developing countries such as Iran, international standards offer good sources to survey and use for appropriate planning in the domain of electronic health records (EHRs). Therefore, in this study, HL7 and ASTM standards were considered as the main sources from which to extract EHR data. The objective of this study was to propose a hospital data set for a national EHR consisting of data classes and data elements by adjusting data sets extracted from the standards and paper-based records. This comparative study was carried out in 2017 by studying the contents of the paper-based records approved by the health ministry in Iran and the international ASTM and HL7 standards in order to extract a minimum hospital data set for a national EHR. As a result of studying the standards and paper-based records, a total of 526 data elements in 174 classes were extracted. An examination of the data indicated that the highest number of extracted data came from the free text elements, both in the paper-based records and in the standards related to the administrative data. The major sources of data extracted from ASTM and HL7 were the E1384 and Hl7V.x standards, respectively. In the paper-based records, data were extracted from 19 forms sporadically. By declaring the confidentiality of information, the ASTM standards acknowledge the issue of confidentiality of information as one of the main challenges of EHR development, and propose new types of admission, such as teleconference, tele-video, and home visit, which are inevitable with the advent of new technology for providing healthcare and treating diseases. Data related to finance and insurance, which were scattered in different categories by three organizations, emerged as the financial category. Documenting the role and responsibility of the provider by adding the authenticator/signature data element was deemed essential. Not only using well-defined and standardized data, but also adapting EHR systems to the local facilities and the existing social and cultural conditions, will facilitate the development of structured data sets.

Cross-vendor evaluation of key user-defined clinical decision support capabilities: a scenario-based assessment of certified electronic health records with guidelines for future development.

PubMed

McCoy, Allison B; Wright, Adam; Sittig, Dean F

2015-09-01

Clinical decision support (CDS) is essential for delivery of high-quality, cost-effective, and safe healthcare. The authors sought to evaluate the CDS capabilities across electronic health record (EHR) systems. We evaluated the CDS implementation capabilities of 8 Office of the National Coordinator for Health Information Technology Authorized Certification Body (ONC-ACB)-certified EHRs. Within each EHR, the authors attempted to implement 3 user-defined rules that utilized the various data and logic elements expected of typical EHRs and that represented clinically important evidenced-based care. The rules were: 1) if a patient has amiodarone on his or her active medication list and does not have a thyroid-stimulating hormone (TSH) result recorded in the last 12 months, suggest ordering a TSH; 2) if a patient has a hemoglobin A1c result >7% and does not have diabetes on his or her problem list, suggest adding diabetes to the problem list; and 3) if a patient has coronary artery disease on his or her problem list and does not have aspirin on the active medication list, suggest ordering aspirin. Most evaluated EHRs lacked some CDS capabilities; 5 EHRs were able to implement all 3 rules, and the remaining 3 EHRs were unable to implement any of the rules. One of these did not allow users to customize CDS rules at all. The most frequently found shortcomings included the inability to use laboratory test results in rules, limit rules by time, use advanced Boolean logic, perform actions from the alert interface, and adequately test rules. Significant improvements in the EHR certification and implementation procedures are necessary. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Modeling Disease Severity in Multiple Sclerosis Using Electronic Health Records

PubMed Central

Xia, Zongqi; Secor, Elizabeth; Chibnik, Lori B.; Bove, Riley M.; Cheng, Suchun; Chitnis, Tanuja; Cagan, Andrew; Gainer, Vivian S.; Chen, Pei J.; Liao, Katherine P.; Shaw, Stanley Y.; Ananthakrishnan, Ashwin N.; Szolovits, Peter; Weiner, Howard L.; Karlson, Elizabeth W.; Murphy, Shawn N.; Savova, Guergana K.; Cai, Tianxi; Churchill, Susanne E.; Plenge, Robert M.; Kohane, Isaac S.; De Jager, Philip L.

2013-01-01

Objective To optimally leverage the scalability and unique features of the electronic health records (EHR) for research that would ultimately improve patient care, we need to accurately identify patients and extract clinically meaningful measures. Using multiple sclerosis (MS) as a proof of principle, we showcased how to leverage routinely collected EHR data to identify patients with a complex neurological disorder and derive an important surrogate measure of disease severity heretofore only available in research settings. Methods In a cross-sectional observational study, 5,495 MS patients were identified from the EHR systems of two major referral hospitals using an algorithm that includes codified and narrative information extracted using natural language processing. In the subset of patients who receive neurological care at a MS Center where disease measures have been collected, we used routinely collected EHR data to extract two aggregate indicators of MS severity of clinical relevance multiple sclerosis severity score (MSSS) and brain parenchymal fraction (BPF, a measure of whole brain volume). Results The EHR algorithm that identifies MS patients has an area under the curve of 0.958, 83% sensitivity, 92% positive predictive value, and 89% negative predictive value when a 95% specificity threshold is used. The correlation between EHR-derived and true MSSS has a mean R2 = 0.38±0.05, and that between EHR-derived and true BPF has a mean R2 = 0.22±0.08. To illustrate its clinical relevance, derived MSSS captures the expected difference in disease severity between relapsing-remitting and progressive MS patients after adjusting for sex, age of symptom onset and disease duration (p = 1.56×10−12). Conclusion Incorporation of sophisticated codified and narrative EHR data accurately identifies MS patients and provides estimation of a well-accepted indicator of MS severity that is widely used in research settings but not part of the routine medical records. Similar approaches could be applied to other complex neurological disorders. PMID:24244385

[Computers in the consultation: can we stay patient-centered?].

PubMed

Lanier, Cédric; Sommer, Johanna; Perron, Noelle Junod

2015-05-13

Eletronic health records (EHR) are now part of most medical practices in many countries including Switzerland. Their use facilitates access and exchange of information among health professionals, improves the quality of medical care and decreases the number of medical errors. Even patients express their satisfaction with the use of EHR. However, it has been observed that use of EHR can modify patient-physician communication. The present article describes the different elements linked to EHR which can enhance or inhibit patient-physician communication. It also suggests strategies for improving it.

Avoiding fraud risks associated with EHRs.

PubMed

Helton, Jeffrey R

2010-07-01

Fraud associated with electronic health records (EHRs) generally falls into two categories: inappropriate billing by healthcare providers and inappropriate access by a system's users. A provider's EHR system requires controls to be of any significant help in detecting such fraudulent activity, or in gathering transactional evidence should such activity be identified. To protect against potential EHR-related healthcare fraud, providers should follow the recommendations established in 2007 by RTI International for the Office of the National Coordinator for Health Information Technology of the U.S. Department of Health and Human Services.

Medicare and Medicaid programs; modifications to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program for 2014 and other changes to EHR Incentive Program; and health information technology: revision to the certified EHR technology definition and EHR certification changes related to standards. Final rule.

PubMed

2014-09-04

This final rule changes the meaningful use stage timeline and the definition of certified electronic health record technology (CEHRT) to allow options in the use of CEHRT for the EHR reporting period in 2014. It also sets the requirements for reporting on meaningful use objectives and measures as well as clinical quality measure (CQM) reporting in 2014 for providers who use one of the CEHRT options finalized in this rule for their EHR reporting period in 2014. In addition, it finalizes revisions to the Medicare and Medicaid EHR Incentive Programs to adopt an alternate measure for the Stage 2 meaningful use objective for hospitals to provide structured electronic laboratory results to ambulatory providers; to correct the regulation text for the measures associated with the objective for hospitals to provide patients the ability to view online, download, and transmit information about a hospital admission; and to set a case number threshold exemption for CQM reporting applicable for eligible hospitals and critical access hospitals (CAHs) beginning with FY 2013. Finally, this rule finalizes the provisionally adopted replacement of the Data Element Catalog (DEC) and the Quality Reporting Document Architecture (QRDA) Category III standards with updated versions of these standards.

openEHR Based Systems and the General Data Protection Regulation (GDPR).

PubMed

Sousa, Mariana; Ferreira, Duarte; Santos-Pereira, Cátia; Bacelar, Gustavo; Frade, Samuel; Pestana, Olívia; Cruz-Correia, Ricardo

2018-01-01

The concerns about privacy and personal data protection resulted in reforms of the existing legislation in European Union (EU). The General Data Protection Regulation (GDPR) aims to reform the existing measures on the topic of personal data protection of the European Union citizens, with a strong input on the rights and freedoms of people and in the establishment of rules for the processing of personal data. OpenEHR is a standard that embodies many principles of interoperable and secure software for electronic health records. This work aims to understand to what extent the openEHR standard can be considered a solution for the requirements needed by GDPR. A list of requirements for a Hospital Information Systems (HIS) compliant with GDPR and an identification of openEHR specifications was made. The requirements were categorized and compared with the specifications. The requirements identified for the systems were matched with the openEHR specifications, which result in 16 requirements matched with openEHR. All the specifications identified matched at least one requirement. OpenEHR is a solution for the development of HIS that reinforce privacy and personal data protection, ensuring that they are contemplated in the system development. The institutions can secure that their Eletronic Health Record are compliant with GDPR while safeguarding the medical data quality and, as a result, the healthcare delivery.

Development of Mobile Electronic Health Records Application in a Secondary General Hospital in Korea

PubMed Central

Park, Min Ah; Hong, Eunseok; Kim, Sunhyu; Ahn, Ryeok; Hong, Jungseok; Song, Seungyeol; Kim, Tak; Kim, Jeongkeun; Yeo, Seongwoon

2013-01-01

Objectives The recent evolution of mobile devices has opened new possibilities of providing strongly integrated mobile services in healthcare. The objective of this paper is to describe the decision driver, development, and implementation of an integrated mobile Electronic Health Record (EHR) application at Ulsan University Hospital. This application helps healthcare providers view patients' medical records and information without a stationary computer workstation. Methods We developed an integrated mobile application prototype that aimed to improve the mobility and usability of healthcare providers during their daily medical activities. The Android and iOS platform was used to create the mobile EHR application. The first working version was completed in 5 months and required 1,080 development hours. Results The mobile EHR application provides patient vital signs, patient data, text communication, and integrated EHR. The application allows our healthcare providers to know the status of patients within and outside the hospital environment. The application provides a consistent user environment on several compatible Android and iOS devices. A group of 10 beta testers has consistently used and maintained our copy of the application, suggesting user acceptance. Conclusions We are developing the integrated mobile EHR application with the goals of implementing an environment that is user-friendly, implementing a patient-centered system, and increasing the hospital's competitiveness. PMID:24523996

Development of mobile electronic health records application in a secondary general hospital in Korea.

PubMed

Choi, Wookjin; Park, Min Ah; Hong, Eunseok; Kim, Sunhyu; Ahn, Ryeok; Hong, Jungseok; Song, Seungyeol; Kim, Tak; Kim, Jeongkeun; Yeo, Seongwoon

2013-12-01

The recent evolution of mobile devices has opened new possibilities of providing strongly integrated mobile services in healthcare. The objective of this paper is to describe the decision driver, development, and implementation of an integrated mobile Electronic Health Record (EHR) application at Ulsan University Hospital. This application helps healthcare providers view patients' medical records and information without a stationary computer workstation. We developed an integrated mobile application prototype that aimed to improve the mobility and usability of healthcare providers during their daily medical activities. The Android and iOS platform was used to create the mobile EHR application. The first working version was completed in 5 months and required 1,080 development hours. The mobile EHR application provides patient vital signs, patient data, text communication, and integrated EHR. The application allows our healthcare providers to know the status of patients within and outside the hospital environment. The application provides a consistent user environment on several compatible Android and iOS devices. A group of 10 beta testers has consistently used and maintained our copy of the application, suggesting user acceptance. We are developing the integrated mobile EHR application with the goals of implementing an environment that is user-friendly, implementing a patient-centered system, and increasing the hospital's competitiveness.

Development of an open metadata schema for prospective clinical research (openPCR) in China.

PubMed

Xu, W; Guan, Z; Sun, J; Wang, Z; Geng, Y

2014-01-01

In China, deployment of electronic data capture (EDC) and clinical data management system (CDMS) for clinical research (CR) is in its very early stage, and about 90% of clinical studies collected and submitted clinical data manually. This work aims to build an open metadata schema for Prospective Clinical Research (openPCR) in China based on openEHR archetypes, in order to help Chinese researchers easily create specific data entry templates for registration, study design and clinical data collection. Singapore Framework for Dublin Core Application Profiles (DCAP) is used to develop openPCR and four steps such as defining the core functional requirements and deducing the core metadata items, developing archetype models, defining metadata terms and creating archetype records, and finally developing implementation syntax are followed. The core functional requirements are divided into three categories: requirements for research registration, requirements for trial design, and requirements for case report form (CRF). 74 metadata items are identified and their Chinese authority names are created. The minimum metadata set of openPCR includes 3 documents, 6 sections, 26 top level data groups, 32 lower data groups and 74 data elements. The top level container in openPCR is composed of public document, internal document and clinical document archetypes. A hierarchical structure of openPCR is established according to Data Structure of Electronic Health Record Architecture and Data Standard of China (Chinese EHR Standard). Metadata attributes are grouped into six parts: identification, definition, representation, relation, usage guides, and administration. OpenPCR is an open metadata schema based on research registration standards, standards of the Clinical Data Interchange Standards Consortium (CDISC) and Chinese healthcare related standards, and is to be publicly available throughout China. It considers future integration of EHR and CR by adopting data structure and data terms in Chinese EHR Standard. Archetypes in openPCR are modularity models and can be separated, recombined, and reused. The authors recommend that the method to develop openPCR can be referenced by other countries when designing metadata schema of clinical research. In the next steps, openPCR should be used in a number of CR projects to test its applicability and to continuously improve its coverage. Besides, metadata schema for research protocol can be developed to structurize and standardize protocol, and syntactical interoperability of openPCR with other related standards can be considered.

Achieving the Meaningful Use Standard: A Model for Implementing Change Within Medical Practices.

PubMed

Fryefield, David C; Staggs, Stuart; Herman, William; Stickler, Alan; Ahmad, Asif; Patt, Debra A; Beveridge, Roy A

2014-03-01

Change management in medical practices is often an uphill battle. Lack of agreement on standards, ineffective leadership, inertia, inconsistent access to data, and inability to clearly define and communicate the benefits of change represent significant barriers to success. In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act created the meaningful use (MU) incentive program administered through the Centers for Medicare and Medicaid Services (CMS). To earn financial incentive payments, eligible physicians adopt certified electronic health record (EHR) technology and use it to meet specified objectives. In response, leadership of the US Oncology Network launched an MU initiative designed to create a comprehensive system of tools, education, performance feedback, and support that would facilitate successful achievement of the MU standards. The EHR used by the majority of network physicians was modified according to the MU specifications, and EHR certification was obtained. Baseline compliance data were measured for each of the MU standards and for each of the eligible physicians. Physician and staff workflow processes necessary for consistent data input and compliance were outlined for each standard. Each practice identified one or more staff members who would act as MU leads. Training modules were developed for the MU leads as well as for physicians, mid-level providers, nurses, medical assistants, and office staff. An MU measurement tool was created, designed to target areas for MU process improvement and automate reporting. Data were updated and verified weekly to provide timely feedback to practices, including individual physician detail and links to individual patient records. A total of 943 practitioners within the US Oncology Network met eligibility criteria for the MU program. At baseline, compliance with each MU standard ranged from 0% (clinical summaries) to 100% (computerized order entry). In many cases, data were simply not being entered into the EHR. Time from program launch to first submission of MU attestation was 18 months. As of March 2013, 781 practitioners (83%) had achieved the MU standards. In comparison, CMS reported that 44% of all eligible physicians and 26% of hematologists and oncologists had successfully achieved Medicare MU standards and received payment. Successful change management in medical practices can be accomplished through a comprehensive system of leadership, education, support, timely feedback of data, and clearly defined incentives. Incentives alone may be far less effective.

Acceptance and Usage of Electronic Health Record Systems in Small Medical Practices

ERIC Educational Resources Information Center

Tannan, Ritu

2012-01-01

One of the objectives of the U.S. government has been the development of a nationwide health information infrastructure, including adoption and use of an electronic health records (EHR) system. However, a 2008 survey conducted by the National Center for Health Statistics indicated a 41.5% usage of the EHR system by physicians in office-based…

Advanced Development and Dissemination of EMERSE for Cancer Phenotyping from Medical Records | Informatics Technology for Cancer Research (ITCR)

Cancer.gov

The increasing use of electronic health records (EHRs) by cancer centers nationwide has led to the tremendous growth of repositories containing unstructured, free text notes. These notes include clinical concepts that cannot be found anywhere else in the EHR, and these concepts are needed to characterize a patient’s specific ‘phenotype’.

Trust and Privacy in Healthcare

NASA Astrophysics Data System (ADS)

Singleton, Peter; Kalra, Dipak

This paper considers issues of trust and privacy in healthcare around increased data-sharing through Electronic Health Records (EHRs). It uses a model structured around different aspects of trust in the healthcare organisation’s reasons for greater data-sharing and their ability to execute EHR projects, particularly any associated confidentiality controls. It reflects the individual’s personal circumstances and attitude to use of health records.

National electronic health record interoperability chronology.

PubMed

Hufnagel, Stephen P

2009-05-01

The federal initiative for electronic health record (EHR) interoperability began in 2000 and set the stage for the establishment of the 2004 Executive Order for EHR interoperability by 2014. This article discusses the chronology from the 2001 e-Government Consolidated Health Informatics (CHI) initiative through the current congressional mandates for an aligned, interoperable, and agile DoD AHLTA and VA VistA.

Adoption factors associated with electronic health record among long-term care facilities: a systematic review

PubMed Central

Kruse, Clemens Scott; Mileski, Michael; Alaytsev, Vyachelslav; Carol, Elizabeth; Williams, Ariana

2015-01-01

Objectives The Health Information Technology for Economic and Clinical Health (HITECH) Act created incentives for adopting electronic health records (EHRs) for some healthcare organisations, but long-term care (LTC) facilities are excluded from those incentives. There are realisable benefits of EHR adoption in LTC facilities; however, there is limited research about this topic. The purpose of this systematic literature review is to identify EHR adoption factors for LTC facilities that are ineligible for the HITECH Act incentives. Setting We conducted systematic searches of Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete via Ebson B. Stephens Company (EBSCO Host), Google Scholar and the university library search engine to collect data about EHR adoption factors in LTC facilities since 2009. Participants Search results were filtered by date range, full text, English language and academic journals (n=22). Interventions Multiple members of the research team read each article to confirm applicability and study conclusions. Primary and secondary outcome measures Researchers identified common themes across the literature: specifically facilitators and barriers to adoption of the EHR in LTC. Results Results identify facilitators and barriers associated with EHR adoption in LTC facilities. The most common facilitators include access to information and error reduction. The most prevalent barriers include initial costs, user perceptions and implementation problems. Conclusions Similarities span the system selection phases and implementation process; of those, cost was the most common mentioned. These commonalities should help leaders in LTC facilities align strategic decisions to EHR adoption. This review may be useful for decision-makers attempting successful EHR adoption, policymakers trying to increase adoption rates without expanding incentives and vendors that produce EHRs. PMID:25631311

Does electronic health record use improve hospital financial performance? Evidence from panel data.

PubMed

Collum, Taleah H; Menachemi, Nir; Sen, Bisakha

2016-01-01

The aim of this study was to examine the impact of electronic health record (EHR) adoption on hospital financial performance. We constructed a longitudinal panel using data from the three secondary sources: (a) the 2007-2010 American Hospital Association (AHA) Annual Survey, (b) the 2007-2010 AHA Annual Survey Information Technology Supplement, and (c) the 2007-2011 Medicare Cost Reports from Centers for Medicare and Medicaid Services. Because potential financial benefits attributable to EHR adoption may take some time to accrue, we ran regressions with lags of 1 and 2 years that included hospital and year fixed effects to examine the relationship between the level of EHR adoption and three hospital financial performance measures. A change in the level of EHR adoption was not associated with changes in operating margin or return on assets within hospitals. However, total margin was significantly improved, after 2 years, in hospitals that moved from no EHR to having a comprehensive EHR in all areas of their hospital (β = 0.030, p < .034). On the other hand, hospitals that increased their level of EHR adoption but did not achieve hospital-wide comprehensive adoption did not experience changes in any financial performance measures examined. The improvements in total margin, as opposed to operating margin, are likely due to hospital incentive payments under the Health Information Technology for Economic and Clinical Health Act that are reflected in nonpatient revenues and therefore show up in total margin calculations. Thus, after 2 years of EHR adoption, hospital financial performance is observed to improve based only on meaningful use incentive payments. More research will be needed to determine whether EHR adoption impacts financial performance on a longer time horizon.

rEHR: An R package for manipulating and analysing Electronic Health Record data.

PubMed

Springate, David A; Parisi, Rosa; Olier, Ivan; Reeves, David; Kontopantelis, Evangelos

2017-01-01

Research with structured Electronic Health Records (EHRs) is expanding as data becomes more accessible; analytic methods advance; and the scientific validity of such studies is increasingly accepted. However, data science methodology to enable the rapid searching/extraction, cleaning and analysis of these large, often complex, datasets is less well developed. In addition, commonly used software is inadequate, resulting in bottlenecks in research workflows and in obstacles to increased transparency and reproducibility of the research. Preparing a research-ready dataset from EHRs is a complex and time consuming task requiring substantial data science skills, even for simple designs. In addition, certain aspects of the workflow are computationally intensive, for example extraction of longitudinal data and matching controls to a large cohort, which may take days or even weeks to run using standard software. The rEHR package simplifies and accelerates the process of extracting ready-for-analysis datasets from EHR databases. It has a simple import function to a database backend that greatly accelerates data access times. A set of generic query functions allow users to extract data efficiently without needing detailed knowledge of SQL queries. Longitudinal data extractions can also be made in a single command, making use of parallel processing. The package also contains functions for cutting data by time-varying covariates, matching controls to cases, unit conversion and construction of clinical code lists. There are also functions to synthesise dummy EHR. The package has been tested with one for the largest primary care EHRs, the Clinical Practice Research Datalink (CPRD), but allows for a common interface to other EHRs. This simplified and accelerated work flow for EHR data extraction results in simpler, cleaner scripts that are more easily debugged, shared and reproduced.

Evaluation of the use of Swedish integrated electronic health records and register health care data as support clinical trials in severe asthma: the PACEHR study.

PubMed

Franzén, Stefan; Janson, Christer; Larsson, Kjell; Petzold, Max; Olsson, Urban; Magnusson, Gunnar; Telg, Gunilla; Colice, Gene; Johansson, Gunnar; Sundgren, Mats

2016-11-15

In the development of new drugs for severe asthma, it is a challenge from an ethical point of view to randomize severe asthma patients to placebo, and to obtain long-term safety data due to discontinuations. The aim of this study was to evaluate the feasibility of using electronic health record (EHR) data to create a real-world reference population of uncontrolled asthmatic patients to supplement the concurrent control/placebo group in long-term studies of asthma. EHR data from 36 primary care centres and a University hospital in Sweden were linked to Swedish mandatory health registers (2005-2013), creating a population covering 33 890 asthma patients, including data on co-morbidities, risk factors and laboratory/respiratory measurements. A severe asthma EHR reference cohort was established. We used logistic regression to estimate the propensity score (probability) of each RCT or EHR patient existing in the EHR cohort given their covariates. We created an EHR-derived reference cohort of 240 patients, matching the placebo group (N = 151) in an RCT of severe asthma. The exacerbation rate during follow-up in the EHR study population was 1.24 (weighted) compared to 0.9 in the RCT placebo group. Patients in the EHR cohort were of similar age as in the RCT placebo group, 50.6 years versus 50.1 years; had slightly higher body mass index 27.0 kg/m 2 versus 27.3 kg/m 2 ; and consisted of 40% versus 34% males. The results indicate that EHRs provide an opportunity to supplement the control group in RCTs of severe diseases.

Secretaries' role in EHR Documentation and the Implications of Establishing a Structured EHR System.

PubMed

Johansen, Monika Alise; Pedersen, Åse-Merete; Ellingsen, Gunnar

2015-01-01

Secretaries play an important quality assurance role in today's medical record production. This study aimed to identify quality assurance tasks that a future system cannot easily compensate for when developing a new structured EHR in which the physicians do the writing themselves. The study identified two tasks, which we suggest should also be performed by secretaries in the future.

DEVELOPMENT AND PERFORMANCE OF TEXT-MINING ALGORITHMS TO EXTRACT SOCIOECONOMIC STATUS FROM DE-IDENTIFIED ELECTRONIC HEALTH RECORDS.

PubMed

Hollister, Brittany M; Restrepo, Nicole A; Farber-Eger, Eric; Crawford, Dana C; Aldrich, Melinda C; Non, Amy

2017-01-01

Socioeconomic status (SES) is a fundamental contributor to health, and a key factor underlying racial disparities in disease. However, SES data are rarely included in genetic studies due in part to the difficultly of collecting these data when studies were not originally designed for that purpose. The emergence of large clinic-based biobanks linked to electronic health records (EHRs) provides research access to large patient populations with longitudinal phenotype data captured in structured fields as billing codes, procedure codes, and prescriptions. SES data however, are often not explicitly recorded in structured fields, but rather recorded in the free text of clinical notes and communications. The content and completeness of these data vary widely by practitioner. To enable gene-environment studies that consider SES as an exposure, we sought to extract SES variables from racial/ethnic minority adult patients (n=9,977) in BioVU, the Vanderbilt University Medical Center biorepository linked to de-identified EHRs. We developed several measures of SES using information available within the de-identified EHR, including broad categories of occupation, education, insurance status, and homelessness. Two hundred patients were randomly selected for manual review to develop a set of seven algorithms for extracting SES information from de-identified EHRs. The algorithms consist of 15 categories of information, with 830 unique search terms. SES data extracted from manual review of 50 randomly selected records were compared to data produced by the algorithm, resulting in positive predictive values of 80.0% (education), 85.4% (occupation), 87.5% (unemployment), 63.6% (retirement), 23.1% (uninsured), 81.8% (Medicaid), and 33.3% (homelessness), suggesting some categories of SES data are easier to extract in this EHR than others. The SES data extraction approach developed here will enable future EHR-based genetic studies to integrate SES information into statistical analyses. Ultimately, incorporation of measures of SES into genetic studies will help elucidate the impact of the social environment on disease risk and outcomes.

Clinical height measurements are unreliable: a call for improvement.

PubMed

Mikula, A L; Hetzel, S J; Binkley, N; Anderson, P A

2016-10-01

Height measurements are currently used to guide imaging decisions that assist in osteoporosis care, but their clinical reliability is largely unknown. We found both clinical height measurements and electronic health record height data to be unreliable. Improvement in height measurement is needed to improve osteoporosis care. The aim of this study is to assess the accuracy and reliability of clinical height measurement in a university healthcare clinical setting. Electronic health record (EHR) review, direct measurement of clinical stadiometer accuracy, and observation of staff height measurement technique at outpatient facilities of the University of Wisconsin Hospital and Clinics. We examined 32 clinical stadiometers for reliability and observed 34 clinic staff perform height measurements at 12 outpatient primary care and specialty clinics. An EHR search identified 4711 men and women age 43 to 89 with no known metabolic bone disease who had more than one height measurement over 3 months. The short study period and exclusion were selected to evaluate change in recorded height not due to pathologic processes. Mean EHR recorded height change (first to last measurement) was -0.02 cm (SD 1.88 cm). Eighteen percent of patients had height measurement differences noted in the EHR of ≥2 cm over 3 months. The technical error of measurement (TEM) was 1.77 cm with a relative TEM of 1.04 %. None of the staff observed performing height measurements followed all recommended height measurement guidelines. Fifty percent of clinic staff reported they on occasion enter patient reported height into the EHR rather than performing a measurement. When performing direct measurements on stadiometers, the mean difference from a gold standard length was 0.24 cm (SD 0.80). Nine percent of stadiometers examined had an error of >1.5 cm. Clinical height measurements and EHR recorded height results are unreliable. Improvement in this measure is needed as an adjunct to improve osteoporosis care.

Innovative uses of electronic health records and social media for public health surveillance.

PubMed

Eggleston, Emma M; Weitzman, Elissa R

2014-03-01

Electronic health records (EHRs) and social media have the potential to enrich public health surveillance of diabetes. Clinical and patient-facing data sources for diabetes surveillance are needed given its profound public health impact, opportunity for primary and secondary prevention, persistent disparities, and requirement for self-management. Initiatives to employ data from EHRs and social media for diabetes surveillance are in their infancy. With their transformative potential come practical limitations and ethical considerations. We explore applications of EHR and social media for diabetes surveillance, limitations to approaches, and steps for moving forward in this partnership between patients, health systems, and public health.

Impact of Electronic Health Records on Long-Term Care Facilities: Systematic Review

PubMed Central

Mileski, Michael; Vijaykumar, Alekhya Ganta; Viswanathan, Sneha Vishnampet; Suskandla, Ujwala; Chidambaram, Yazhini

2017-01-01

Background Long-term care (LTC) facilities are an important part of the health care industry, providing care to the fastest-growing group of the population. However, the adoption of electronic health records (EHRs) in LTC facilities lags behind other areas of the health care industry. One of the reasons for the lack of widespread adoption in the United States is that LTC facilities are not eligible for incentives under the Meaningful Use program. Implementation of an EHR system in an LTC facility can potentially enhance the quality of care, provided it is appropriately implemented, used, and maintained. Unfortunately, the lag in adoption of the EHR in LTC creates a paucity of literature on the benefits of EHR implementation in LTC facilities. Objective The objective of this systematic review was to identify the potential benefits of implementing an EHR system in LTC facilities. The study also aims to identify the common conditions and EHR features that received favorable remarks from providers and the discrepancies that needed improvement to build up momentum across LTC settings in adopting this technology. Methods The authors conducted a systematic search of PubMed, Cumulative Index of Nursing and Allied Health (CINAHL), and MEDLINE databases. Papers were analyzed by multiple referees to filter out studies not germane to our research objective. A final sample of 28 papers was selected to be included in the systematic review. Results Results of this systematic review conclude that EHRs show significant improvement in the management of documentation in LTC facilities and enhanced quality outcomes. Approximately 43% (12/28) of the papers reported a mixed impact of EHRs on the management of documentation, and 33% (9/28) of papers reported positive quality outcomes using EHRs. Surprisingly, very few papers demonstrated an impact on patient satisfaction, physician satisfaction, the length of stay, and productivity using EHRs. Conclusions Overall, implementation of EHRs has been found to be effective in the few LTC facilities that have implemented them. Implementation of EHRs in LTC facilities caused improved management of clinical documentation that enabled better decision making. PMID:28963091

Annual survey on the level and extent of usage of electronic health records in government-related hospitals in Eastern Province, Saudi Arabia.

PubMed

Bah, Sulaiman; Alharthi, Hana; El Mahalli, Azza Ali; Jabali, Abdelkaream; Al-Qahtani, Mona; Al-kahtani, Nouf

2011-01-01

This study aims to determine the level and extent of usage of electronic health records (EHRs) in government-related hospitals in Eastern Province, Saudi Arabia. Another aim is to develop a Web site to serve as a forum of exchange on the development of EHRs in Saudi Arabia. All government hospitals (n = 19) in the province were included. The information technology (IT) managers in those hospitals made up the target population. An online questionnaire was developed, and the IT managers in all 19 government hospitals were invited to participate in the survey. The responses from the online survey were downloaded and analyzed using descriptive statistics. Of the 19 hospitals, only three (15.8 percent) use EHRs. These hospitals were established in 1984, 1995, and 2005. All three of these hospitals have implemented the same EHR software and were using it successfully, and all three were using the three core features of laboratory, radiology, and pharmacy electronic modules. Some modules were present in the EHR system but were underutilized. Some of the main challenges faced by the IT managers in implementing EHRs in their hospitals were related to the uncooperative attitudes of some physicians and nurses toward EHRs. In fulfillment of the second aim of the study, a Web site, http://ehr2011.weebly.com, was developed to serve as a forum for exchange of information on the development of EHRs in Saudi Arabia. The government of Saudi Arabia has prioritized the development of eHealth (health information technology) and allocated committed funding for it during 2008-2011. During this period, some sectors of government made highly commendable efforts in developing eHealth services. Along these lines, we had hoped to see higher uptake of EHRs than the 15.8 percent found in this study. The rate of implementing EHRs in government hospitals should be accelerated. The aim should be on achieving some basic EHR functionality in these hospitals, and once this has been achieved, additional functionality can be pursued in stages.

Safeguarding Confidentiality in Electronic Health Records.

PubMed

Shenoy, Akhil; Appel, Jacob M

2017-04-01

Electronic health records (EHRs) offer significant advantages over paper charts, such as ease of portability, facilitated communication, and a decreased risk of medical errors; however, important ethical concerns related to patient confidentiality remain. Although legal protections have been implemented, in practice, EHRs may be still prone to breaches that threaten patient privacy. Potential safeguards are essential, and have been implemented especially in sensitive areas such as mental illness, substance abuse, and sexual health. Features of one institutional model are described that may illustrate the efforts to both ensure adequate transparency and ensure patient confidentiality. Trust and the therapeutic alliance are critical to the provider-patient relationship and quality healthcare services. All of the benefits of an EHR are only possible if patients retain confidence in the security and accuracy of their medical records.

Physician Interactions with Electronic Health Records in Primary Care

PubMed Central

Montague, Enid; Asan, Onur

2013-01-01

Objective It is essential to design technologies and systems that promote appropriate interactions between physicians and patients. This study explored how physicians interact with Electronic Health Records (EHRs) to understand the qualities of the interaction between the physician and the EHR that may contribute to positive physician-patient interactions. Study Design Video-taped observations of 100 medical consultations were used to evaluate interaction patterns between physicians and EHRs. Quantified observational methods were used to contribute to ecological validity. Methods Ten primary care physicians and 100 patients from five clinics participated in the study. Clinical encounters were recorded with video cameras and coded using a validated objective coding methodology in order to examine how physicians interact with electronic health records. Results Three distinct styles were identified that characterize physician interactions with the EHR: technology-centered, human-centered, and mixed. Physicians who used a technology-centered style spent more time typing and gazing at the computer during the visit. Physicians who used a mixed style shifted their attention and body language between their patients and the technology throughout the visit. Physicians who used the human-centered style spent the least amount of time typing and focused more on the patient. Conclusion A variety of EHR interaction styles may be effective in facilitating patient-centered care. However, potential drawbacks of each style exist and are discussed. Future research on this topic and design strategies for effective health information technology in primary care are also discussed. PMID:24009982

Archetype Model-Driven Development Framework for EHR Web System.

PubMed

Kobayashi, Shinji; Kimura, Eizen; Ishihara, Ken

2013-12-01

This article describes the Web application framework for Electronic Health Records (EHRs) we have developed to reduce construction costs for EHR sytems. The openEHR project has developed clinical model driven architecture for future-proof interoperable EHR systems. This project provides the specifications to standardize clinical domain model implementations, upon which the ISO/CEN 13606 standards are based. The reference implementation has been formally described in Eiffel. Moreover C# and Java implementations have been developed as reference. While scripting languages had been more popular because of their higher efficiency and faster development in recent years, they had not been involved in the openEHR implementations. From 2007, we have used the Ruby language and Ruby on Rails (RoR) as an agile development platform to implement EHR systems, which is in conformity with the openEHR specifications. We implemented almost all of the specifications, the Archetype Definition Language parser, and RoR scaffold generator from archetype. Although some problems have emerged, most of them have been resolved. We have provided an agile EHR Web framework, which can build up Web systems from archetype models using RoR. The feasibility of the archetype model to provide semantic interoperability of EHRs has been demonstrated and we have verified that that it is suitable for the construction of EHR systems.

Archetype-based conversion of EHR content models: pilot experience with a regional EHR system.

PubMed

Chen, Rong; Klein, Gunnar O; Sundvall, Erik; Karlsson, Daniel; Ahlfeldt, Hans

2009-07-01

Exchange of Electronic Health Record (EHR) data between systems from different suppliers is a major challenge. EHR communication based on archetype methodology has been developed by openEHR and CEN/ISO. The experience of using archetypes in deployed EHR systems is quite limited today. Currently deployed EHR systems with large user bases have their own proprietary way of representing clinical content using various models. This study was designed to investigate the feasibility of representing EHR content models from a regional EHR system as openEHR archetypes and inversely to convert archetypes to the proprietary format. The openEHR EHR Reference Model (RM) and Archetype Model (AM) specifications were used. The template model of the Cambio COSMIC, a regional EHR product from Sweden, was analyzed and compared to the openEHR RM and AM. This study was focused on the convertibility of the EHR semantic models. A semantic mapping between the openEHR RM/AM and the COSMIC template model was produced and used as the basis for developing prototype software that performs automated bi-directional conversion between openEHR archetypes and COSMIC templates. Automated bi-directional conversion between openEHR archetype format and COSMIC template format has been achieved. Several archetypes from the openEHR Clinical Knowledge Repository have been imported into COSMIC, preserving most of the structural and terminology related constraints. COSMIC templates from a large regional installation were successfully converted into the openEHR archetype format. The conversion from the COSMIC templates into archetype format preserves nearly all structural and semantic definitions of the original content models. A strategy of gradually adding archetype support to legacy EHR systems was formulated in order to allow sharing of clinical content models defined using different formats. The openEHR RM and AM are expressive enough to represent the existing clinical content models from the template based EHR system tested and legacy content models can automatically be converted to archetype format for sharing of knowledge. With some limitations, internationally available archetypes could be converted to the legacy EHR models. Archetype support can be added to legacy EHR systems in an incremental way allowing a migration path to interoperability based on standards.

Methods and dimensions of electronic health record data quality assessment: enabling reuse for clinical research

PubMed Central

Weng, Chunhua

2013-01-01

Objective To review the methods and dimensions of data quality assessment in the context of electronic health record (EHR) data reuse for research. Materials and methods A review of the clinical research literature discussing data quality assessment methodology for EHR data was performed. Using an iterative process, the aspects of data quality being measured were abstracted and categorized, as well as the methods of assessment used. Results Five dimensions of data quality were identified, which are completeness, correctness, concordance, plausibility, and currency, and seven broad categories of data quality assessment methods: comparison with gold standards, data element agreement, data source agreement, distribution comparison, validity checks, log review, and element presence. Discussion Examination of the methods by which clinical researchers have investigated the quality and suitability of EHR data for research shows that there are fundamental features of data quality, which may be difficult to measure, as well as proxy dimensions. Researchers interested in the reuse of EHR data for clinical research are recommended to consider the adoption of a consistent taxonomy of EHR data quality, to remain aware of the task-dependence of data quality, to integrate work on data quality assessment from other fields, and to adopt systematic, empirically driven, statistically based methods of data quality assessment. Conclusion There is currently little consistency or potential generalizability in the methods used to assess EHR data quality. If the reuse of EHR data for clinical research is to become accepted, researchers should adopt validated, systematic methods of EHR data quality assessment. PMID:22733976

Facilitating secondary use of medical data by using openEHR archetypes.

PubMed

Kohl, Christian D; Garde, Sebastian; Knaup, Petra

2010-01-01

Clinical trials are of high importance for medical progress. But even though more and more clinical data is available in electronic patient records (EPRs) and more and more electronic data capture (EDC) systems are used in trials, there is still a gap which makes EPR / EDC interoperability difficult and hampers secondary use of medical routine data. The openEHR architecture for Electronic Health Records is based on a two level modeling approach which makes use of 'archetypes'. We want to analyze whether archetypes can help to bridge this gap by building an integrated EPR / EDC system based on openEHR archetypes. We used the 'openEHR Reference Framework and Application' (Opereffa) and existing archetypes for medical data. Furthermore, we developed dedicated archetypes to document study meta data. We developed a first prototype implementation of an archetype based integrated EPR / EDC system. Next steps will be the evaluation of an extended prototype in a real clinical trial scenario. Opereffa was a good starting point for our work. OpenEHR archetypes proved useful for secondary use of health data.

A virtual platform for electronic health record (EHR) education for nursing students: moving from in-house solutions to the cloud.

PubMed

Kushniruk, Andre W; Kuo, Mu-Hsing; Parapini, Eric; Borycki, Elizabeth M

2014-01-01

There is a need to develop cost effective ways to bring hands-on education about essential information technologies, such as electronic health record (EHR) systems to nursing students, nursing faculty and practitioners. This is especially the case as worldwide there is an increased deployment of these systems and they are transforming the practice of healthcare. However, due to technical, financial and knowledge limitations, many nursing schools and programs do not have an adequate way to bring such technology into their classes and curricula. In this paper we describe an approach to developing Web-based EHR education that allows students from any Web-accessible location to access and work with real EHR systems remotely over the Internet for learning purposes. In this paper we describe our work in moving this approach to a cloud-based solution to allow access to EHRs for educational purposes from any location with Web access and to do so in a way that is both educationally sound and cost effective.

An audit of the reliability of influenza vaccination and medical information extracted from eHealth records in general practice.

PubMed

Regan, Annette K; Gibbs, Robyn A; Effler, Paul V

2018-05-31

To evaluate the reliability of information in general practice (GP) electronic health records (EHRs), 2100 adult patients were randomly selected for interview regarding the presence of specific medical conditions and recent influenza vaccination. Agreement between self-report and data extracted from EHRs was compared using Cohen's kappa coefficient (k) and interpreted in accordance with Altman's Kappa Benchmarking criteria; 377 (18%) patients declined participation, and 608 (29%) could not be contacted. Of 1115 (53%) remaining, 856 (77%) were active patients (≥3 visits to the GP practice in the last two years) who provided complete information for analysis. Although a higher proportion of patients self-reported being vaccinated or having a medical condition compared to the EHR (50.7% vs 36.9%, and 39.4% vs 30.3%, respectively), there was "good" agreement between self-report and EHR for both vaccination status (κ = 0.67) and medical conditions (κ = 0.66). These findings suggest EHR may be useful for public health surveillance. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

A national survey assessing the number of records allowed open in electronic health records at hospitals and ambulatory sites.

PubMed

Adelman, Jason S; Berger, Matthew A; Rai, Amisha; Galanter, William L; Lambert, Bruce L; Schiff, Gordon D; Vawdrey, David K; Green, Robert A; Salmasian, Hojjat; Koppel, Ross; Schechter, Clyde B; Applebaum, Jo R; Southern, William N

2017-09-01

To reduce the risk of wrong-patient errors, safety experts recommend limiting the number of patient records providers can open at once in electronic health records (EHRs). However, it is unknown whether health care organizations follow this recommendation or what rationales drive their decisions. To address this gap, we conducted an electronic survey via 2 national listservs. Among 167 inpatient and outpatient study facilities using EHR systems designed to open multiple records at once, 44.3% were configured to allow ≥3 records open at once (unrestricted), 38.3% allowed only 1 record open (restricted), and 17.4% allowed 2 records open (hedged). Decision-making centered on efforts to balance safety and efficiency, but there was disagreement among organizations about how to achieve that balance. Results demonstrate no consensus on the number of records to be allowed open at once in EHRs. Rigorous studies are needed to determine the optimal number of records that balances safety and efficiency. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Integrated Electronic Health Record Database Management System: A Proposal.

PubMed

Schiza, Eirini C; Panos, George; David, Christiana; Petkov, Nicolai; Schizas, Christos N

2015-01-01

eHealth has attained significant importance as a new mechanism for health management and medical practice. However, the technological growth of eHealth is still limited by technical expertise needed to develop appropriate products. Researchers are constantly in a process of developing and testing new software for building and handling Clinical Medical Records, being renamed to Electronic Health Record (EHR) systems; EHRs take full advantage of the technological developments and at the same time provide increased diagnostic and treatment capabilities to doctors. A step to be considered for facilitating this aim is to involve more actively the doctor in building the fundamental steps for creating the EHR system and database. A global clinical patient record database management system can be electronically created by simulating real life medical practice health record taking and utilizing, analyzing the recorded parameters. This proposed approach demonstrates the effective implementation of a universal classic medical record in electronic form, a procedure by which, clinicians are led to utilize algorithms and intelligent systems for their differential diagnosis, final diagnosis and treatment strategies.

Graphical overview and navigation of electronic health records in a prototyping environment using Google Earth and openEHR archetypes.

PubMed

Sundvall, Erik; Nyström, Mikael; Forss, Mattias; Chen, Rong; Petersson, Håkan; Ahlfeldt, Hans

2007-01-01

This paper describes selected earlier approaches to graphically relating events to each other and to time; some new combinations are also suggested. These are then combined into a unified prototyping environment for visualization and navigation of electronic health records. Google Earth (GE) is used for handling display and interaction of clinical information stored using openEHR data structures and 'archetypes'. The strength of the approach comes from GE's sophisticated handling of detail levels, from coarse overviews to fine-grained details that has been combined with linear, polar and region-based views of clinical events related to time. The system should be easy to learn since all the visualization styles can use the same navigation. The structured and multifaceted approach to handling time that is possible with archetyped openEHR data lends itself well to visualizing and integration with openEHR components is provided in the environment.

Improving EHR Capabilities to Facilitate Stage 3 Meaningful Use Care Coordination Criteria.

PubMed

Cross, Dori A; Cohen, Genna R; Nong, Paige; Day, Anya-Victoria; Vibbert, Danielle; Naraharisetti, Ramya; Adler-Milstein, Julia

Primary care practices have been limited in their ability to leverage electronic health records (EHRs) and health information exchange (HIE) to improve care coordination, but will soon be incentivized to do so under proposed Stage 3 meaningful use criteria. We use mixed methods to understand how primary care practices manage, share and reconcile electronic patient information across care settings, and identify innovations in EHR design to support enhanced care coordination. Opportunities identified by practices focused on availability and usability of features that facilitate (1) generation of customized summary of care records, (2) team-based care approaches, and (3) management of the increased volume of electronic information generated and exchanged during care transitions. More broadly, vendors and policymakers need to continue to work together to improve interoperability as the key to effective care coordination. If these EHR innovations were widespread, the value of meeting the proposed Stage 3 care coordination criteria would be substantially enhanced.

Automated integration of continuous glucose monitor data in the electronic health record using consumer technology.

PubMed

Kumar, Rajiv B; Goren, Nira D; Stark, David E; Wall, Dennis P; Longhurst, Christopher A

2016-05-01

The diabetes healthcare provider plays a key role in interpreting blood glucose trends, but few institutions have successfully integrated patient home glucose data in the electronic health record (EHR). Published implementations to date have required custom interfaces, which limit wide-scale replication. We piloted automated integration of continuous glucose monitor data in the EHR using widely available consumer technology for 10 pediatric patients with insulin-dependent diabetes. Establishment of a passive data communication bridge via a patient's/parent's smartphone enabled automated integration and analytics of patient device data within the EHR between scheduled clinic visits. It is feasible to utilize available consumer technology to assess and triage home diabetes device data within the EHR, and to engage patients/parents and improve healthcare provider workflow. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association.

The Challenges of Electronic Health Records and Diabetes Electronic Prescribing: Implications for Safety Net Care for Diverse Populations

PubMed Central

Chan, Lenny L. S.; Fouts, Michelle M.; Murphy, Elizabeth J.

2017-01-01

Widespread electronic health record (EHR) implementation creates new challenges in the diabetes care of complex and diverse populations, including safe medication prescribing for patients with limited health literacy and limited English proficiency. This review highlights how the EHR electronic prescribing transformation has affected diabetes care for vulnerable patients and offers recommendations for improving patient safety through EHR electronic prescribing design, implementation, policy, and research. Specifically, we present evidence for (1) the adoption of RxNorm; (2) standardized naming and picklist options for high alert medications such as insulin; (3) the widespread implementation of universal medication schedule and language-concordant labels, with the expansion of electronic prescription 140-character limit; (4) enhanced bidirectional communication with pharmacy partners; and (5) informatics and implementation research in safety net healthcare systems to examine how EHR tools and practices affect diverse vulnerable populations. PMID:28197420

The Challenges of Electronic Health Records and Diabetes Electronic Prescribing: Implications for Safety Net Care for Diverse Populations.

PubMed

Ratanawongsa, Neda; Chan, Lenny L S; Fouts, Michelle M; Murphy, Elizabeth J

2017-01-01

Widespread electronic health record (EHR) implementation creates new challenges in the diabetes care of complex and diverse populations, including safe medication prescribing for patients with limited health literacy and limited English proficiency. This review highlights how the EHR electronic prescribing transformation has affected diabetes care for vulnerable patients and offers recommendations for improving patient safety through EHR electronic prescribing design, implementation, policy, and research. Specifically, we present evidence for (1) the adoption of RxNorm; (2) standardized naming and picklist options for high alert medications such as insulin; (3) the widespread implementation of universal medication schedule and language-concordant labels, with the expansion of electronic prescription 140-character limit; (4) enhanced bidirectional communication with pharmacy partners; and (5) informatics and implementation research in safety net healthcare systems to examine how EHR tools and practices affect diverse vulnerable populations.

Electronic health record - public health (EHR-PH) system prototype for interoperability in 21st century healthcare systems.

PubMed

Orlova, Anna O; Dunnagan, Mark; Finitzo, Terese; Higgins, Michael; Watkins, Todd; Tien, Allen; Beales, Steven

2005-01-01

Information exchange, enabled by computable interoperability, is the key to many of the initiatives underway including the development of Regional Health Information Exchanges, Regional Health Information Organizations, and the National Health Information Network. These initiatives must include public health as a full partner in the emerging transformation of our nation's healthcare system through the adoption and use of information technology. An electronic health record - public health (EHR-PH)system prototype was developed to demonstrate the feasibility of electronic data transfer from a health care provider, i.e. hospital or ambulatory care settings, to multiple customized public health systems which include a Newborn Metabolic Screening Registry, a Newborn Hearing Screening Registry, an Immunization Registry and a Communicable Disease Registry, using HL7 messaging standards. Our EHR-PH system prototype can be considered a distributed EHR-based RHIE/RHIO model - a principal element for a potential technical architecture for a NHIN.

Promoting Secondary Analysis of Electronic Medical Records in China: Summary of the PLAGH-MIT Critical Data Conference and Health Datathon

PubMed Central

Pollard, Tom; Johnson, Alistair Edward William; Cao, Desen; Kang, Hongjun; Liang, Hong; Zhang, Yuezhou; Liu, Xiaoli; Fan, Yong; Zhang, Yuan; Xue, Wanguo; Xie, Lixin; Celi, Leo Anthony

2017-01-01

Electronic health records (EHRs) have been widely adopted among modern hospitals to collect and track clinical data. Secondary analysis of EHRs could complement the traditional randomized control trial (RCT) research model. However, most researchers in China lack either the technical expertise or the resources needed to utilize EHRs as a resource. In addition, a climate of cross-disciplinary collaboration to gain insights from EHRs, a crucial component of a learning healthcare system, is not prevalent. To address these issues, members from the Massachusetts Institute of Technology (MIT) and the People’s Liberation Army General Hospital (PLAGH) organized the first clinical data conference and health datathon in China, which provided a platform for clinicians, statisticians, and data scientists to team up and address information gaps in the intensive care unit (ICU). PMID:29138126

Advances and current state of the security and privacy in electronic health records: survey from a social perspective.

PubMed

Tejero, Antonio; de la Torre, Isabel

2012-10-01

E-Health systems are experiencing an impulse in these last years, when many medical agencies began to include digital solutions into their platforms. Electronic Health Records (EHRs) are one of the most important improvements, being in its most part a patient-oriented tool. To achieve a completely operational EHR platform, security and privacy problems have to be resolved, due to the importance of the data included within these records. But given all the different methods to address security and privacy, they still remain in most cases as an open issue. This paper studies existing and proposed solutions included in different scenarios, in order to offer an overview of the current state in EHR systems. Bibliographic material has been obtained mainly from MEDLINE and SCOPUS sources, and over 30 publications have been analyzed. Many EHR platforms are being developed, but most of them present weaknesses when they are opened to the public. These architectures gain significance when they cover all the requisites related to security and privacy.

De-identifying an EHR database - anonymity, correctness and readability of the medical record.

PubMed

Pantazos, Kostas; Lauesen, Soren; Lippert, Soren

2011-01-01

Electronic health records (EHR) contain a large amount of structured data and free text. Exploring and sharing clinical data can improve healthcare and facilitate the development of medical software. However, revealing confidential information is against ethical principles and laws. We de-identified a Danish EHR database with 437,164 patients. The goal was to generate a version with real medical records, but related to artificial persons. We developed a de-identification algorithm that uses lists of named entities, simple language analysis, and special rules. Our algorithm consists of 3 steps: collect lists of identifiers from the database and external resources, define a replacement for each identifier, and replace identifiers in structured data and free text. Some patient records could not be safely de-identified, so the de-identified database has 323,122 patient records with an acceptable degree of anonymity, readability and correctness (F-measure of 95%). The algorithm has to be adjusted for each culture, language and database.

An analysis of electronic health record-related patient safety concerns

PubMed Central

Meeks, Derek W; Smith, Michael W; Taylor, Lesley; Sittig, Dean F; Scott, Jean M; Singh, Hardeep

2014-01-01

Objective A recent Institute of Medicine report called for attention to safety issues related to electronic health records (EHRs). We analyzed EHR-related safety concerns reported within a large, integrated healthcare system. Methods The Informatics Patient Safety Office of the Veterans Health Administration (VA) maintains a non-punitive, voluntary reporting system to collect and investigate EHR-related safety concerns (ie, adverse events, potential events, and near misses). We analyzed completed investigations using an eight-dimension sociotechnical conceptual model that accounted for both technical and non-technical dimensions of safety. Using the framework analysis approach to qualitative data, we identified emergent and recurring safety concerns common to multiple reports. Results We extracted 100 consecutive, unique, closed investigations between August 2009 and May 2013 from 344 reported incidents. Seventy-four involved unsafe technology and 25 involved unsafe use of technology. A majority (70%) involved two or more model dimensions. Most often, non-technical dimensions such as workflow, policies, and personnel interacted in a complex fashion with technical dimensions such as software/hardware, content, and user interface to produce safety concerns. Most (94%) safety concerns related to either unmet data-display needs in the EHR (ie, displayed information available to the end user failed to reduce uncertainty or led to increased potential for patient harm), software upgrades or modifications, data transmission between components of the EHR, or ‘hidden dependencies’ within the EHR. Discussion EHR-related safety concerns involving both unsafe technology and unsafe use of technology persist long after ‘go-live’ and despite the sophisticated EHR infrastructure represented in our data source. Currently, few healthcare institutions have reporting and analysis capabilities similar to the VA. Conclusions Because EHR-related safety concerns have complex sociotechnical origins, institutions with long-standing as well as recent EHR implementations should build a robust infrastructure to monitor and learn from them. PMID:24951796

A Standards-Based Architecture Proposal for Integrating Patient mHealth Apps to Electronic Health Record Systems.

PubMed

Marceglia, S; Fontelo, P; Rossi, E; Ackerman, M J

2015-01-01

Mobile health Applications (mHealth Apps) are opening the way to patients' responsible and active involvement with their own healthcare management. However, apart from Apps allowing patient's access to their electronic health records (EHRs), mHealth Apps are currently developed as dedicated "island systems". Although much work has been done on patient's access to EHRs, transfer of information from mHealth Apps to EHR systems is still low. This study proposes a standards-based architecture that can be adopted by mHealth Apps to exchange information with EHRs to support better quality of care. Following the definition of requirements for the EHR/mHealth App information exchange recently proposed, and after reviewing current standards, we designed the architecture for EHR/mHealth App integration. Then, as a case study, we modeled a system based on the proposed architecture aimed to support home monitoring for congestive heart failure patients. We simulated such process using, on the EHR side, OpenMRS, an open source longitudinal EHR and, on the mHealth App side, the iOS platform. The integration architecture was based on the bi-directional exchange of standard documents (clinical document architecture rel2 - CDA2). In the process, the clinician "prescribes" the home monitoring procedures by creating a CDA2 prescription in the EHR that is sent, encrypted and de-identified, to the mHealth App to create the monitoring calendar. At the scheduled time, the App alerts the patient to start the monitoring. After the measurements are done, the App generates a structured CDA2-compliant monitoring report and sends it to the EHR, thus avoiding local storage. The proposed architecture, even if validated only in a simulation environment, represents a step forward in the integration of personal mHealth Apps into the larger health-IT ecosystem, allowing the bi-directional data exchange between patients and healthcare professionals, supporting the patient's engagement in self-management and self-care.

Deep Patient: An Unsupervised Representation to Predict the Future of Patients from the Electronic Health Records

PubMed Central

Miotto, Riccardo; Li, Li; Kidd, Brian A.; Dudley, Joel T.

2016-01-01

Secondary use of electronic health records (EHRs) promises to advance clinical research and better inform clinical decision making. Challenges in summarizing and representing patient data prevent widespread practice of predictive modeling using EHRs. Here we present a novel unsupervised deep feature learning method to derive a general-purpose patient representation from EHR data that facilitates clinical predictive modeling. In particular, a three-layer stack of denoising autoencoders was used to capture hierarchical regularities and dependencies in the aggregated EHRs of about 700,000 patients from the Mount Sinai data warehouse. The result is a representation we name “deep patient”. We evaluated this representation as broadly predictive of health states by assessing the probability of patients to develop various diseases. We performed evaluation using 76,214 test patients comprising 78 diseases from diverse clinical domains and temporal windows. Our results significantly outperformed those achieved using representations based on raw EHR data and alternative feature learning strategies. Prediction performance for severe diabetes, schizophrenia, and various cancers were among the top performing. These findings indicate that deep learning applied to EHRs can derive patient representations that offer improved clinical predictions, and could provide a machine learning framework for augmenting clinical decision systems. PMID:27185194

Commentary: Lost in translation? How electronic health records structure communication, relationships, and meaning.

PubMed

Lown, Beth A; Rodriguez, Dayron

2012-04-01

The media through which we communicate shape how we think, how we act, and who we are. Electronic health records (EHRs) may promote more effective, efficient, coordinated, safer care. Research is emerging, but more is needed to assess the effect of EHRs on communication, relationships, patients' trust, adherence, and health outcomes. The authors posit that EHRs introduce a "third party" into exam room interactions that competes with the patient for clinicians' attention, affects clinicians' capacity to be fully present, and alters the nature of communication, relationships, and physicians' sense of professional role. Screen-driven communication inhibits patients' narratives and diminishes clinicians' responses to patients' cues about psychosocial issues and emotional concerns. Students, trainees, and clinicians can, however, learn to integrate EHRs into triadic exam room interactions to facilitate information sharing and shared decision making.Student exposure to EHRs is currently limited. Educators and researchers should implement curricula and assessment tools to help learners integrate EHRs into clinical interactions in ways that foster, rather than diminish, communication and relationships. Further, educators must prioritize the teaching and modeling of self-awareness and self-calibration, mindful presence, and compassion within such curricula to prevent these important qualities and skills from being lost in translation in the digital era.

Utilizing IHE-based Electronic Health Record systems for secondary use.

PubMed

Holzer, K; Gall, W

2011-01-01

Due to the increasing adoption of Electronic Health Records (EHRs) for primary use, the number of electronic documents stored in such systems will soar in the near future. In order to benefit from this development in secondary fields such as medical research, it is important to define requirements for the secondary use of EHR data. Furthermore, analyses of the extent to which an IHE (Integrating the Healthcare Enterprise)-based architecture would fulfill these requirements could provide further information on upcoming obstacles for the secondary use of EHRs. A catalog of eight core requirements for secondary use of EHR data was deduced from the published literature, the risk analysis of the IHE profile MPQ (Multi-Patient Queries) and the analysis of relevant questions. The IHE-based architecture for cross-domain, patient-centered document sharing was extended to a cross-patient architecture. We propose an IHE-based architecture for cross-patient and cross-domain secondary use of EHR data. Evaluation of this architecture concerning the eight core requirements revealed positive fulfillment of six and the partial fulfillment of two requirements. Although not regarded as a primary goal in modern electronic healthcare, the re-use of existing electronic medical documents in EHRs for research and other fields of secondary application holds enormous potential for the future. Further research in this respect is necessary.

Deep Patient: An Unsupervised Representation to Predict the Future of Patients from the Electronic Health Records

NASA Astrophysics Data System (ADS)

Miotto, Riccardo; Li, Li; Kidd, Brian A.; Dudley, Joel T.

2016-05-01

Secondary use of electronic health records (EHRs) promises to advance clinical research and better inform clinical decision making. Challenges in summarizing and representing patient data prevent widespread practice of predictive modeling using EHRs. Here we present a novel unsupervised deep feature learning method to derive a general-purpose patient representation from EHR data that facilitates clinical predictive modeling. In particular, a three-layer stack of denoising autoencoders was used to capture hierarchical regularities and dependencies in the aggregated EHRs of about 700,000 patients from the Mount Sinai data warehouse. The result is a representation we name “deep patient”. We evaluated this representation as broadly predictive of health states by assessing the probability of patients to develop various diseases. We performed evaluation using 76,214 test patients comprising 78 diseases from diverse clinical domains and temporal windows. Our results significantly outperformed those achieved using representations based on raw EHR data and alternative feature learning strategies. Prediction performance for severe diabetes, schizophrenia, and various cancers were among the top performing. These findings indicate that deep learning applied to EHRs can derive patient representations that offer improved clinical predictions, and could provide a machine learning framework for augmenting clinical decision systems.

Perceived usefulness and perceived ease of use of electronic health records among nurses: Application of Technology Acceptance Model.

PubMed

Tubaishat, Ahmad

2017-09-18

Electronic health records (EHRs) are increasingly being implemented in healthcare organizations but little attention has been paid to the degree to which nurses as end-users will accept these systems and subsequently use them. To explore nurses' perceptions of usefulness and ease-of-use of EHRs. The relationship between these constructs was examined, and its predictors were studied. A national exploratory study was conducted with 1539 nurses from 15 randomly selected hospitals, representative of different regions and healthcare sectors in Jordan. Data were collected using a self-administered questionnaire, which was based on the Technology Acceptance Model. Correlations and linear multiple regression were utilized to analyze the data. Jordanian nurses demonstrated a positive perception of the usefulness and ease-of-use of EHRs, and subsequently accepted the technology. Significant positive correlations were found between these two constructs. The variables that predict usefulness were the gender, professional rank, EHR experience, and computer skills of the nurses. The perceived ease-of-use was affected by nursing and EHR experience, and computers skills. This study adds to the growing body of knowledge on issues related to the acceptance of technology in the health informatics field, focusing on nurses' acceptance of EHRs.

Patient-centered communication in the era of electronic health records: What does the evidence say?

PubMed

Rathert, Cheryl; Mittler, Jessica N; Banerjee, Sudeep; McDaniel, Jennifer

2017-01-01

Patient-physician communication is essential for patient-centered health care. Physicians are concerned that electronic health records (EHRs) negatively affect communication with patients. This study identified a framework for understanding communication functions that influence patient outcomes. We then conducted a systematic review of the literature and organized it within the framework to better understand what is known. A comprehensive search of three databases (CINAHL, Medline, PsycINFO) yielded 41 articles for analysis. Results indicated that EHR use improves capture and sharing of certain biomedical information. However, it may interfere with collection of psychosocial and emotional information, and therefore may interfere with development of supportive, healing relationships. Patient access to the EHR and messaging functions may improve communication, patient empowerment, engagement, and self-management. More rigorous examination of EHR impacts on communication functions and their influences on patient outcomes is imperative for achieving patient-centered care. By focusing on the role of communication functions on patient outcomes, future EHRs can be developed to facilitate care. Training alone is likely to be insufficient to address disruptions to communication processes. Processes must be improved, and EHRs must be developed to capture useful data without interfering with physicians' and patients' abilities to effectively communicate. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Potential Effects of the Electronic Health Record on the Small Physician Practice: A Delphi Study.

PubMed

Sines, Chad C; Griffin, Gerald R

2017-01-01

The Health Information Technology for Economic and Clinical Health (HITECH) Act established the requirement of all medical practices to have certified electronic health records (EHRs). Some primary concerns that have been delaying implementation are issues of cost, revenue impact, and the effect on the patient encounter. Small physician practices (one to four physicians) account for 46 percent of all physicians. The purpose of this qualitative study using a modified Delphi research design was to examine the potential effect of the adoption of the EHR on revenue, unintended costs or savings, and changes in the patient encounter. Fifteen expert panelists completed the three-round survey process. The expert panelists reached a consensus that EHRs would reduce the number of patients seen per day, thereby reducing their revenue. Although the panelists limited their discussion on the effect of patient outcomes, their most dominant concern was the loss of face-to-face time with the patient. They felt that the use of an EHR would reduce the focus on the patient and potentially cause physicians to miss medical conditions. The results of this study indicate an avenue for EHR vendors to develop educational avenues to teach physicians how to optimize the EHR as well as to share success stories that demonstrate improved financial impact.

Potential Effects of the Electronic Health Record on the Small Physician Practice: A Delphi Study

PubMed Central

Sines, Chad C.; Griffin, Gerald R.

2017-01-01

The Health Information Technology for Economic and Clinical Health (HITECH) Act established the requirement of all medical practices to have certified electronic health records (EHRs). Some primary concerns that have been delaying implementation are issues of cost, revenue impact, and the effect on the patient encounter. Small physician practices (one to four physicians) account for 46 percent of all physicians. The purpose of this qualitative study using a modified Delphi research design was to examine the potential effect of the adoption of the EHR on revenue, unintended costs or savings, and changes in the patient encounter. Fifteen expert panelists completed the three-round survey process. The expert panelists reached a consensus that EHRs would reduce the number of patients seen per day, thereby reducing their revenue. Although the panelists limited their discussion on the effect of patient outcomes, their most dominant concern was the loss of face-to-face time with the patient. They felt that the use of an EHR would reduce the focus on the patient and potentially cause physicians to miss medical conditions. The results of this study indicate an avenue for EHR vendors to develop educational avenues to teach physicians how to optimize the EHR as well as to share success stories that demonstrate improved financial impact. PMID:28566989

Understanding Productivity and Technostress for Oncology Nurses Using an Electronic Health Record (EHR) to Increase Safety, Quality, and Effectiveness of Care for Patients with Cancer

ERIC Educational Resources Information Center

Evans, Elizabeth M. Wertz

2013-01-01

Health information technology has become more prevalent in hospitals, physician offices, clinics, and other areas of medical treatment, especially since the federal government passed legislation to offer incentive payments for the meaningful use of electronic health records (EHRs). Previous research demonstrated a decrease in medical errors as…

Electronic health record in the internal medicine clinic of a Brazilian university hospital: Expectations and satisfaction of physicians and patients.

PubMed

Duarte, Jurandir Godoy; Azevedo, Raymundo Soares

2017-06-01

To evaluate the satisfaction and expectations of patients and physicians before and after the implementation of an electronic health record (EHR) in the outpatient clinic of a university hospital. We conducted 389 interviews with patients and 151 with physicians before and after the implementation of a commercial EHR at the internal medicine clinic of Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (HC-FMUSP), Brazil. The physicians were identified by their connection to the outpatient clinic and categorized by their years since graduation: residents and preceptors (with 10 years or less of graduation) or assistants (with more than 10 years of graduation). The answers to the questionnaire given by the physicians were classified as favorable or against the use of EHR, before and after the implementation of this system in this clinic, receiving 1 or 0 points, respectively. The sum of these points generated a multiple regression score to determine which factors contribute to the acceptance of EHR by physicians. We also did a third survey, after the EHR was routinely established in the outpatient clinic. The degree of patient satisfaction was the same before and after implementation, with more than 90% positive evaluations. They noted the use of the computer during the consultation and valued such use. Resident (younger) physicians had more positive expectations than assistants (older physicians) before EHR implementation. This optimism was reduced after implementation. In the third evaluation the use of EHR was higher among resident physicians. Resident physicians perceived and valued the EHR more and used it more. In 28 of the 57 questions on performance of clinical tasks, resident physicians found it easier to use EHR than assistant physicians with significant differences (p<0.05). When questioned specifically about EHR satisfaction, resident physicians responded "good" and "excellent" to a greater extent than assistant physicians (p=0.002). Our results reinforce the idea that the EHR introduction in a clinical setting should be preceded by careful planning to improve physician's adherence to the use of EHR. Patients do not seem to notice much difference to the quality of the consultation done using paper or EHR. It became clear after the third evaluation with the physicians that the younger (residents and some preceptors) perceived the advantages of the EHR more than the older physicians. Resident physicians use the EHR more and are more satisfied with it. Copyright © 2017 Elsevier B.V. All rights reserved.

Ranking Medical Terms to Support Expansion of Lay Language Resources for Patient Comprehension of Electronic Health Record Notes: Adapted Distant Supervision Approach

PubMed Central

Jagannatha, Abhyuday N; Fodeh, Samah J; Yu, Hong

2017-01-01

Background Medical terms are a major obstacle for patients to comprehend their electronic health record (EHR) notes. Clinical natural language processing (NLP) systems that link EHR terms to lay terms or definitions allow patients to easily access helpful information when reading through their EHR notes, and have shown to improve patient EHR comprehension. However, high-quality lay language resources for EHR terms are very limited in the public domain. Because expanding and curating such a resource is a costly process, it is beneficial and even necessary to identify terms important for patient EHR comprehension first. Objective We aimed to develop an NLP system, called adapted distant supervision (ADS), to rank candidate terms mined from EHR corpora. We will give EHR terms ranked as high by ADS a higher priority for lay language annotation—that is, creating lay definitions for these terms. Methods Adapted distant supervision uses distant supervision from consumer health vocabulary and transfer learning to adapt itself to solve the problem of ranking EHR terms in the target domain. We investigated 2 state-of-the-art transfer learning algorithms (ie, feature space augmentation and supervised distant supervision) and designed 5 types of learning features, including distributed word representations learned from large EHR data for ADS. For evaluating ADS, we asked domain experts to annotate 6038 candidate terms as important or nonimportant for EHR comprehension. We then randomly divided these data into the target-domain training data (1000 examples) and the evaluation data (5038 examples). We compared ADS with 2 strong baselines, including standard supervised learning, on the evaluation data. Results The ADS system using feature space augmentation achieved the best average precision, 0.850, on the evaluation set when using 1000 target-domain training examples. The ADS system using supervised distant supervision achieved the best average precision, 0.819, on the evaluation set when using only 100 target-domain training examples. The 2 ADS systems both performed significantly better than the baseline systems (P<.001 for all measures and all conditions). Using a rich set of learning features contributed to ADS’s performance substantially. Conclusions ADS can effectively rank terms mined from EHRs. Transfer learning improved ADS’s performance even with a small number of target-domain training examples. EHR terms prioritized by ADS were used to expand a lay language resource that supports patient EHR comprehension. The top 10,000 EHR terms ranked by ADS are available upon request. PMID:29089288

A comparison of physician pre-adoption and adoption views on electronic health records in Canadian medical practices.

PubMed

Archer, Norm; Cocosila, Mihail

2011-08-12

There is a major campaign involving large expenditures of public money to increase the adoption rate of electronic health record (EHR) systems in Canada. To maximize the chances of success in this effort, physician views on EHRs must be addressed, since user perceptions are key to successful implementation of technology innovations. We propose a theoretical model comprising behavioral factors either favoring or against EHR adoption and use in Canadian medical practices, from the physicians' point of view. EHR perceptions of physicians already using EHR systems are compared with those not using one, through the lens of this model. We conducted an online cross-sectional survey in both English and French among medical practitioners across Canada. Data were collected both from physicians using EHRs and those not using EHRs, and analyzed with structural equation modeling (SEM) techniques. We collected 119 responses from EHR users and 100 from nonusers, resulting in 2 valid samples of 102 and 83 participants, respectively. The theoretical adoption model explained 55.8% of the variance in behavioral intention to continue using EHRs for physicians already using them, and 66.8% of the variance in nonuser intention to adopt such systems. Perception of ease of use was found to be the strongest motivator for EHR users (total effect .525), while perceptions of usefulness and of ease of use were the key determinants for nonusers (total effect .538 and .519, respectively) to adopt the system. Users see perceived overall risk associated with EHR adoption as a major obstacle (total effect -.371), while nonusers perceive risk only as a weak indirect demotivator. Of the 13 paths of the SEM model, 5 showed significant differences between the 2 samples (at the .05 level): general doubts about using the system (P = .02), the necessity for the system to be relevant for their job (P < .001), and the necessity for the system to be useful (P = .049) are more important for EHR nonusers than for users, while perceptions of overall obstacles to adoption (P = .03) and system ease of use (P = .042) count more for EHR users than for nonusers. Relatively few differences in perceptions about EHR system adoption and use exist between physicians already using such systems and those not yet using the systems. To maximize the chances of success for new EHR implementations from a behavioral point of view, general doubts about the rationale for such systems must be mitigated through improving design, stressing how EHRs are relevant to physician jobs, and providing substantiating evidence that EHRs are easier to use and more effective than nonusers might expect.

Resistance is futile: but it is slowing the pace of EHR adoption nonetheless.

PubMed

Ford, Eric W; Menachemi, Nir; Peterson, Lori T; Huerta, Timothy R

2009-01-01

The purpose of this study is to reassess the projected rate of Electronic Health Record (EHR) diffusion and examine how the federal government's efforts to promote the use of EHR technology have influenced physicians' willingness to adopt such systems. The study recreates and extends the analyses conducted by Ford et al. (1) The two periods examined come before and after the U.S. Federal Government's concerted activity to promote EHR adoption. Meta-analysis and bass modeling are used to compare EHR diffusion rates for two distinct periods of government activity. Very low levels of government activity to promote EHR diffusion marked the first period, before 2004. In 2004, the President of the United States called for a "Universal EHR Adoption" by 2014 (10 yrs), creating the major wave of activity and increased awareness of how EHRs will impact physicians' practices. EHR adoption parameters--external and internal coefficients of influence--are estimated using bass diffusion models and future adoption rates are projected. Comparing the EHR adoption rates before and after 2004 (2001-2004 and 2001-2007 respectively) indicate the physicians' resistance to adoption has increased during the second period. Based on current levels of adoption, less than half the physicians working in small practices will have implemented an EHR by 2014 (47.3%). The external forces driving EHR diffusion have grown in importance since 2004 relative to physicians' internal motivation to adopt such systems. Several national forces are likely contributing to the slowing pace of EHR diffusion.

Challenges to EHR implementation in electronic- versus paper-based office practices.

PubMed

Zandieh, Stephanie O; Yoon-Flannery, Kahyun; Kuperman, Gilad J; Langsam, Daniel J; Hyman, Daniel; Kaushal, Rainu

2008-06-01

Challenges in implementing electronic health records (EHRs) have received some attention, but less is known about the process of transitioning from legacy EHRs to newer systems. To determine how ambulatory leaders differentiate implementation approaches between practices that are currently paper-based and those with a legacy EHR system (EHR-based). Qualitative study. Eleven practice managers and 12 medical directors all part of an academic ambulatory care network of a large teaching hospital in New York City in January to May of 2006. Qualitative approach comparing and contrasting perceived benefits and challenges in implementing an ambulatory EHR between practice leaders from paper- and EHR-based practices. Content analysis was performed using grounded theory and ATLAS.ti 5.0. We found that paper-based leaders prioritized the following: sufficient workstations and printers, a physician information technology (IT) champion at the practice, workflow education to ensure a successful transition to a paperless medical practice, and a high existing comfort level of practitioners and support staff with IT. In contrast, EHR-based leaders prioritized: improved technical training and ongoing technical support, sufficient protection of patient privacy, and open recognition of physician resistance, especially for those who were loyal to a legacy EHR. Unlike paper-based practices, EHR-based leadership believed that comfort level with IT and adjustments to workflow changes would not be difficult challenges to overcome. Leadership at paper- and EHR-based practices in 1 academic network has different priorities for implementing a new EHR. Ambulatory practices upgrading their legacy EHR have unique challenges.

Developing an Interface to Order and Document Health Education Videos in the Electronic Health Record.

PubMed

Wojcik, Lauren

2015-01-01

Transitioning to electronic health records (EHRs) provides an opportunity for health care systems to integrate educational content available on interactive patient systems (IPS) with the medical documentation system. This column discusses how one hospital simplified providers' workflow by making it easier to order educational videos and ensure that completed education is documented within the medical record. Integrating the EHR and IPS streamlined the provision of patient education, improved documentation, and supported the organization in meeting core requirements for Meaningful Use.

Computers in the examination room and the electronic health record: physicians' perceived impact on clinical encounters before and after full installation and implementation.

PubMed

Doyle, Richard J; Wang, Nina; Anthony, David; Borkan, Jeffrey; Shield, Renee R; Goldman, Roberta E

2012-10-01

We compared physicians' self-reported attitudes and behaviours regarding electronic health record (EHR) use before and after installation of computers in patient examination rooms and transition to full implementation of an EHR in a family medicine training practice to identify anticipated and observed effects these changes would have on physicians' practices and clinical encounters. We conducted two individual qualitative interviews with family physicians. The first interview was before and second interview was 8 months later after full implementation of an EHR and computer installation in the examination rooms. Data were analysed through project team discussions and subsequent coding with qualitative analysis software. At the first interviews, physicians frequently expressed concerns about the potential negative effect of the EHR on quality of care and physician-patient interaction, adequacy of their skills in EHR use and privacy and confidentiality concerns. Nevertheless, most physicians also anticipated multiple benefits, including improved accessibility of patient data and online health information. In the second interviews, physicians reported that their concerns did not persist. Many anticipated benefits were realized, appearing to facilitate collaborative physician-patient relationships. Physicians reported a greater teaching role with patients and sharing online medical information and treatment plan decisions. Before computer installation and full EHR implementation, physicians expressed concerns about the impact of computer use on patient care. After installation and implementation, however, many concerns were mitigated. Using computers in the examination rooms to document and access patients' records along with online medical information and decision-making tools appears to contribute to improved physician-patient communication and collaboration.

Hospital financial position and the adoption of electronic health records.

PubMed

Ginn, Gregory O; Shen, Jay J; Moseley, Charles B

2011-01-01

The objective of this study was to examine the relationship between financial position and adoption of electronic health records (EHRs) in 2442 acute care hospitals. The study was cross-sectional and utilized a general linear mixed model with the multinomial distribution specification for data analysis. We verified the results by also running a multinomial logistic regression model. To measure our variables, we used data from (1) the 2007 American Hospital Association (AHA) electronic health record implementation survey, (2) the 2006 Centers for Medicare and Medicaid Cost Reports, and (3) the 2006 AHA Annual Survey containing organizational and operational data. Our dependent variable was an ordinal variable with three levels used to indicate the extent of EHR adoption by hospitals. Our independent variables were five financial ratios: (1) net days revenue in accounts receivable, (2) total margin, (3) the equity multiplier, (4) total asset turnover, and (5) the ratio of total payroll to total expenses. For control variables, we used (1) bed size, (2) ownership type, (3) teaching affiliation, (4) system membership, (5) network participation, (6) fulltime equivalent nurses per adjusted average daily census, (7) average daily census per staffed bed, (8) Medicare patients percentage, (9) Medicaid patients percentage, (10) capitation-based reimbursement, and (11) nonconcentrated market. Only liquidity was significant and positively associated with EHR adoption. Asset turnover ratio was significant but, unexpectedly, was negatively associated with EHR adoption. However, many control variables, most notably bed size, showed significant positive associations with EHR adoption. Thus, it seems that hospitals adopt EHRs as a strategic move to better align themselves with their environment.

Interoperability of clinical decision-support systems and electronic health records using archetypes: a case study in clinical trial eligibility.

PubMed

Marcos, Mar; Maldonado, Jose A; Martínez-Salvador, Begoña; Boscá, Diego; Robles, Montserrat

2013-08-01

Clinical decision-support systems (CDSSs) comprise systems as diverse as sophisticated platforms to store and manage clinical data, tools to alert clinicians of problematic situations, or decision-making tools to assist clinicians. Irrespective of the kind of decision-support task CDSSs should be smoothly integrated within the clinical information system, interacting with other components, in particular with the electronic health record (EHR). However, despite decades of developments, most CDSSs lack interoperability features. We deal with the interoperability problem of CDSSs and EHRs by exploiting the dual-model methodology. This methodology distinguishes a reference model and archetypes. A reference model is represented by a stable and small object-oriented model that describes the generic properties of health record information. For their part, archetypes are reusable and domain-specific definitions of clinical concepts in the form of structured and constrained combinations of the entities of the reference model. We rely on archetypes to make the CDSS compatible with EHRs from different institutions. Concretely, we use archetypes for modelling the clinical concepts that the CDSS requires, in conjunction with a series of knowledge-intensive mappings relating the archetypes to the data sources (EHR and/or other archetypes) they depend on. We introduce a comprehensive approach, including a set of tools as well as methodological guidelines, to deal with the interoperability of CDSSs and EHRs based on archetypes. Archetypes are used to build a conceptual layer of the kind of a virtual health record (VHR) over the EHR whose contents need to be integrated and used in the CDSS, associating them with structural and terminology-based semantics. Subsequently, the archetypes are mapped to the EHR by means of an expressive mapping language and specific-purpose tools. We also describe a case study where the tools and methodology have been employed in a CDSS to support patient recruitment in the framework of a clinical trial for colorectal cancer screening. The utilisation of archetypes not only has proved satisfactory to achieve interoperability between CDSSs and EHRs but also offers various advantages, in particular from a data model perspective. First, the VHR/data models we work with are of a high level of abstraction and can incorporate semantic descriptions. Second, archetypes can potentially deal with different EHR architectures, due to their deliberate independence of the reference model. Third, the archetype instances we obtain are valid instances of the underlying reference model, which would enable e.g. feeding back the EHR with data derived by abstraction mechanisms. Lastly, the medical and technical validity of archetype models would be assured, since in principle clinicians should be the main actors in their development. Copyright © 2013 Elsevier Inc. All rights reserved.

Integration of DICOM and openEHR standards

NASA Astrophysics Data System (ADS)

Wang, Ying; Yao, Zhihong; Liu, Lei

2011-03-01

The standard format for medical imaging storage and transmission is DICOM. openEHR is an open standard specification in health informatics that describes the management and storage, retrieval and exchange of health data in electronic health records. Considering that the integration of DICOM and openEHR is beneficial to information sharing, on the basis of XML-based DICOM format, we developed a method of creating a DICOM Imaging Archetype in openEHR to enable the integration of DICOM and openEHR. Each DICOM file contains abundant imaging information. However, because reading a DICOM involves looking up the DICOM Data Dictionary, the readability of a DICOM file has been limited. openEHR has innovatively adopted two level modeling method, making clinical information divided into lower level, the information model, and upper level, archetypes and templates. But one critical challenge posed to the development of openEHR is the information sharing problem, especially in imaging information sharing. For example, some important imaging information cannot be displayed in an openEHR file. In this paper, to enhance the readability of a DICOM file and semantic interoperability of an openEHR file, we developed a method of mapping a DICOM file to an openEHR file by adopting the form of archetype defined in openEHR. Because an archetype has a tree structure, after mapping a DICOM file to an openEHR file, the converted information is structuralized in conformance with openEHR format. This method enables the integration of DICOM and openEHR and data exchange without losing imaging information between two standards.

Exploring the Association Between Electronic Health Record Use and Burnout Among Psychiatry Residents and Faculty: a Pilot Survey Study.

PubMed

Domaney, Nicholas M; Torous, John; Greenberg, William E

2018-05-21

Burnout is a phenomenon with profound negative effects on the US healthcare system. Little is known about the relationship between time spent working on electronic health record (EHR) and burnout among psychiatry residents. The purpose of this study is to generate preliminary data on EHR use and burnout among psychiatry residents and faculty. In August 2017, psychiatry residents and faculty at an academic medical center were given the Maslach Burnout Inventory (MBI), a standardized measurement tool for burnout, and a survey of factors related to EHR use and potential risk factors for burnout. MBI data along with selected burnout risk and protective factors were analyzed with R Studio software. Responses were obtained from 40 psychiatry residents (73%) and 12 clinical faculty members (40%). Residents reported 22 h per week using EHR on average. Mean score of residents surveyed in postgraduate year (PGY)-1-4 met criteria for high emotional exhaustion associated with burnout. The magnitude of correlation between EHR use and emotional exhaustion was stronger than for other burnout factors including sleep, exercise, and clinical service. Psychiatry residents show signs of high emotional exhaustion, which is associated with burnout. Results demonstrate a strong positive correlation between EHR use and resident burnout. Time spent on EHR use may be an area of importance for psychiatry program directors and other psychiatric educators to consider when seeking to minimize burnout and promote wellness.

The use of open source electronic health records within the federal safety net.

PubMed

Goldwater, Jason C; Kwon, Nancy J; Nathanson, Ashley; Muckle, Alison E; Brown, Alexa; Cornejo, Kerri

2014-01-01

To conduct a federally funded study that examines the acquisition, implementation and operation of open source electronic health records (EHR) within safety net medical settings, such as federally qualified health centers (FQHC). The study was conducted by the National Opinion Research Center (NORC) at the University of Chicago from April to September 2010. The NORC team undertook a comprehensive environmental scan, including a literature review, a dozen key informant interviews using a semistructured protocol, and a series of site visits to West Virginia, California and Arizona FQHC that were currently using an open source EHR. Five of the six sites that were chosen as part of the study found a number of advantages in the use of their open source EHR system, such as utilizing a large community of users and developers to modify their EHR to fit the needs of their provider and patient communities, and lower acquisition and implementation costs as compared to a commercial system. Despite these advantages, many of the informants and site visit participants felt that widespread dissemination and use of open source was restrained due to a negative connotation regarding this type of software. In addition, a number of participants stated that there is a necessary level of technical acumen needed within the FQHC to make an open source EHR effective. An open source EHR provides advantages for FQHC that have limited resources to acquire and implement an EHR, but additional study is needed to evaluate its overall effectiveness.

Challenges in using electronic health record data for CER: experience of 4 learning organizations and solutions applied.

PubMed

Bayley, K Bruce; Belnap, Tom; Savitz, Lucy; Masica, Andrew L; Shah, Nilay; Fleming, Neil S

2013-08-01

To document the strengths and challenges of using electronic health records (EHRs) for comparative effectiveness research (CER). A replicated case study of comparative effectiveness in hypertension treatment was conducted across 4 health systems, with instructions to extract data and document problems encountered using a specified list of required data elements. Researchers at each health system documented successes and challenges, and suggested solutions for addressing challenges. Data challenges fell into 5 categories: missing data, erroneous data, uninterpretable data, inconsistencies among providers and over time, and data stored in noncoded text notes. Suggested strategies to address these issues include data validation steps, use of surrogate markers, natural language processing, and statistical techniques. A number of EHR issues can hamper the extraction of valid data for cross-health system comparative effectiveness studies. Our case example cautions against a blind reliance on EHR data as a single definitive data source. Nevertheless, EHR data are superior to administrative or claims data alone, and are cheaper and timelier than clinical trials or manual chart reviews. All 4 participating health systems are pursuing pathways to more effectively use EHR data for CER.A partnership between clinicians, researchers, and information technology specialists is encouraged as a way to capitalize on the wealth of information contained in the EHR. Future developments in both technology and care delivery hold promise for improvement in the ability to use EHR data for CER.

Opening the Duke electronic health record to apps: Implementing SMART on FHIR.

PubMed

Bloomfield, Richard A; Polo-Wood, Felipe; Mandel, Joshua C; Mandl, Kenneth D

2017-03-01

Recognizing a need for our EHR to be highly interoperable, our team at Duke Health enabled our Epic-based electronic health record to be compatible with the Boston Children's project called Substitutable Medical Apps and Reusable Technologies (SMART), which employed Health Level Seven International's (HL7) Fast Healthcare Interoperability Resources (FHIR), commonly known as SMART on FHIR. We created a custom SMART on FHIR-compatible server infrastructure written in Node.js that served two primary functions. First, it handled API management activities such rate-limiting, authorization, auditing, logging, and analytics. Second, it retrieved the EHR data and made it available in a FHIR-compatible format. Finally, we made required changes to the EHR user interface to allow us to integrate several compatible apps into the provider- and patient-facing EHR workflows. After integrating SMART on FHIR into our Epic-based EHR, we demonstrated several types of apps running on the infrastructure. This included both provider- and patient-facing apps as well as apps that are closed source, open source and internally-developed. We integrated the apps into the testing environment of our desktop EHR as well as our patient portal. We also demonstrated the integration of a native iOS app. In this paper, we demonstrate the successful implementation of the SMART and FHIR technologies on our Epic-based EHR and subsequent integration of several compatible provider- and patient-facing apps. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The pharmacist and the EHR.

PubMed

Nelson, Scott D; Poikonen, John; Reese, Thomas; El Halta, David; Weir, Charlene

2017-01-01

The adoption of electronic health records (EHRs) across the United States has impacted the methods by which health care professionals care for their patients. It is not always recognized, however, that pharmacists also actively use advanced functionality within the EHR. As critical members of the health care team, pharmacists utilize many different features of the EHR. The literature focuses on 3 main roles: documentation, medication reconciliation, and patient evaluation and monitoring. As health information technology proliferates, it is imperative that pharmacists' workflow and information needs are met within the EHR to optimize medication therapy quality, team communication, and patient outcomes. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Leveraging EHR Data for Outcomes and Comparative Effectiveness Research in Oncology

PubMed Central

Harris, Marcelline R.; Buyuktur, Ayse G.; Clark, Patricia M.; An, Lawrence C.; Hanauer, David A.

2012-01-01

Along with the increasing adoption of electronic health records (EHRs) are expectations that data collected within EHRs will be readily available for outcomes and comparative effectiveness research. Yet the ability to effectively share and reuse data depends on implementing and configuring EHRs with these goals in mind from the beginning. Data sharing and integration must be planned both locally as well as nationally. The rich data transmission and semantic infrastructure developed by the National Cancer Institute (NCI) for research provides an excellent example of moving beyond paper-based paradigms and exploiting the power of semantically robust, network-based systems, and engaging both domain and informatics expertise. Similar efforts are required to address current challenges in sharing EHR data. PMID:22948276

A red-flag-based approach to risk management of EHR-related safety concerns.

PubMed

Sittig, Dean F; Singh, Hardeep

2013-01-01

Although electronic health records (EHRs) have a significant potential to improve patient safety, EHR-related safety concerns have begun to emerge. Based on 369 responses to a survey sent to the memberships of the American Society for Healthcare Risk Management and the American Health Lawyers Association and supplemented by our previous work in EHR-related patient safety, we identified the following common EHR-related safety concerns: (1) incorrect patient identification; (2) extended EHR unavailability (either planned or unplanned); (3) failure to heed a computer-generated warning or alert; (4) system-to-system interface errors; (5) failure to identify, find, or use the most recent patient data; (6) misunderstandings about time; (7) incorrect item selected from a list of items; and (8) open or incomplete orders. In this article, we present a "red-flag"-based approach that can be used by risk managers to identify potential EHR safety concerns in their institutions. An organization that routinely conducts EHR-related surveillance activities, such as the ones proposed here, can significantly reduce risks associated with EHR implementation and use. © 2013 American Society for Healthcare Risk Management of the American Hospital Association.

Clinical Genomics in the World of the Electronic Health Record

PubMed Central

Marsolo, Keith; Spooner, S. Andrew

2014-01-01

The widespread of adoption of EHRs presents a number of benefits to the field of clinical genomics. They include the ability to return results to the practitioner, the ability to use genetic findings in clinical decision support, and to have data collected in the EHR serve as a source of phenotypic information for analysis purposes. Not all EHRs are created equal, however. They differ in their features, capabilities and ease-of-use. Therefore, in order to understand the potential of the EHR, it is first necessary to understand its capabilities and the impact that implementation strategy has on usability. Specifically, we focus on the following areas: 1) how the EHR is used to capture data in clinical practice settings; 2) how the implementation and configuration of the EHR affects the quality and availability of data; 3) the management of clinical genetic test results and the feasibility of EHR integration; and 4) the challenges of implementing an EHR in a research-intensive environment. This is followed by a discussion of the minimum functional requirements that an EHR must meet to enable the satisfactory integration of genomic results as well as the open issues that remain. PMID:23846403

Requirements for Workflow-Based EHR Systems - Results of a Qualitative Study.

PubMed

Schweitzer, Marco; Lasierra, Nelia; Hoerbst, Alexander

2016-01-01

Today's high quality healthcare delivery strongly relies on efficient electronic health records (EHR). These EHR systems or in general healthcare IT-systems are usually developed in a static manner according to a given workflow. Hence, they are not flexible enough to enable access to EHR data and to execute individual actions within a consultation. This paper reports on requirements pointed by experts in the domain of diabetes mellitus to design a system for supporting dynamic workflows to serve personalization within a medical activity. Requirements were collected by means of expert interviews. These interviews completed a conducted triangulation approach, aimed to gather requirements for workflow-based EHR interactions. The data from the interviews was analyzed through a qualitative approach resulting in a set of requirements enhancing EHR functionality from the user's perspective. Requirements were classified according to four different categorizations: (1) process-related requirements, (2) information needs, (3) required functions, (4) non-functional requirements. Workflow related requirements were identified which should be considered when developing and deploying EHR systems.

Development and evaluation of an electronic health record configuration and customization laboratory course for clinical informatics students.

PubMed

Mohan, Vishnu; Hersh, William R

2013-01-01

There is a need for informatics educational programs to develop laboratory courses that facilitate hands-on access to an EHR, and allow students to learn and evaluate functionality and configuration options. This is particularly relevant given the diversity of backgrounds of informatics students. We implemented an EHR laboratory course that allowed students to explore an EHR in both inpatient and outpatient clinical environments. The course focused on specific elements of the EHR including order set development, customization, clinical decision support, ancillary services, and billing and coding functionality. Students were surveyed at the end of the course for their satisfaction with the learning experience. We detailed challenges as well as lessons learned after analyzing student evaluations of this course. Features that promote the successful offering of an online EHR course, include (1) using more than one EHR to allow students to compare functionalities, (2) ensuring appropriate course calibration, (3) countering issues specific to EHR usability, and (4) fostering a fertile environment for rich online conversations are discussed.

The association between EHRs and care coordination varies by team cohesion.

PubMed

Graetz, Ilana; Reed, Mary; Shortell, Stephen M; Rundall, Thomas G; Bellows, Jim; Hsu, John

2014-02-01

To examine whether primary care team cohesion changes the association between using an integrated outpatient-inpatient electronic health record (EHR) and clinician-rated care coordination across delivery sites. Self-administered surveys of primary care clinicians in a large integrated delivery system, collected in 2005 (N=565), 2006 (N=678), and 2008 (N=626) during the staggered implementation of an integrated EHR (2005-2010), including validated questions on team cohesion. Using multivariable regression, we examined the combined effect of EHR use and team cohesion on three dimensions of care coordination across delivery sites: access to timely and complete information, treatment agreement, and responsibility agreement. Among clinicians working in teams with higher cohesion, EHR use was associated with significant improvements in reported access to timely and complete information (53.5 percent with EHR vs. 37.6 percent without integrated-EHR), agreement on treatment goals (64.3 percent vs. 50.6 percent), and agreement on responsibilities (63.9 percent vs. 55.2 percent, all p<.05). We found no statistically significant association between use of the integrated-EHR and reported care coordination in less cohesive teams. The association between EHR use and reported care coordination varied by level of team cohesion. EHRs may not improve care coordination in less cohesive teams. © Health Research and Educational Trust.

Lessons about So-Called "Difficult" Patients from the UK Controversy over Patient Access to Electronic Health Records.

PubMed

Lucivero, Federica

2017-04-01

Increasing numbers of patients have direct access to their electronic health records (EHRs). Proponents of direct access argue that it empowers patients by making them more informed and offering them more control over their health and care. According to some proponents of patients' access to EHRs, clinicians' concerns about potential negative implications are grounded in a form of paternalism that protects clinicians' authority. This paper draws upon narratives from patients in the United Kingdom (UK) who have access to their EHRs and suggests strategies for moving beyond these controversies between proponents and critics of the system. It additionally shows that the very organizational, procedural, and technological infrastructure that promises patients' increased access to records can also exacerbate some patients' "difficult" behaviors. © 2017 American Medical Association. All Rights Reserved.

Trust in government and support for governmental regulation: the case of electronic health records.

PubMed

Herian, Mitchel N; Shank, Nancy C; Abdel-Monem, Tarik L

2014-12-01

This paper presents results from a public engagement effort in Nebraska, USA, which measured public opinions about governmental involvement in encouraging the use of electronic health records (EHRs). We examine the role of trust in government in contributing to public support for government involvement in the development of EHR technologies. We hypothesize that trust in government will lead to support for federal and state governmental encouragement of the use of EHRs among doctors and insurance companies. Further, because individual experiences with health-care professionals will reduce perceptions of risk, we expect that support for governmental involvement will be tempered by greater personal experience with the health-care industry. Examining a small survey of individuals on the issue, we find general support for both of our hypotheses. The findings suggest that trust in government does have a positive relationship with support for government involvement in the policy domain, but that the frequency of personal experiences with health-care providers reduces the extent to which the public supports governmental involvement in the development of EHR technology. This inquiry contributes to our understanding of public attitudes towards government involvement in EHRs in the United States specifically and contributes to social science examining links between trust in government and support for governmental activity in the emerging policy domain regarding electronic health records systems. © 2012 John Wiley & Sons Ltd.

Taking a quality assurance program from paper to electronic health records: one dental school's experience.

PubMed

Filker, Phyllis J; Muckey, Erin Joy; Kelner, Steven M; Kodish-Stav, Jodi

2009-09-01

The Obama administration is seeking to increase access to and improve the efficiency of the health care system in the United States. One aspect of those efforts is a push towards the utilization of electronic health records (EHRs) by health care providers. Nova Southeastern University College of Dental Medicine (NSU-CDM) opened its doors in 1997 and began its evolution from paper charts to EHRs in 2006. AxiUm, a computer-run patient record and clinical management system, has become an integral part of the college's quality assurance program and its students' clinical education. Since the introduction of axiUm, the school has already noticed an increase in the quality of patient care due to improved oversight of patient management and the ability to more efficiently track treatment outcomes. Over time, the system will enable data collected by students providing care in the clinics to be quantified. Opposition to EHRs tends to stem primarily from the amount of time required for users to gain proficiency in the new technology, as well as from the initial cost to the provider. But there is no better place to begin this learning process regarding the importance and utilization of EHR systems than universities, where health professions students can acquire a comfort level with EHRs in an academic environment that they may then implement in their future practice.

Quality and Certification of Electronic Health Records

PubMed Central

Hoerbst, A.; Ammenwerth, E.

2010-01-01

Background Numerous projects, initiatives, and programs are dedicated to the development of Electronic Health Records (EHR) worldwide. Increasingly more of these plans have recently been brought from a scientific environment to real life applications. In this context, quality is a crucial factor with regard to the acceptance and utility of Electronic Health Records. However, the dissemination of the existing quality approaches is often rather limited. Objectives The present paper aims at the description and comparison of the current major quality certification approaches to EHRs. Methods A literature analysis was carried out in order to identify the relevant publications with regard to EHR quality certification. PubMed, ACM Digital Library, IEEExplore, CiteSeer, and Google (Scholar) were used to collect relevant sources. The documents that were obtained were analyzed using techniques of qualitative content analysis. Results The analysis discusses and compares the quality approaches of CCHIT, EuroRec, IHE, openEHR, and EN13606. These approaches differ with regard to their focus, support of service-oriented EHRs, process of (re-)certification and testing, number of systems certified and tested, supporting organizations, and regional relevance. Discussion The analyzed approaches show differences with regard to their structure and processes. System vendors can exploit these approaches in order to improve and certify their information systems. Health care organizations can use these approaches to support selection processes or to assess the quality of their own information systems. PMID:23616834

Adoption of electronic health records and preparations for demonstrating meaningful use: an American Academy of Ophthalmology survey.

PubMed

Boland, Michael V; Chiang, Michael F; Lim, Michele C; Wedemeyer, Linda; Epley, K David; McCannel, Colin A; Silverstone, David E; Lum, Flora

2013-08-01

To assess the current state of electronic health record (EHR) use by ophthalmologists, including adoption rate, user satisfaction, functionality, benefits, barriers, and knowledge of meaningful use criteria. Population-based, cross-sectional study. A total of 492 members of the American Academy of Ophthalmology (AAO). A random sample of 1500 AAO members were selected on the basis of their practice location and solicited to participate in a study of EHR use, practice management, and image management system use. Participants completed the survey via the Internet, phone, or fax. The survey included questions about the adoption of EHRs, available functionality, benefits, barriers, satisfaction, and understanding of meaningful use criteria and health information technology concepts. Current adoption rate of EHRs, user satisfaction, benefits and barriers, and availability of EHR functionality. Overall, 32% of the practices surveyed had already implemented an EHR, 15% had implemented an EHR for some of their physicians or were in the process of implementation, and another 31% had plans to do so within 2 years. Among those with an EHR in their practice, 49% were satisfied or extremely satisfied with their system, 42% reported increased or stable overall productivity, 19% reported decreased or stable overall costs, and 55% would recommend an EHR to a fellow ophthalmologist. For those with an electronic image management system, only 15% had all devices integrated, 33% had images directly uploaded into their system, and 12% had electronic association of patient demographics with the image. The adoption of EHRs by ophthalmology practices more than doubled from 2007 to 2011. The satisfaction of ophthalmologists with their EHR and their perception of beneficial effects on productivity and costs were all lower in 2011 than in 2007. Knowledge about meaningful use is high, but the percentage of physicians actually receiving incentive payments is relatively low. Given the importance of imaging in ophthalmology, the shortcomings in current image management systems need to be addressed. The author(s) have no proprietary or commercial interest in any materials discussed in this article. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Electronic health records implementation: an evaluation of information system impact and contingency factors.

PubMed

Nguyen, Lemai; Bellucci, Emilia; Nguyen, Linh Thuy

2014-11-01

This paper provides a review of EHR (electronic health record) implementations around the world and reports on findings including benefits and issues associated with EHR implementation. A systematic literature review was conducted from peer-reviewed scholarly journal publications from the last 10 years (2001-2011). The search was conducted using various publication collections including: Scopus, Embase, Informit, Medline, Proquest Health and Medical Complete. This paper reports on our analysis of previous empirical studies of EHR implementations. We analysed data based on an extension of DeLone and McLean's information system (IS) evaluation framework. The extended framework integrates DeLone and McLean's dimensions, including information quality, system quality, service quality, intention of use and usage, user satisfaction and net benefits, together with contingent dimensions, including systems development, implementation attributes and organisational aspects, as identified by Van der Meijden and colleagues. A mix of evidence-based positive and negative impacts of EHR was found across different evaluation dimensions. In addition, a number of contingent factors were found to contribute to successful implementation of EHR. This review does not include white papers or industry surveys, non-English papers, or those published outside the review time period. This review confirms the potential of this technology to aid patient care and clinical documentation; for example, in improved documentation quality, increased administration efficiency, as well as better quality, safety and coordination of care. Common negative impacts include changes to workflow and work disruption. Mixed observations were found on EHR quality, adoption and satisfaction. The review warns future implementers of EHR to carefully undertake the technology implementation exercise. The review also informs healthcare providers of contingent factors that potentially affect EHR development and implementation in an organisational setting. Our findings suggest a lack of socio-technical connectives between the clinician, the patient and the technology in developing and implementing EHR and future developments in patient-accessible EHR. In addition, a synthesis of DeLone and McLean's framework and Van der Meijden and colleagues' contingent factors has been found useful in comprehensively understanding and evaluating EHR implementations. Crown Copyright © 2014. Published by Elsevier Ireland Ltd. All rights reserved.

Quality requirements for EHR archetypes.

PubMed

Kalra, Dipak; Tapuria, Archana; Austin, Tony; De Moor, Georges

2012-01-01

The realisation of semantic interoperability, in which any EHR data may be communicated between heterogeneous systems and fully understood by computers as well as people on receipt, is a challenging goal. Despite the use of standardised generic models for the EHR and standard terminology systems, too much optionality and variability exists in how particular clinical entries may be represented. Clinical archetypes provide a means of defining how generic models should be shaped and bound to terminology for specific kinds of clinical data. However, these will only contribute to semantic interoperability if libraries of archetypes can be built up consistently. This requires the establishment of design principles, editorial and governance policies, and further research to develop ways for archetype authors to structure clinical data and to use terminology consistently. Drawing on several years of work within communities of practice developing archetypes and implementing systems from them, this paper presents quality requirements for the development of archetypes. Clinical engagement on a wide scale is also needed to help grow libraries of good quality archetypes that can be certified. Vendor and eHealth programme engagement is needed to validate such archetypes and achieve safe, meaningful exchange of EHR data between systems.

Archetype Model-Driven Development Framework for EHR Web System

PubMed Central

Kimura, Eizen; Ishihara, Ken

2013-01-01

Objectives This article describes the Web application framework for Electronic Health Records (EHRs) we have developed to reduce construction costs for EHR sytems. Methods The openEHR project has developed clinical model driven architecture for future-proof interoperable EHR systems. This project provides the specifications to standardize clinical domain model implementations, upon which the ISO/CEN 13606 standards are based. The reference implementation has been formally described in Eiffel. Moreover C# and Java implementations have been developed as reference. While scripting languages had been more popular because of their higher efficiency and faster development in recent years, they had not been involved in the openEHR implementations. From 2007, we have used the Ruby language and Ruby on Rails (RoR) as an agile development platform to implement EHR systems, which is in conformity with the openEHR specifications. Results We implemented almost all of the specifications, the Archetype Definition Language parser, and RoR scaffold generator from archetype. Although some problems have emerged, most of them have been resolved. Conclusions We have provided an agile EHR Web framework, which can build up Web systems from archetype models using RoR. The feasibility of the archetype model to provide semantic interoperability of EHRs has been demonstrated and we have verified that that it is suitable for the construction of EHR systems. PMID:24523991

Exploiting Temporal Constraints of Clinical Guidelines by Applying OpenEHR Archetypes.

PubMed

Cintho, Lilian Mie Mukai; Garcia, Diego; da Silva Santos, Bruno Henrique; Sacchi, Lucia; Quaglini, Silvana; Moro, Claudia Maria Cabral

2017-01-01

Studies describing Computer-Interpretable Clinical Guidelines (CIG) with temporal constrains (TC) generally have not addressed issues related to their integration into Electronic Health Record (EHR) systems. This study aimed to represent TCs contained in clinical guidelines by applying archetypes and Guideline Definition Language (GDL) to incorporate decision support into EHRs. An example of each TC class in the clinical guideline for management of Atrial Fibrillation was represented using archetypes and GDL.

Health Technology Integration for Clinical, Patient Records and Financial Management Related to the Military

DTIC Science & Technology

2012-09-01

approaches for nurses regarding the usage of a newly-implemented electronic health records (EHR) system at a large hospital. The study compares the...standard classroom training had no measureable effect on training outcomes. Our second key finding is that nurses with higher levels of education and...Staff Training, Nurse Training, Web-Based Training, EHR Training, Health Information Technology, HIT Health Technology Integration for Clinical

Electronic Immunization Alerts and Spillover Effects on Other Preventive Care.

PubMed

Kim, Julia M; Rivera, Maria; Persing, Nichole; Bundy, David G; Psoter, Kevin J; Ghazarian, Sharon R; Miller, Marlene R; Solomon, Barry S

2017-08-01

The impact of electronic health record (EHR) immunization clinical alert systems on the delivery of other preventive services remains unknown. We assessed for spillover effects of an EHR immunization alert on delivery of 6 other preventive services, in children 18 to 30 months of age needing immunizations. We conducted a secondary data analysis, with additional primary data collection, of a randomized, historically controlled trial to improve immunization rates with EHR alerts, in an urban, primary care clinic. No significant differences were found in screening for anemia, lead, development, nutrition, and injury prevention counseling in children prompting EHR immunization alerts (n = 129), compared with controls (n = 135). Significant increases in oral health screening in patients prompting EHR alerts (odds ratio = 4.8, 95% CI = 1.8-13.0) were likely due to practice changes over time. An EHR clinical alert system targeting immunizations did not have a spillover effect on the delivery of other preventive services.

Dynamic User Interfaces for Service Oriented Architectures in Healthcare.

PubMed

Schweitzer, Marco; Hoerbst, Alexander

2016-01-01

Electronic Health Records (EHRs) play a crucial role in healthcare today. Considering a data-centric view, EHRs are very advanced as they provide and share healthcare data in a cross-institutional and patient-centered way adhering to high syntactic and semantic interoperability. However, the EHR functionalities available for the end users are rare and hence often limited to basic document query functions. Future EHR use necessitates the ability to let the users define their needed data according to a certain situation and how this data should be processed. Workflow and semantic modelling approaches as well as Web services provide means to fulfil such a goal. This thesis develops concepts for dynamic interfaces between EHR end users and a service oriented eHealth infrastructure, which allow the users to design their flexible EHR needs, modeled in a dynamic and formal way. These are used to discover, compose and execute the right Semantic Web services.

Disassociation for electronic health record privacy.

PubMed

Loukides, Grigorios; Liagouris, John; Gkoulalas-Divanis, Aris; Terrovitis, Manolis

2014-08-01

The dissemination of Electronic Health Record (EHR) data, beyond the originating healthcare institutions, can enable large-scale, low-cost medical studies that have the potential to improve public health. Thus, funding bodies, such as the National Institutes of Health (NIH) in the U.S., encourage or require the dissemination of EHR data, and a growing number of innovative medical investigations are being performed using such data. However, simply disseminating EHR data, after removing identifying information, may risk privacy, as patients can still be linked with their record, based on diagnosis codes. This paper proposes the first approach that prevents this type of data linkage using disassociation, an operation that transforms records by splitting them into carefully selected subsets. Our approach preserves privacy with significantly lower data utility loss than existing methods and does not require data owners to specify diagnosis codes that may lead to identity disclosure, as these methods do. Consequently, it can be employed when data need to be shared broadly and be used in studies, beyond the intended ones. Through extensive experiments using EHR data, we demonstrate that our method can construct data that are highly useful for supporting various types of clinical case count studies and general medical analysis tasks. Copyright © 2014 Elsevier Inc. All rights reserved.

Archetype-based conversion of EHR content models: pilot experience with a regional EHR system

PubMed Central

2009-01-01

Background Exchange of Electronic Health Record (EHR) data between systems from different suppliers is a major challenge. EHR communication based on archetype methodology has been developed by openEHR and CEN/ISO. The experience of using archetypes in deployed EHR systems is quite limited today. Currently deployed EHR systems with large user bases have their own proprietary way of representing clinical content using various models. This study was designed to investigate the feasibility of representing EHR content models from a regional EHR system as openEHR archetypes and inversely to convert archetypes to the proprietary format. Methods The openEHR EHR Reference Model (RM) and Archetype Model (AM) specifications were used. The template model of the Cambio COSMIC, a regional EHR product from Sweden, was analyzed and compared to the openEHR RM and AM. This study was focused on the convertibility of the EHR semantic models. A semantic mapping between the openEHR RM/AM and the COSMIC template model was produced and used as the basis for developing prototype software that performs automated bi-directional conversion between openEHR archetypes and COSMIC templates. Results Automated bi-directional conversion between openEHR archetype format and COSMIC template format has been achieved. Several archetypes from the openEHR Clinical Knowledge Repository have been imported into COSMIC, preserving most of the structural and terminology related constraints. COSMIC templates from a large regional installation were successfully converted into the openEHR archetype format. The conversion from the COSMIC templates into archetype format preserves nearly all structural and semantic definitions of the original content models. A strategy of gradually adding archetype support to legacy EHR systems was formulated in order to allow sharing of clinical content models defined using different formats. Conclusion The openEHR RM and AM are expressive enough to represent the existing clinical content models from the template based EHR system tested and legacy content models can automatically be converted to archetype format for sharing of knowledge. With some limitations, internationally available archetypes could be converted to the legacy EHR models. Archetype support can be added to legacy EHR systems in an incremental way allowing a migration path to interoperability based on standards. PMID:19570196

Implementing electronic health records (EHRs): health care provider perceptions before and after transition from a local basic EHR to a commercial comprehensive EHR.

PubMed

Krousel-Wood, Marie; McCoy, Allison B; Ahia, Chad; Holt, Elizabeth W; Trapani, Donnalee N; Luo, Qingyang; Price-Haywood, Eboni G; Thomas, Eric J; Sittig, Dean F; Milani, Richard V

2018-06-01

We assessed changes in the percentage of providers with positive perceptions of electronic health record (EHR) benefit before and after transition from a local basic to a commercial comprehensive EHR. Changes in the percentage of providers with positive perceptions of EHR benefit were captured via a survey of academic health care providers before (baseline) and at 6-12 months (short term) and 12-24 months (long term) after the transition. We analyzed 32 items for the overall group and by practice setting, provider age, and specialty using separate multivariable-adjusted random effects logistic regression models. A total of 223 providers completed all 3 surveys (30% response rate): 85.6% had outpatient practices, 56.5% were >45 years old, and 23.8% were primary care providers. The percentage of providers with positive perceptions significantly increased from baseline to long-term follow-up for patient communication, hospital transitions - access to clinical information, preventive care delivery, preventive care prompt, preventive lab prompt, satisfaction with system reliability, and sharing medical information (P < .05 for each). The percentage of providers with positive perceptions significantly decreased over time for overall satisfaction, productivity, better patient care, clinical decision quality, easy access to patient information, monitoring patients, more time for patients, coordination of care, computer access, adequate resources, and satisfaction with ease of use (P < 0.05 for each). Results varied by subgroup. After a transition to a commercial comprehensive EHR, items with significant increases and significant decreases in the percentage of providers with positive perceptions of EHR benefit were identified, overall and by subgroup.

Opportunities and challenges in developing risk prediction models with electronic health records data: a systematic review.

PubMed

Goldstein, Benjamin A; Navar, Ann Marie; Pencina, Michael J; Ioannidis, John P A

2017-01-01

Electronic health records (EHRs) are an increasingly common data source for clinical risk prediction, presenting both unique analytic opportunities and challenges. We sought to evaluate the current state of EHR based risk prediction modeling through a systematic review of clinical prediction studies using EHR data. We searched PubMed for articles that reported on the use of an EHR to develop a risk prediction model from 2009 to 2014. Articles were extracted by two reviewers, and we abstracted information on study design, use of EHR data, model building, and performance from each publication and supplementary documentation. We identified 107 articles from 15 different countries. Studies were generally very large (median sample size = 26 100) and utilized a diverse array of predictors. Most used validation techniques (n = 94 of 107) and reported model coefficients for reproducibility (n = 83). However, studies did not fully leverage the breadth of EHR data, as they uncommonly used longitudinal information (n = 37) and employed relatively few predictor variables (median = 27 variables). Less than half of the studies were multicenter (n = 50) and only 26 performed validation across sites. Many studies did not fully address biases of EHR data such as missing data or loss to follow-up. Average c-statistics for different outcomes were: mortality (0.84), clinical prediction (0.83), hospitalization (0.71), and service utilization (0.71). EHR data present both opportunities and challenges for clinical risk prediction. There is room for improvement in designing such studies. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The Impact of Electronic Health Records and Teamwork on Diabetes Care Quality

PubMed Central

Graetz, Ilana; Huang, Jie; Brand, Richard; Shortell, Stephen M.; Rundall, Thomas G.; Bellows, Jim; Hsu, John; Jaffe, Marc; Reed, Mary E.

2016-01-01

Objective Evidence of the impact Electronic Health Records (EHR) on clinical outcomes remains mixed. The impact EHRs likely depends on the organizational context in which they are used. We focus on one aspect of the organizational context: cohesion of primary care teams. We examined whether team cohesion among primary care team members changed the association of EHR use and changes in clinical outcomes for patients with diabetes. Study Design We combined provider-reported primary care team cohesion with lab values for patients with diabetes collected during the staggered EHR implementation (2005–2009). We used multivariate regression models with patient-level fixed effects to assess whether team cohesion levels changed the association between outpatient EHR use and clinical outcomes for patients with diabetes. Subjects 80,611 patients with diabetes mellitus. Measures Changes in hemoglobin A1c (HbA1c) and low-density lipoprotein cholesterol (LDL-C) Results For HbA1c, EHR use was associated with an average decrease of 0.11% for patients with higher cohesion primary care teams compared with a decrease of 0.08% for patients with lower cohesion teams (difference 0.02% in HbA1c, 95%CI: 0.01–0.03). For LDL-C, EHR use was associated with a decrease of 2.15 mg/dL for patients with higher cohesion primary teams compared with a decrease of 1.42 mg/dL for patients with lower cohesion teams (difference 0.73 mg/dL, 95%CI: 0.41–1.11 mg/dL). Conclusions Patients cared for by higher cohesion primary care teams experienced modest but statistically significantly greater EHR-related health outcome improvements, compared with patients cared for by providers practicing in lower cohesion teams. PMID:26671699

Electronic health record acceptance by physicians: testing an integrated theoretical model.

PubMed

Gagnon, Marie-Pierre; Ghandour, El Kebir; Talla, Pascaline Kengne; Simonyan, David; Godin, Gaston; Labrecque, Michel; Ouimet, Mathieu; Rousseau, Michel

2014-04-01

Several countries are in the process of implementing an Electronic Health Record (EHR), but limited physicians' acceptance of this technology presents a serious threat to its successful implementation. The aim of this study was to identify the main determinants of physician acceptance of EHR in a sample of general practitioners and specialists of the Province of Quebec (Canada). We sent an electronic questionnaire to physician members of the Quebec Medical Association. We tested four theoretical models (Technology acceptance model (TAM), Extended TAM, Psychosocial Model, and Integrated Model) using path analysis and multiple linear regression analysis in order to identify the main determinants of physicians' intention to use the EHR. We evaluated the modifying effect of sociodemographic characteristics using multi-group analysis of structural weights invariance. A total of 157 questionnaires were returned. The four models performed well and explained between 44% and 55% of the variance in physicians' intention to use the EHR. The Integrated model performed the best and showed that perceived ease of use, professional norm, social norm, and demonstrability of the results are the strongest predictors of physicians' intention to use the EHR. Age, gender, previous experience and specialty modified the association between those determinants and intention. The proposed integrated theoretical model is useful in identifying which factors could motivate physicians from different backgrounds to use the EHR. Physicians who perceive the EHR to be easy to use, coherent with their professional norms, supported by their peers and patients, and able to demonstrate tangible results are more likely to accept this technology. Age, gender, specialty and experience should also be taken into account when developing EHR implementation strategies targeting physicians. Copyright © 2013 Elsevier Inc. All rights reserved.

Use of electronic health records to ascertain, validate and phenotype acute myocardial infarction: A systematic review and recommendations.

PubMed

Rubbo, Bruna; Fitzpatrick, Natalie K; Denaxas, Spiros; Daskalopoulou, Marina; Yu, Ning; Patel, Riyaz S; Hemingway, Harry

2015-01-01

Electronic health records (EHRs) offer the opportunity to ascertain clinical outcomes at large scale and low cost, thus facilitating cohort studies, quality of care research and clinical trials. For acute myocardial infarction (AMI) the extent to which different EHR sources are accessible and accurate remains uncertain. Using MEDLINE and EMBASE we identified thirty three studies, reporting a total of 128658 patients, published between January 2000 and July 2014 that permitted assessment of the validity of AMI diagnosis drawn from EHR sources against a reference such as manual chart review. In contrast to clinical practice, only one study used EHR-derived markers of myocardial necrosis to identify possible AMI cases, none used electrocardiogram findings and one used symptoms in the form of free text combined with coded diagnosis. The remaining studies relied mostly on coded diagnosis. Thirty one studies reported positive predictive value (PPV)≥ 70% between AMI diagnosis from both secondary care and primary care EHRs and the reference. Among fifteen studies reporting EHR-derived AMI phenotypes, three cross-referenced ST-segment elevation AMI diagnosis (PPV range 71-100%), two non-ST-segment elevation AMI (PPV 91.0, 92.1%), three non-fatal AMI (PPV range 82-92.2%) and six fatal AMI (PPV range 64-91.7%). Clinical coding of EHR-derived AMI diagnosis in primary care and secondary care was found to be accurate in different clinical settings and for different phenotypes. However, markers of myocardial necrosis, ECG and symptoms, the cornerstones of a clinical diagnosis, are underutilised and remain a challenge to retrieve from EHRs. Copyright © 2015. Published by Elsevier Ireland Ltd.

Comparison of accuracy of physical examination findings in initial progress notes between paper charts and a newly implemented electronic health record.

PubMed

Yadav, Siddhartha; Kazanji, Noora; K C, Narayan; Paudel, Sudarshan; Falatko, John; Shoichet, Sandor; Maddens, Michael; Barnes, Michael A

2017-01-01

There have been several concerns about the quality of documentation in electronic health records (EHRs) when compared to paper charts. This study compares the accuracy of physical examination findings documentation between the two in initial progress notes. Initial progress notes from patients with 5 specific diagnoses with invariable physical findings admitted to Beaumont Hospital, Royal Oak, between August 2011 and July 2013 were randomly selected for this study. A total of 500 progress notes were retrospectively reviewed. The paper chart arm consisted of progress notes completed prior to the transition to an EHR on July 1, 2012. The remaining charts were placed in the EHR arm. The primary endpoints were accuracy, inaccuracy, and omission of information. Secondary endpoints were time of initiation of progress note, word count, number of systems documented, and accuracy based on level of training. The rate of inaccurate documentation was significantly higher in the EHRs compared to the paper charts (24.4% vs 4.4%). However, expected physical examination findings were more likely to be omitted in the paper notes compared to EHRs (41.2% vs 17.6%). Resident physicians had a smaller number of inaccuracies (5.3% vs 17.3%) and omissions (16.8% vs 33.9%) compared to attending physicians. During the initial phase of implementation of an EHR, inaccuracies were more common in progress notes in the EHR compared to the paper charts. Residents had a lower rate of inaccuracies and omissions compared to attending physicians. Further research is needed to identify training methods and incentives that can reduce inaccuracies in EHRs during initial implementation. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Development and evaluation of a comprehensive clinical decision support taxonomy: comparison of front-end tools in commercial and internally developed electronic health record systems

PubMed Central

Sittig, Dean F; Ash, Joan S; Feblowitz, Joshua; Meltzer, Seth; McMullen, Carmit; Guappone, Ken; Carpenter, Jim; Richardson, Joshua; Simonaitis, Linas; Evans, R Scott; Nichol, W Paul; Middleton, Blackford

2011-01-01

Background Clinical decision support (CDS) is a valuable tool for improving healthcare quality and lowering costs. However, there is no comprehensive taxonomy of types of CDS and there has been limited research on the availability of various CDS tools across current electronic health record (EHR) systems. Objective To develop and validate a taxonomy of front-end CDS tools and to assess support for these tools in major commercial and internally developed EHRs. Study design and methods We used a modified Delphi approach with a panel of 11 decision support experts to develop a taxonomy of 53 front-end CDS tools. Based on this taxonomy, a survey on CDS tools was sent to a purposive sample of commercial EHR vendors (n=9) and leading healthcare institutions with internally developed state-of-the-art EHRs (n=4). Results Responses were received from all healthcare institutions and 7 of 9 EHR vendors (response rate: 85%). All 53 types of CDS tools identified in the taxonomy were found in at least one surveyed EHR system, but only 8 functions were present in all EHRs. Medication dosing support and order facilitators were the most commonly available classes of decision support, while expert systems (eg, diagnostic decision support, ventilator management suggestions) were the least common. Conclusion We developed and validated a comprehensive taxonomy of front-end CDS tools. A subsequent survey of commercial EHR vendors and leading healthcare institutions revealed a small core set of common CDS tools, but identified significant variability in the remainder of clinical decision support content. PMID:21415065

Evaluating quality of care for patients with type 2 diabetes using electronic health record information in Mexico

PubMed Central

2012-01-01

Background Several low and middle-income countries are implementing electronic health records (EHR). In the near future, EHRs could become an efficient tool to evaluate healthcare performance if appropriate indicators are developed. The aims of this study are: a) to develop quality of care indicators (QCIs) for type 2 diabetes (T2DM) in the Mexican Institute of Social Security (IMSS) health system; b) to determine the feasibility of constructing QCIs using the IMSS EHR data; and c) to evaluate the quality of care (QC) provided to IMSS patients with T2DM. Methods We used a three-stage mixed methods approach: a) development of QCIs following the RAND-UCLA method; b) EHR data extraction and construction of indicators; c) QC evaluation using EHR data from 25,130 T2DM patients who received care in 2009. Results We developed 18 QCIs, of which 14 were possible to construct using available EHR data. QCIs comprised both process of care and health outcomes. Several flaws in the EHR design and quality of data were identified. The indicators of process and outcomes of care suggested areas for improvement. For example, only 13.0% of patients were referred to an ophthalmologist; 3.9% received nutritional counseling; 63.2% of overweight/obese patients were prescribed metformin, and only 23% had HbA1c <7% (or plasma glucose ≤130 mg/dl). Conclusions EHR data can be used to evaluate QC. The results identified both strengths and weaknesses in the electronic information system as well as in the process and outcomes of T2DM care at IMSS. This information can be used to guide targeted interventions to improve QC. PMID:22672471

Development and use of active clinical decision support for preemptive pharmacogenomics

PubMed Central

Bell, Gillian C; Crews, Kristine R; Wilkinson, Mark R; Haidar, Cyrine E; Hicks, J Kevin; Baker, Donald K; Kornegay, Nancy M; Yang, Wenjian; Cross, Shane J; Howard, Scott C; Freimuth, Robert R; Evans, William E; Broeckel, Ulrich; Relling, Mary V; Hoffman, James M

2014-01-01

Background Active clinical decision support (CDS) delivered through an electronic health record (EHR) facilitates gene-based drug prescribing and other applications of genomics to patient care. Objective We describe the development, implementation, and evaluation of active CDS for multiple pharmacogenetic test results reported preemptively. Materials and methods Clinical pharmacogenetic test results accompanied by clinical interpretations are placed into the patient's EHR, typically before a relevant drug is prescribed. Problem list entries created for high-risk phenotypes provide an unambiguous trigger for delivery of post-test alerts to clinicians when high-risk drugs are prescribed. In addition, pre-test alerts are issued if a very-high risk medication is prescribed (eg, a thiopurine), prior to the appropriate pharmacogenetic test result being entered into the EHR. Our CDS can be readily modified to incorporate new genes or high-risk drugs as they emerge. Results Through November 2012, 35 customized pharmacogenetic rules have been implemented, including rules for TPMT with azathioprine, thioguanine, and mercaptopurine, and for CYP2D6 with codeine, tramadol, amitriptyline, fluoxetine, and paroxetine. Between May 2011 and November 2012, the pre-test alerts were electronically issued 1106 times (76 for thiopurines and 1030 for drugs metabolized by CYP2D6), and the post-test alerts were issued 1552 times (1521 for TPMT and 31 for CYP2D6). Analysis of alert outcomes revealed that the interruptive CDS appropriately guided prescribing in 95% of patients for whom they were issued. Conclusions Our experience illustrates the feasibility of developing computational systems that provide clinicians with actionable alerts for gene-based drug prescribing at the point of care. PMID:23978487

Resistance Is Futile: But It Is Slowing the Pace of EHR Adoption Nonetheless

PubMed Central

Ford, Eric W.; Menachemi, Nir; Peterson, Lori T.; Huerta, Timothy R.

2009-01-01

Objective The purpose of this study is to reassess the projected rate of Electronic Health Record (EHR) diffusion and examine how the federal government's efforts to promote the use of EHR technology have influenced physicians' willingness to adopt such systems. The study recreates and extends the analyses conducted by Ford et al. 1 The two periods examined come before and after the U.S. Federal Government's concerted activity to promote EHR adoption. Design Meta-analysis and bass modeling are used to compare EHR diffusion rates for two distinct periods of government activity. Very low levels of government activity to promote EHR diffusion marked the first period, before 2004. In 2004, the President of the United States called for a “Universal EHR Adoption” by 2014 (10 yrs), creating the major wave of activity and increased awareness of how EHRs will impact physicians' practices. Measurement EHR adoption parameters—external and internal coefficients of influence—are estimated using bass diffusion models and future adoption rates are projected. Results Comparing the EHR adoption rates before and after 2004 (2001–2004 and 2001–2007 respectively) indicate the physicians' resistance to adoption has increased during the second period. Based on current levels of adoption, less than half the physicians working in small practices will have implemented an EHR by 2014 (47.3%). Conclusions The external forces driving EHR diffusion have grown in importance since 2004 relative to physicians' internal motivation to adopt such systems. Several national forces are likely contributing to the slowing pace of EHR diffusion. PMID:19261931

A population-based approach for implementing change from opt-out to opt-in research permissions

PubMed Central

Oates, Jim C.; Shoaibi, Azza; Obeid, Jihad S.; Habrat, Melissa L.; Warren, Robert W.; Brady, Kathleen T.; Lenert, Leslie A.

2017-01-01

Due to recently proposed changes in the Common Rule regarding the collection of research preferences, there is an increased need for efficient methods to document opt-in research preferences at a population level. Previously, our institution developed an opt-out paper-based workflow that could not be utilized for research in a scalable fashion. This project was designed to demonstrate the feasibility of implementing an electronic health record (EHR)-based active opt-in research preferences program. The first phase of implementation required creating and disseminating a patient questionnaire through the EHR portal to populate discreet fields within the EHR indicating patients’ preferences for future research study contact (contact) and their willingness to allow anonymised use of excess tissue and fluid specimens (biobank). In the second phase, the questionnaire was presented within a clinic nurse intake workflow in an obstetrical clinic. These permissions were tabulated in registries for use by investigators for feasibility studies and recruitment. The registry was also used for research patient contact management using a new EHR encounter type to differentiate research from clinical encounters. The research permissions questionnaire was sent to 59,670 patients via the EHR portal. Within four months, 21,814 responses (75% willing to participate in biobanking, and 72% willing to be contacted for future research) were received. Each response was recorded within a patient portal encounter to enable longitudinal analysis of responses. We obtained a significantly lower positive response from the 264 females who completed the questionnaire in the obstetrical clinic (55% volunteers for biobank and 52% for contact). We demonstrate that it is possible to establish a research permissions registry using the EHR portal and clinic-based workflows. This patient-centric, population-based, opt-in approach documents preferences in the EHR, allowing linkage of these preferences to health record information. PMID:28441388

Time Spent on Dedicated Patient Care and Documentation Tasks Before and After the Introduction of a Structured and Standardized Electronic Health Record.

PubMed

Joukes, Erik; Abu-Hanna, Ameen; Cornet, Ronald; de Keizer, Nicolette F

2018-01-01

Physicians spend around 35% of their time documenting patient data. They are concerned that adopting a structured and standardized electronic health record (EHR) will lead to more time documenting and less time for patient care, especially during consultations. This study measures the effect of the introduction of a structured and standardized EHR on documentation time and time for dedicated patient care during outpatient consultations. We measured physicians' time spent on four task categories during outpatient consultations: documentation, patient care, peer communication, and other activities. Physicians covered various specialties from two university hospitals that jointly implemented a structured and standardized EHR. Preimplementation, one hospital used a legacy-EHR, and one primarily paper-based records. The same physicians were observed 2 to 6 months before and 6 to 8 months after implementation.We analyzed consultation duration, and percentage of time spent on each task category. Differences in time distribution before and after implementation were tested using multilevel linear regression. We observed 24 physicians (162 hours, 439 consultations). We found no significant difference in consultation duration or number of consultations per hour. In the legacy-EHR center, we found the implementation associated with a significant decrease in time spent on dedicated patient care (-8.5%). In contrast, in the previously paper-based center, we found a significant increase in dedicated time spent on documentation (8.3%) and decrease in time on combined patient care and documentation (-4.6%). The effect on dedicated documentation time significantly differed between centers. Implementation of a structured and standardized EHR was associated with 8.5% decrease in time for dedicated patient care during consultations in one center and 8.3% increase in dedicated documentation time in another center. These results are in line with physicians' concerns that the introduction of a structured and standardized EHR might lead to more documentation burden and less time for dedicated patient care. Schattauer GmbH Stuttgart.

Domain Modeling and Application Development of an Archetype- and XML-based EHRS. Practical Experiences and Lessons Learnt.

PubMed

Kropf, Stefan; Chalopin, Claire; Lindner, Dirk; Denecke, Kerstin

2017-06-28

Access to patient data within the hospital or between hospitals is still problematic since a variety of information systems is in use applying different vendor specific terminologies and underlying knowledge models. Beyond, the development of electronic health record systems (EHRSs) is time and resource consuming. Thus, there is a substantial need for a development strategy of standardized EHRSs. We are applying a reuse-oriented process model and demonstrate its feasibility and realization on a practical medical use case, which is an EHRS holding all relevant data arising in the context of treatment of tumors of the sella region. In this paper, we describe the development process and our practical experiences. Requirements towards the development of the EHRS were collected by interviews with a neurosurgeon and patient data analysis. For modelling of patient data, we selected openEHR as standard and exploited the software tools provided by the openEHR foundation. The patient information model forms the core of the development process, which comprises the EHR generation and the implementation of an EHRS architecture. Moreover, a reuse-oriented process model from the business domain was adapted to the development of the EHRS. The reuse-oriented process model is a model for a suitable abstraction of both, modeling and development of an EHR centralized EHRS. The information modeling process resulted in 18 archetypes that were aggregated in a template and built the boilerplate of the model driven development. The EHRs and the EHRS were developed by openEHR and W3C standards, tightly supported by well-established XML techniques. The GUI of the final EHRS integrates and visualizes information from various examinations, medical reports, findings and laboratory test results. We conclude that the development of a standardized overarching EHR and an EHRS is feasible using openEHR and W3C standards, enabling a high degree of semantic interoperability. The standardized representation visualizes data and can in this way support the decision process of clinicians.

Archetype-based data warehouse environment to enable the reuse of electronic health record data.

PubMed

Marco-Ruiz, Luis; Moner, David; Maldonado, José A; Kolstrup, Nils; Bellika, Johan G

2015-09-01

The reuse of data captured during health care delivery is essential to satisfy the demands of clinical research and clinical decision support systems. A main barrier for the reuse is the existence of legacy formats of data and the high granularity of it when stored in an electronic health record (EHR) system. Thus, we need mechanisms to standardize, aggregate, and query data concealed in the EHRs, to allow their reuse whenever they are needed. To create a data warehouse infrastructure using archetype-based technologies, standards and query languages to enable the interoperability needed for data reuse. The work presented makes use of best of breed archetype-based data transformation and storage technologies to create a workflow for the modeling, extraction, transformation and load of EHR proprietary data into standardized data repositories. We converted legacy data and performed patient-centered aggregations via archetype-based transformations. Later, specific purpose aggregations were performed at a query level for particular use cases. Laboratory test results of a population of 230,000 patients belonging to Troms and Finnmark counties in Norway requested between January 2013 and November 2014 have been standardized. Test records normalization has been performed by defining transformation and aggregation functions between the laboratory records and an archetype. These mappings were used to automatically generate open EHR compliant data. These data were loaded into an archetype-based data warehouse. Once loaded, we defined indicators linked to the data in the warehouse to monitor test activity of Salmonella and Pertussis using the archetype query language. Archetype-based standards and technologies can be used to create a data warehouse environment that enables data from EHR systems to be reused in clinical research and decision support systems. With this approach, existing EHR data becomes available in a standardized and interoperable format, thus opening a world of possibilities toward semantic or concept-based reuse, query and communication of clinical data. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Impact of Electronic Health Records on Long-Term Care Facilities: Systematic Review.

PubMed

Kruse, Clemens Scott; Mileski, Michael; Vijaykumar, Alekhya Ganta; Viswanathan, Sneha Vishnampet; Suskandla, Ujwala; Chidambaram, Yazhini

2017-09-29

Long-term care (LTC) facilities are an important part of the health care industry, providing care to the fastest-growing group of the population. However, the adoption of electronic health records (EHRs) in LTC facilities lags behind other areas of the health care industry. One of the reasons for the lack of widespread adoption in the United States is that LTC facilities are not eligible for incentives under the Meaningful Use program. Implementation of an EHR system in an LTC facility can potentially enhance the quality of care, provided it is appropriately implemented, used, and maintained. Unfortunately, the lag in adoption of the EHR in LTC creates a paucity of literature on the benefits of EHR implementation in LTC facilities. The objective of this systematic review was to identify the potential benefits of implementing an EHR system in LTC facilities. The study also aims to identify the common conditions and EHR features that received favorable remarks from providers and the discrepancies that needed improvement to build up momentum across LTC settings in adopting this technology. The authors conducted a systematic search of PubMed, Cumulative Index of Nursing and Allied Health (CINAHL), and MEDLINE databases. Papers were analyzed by multiple referees to filter out studies not germane to our research objective. A final sample of 28 papers was selected to be included in the systematic review. Results of this systematic review conclude that EHRs show significant improvement in the management of documentation in LTC facilities and enhanced quality outcomes. Approximately 43% (12/28) of the papers reported a mixed impact of EHRs on the management of documentation, and 33% (9/28) of papers reported positive quality outcomes using EHRs. Surprisingly, very few papers demonstrated an impact on patient satisfaction, physician satisfaction, the length of stay, and productivity using EHRs. Overall, implementation of EHRs has been found to be effective in the few LTC facilities that have implemented them. Implementation of EHRs in LTC facilities caused improved management of clinical documentation that enabled better decision making. ©Clemens Scott Kruse, Michael Mileski, Alekhya Ganta Vijaykumar, Sneha Vishnampet Viswanathan, Ujwala Suskandla, Yazhini Chidambaram. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 29.09.2017.

Evaluation of Documentation Patterns of Trainees and Supervising Physicians Using Data Mining.

PubMed

Madhavan, Ramesh; Tang, Chi; Bhattacharya, Pratik; Delly, Fadi; Basha, Maysaa M

2014-09-01

The electronic health record (EHR) includes a rich data set that may offer opportunities for data mining and natural language processing to answer questions about quality of care, key aspects of resident education, or attributes of the residents' learning environment. We used data obtained from the EHR to report on inpatient documentation practices of residents and attending physicians at a large academic medical center. We conducted a retrospective observational study of deidentified patient notes entered over 7 consecutive months by a multispecialty university physician group at an urban hospital. A novel automated data mining technology was used to extract patient note-related variables. A sample of 26 802 consecutive patient notes was analyzed using the data mining and modeling tool Healthcare Smartgrid. Residents entered most of the notes (33%, 8178 of 24 787) between noon and 4 pm and 31% (7718 of 24 787) of notes between 8 am and noon. Attending physicians placed notes about teaching attestations within 24 hours in only 73% (17 843 of 24 443) of the records. Surgical residents were more likely to place notes before noon (P < .001). Nonsurgical faculty were more likely to provide attestation of resident notes within 24 hours (P < .001). Data related to patient note entry was successfully used to objectively measure current work flow of resident physicians and their supervising faculty, and the findings have implications for physician oversight of residents' clinical work. We were able to demonstrate the utility of a data mining model as an assessment tool in graduate medical education.

Terminology Services: Standard Terminologies to Control Health Vocabulary.

PubMed

González Bernaldo de Quirós, Fernán; Otero, Carlos; Luna, Daniel

2018-04-22

Healthcare Information Systems should capture clinical data in a structured and preferably coded format. This is crucial for data exchange between health information systems, epidemiological analysis, quality and research, clinical decision support systems, administrative functions, among others. Structured data entry is an obstacle for the usability of electronic health record (EHR) applications and their acceptance by physicians who prefer to document patient EHRs using "free text". Natural language allows for rich expressiveness but at the same time is ambiguous; it has great dependence on context and uses jargon and acronyms. Although much progress has been made in knowledge and natural language processing techniques, the result is not yet satisfactory enough for the use of free text in all dimensions of clinical documentation. In order to address the trade-off between capturing data with free text and at the same time coding data for computer processing, numerous terminological systems for the systematic recording of clinical data have been developed. The purpose of terminology services consists of representing facts that happen in the real world through database management in order to allow for semantic interoperability and computerized applications. These systems interrelate concepts of a particular domain and provide references to related terms with standards codes. In this way, standard terminologies allow the creation of a controlled medical vocabulary, making terminology services a fundamental component for health data management in the healthcare environment. The Hospital Italiano de Buenos Aires has been working in the development of its own terminology server. This work describes its experience in the field. Georg Thieme Verlag KG Stuttgart.

Calculations of financial incentives for providers in a pay-for-performance program: Manual review versus data from structured fields in electronic health records

PubMed Central

Urech, Tracy H.; Woodard, LeChauncy D.; Virani, Salim S.; Dudley, R. Adams; Lutschg, Meghan Z.; Petersen, Laura A.

2015-01-01

Background Hospital report cards and financial incentives linked to performance require clinical data that are reliable, appropriate, timely, and cost-effective to process. Pay-for-performance plans are transitioning to automated electronic health record (EHR) data as an efficient method to generate data needed for these programs. Objective To determine how well data from automated processing of structured EHR fields (AP-EHR) reflect data from manual chart review and the impact of these data on performance rewards. Research Design Cross-sectional analysis of performance measures used in a cluster randomized trial assessing the impact of financial incentives on guideline-recommended care for hypertension. Subjects A total of 2,840 patients with hypertension assigned to participating physicians at 12 Veterans Affairs hospital-based outpatient clinics. Fifty-two physicians and 33 primary care personnel received incentive payments. Measures Overall, positive and negative agreement indices and Cohen's kappa were calculated for assessments of guideline-recommended antihypertensive medication use, blood pressure (BP) control, and appropriate response to uncontrolled BP. Pearson's correlation coefficient was used to assess how similar participants’ calculated earnings were between the data sources. Results By manual chart review data, 72.3% of patients were considered to have received guideline-recommended antihypertensive medications compared to 65.0% by AP-EHR review (k=0.51). Manual review indicated 69.5% of patients had controlled BP compared to 66.8% by AP-EHR review (k=0.87). Compared to 52.2% of patients per the manual review, 39.8% received an appropriate response by AP-EHR review (k=0.28). Participants’ incentive payments calculated using the two methods were highly correlated (r≥0.98). Using the AP-EHR data to calculate earnings, participants’ payment changes ranged from a decrease of $91.00 (−30.3%) to an increase of $18.20 (+7.4%) for medication use (IQR, −14.4% to 0%) and a decrease of $100.10 (−31.4%) to an increase of $36.40 (+15.4%) for BP control or appropriate response to uncontrolled BP (IQR, −11.9% to −6.1%). Conclusions Pay-for-performance plans that use only EHR data should carefully consider the measures and the structure of the EHR before data collection and financial incentive disbursement. For this study, we feel that a 10% difference in the total amount of incentive earnings disbursed based on AP-EHR data compared to manual review is acceptable given the time and resources required to abstract data from medical records. PMID:26340661

Automated population of an i2b2 clinical data warehouse from an openEHR-based data repository.

PubMed

Haarbrandt, Birger; Tute, Erik; Marschollek, Michael

2016-10-01

Detailed Clinical Model (DCM) approaches have recently seen wider adoption. More specifically, openEHR-based application systems are now used in production in several countries, serving diverse fields of application such as health information exchange, clinical registries and electronic medical record systems. However, approaches to efficiently provide openEHR data to researchers for secondary use have not yet been investigated or established. We developed an approach to automatically load openEHR data instances into the open source clinical data warehouse i2b2. We evaluated query capabilities and the performance of this approach in the context of the Hanover Medical School Translational Research Framework (HaMSTR), an openEHR-based data repository. Automated creation of i2b2 ontologies from archetypes and templates and the integration of openEHR data instances from 903 patients of a paediatric intensive care unit has been achieved. In total, it took an average of ∼2527s to create 2.311.624 facts from 141.917 XML documents. Using the imported data, we conducted sample queries to compare the performance with two openEHR systems and to investigate if this representation of data is feasible to support cohort identification and record level data extraction. We found the automated population of an i2b2 clinical data warehouse to be a feasible approach to make openEHR data instances available for secondary use. Such an approach can facilitate timely provision of clinical data to researchers. It complements analytics based on the Archetype Query Language by allowing querying on both, legacy clinical data sources and openEHR data instances at the same time and by providing an easy-to-use query interface. However, due to different levels of expressiveness in the data models, not all semantics could be preserved during the ETL process. Copyright © 2016 Elsevier Inc. All rights reserved.

Which functionalities are available in the electronic health record systems used by French general practitioners? An assessment study of 15 systems.

PubMed

Darmon, David; Sauvant, Rémy; Staccini, Pascal; Letrilliart, Laurent

2014-01-01

Whereas an unprecedented effort is currently under way worldwide for the implementation of electronic health record (EHR) systems, their capabilities are poorly understood, especially in primary care. The objective of this study was to assess the main functionalities of the EHR systems used in French general practices. Among the 20 EHR systems marketed in France, we assessed the 15 systems used by more than 1500 general practitioners in the Provence-Alpes-Côte d'Azur region in the southeast part of France. Each EHR system was assessed in a general practice office, using two clinical vignettes describing virtual patient consultations. The evaluation criteria were derived from the EuroRec requirements for EHR system quality. The assessment scale included 37 criteria grouped into three sets: background data, consultation data, and exchange functionalities. The scoring system used, totalling 64 points, was based on the validation of the criteria and was adjusted based on the possibility of standardising the data. A high score indicated a good EHR system quality. The median global score was 32 points out of a possible 64 (range: 20-39). The median score was 12 points out of 22 (range: 6-15) for the background data set, 16 points out of 32 (range: 9-22) for the consultation data set, and four points out of 10 (range: 0-6) for the exchange functionalities. No association was found between the number of users and the assessment score of the EHR systems (p=0.79). One third of the EHR systems lacked a problem list and only one of them supported the episode of care. Functionalities noticeably vary among the EHR systems currently used in French primary care. Whereas these systems are globally very focused on drug prescriptions, several core functionalities are frequently lacking. They are also poorly interoperable for healthcare professionals and patients. Further research is necessary to assess their actual use. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Electronic health records, adoption, quality of care, legal and privacy issues and their implementation in emergency departments.

PubMed

Ben-Assuli, Ofir

2015-03-01

Recently, the healthcare sector has shown a growing interest in information technologies. Two popular health IT (HIT) products are the electronic health record (EHR) and health information exchange (HIE) networks. The introduction of these tools is believed to improve care, but has also raised some important questions and legal and privacy issues. The implementation of these systems has not gone smoothly, and still faces some considerable barriers. This article reviews EHR and HIE to address these obstacles, and analyzes the current state of development and adoption in various countries around the world. Moreover, legal and ethical concerns that may be encountered by EHR users and purchasers are reviewed. Finally, links and interrelations between EHR and HIE and several quality of care issues in today's healthcare domain are examined with a focus on EHR and HIE in the emergency department (ED), whose unique characteristics makes it an environment in which the implementation of such technology may be a major contributor to health, but also faces substantial challenges. The paper ends with a discussion of specific policy implications and recommendations based on an examination of the current limitations of these systems. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Adherence to recommended electronic health record safety practices across eight health care organizations.

PubMed

Sittig, Dean F; Salimi, Mandana; Aiyagari, Ranjit; Banas, Colin; Clay, Brian; Gibson, Kathryn A; Goel, Ashutosh; Hines, Robert; Longhurst, Christopher A; Mishra, Vimal; Sirajuddin, Anwar M; Satterly, Tyler; Singh, Hardeep

2018-04-26

The Safety Assurance Factors for EHR Resilience (SAFER) guides were released in 2014 to help health systems conduct proactive risk assessment of electronic health record (EHR)- safety related policies, processes, procedures, and configurations. The extent to which SAFER recommendations are followed is unknown. We conducted risk assessments of 8 organizations of varying size, complexity, EHR, and EHR adoption maturity. Each organization self-assessed adherence to all 140 unique SAFER recommendations contained within 9 guides (range 10-29 recommendations per guide). In each guide, recommendations were organized into 3 broad domains: "safe health IT" (total 45 recommendations); "using health IT safely" (total 80 recommendations); and "monitoring health IT" (total 15 recommendations). The 8 sites fully implemented 25 of 140 (18%) SAFER recommendations. Mean number of "fully implemented" recommendations per guide ranged from 94% (System Interfaces-18 recommendations) to 63% (Clinical Communication-12 recommendations). Adherence was higher for "safe health IT" domain (82.1%) vs "using health IT safely" (72.5%) and "monitoring health IT" (67.3%). Despite availability of recommendations on how to improve use of EHRs, most recommendations were not fully implemented. New national policy initiatives are needed to stimulate implementation of these best practices.

Hospitals ineligible for federal meaningful-use incentives have dismally low rates of adoption of electronic health records.

PubMed

Wolf, Larry; Harvell, Jennie; Jha, Ashish K

2012-03-01

The US government has dedicated substantial resources to help certain providers, such as short-term acute care hospitals and physicians, adopt and meaningfully use electronic health record (EHR) systems. We used national data to determine adoption rates of EHR systems among all types of inpatient providers that were ineligible for these same federal meaningful-use incentives: long-term acute care hospitals, rehabilitation hospitals, and psychiatric hospitals. Adoption rates for these institutions were dismally low: less than half of the rate among short-term acute care hospitals. Specifically, 12 percent of short-term acute care hospitals have at least a basic EHR system, compared with 6 percent of long-term acute care hospitals, 4 percent of rehabilitation hospitals, and 2 percent of psychiatric hospitals. To advance the creation of a nationwide health information technology infrastructure, federal and state policy makers should consider additional measures, such as adopting health information technology standards and EHR system certification criteria appropriate for these ineligible hospitals; including such hospitals in state health information exchange programs; and establishing low-interest loan programs for the acquisition and use of certified EHR systems by ineligible providers.

75 FR 36157 - Establishment of the Temporary Certification Program for Health Information Technology

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-24

...This final rule establishes a temporary certification program for the purposes of testing and certifying health information technology. This final rule is established under the authority granted to the National Coordinator for Health Information Technology (the National Coordinator) by section 3001(c)(5) of the Public Health Service Act (PHSA), as added by the Health Information Technology for Economic and Clinical Health (HITECH) Act. The National Coordinator will utilize the temporary certification program to authorize organizations to test and certify Complete Electronic Health Records (EHRs) and/or EHR Modules, thereby making Certified EHR Technology available prior to the date on which health care providers seeking incentive payments available under the Medicare and Medicaid EHR Incentive Programs may begin demonstrating meaningful use of Certified EHR Technology.

The State of Open Source Electronic Health Record Projects: A Software Anthropology Study

PubMed Central

2017-01-01

Background Electronic health records (EHR) are a key tool in managing and storing patients’ information. Currently, there are over 50 open source EHR systems available. Functionality and usability are important factors for determining the success of any system. These factors are often a direct reflection of the domain knowledge and developers’ motivations. However, few published studies have focused on the characteristics of free and open source software (F/OSS) EHR systems and none to date have discussed the motivation, knowledge background, and demographic characteristics of the developers involved in open source EHR projects. Objective This study analyzed the characteristics of prevailing F/OSS EHR systems and aimed to provide an understanding of the motivation, knowledge background, and characteristics of the developers. Methods This study identified F/OSS EHR projects on SourceForge and other websites from May to July 2014. Projects were classified and characterized by license type, downloads, programming languages, spoken languages, project age, development status, supporting materials, top downloads by country, and whether they were “certified” EHRs. Health care F/OSS developers were also surveyed using an online survey. Results At the time of the assessment, we uncovered 54 open source EHR projects, but only four of them had been successfully certified under the Office of the National Coordinator for Health Information Technology (ONC Health IT) Certification Program. In the majority of cases, the open source EHR software was downloaded by users in the United States (64.07%, 148,666/232,034), underscoring that there is a significant interest in EHR open source applications in the United States. A survey of EHR open source developers was conducted and a total of 103 developers responded to the online questionnaire. The majority of EHR F/OSS developers (65.3%, 66/101) are participating in F/OSS projects as part of a paid activity and only 25.7% (26/101) of EHR F/OSS developers are, or have been, health care providers in their careers. In addition, 45% (45/99) of developers do not work in the health care field. Conclusion The research presented in this study highlights some challenges that may be hindering the future of health care F/OSS. A minority of developers have been health care professionals, and only 55% (54/99) work in the health care field. This undoubtedly limits the ability of functional design of F/OSS EHR systems from being a competitive advantage over prevailing commercial EHR systems. Open source software seems to be a significant interest to many; however, given that only four F/OSS EHR systems are ONC-certified, this interest is unlikely to yield significant adoption of these systems in the United States. Although the Health Information Technology for Economic and Clinical Health (HITECH) act was responsible for a substantial infusion of capital into the EHR marketplace, the lack of a corporate entity in most F/OSS EHR projects translates to a marginal capacity to market the respective F/OSS system and to navigate certification. This likely has further disadvantaged F/OSS EHR adoption in the United States. PMID:28235750

Better Data Quality for Better Healthcare Research Results - A Case Study.

PubMed

Hart, Robert; Kuo, Mu-Hsing

2017-01-01

Electronic Health Records (EHRs) have been identified as a key tool to collect data for healthcare research. However, EHR data must be of sufficient quality to support quality research results. Island Health, BC, Canada has invested and continues to invest in the development of solutions to address the quality of its EHR data and support high quality healthcare studies. This paper examines Island Health's data quality engine, its development and its successful implementation.

Electronic health record training in undergraduate medical education: bridging theory to practice with curricula for empowering patient- and relationship-centered care in the computerized setting.

PubMed

Wald, Hedy S; George, Paul; Reis, Shmuel P; Taylor, Julie Scott

2014-03-01

While electronic health record (EHR) use is becoming state-of-the-art, deliberate teaching of health care information technology (HCIT) competencies is not keeping pace with burgeoning use. Medical students require training to become skilled users of HCIT, but formal pedagogy within undergraduate medical education (UME) is sparse. How can medical educators best meet the needs of learners while integrating EHRs into medical education and practice? How can they help learners preserve and foster effective communication skills within the computerized setting? In general, how can UME curricula be devised for skilled use of EHRs to enhance rather than hinder provision of effective, humanistic health care?Within this Perspective, the authors build on recent publications that "set the stage" for next steps: EHR curricula innovation and implementation as concrete embodiments of theoretical underpinnings. They elaborate on previous calls for maximizing benefits and minimizing risks of EHR use with sufficient focus on physician-patient communication skills and for developing core competencies within medical education. The authors describe bridging theory into practice with systematic longitudinal curriculum development for EHR training in UME at their institution, informed by Kern and colleagues' curriculum development framework, narrative medicine, and reflective practice. They consider this innovation within a broader perspective-the overarching goal of empowering undergraduate medical students' patient- and relationship-centered skills while effectively demonstrating HCIT-related skills.

Significance of electronic health records: A comparative study of vaccination rates in patients with sickle cell disease.

PubMed

Korur, Asli; Asma, Süheyl; Gereklioglu, Cigdem; Solmaz, Soner; Boga, Can; Ozsahin, Akatlı Kürsat; Kut, Altug

2017-01-01

In this study, we investigated the influence of electronic health records (EHR) and electronic vaccination schedule applications on the vaccination status of patients who were admitted to our Center for the treatment of sickle cell disease (SCD). The vaccination status against influenza and pneumococcus infection was determined in 93 patients who were admitted to the hematology outpatient clinic, Baskent University Adana Hospital from April 2004 to March 2009. The vaccination status was then re-evaluated following establishment of EHR and electronic vaccination schedules in 2012. Of the 93 patients with SCD 21.5% (n = 20) were vaccinated against pneumococcus and 21.5% (n = 20) were regularly vaccinated against influenza. When the vaccination rates of 59 of 93 patients who presented for their regular control examinations were analyzed following establishment of EHR and vaccination schedules in 2012, these rates were 49.2% (n = 29) and 50.8% (n = 30) for influenza and pneumococcus, respectively, after EHR; there were 23.7% (n = 14) and 20.3% (n = 12), respectively, before EHR. A statistically significant difference was found between the vaccination rates before and after EHR (p < 0.05). Although viral and bacterial infections are life-threatening health problems in patients with SCD, the vaccination rates were low in high-risk patients. However, these rates increased after application of electronic vaccination schedules.

Significance of electronic health records: A comparative study of vaccination rates in patients with sickle cell disease

PubMed Central

Korur, Asli; Asma, Süheyl; Gereklioglu, Cigdem; Solmaz, Soner; Boga, Can; Ozsahin, Akatlı Kürsat; Kut, Altug

2017-01-01

Objective: In this study, we investigated the influence of electronic health records (EHR) and electronic vaccination schedule applications on the vaccination status of patients who were admitted to our Center for the treatment of sickle cell disease (SCD). Methods: The vaccination status against influenza and pneumococcus infection was determined in 93 patients who were admitted to the hematology outpatient clinic, Baskent University Adana Hospital from April 2004 to March 2009. The vaccination status was then re-evaluated following establishment of EHR and electronic vaccination schedules in 2012. Results: Of the 93 patients with SCD 21.5% (n = 20) were vaccinated against pneumococcus and 21.5% (n = 20) were regularly vaccinated against influenza. When the vaccination rates of 59 of 93 patients who presented for their regular control examinations were analyzed following establishment of EHR and vaccination schedules in 2012, these rates were 49.2% (n = 29) and 50.8% (n = 30) for influenza and pneumococcus, respectively, after EHR; there were 23.7% (n = 14) and 20.3% (n = 12), respectively, before EHR. A statistically significant difference was found between the vaccination rates before and after EHR (p < 0.05). Conclusion: Although viral and bacterial infections are life-threatening health problems in patients with SCD, the vaccination rates were low in high-risk patients. However, these rates increased after application of electronic vaccination schedules. PMID:28811769

Comparison of methodologies for calculating quality measures based on administrative data versus clinical data from an electronic health record system: implications for performance measures.

PubMed

Tang, Paul C; Ralston, Mary; Arrigotti, Michelle Fernandez; Qureshi, Lubna; Graham, Justin

2007-01-01

New reimbursement policies and pay-for-performance programs to reward providers for producing better outcomes are proliferating. Although electronic health record (EHR) systems could provide essential clinical data upon which to base quality measures, most metrics in use were derived from administrative claims data. We compared commonly used quality measures calculated from administrative data to those derived from clinical data in an EHR based on a random sample of 125 charts of Medicare patients with diabetes. Using standard definitions based on administrative data (which require two visits with an encounter diagnosis of diabetes during the measurement period), only 75% of diabetics determined by manually reviewing the EHR (the gold standard) were identified. In contrast, 97% of diabetics were identified using coded information in the EHR. The discrepancies in identified patients resulted in statistically significant differences in the quality measures for frequency of HbA1c testing, control of blood pressure, frequency of testing for urine protein, and frequency of eye exams for diabetic patients. New development of standardized quality measures should shift from claims-based measures to clinically based measures that can be derived from coded information in an EHR. Using data from EHRs will also leverage their clinical content without adding burden to the care process.

A novel approach to leveraging electronic health record data to enhance pediatric surgical quality improvement bundle process compliance.

PubMed

Fisher, Jason C; Godfried, David H; Lighter-Fisher, Jennifer; Pratko, Joseph; Sheldon, Mary Ellen; Diago, Thelma; Kuenzler, Keith A; Tomita, Sandra S; Ginsburg, Howard B

2016-06-01

Quality improvement (QI) bundles have been widely adopted to reduce surgical site infections (SSI). Improvement science suggests when organizations achieve high-reliability to QI processes, outcomes dramatically improve. However, measuring QI process compliance is poorly supported by electronic health record (EHR) systems. We developed a custom EHR tool to facilitate capture of process data for SSI prevention with the aim of increasing bundle compliance and reducing adverse events. Ten SSI prevention bundle processes were linked to EHR data elements that were then aggregated into a snapshot display superimposed on weekly case-log reports. The data aggregation and user interface facilitated efficient review of all SSI bundle elements, providing an exact bundle compliance rate without random sampling or chart review. Nine months after implementation of our custom EHR tool, we observed centerline shifts in median SSI bundle compliance (46% to 72%). Additionally, as predicted by high reliability principles, we began to see a trend toward improvement in SSI rates (1.68 to 0.87 per 100 operations), but a discrete centerline shift was not detected. Simple informatics solutions can facilitate extraction of QI process data from the EHR without relying on adjunctive systems. Analyses of these data may drive reductions in adverse events. Pediatric surgical departments should consider leveraging the EHR to enhance bundle compliance as they implement QI strategies. Copyright © 2016 Elsevier Inc. All rights reserved.

Ranking Medical Terms to Support Expansion of Lay Language Resources for Patient Comprehension of Electronic Health Record Notes: Adapted Distant Supervision Approach.

PubMed

Chen, Jinying; Jagannatha, Abhyuday N; Fodeh, Samah J; Yu, Hong

2017-10-31

Medical terms are a major obstacle for patients to comprehend their electronic health record (EHR) notes. Clinical natural language processing (NLP) systems that link EHR terms to lay terms or definitions allow patients to easily access helpful information when reading through their EHR notes, and have shown to improve patient EHR comprehension. However, high-quality lay language resources for EHR terms are very limited in the public domain. Because expanding and curating such a resource is a costly process, it is beneficial and even necessary to identify terms important for patient EHR comprehension first. We aimed to develop an NLP system, called adapted distant supervision (ADS), to rank candidate terms mined from EHR corpora. We will give EHR terms ranked as high by ADS a higher priority for lay language annotation-that is, creating lay definitions for these terms. Adapted distant supervision uses distant supervision from consumer health vocabulary and transfer learning to adapt itself to solve the problem of ranking EHR terms in the target domain. We investigated 2 state-of-the-art transfer learning algorithms (ie, feature space augmentation and supervised distant supervision) and designed 5 types of learning features, including distributed word representations learned from large EHR data for ADS. For evaluating ADS, we asked domain experts to annotate 6038 candidate terms as important or nonimportant for EHR comprehension. We then randomly divided these data into the target-domain training data (1000 examples) and the evaluation data (5038 examples). We compared ADS with 2 strong baselines, including standard supervised learning, on the evaluation data. The ADS system using feature space augmentation achieved the best average precision, 0.850, on the evaluation set when using 1000 target-domain training examples. The ADS system using supervised distant supervision achieved the best average precision, 0.819, on the evaluation set when using only 100 target-domain training examples. The 2 ADS systems both performed significantly better than the baseline systems (P<.001 for all measures and all conditions). Using a rich set of learning features contributed to ADS's performance substantially. ADS can effectively rank terms mined from EHRs. Transfer learning improved ADS's performance even with a small number of target-domain training examples. EHR terms prioritized by ADS were used to expand a lay language resource that supports patient EHR comprehension. The top 10,000 EHR terms ranked by ADS are available upon request. ©Jinying Chen, Abhyuday N Jagannatha, Samah J Fodeh, Hong Yu. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 31.10.2017.

Your Medical Records

MedlinePlus

... sometimes, but many health care providers now keep electronic records. You might hear medical people call these EHRs — short for electronic health records . Electronic records make it easier for ...

Experiences of Healthcare Professionals to the Introduction in Sweden of a Public eHealth Service: Patients' Online Access to their Electronic Health Records.

PubMed

Ålander, Ture; Scandurra, Isabella

2015-01-01

Patients' increasing demands for medical information, the digitization of health records and the fast spread of Internet access form a basis of introducing new eHealth services. An international trend is to provide access for patients to health information of various kind. In Sweden, access by patients to their proper electronic health record (EHR) has been provided in a pilot county since November 2012. This eHealth service is controversial and criticism has arised from the clinical professions, mainly physicians. Two web surveys were conducted to discover whether the opinions of healthcare professionals differ; between staff that have had experience with patients accessing their own EHR and those who have no such expericence. Experienced nurses found the EHR more important for the patients and a better reform, compared to unexperienced nurses in the rest of the country. Similarly, physicians with their own experience had a more positive attitude compared to non-experienced physicians. The conclusion of this study is that healthcare professionals must be involved in the implementation of public eHealth services such as EHRs and that real experiences of the professionals should be better disseminated to their inexperienced peers.

Query Log Analysis of an Electronic Health Record Search Engine

PubMed Central

Yang, Lei; Mei, Qiaozhu; Zheng, Kai; Hanauer, David A.

2011-01-01

We analyzed a longitudinal collection of query logs of a full-text search engine designed to facilitate information retrieval in electronic health records (EHR). The collection, 202,905 queries and 35,928 user sessions recorded over a course of 4 years, represents the information-seeking behavior of 533 medical professionals, including frontline practitioners, coding personnel, patient safety officers, and biomedical researchers for patient data stored in EHR systems. In this paper, we present descriptive statistics of the queries, a categorization of information needs manifested through the queries, as well as temporal patterns of the users’ information-seeking behavior. The results suggest that information needs in medical domain are substantially more sophisticated than those that general-purpose web search engines need to accommodate. Therefore, we envision there exists a significant challenge, along with significant opportunities, to provide intelligent query recommendations to facilitate information retrieval in EHR. PMID:22195150

Ubiquitous-Severance Hospital Project: Implementation and Results

PubMed Central

Chang, Bung-Chul; Kim, Young-A; Kim, Jee Hea; Jung, Hae Kyung; Kang, Eun Hae; Kang, Hee Suk; Lee, Hyung Il; Kim, Yong Ook; Yoo, Sun Kook; Sunwoo, Ilnam; An, Seo Yong; Jeong, Hye Jeong

2010-01-01

Objectives The purpose of this study was to review an implementation of u-Severance information system with focus on electronic hospital records (EHR) and to suggest future improvements. Methods Clinical Data Repository (CDR) of u-Severance involved implementing electronic medical records (EMR) as the basis of EHR and the management of individual health records. EHR were implemented with service enhancements extending to the clinical decision support system (CDSS) and expanding the knowledge base for research with a repository for clinical data and medical care information. Results The EMR system of Yonsei University Health Systems (YUHS) consists of HP integrity superdome servers using MS SQL as a database management system and MS Windows as its operating system. Conclusions YUHS is a high-performing medical institution with regards to efficient management and customer satisfaction; however, after 5 years of implementation of u-Severance system, several limitations with regards to expandability and security have been identified. PMID:21818425

Ubiquitous-severance hospital project: implementation and results.

PubMed

Chang, Bung-Chul; Kim, Nam-Hyun; Kim, Young-A; Kim, Jee Hea; Jung, Hae Kyung; Kang, Eun Hae; Kang, Hee Suk; Lee, Hyung Il; Kim, Yong Ook; Yoo, Sun Kook; Sunwoo, Ilnam; An, Seo Yong; Jeong, Hye Jeong

2010-03-01

The purpose of this study was to review an implementation of u-Severance information system with focus on electronic hospital records (EHR) and to suggest future improvements. Clinical Data Repository (CDR) of u-Severance involved implementing electronic medical records (EMR) as the basis of EHR and the management of individual health records. EHR were implemented with service enhancements extending to the clinical decision support system (CDSS) and expanding the knowledge base for research with a repository for clinical data and medical care information. The EMR system of Yonsei University Health Systems (YUHS) consists of HP integrity superdome servers using MS SQL as a database management system and MS Windows as its operating system. YUHS is a high-performing medical institution with regards to efficient management and customer satisfaction; however, after 5 years of implementation of u-Severance system, several limitations with regards to expandability and security have been identified.

Gradual electronic health record implementation: new insights on physician and patient adaptation.

PubMed

Shield, Renée R; Goldman, Roberta E; Anthony, David A; Wang, Nina; Doyle, Richard J; Borkan, Jeffrey

2010-01-01

Although there is significant interest in implementation of electronic health records (EHRs), limited data have been published in the United States about how physicians, staff, and patients adapt to this implementation process. The purpose of this research was to examine the effects of EHR implementation, especially regarding physician-patient communication and behaviors and patients' responses. We undertook a 22-month, triangulation design, mixed methods study of gradual EHR implementation in a residency-based family medicine outpatient center. Data collection included participant observation and time measurements of 170 clinical encounters, patient exit interviews, focus groups with nurses, nurse's aides, and office staff, and unstructured observations and interviews with nursing staff and physicians. Analysis involved iterative immersion-crystallization discussion and searches for alternate hypotheses. Patient trust in the physician and security in the physician-patient relationship appeared to override most patients' concerns about information technology. Overall, staff concerns about potential deleterious consequences of EHR implementation were dispelled, positive anticipated outcomes were realized, and unexpected benefits were found. Physicians appeared to become comfortable with the "third actor" in the room, and nursing and office staff resistance to EHR implementation was ameliorated with improved work efficiencies. Unexpected advantages included just-in-time improvements and decreased physician time out of the examination room. Strong patient trust in the physician-patient relationship was maintained and work flow improved with EHR implementation. Gradual EHR implementation may help support the development of beneficial physician and staff adaptations, while maintaining positive patient-physician relationships and fostering the sharing of medical information.

Congruency between educators' teaching beliefs and an electronic health record teaching strategy.

PubMed

Bani-issa, Wegdan; Rempusheski, Veronica F

2014-06-01

Technology has changed healthcare institutions into automated settings with the potential to greatly enhance the quality of healthcare. Implementation of electronic health records (EHRs) to replace paper charting is one example of the influence of technology on healthcare worldwide. In the past decade nursing higher education has attempted to keep pace with technological changes by integrating EHRs into learning experiences. Little is known about educators' teaching beliefs and the use of EHRs as a teaching strategy. This study explores the composition of core teaching beliefs of nurse educators and their related teaching practices within the context of teaching with EHRs in the classroom. A collective case study and qualitative research approach was used to explore and describe teaching beliefs of seven nurse educators teaching with EHRs. Data collection included open-ended, audio-taped interviews and non-participant observation. Content analysis of transcribed interviews and observational field notes focused on identification of teaching belief themes and associated practices. Two contrasting collective case studies of teaching beliefs emerged. Constructivist beliefs were dominant, focused on experiential, student-centered, contextual and collaborative learning, and associated with expanded and a futuristic view of EHRs use. Objectivist beliefs focused on educators' control of the context of learning and were associated with a constrained, limited view of EHRs. Constructivist educators embrace technological change, an essential ingredient of educational reform. We encourage nurse educators to adopt a constructivist view to using technology in teaching in order to prepare nurses for a rapidly changing, technologically sophisticated practice. Copyright © 2014 Elsevier Ltd. All rights reserved.

Mixed Influence of Electronic Health Record Implementation on Diabetes Order Patterns for Michigan Medicaid Adults.

PubMed

Corser, William; Yuan, Sha

2015-08-20

These 2011-2013 analyses examined the authors' hypothesis that relative diabetes care order changes would be measured after electronic health record (EHR) implementation for 291 Medicaid adults who received all of their office-based care at one midwestern federally qualified health center (FQHC) over a 24-month period (n = 2727 encounters, 2489 claims). Beneficiary sociodemographic, clinical, and claims data were validated with clinic EHR and state Medicaid claims linked to providers' national identifier numbers. Overall pre-post order rate comparisons, and a series of controlled within group binary logistic models were conducted under penalized maximum likelihood estimation terms. After EHR implementation, both the overall order rates and odds ratios of per beneficiary hemoglobin A1C (HbA1C) orders increased significantly (ie, from mean of 0.65 [SD = 1.19] annual tests to 0.96 tests [SD = 1.24] [P < .001]). Although the overall post-EHR order rates of dilated eye exams and microalbumin urine tests appeared fairly stable, the odds of eye exam orders being placed at the claims level decreased significantly (OR = 0.774, P = .0030). These mixed results provide evidence of the varied diabetes care ordering patterns likely seen from increased office use of EHR technologies. The authors attempt to explain these post-EHR differences (or lack of) that generally resemble some of the authors' results from another funded project. Ideally, these findings provide Medicaid and health care officials with a more realistic indication of how EHRs may, or may not, influence diabetes care ordering patterns for vulnerable lower-income primary health care consumers. © 2015 Diabetes Technology Society.

The use of open source electronic health records within the federal safety net

PubMed Central

Goldwater, Jason C; Kwon, Nancy J; Nathanson, Ashley; Muckle, Alison E; Brown, Alexa; Cornejo, Kerri

2014-01-01

Objective To conduct a federally funded study that examines the acquisition, implementation and operation of open source electronic health records (EHR) within safety net medical settings, such as federally qualified health centers (FQHC). Methods and materials The study was conducted by the National Opinion Research Center (NORC) at the University of Chicago from April to September 2010. The NORC team undertook a comprehensive environmental scan, including a literature review, a dozen key informant interviews using a semistructured protocol, and a series of site visits to West Virginia, California and Arizona FQHC that were currently using an open source EHR. Results Five of the six sites that were chosen as part of the study found a number of advantages in the use of their open source EHR system, such as utilizing a large community of users and developers to modify their EHR to fit the needs of their provider and patient communities, and lower acquisition and implementation costs as compared to a commercial system. Discussion Despite these advantages, many of the informants and site visit participants felt that widespread dissemination and use of open source was restrained due to a negative connotation regarding this type of software. In addition, a number of participants stated that there is a necessary level of technical acumen needed within the FQHC to make an open source EHR effective. Conclusions An open source EHR provides advantages for FQHC that have limited resources to acquire and implement an EHR, but additional study is needed to evaluate its overall effectiveness. PMID:23744787

75 FR 65354 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-22

... of information technology to minimize the information collection burden. 1. Type of Information... information technology (HIT) and certified electronic health records (EHRs) will improve the quality and value... for Health Information Technology (ONC). The functionality of certified EHR technology should...

Problems with the electronic health record.

PubMed

de Ruiter, Hans-Peter; Liaschenko, Joan; Angus, Jan

2016-01-01

One of the most significant changes in modern healthcare delivery has been the evolution of the paper record to the electronic health record (EHR). In this paper we argue that the primary change has been a shift in the focus of documentation from monitoring individual patient progress to recording data pertinent to Institutional Priorities (IPs). The specific IPs to which we refer include: finance/reimbursement; risk management/legal considerations; quality improvement/safety initiatives; meeting regulatory and accreditation standards; and patient care delivery/evidence based practice. Following a brief history of the transition from the paper record to the EHR, the authors discuss unintended or contested consequences resulting from this change. These changes primarily reflect changes in the organization and amount of clinician work and clinician-patient relationships. The paper is not a research report but was informed by an institutional ethnography the aim of which was to understand how the EHR impacted clinicians and administrators in a large, urban hospital in the United States. The paper was also informed by other sources, including the philosophies of Jacques Ellul, Don Idhe, and Langdon Winner. © 2015 John Wiley & Sons Ltd.

Learning Optimal Individualized Treatment Rules from Electronic Health Record Data

PubMed Central

Wang, Yuanjia; Wu, Peng; Liu, Ying; Weng, Chunhua; Zeng, Donglin

2016-01-01

Medical research is experiencing a paradigm shift from “one-size-fits-all” strategy to a precision medicine approach where the right therapy, for the right patient, and at the right time, will be prescribed. We propose a statistical method to estimate the optimal individualized treatment rules (ITRs) that are tailored according to subject-specific features using electronic health records (EHR) data. Our approach merges statistical modeling and medical domain knowledge with machine learning algorithms to assist personalized medical decision making using EHR. We transform the estimation of optimal ITR into a classification problem and account for the non-experimental features of the EHR data and confounding by clinical indication. We create a broad range of feature variables that reflect both patient health status and healthcare data collection process. Using EHR data collected at Columbia University clinical data warehouse, we construct a decision tree for choosing the best second line therapy for treating type 2 diabetes patients. PMID:28503676

Leveraging electronic health records to support chronic disease management: the need for temporal data views.

PubMed

Samal, Lipika; Wright, Adam; Wong, Bang T; Linder, Jeffrey A; Bates, David W

2011-01-01

The ageing population worldwide is increasingly acquiring multiple chronic diseases. The complex management of chronic diseases could be improved with electronic health records (EHRs) tailored to chronic disease care, but most EHRs in use today do not adequately support longitudinal data management. A key aspect of chronic disease management is that it takes place over long periods, but the way that most EHRs display longitudinal data makes it difficult to trend changes over time and slows providers as they review each patient's unique course. We present five clinical scenarios illustrating longitudinal data needs in complex chronic disease management. These scenarios may function as example cases for software development. For each scenario, we describe and illustrate improvements in temporal data views. Two potential solutions are visualisation for numerical data and disease-oriented text summaries for non-numerical data. We believe that development and widespread implementation of improved temporal data views in EHRs will improve the efficiency and quality of chronic disease management in primary care.

An Electronic Health Record - Public Health (EHR-PH) System Prototype for Interoperability in 21st Century Healthcare Systems

PubMed Central

Orlova, Anna O.; Dunnagan, Mark; Finitzo, Terese; Higgins, Michael; Watkins, Todd; Tien, Allen; Beales, Steven

2005-01-01

Information exchange, enabled by computable interoperability, is the key to many of the initiatives underway including the development of Regional Health Information Exchanges, Regional Health Information Organizations, and the National Health Information Network. These initiatives must include public health as a full partner in the emerging transformation of our nation’s healthcare system through the adoption and use of information technology. An electronic health record - public health (EHR-PH) system prototype was developed to demonstrate the feasibility of electronic data transfer from a health care provider, i.e. hospital or ambulatory care settings, to multiple customized public health systems which include a Newborn Metabolic Screening Registry, a Newborn Hearing Screening Registry, an Immunization Registry and a Communicable Disease Registry, using HL7 messaging standards. Our EHR-PH system prototype can be considered a distributed EHR-based RHIE/RHIO model - a principal element for a potential technical architecture for a NHIN. PMID:16779105

Ethics of Implementing Electronic Health Records in Developing Countries: Points to Consider

PubMed Central

Were, Martin C.; Meslin, Eric M.

2011-01-01

Electronic Health Record systems (EHRs) are increasingly being used in many developing countries, several of which have moved beyond isolated pilot projects to active large-scale implementation as part of their national health strategies. Despite growing enthusiasm for adopting EHRs in resource poor settings, almost no attention has been paid to the ethical issues that might arise. In this article we argue that these ethical issues should be addressed now if EHRs are to be appropriately implemented in these settings. We take a systematic approach guided by a widely accepted ethical framework currently in use for developing countries to first describe the ethical issues, and then propose a set of ‘Points to Consider’ to guide further thinking and decision-making. PMID:22195214

Opportunities and challenges in leveraging electronic health record data in oncology.

PubMed

Berger, Marc L; Curtis, Melissa D; Smith, Gregory; Harnett, James; Abernethy, Amy P

2016-05-01

The widespread adoption of electronic health records (EHRs) and the growing wealth of digitized information sources about patients is ushering in an era of 'Big Data' that may revolutionize clinical research in oncology. Research will likely be more efficient and potentially more accurate than the current gold standard of manual chart review studies. However, EHRs as they exist today have significant limitations: important data elements are missing or are only captured in free text or PDF documents. Using two case studies, we illustrate the challenges of leveraging the data that are routinely collected by the healthcare system in EHRs (e.g., real-world data), specific challenges encountered in the cancer domain and opportunities that can be achieved when these are overcome.

Health information technology: standards, implementation specifications, and certification criteria for electronic health record technology, 2014 edition; revisions to the permanent certification program for health information technology. Final rule.

PubMed

2012-09-04

With this final rule, the Secretary of Health and Human Services adopts certification criteria that establish the technical capabilities and specify the related standards and implementation specifications that Certified Electronic Health Record (EHR) Technology will need to include to, at a minimum, support the achievement of meaningful use by eligible professionals, eligible hospitals, and critical access hospitals under the Medicare and Medicaid EHR Incentive Programs beginning with the EHR reporting periods in fiscal year and calendar year 2014. This final rule also makes changes to the permanent certification program for health information technology, including changing the program's name to the ONC HIT Certification Program.

Safety Assurance Factors for Electronic Health Record Resilience (SAFER): study protocol

PubMed Central

2013-01-01

Background Implementation and use of electronic health records (EHRs) could lead to potential improvements in quality of care. However, the use of EHRs also introduces unique and often unexpected patient safety risks. Proactive assessment of risks and vulnerabilities can help address potential EHR-related safety hazards before harm occurs; however, current risk assessment methods are underdeveloped. The overall objective of this project is to develop and validate proactive assessment tools to ensure that EHR-enabled clinical work systems are safe and effective. Methods/Design This work is conceptually grounded in an 8-dimension model of safe and effective health information technology use. Our first aim is to develop self-assessment guides that can be used by health care institutions to evaluate certain high-risk components of their EHR-enabled clinical work systems. We will solicit input from subject matter experts and relevant stakeholders to develop guides focused on 9 specific risk areas and will subsequently pilot test the guides with individuals representative of likely users. The second aim will be to examine the utility of the self-assessment guides by beta testing the guides at selected facilities and conducting on-site evaluations. Our multidisciplinary team will use a variety of methods to assess the content validity and perceived usefulness of the guides, including interviews, naturalistic observations, and document analysis. The anticipated output of this work will be a series of self-administered EHR safety assessment guides with clear, actionable, checklist-type items. Discussion Proactive assessment of patient safety risks increases the resiliency of health care organizations to unanticipated hazards of EHR use. The resulting products and lessons learned from the development of the assessment guides are expected to be helpful to organizations that are beginning the EHR selection and implementation process as well as those that have already implemented EHRs. Findings from our project, currently underway, will inform future efforts to validate and implement tools that can be used by health care organizations to improve the safety of EHR-enabled clinical work systems. PMID:23587208

User-composable Electronic Health Record Improves Efficiency of Clinician Data Viewing for Patient Case Appraisal: A Mixed-Methods Study.

PubMed

Senathirajah, Yalini; Kaufman, David; Bakken, Suzanne

2016-01-01

Challenges in the design of electronic health records (EHRs) include designing usable systems that must meet the complex, rapidly changing, and high-stakes information needs of clinicians. The ability to move and assemble elements together on the same page has significant human-computer interaction (HCI) and efficiency advantages, and can mitigate the problems of negotiating multiple fixed screens and the associated cognitive burdens. We compare MedWISE-a novel EHR that supports user-composable displays-with a conventional EHR in terms of the number of repeat views of data elements for patient case appraisal. The study used mixed-methods for examination of clinical data viewing in four patient cases. The study compared use of an experimental user-composable EHR with use of a conventional EHR, for case appraisal. Eleven clinicians used a user-composable EHR in a case appraisal task in the laboratory setting. This was compared with log file analysis of the same patient cases in the conventional EHR. We investigated the number of repeat views of the same clinical information during a session and across these two contexts, and compared them using Fisher's exact test. There was a significant difference (p<.0001) in proportion of cases with repeat data element viewing between the user-composable EHR (14.6 percent) and conventional EHR (72.6 percent). Users of conventional EHRs repeatedly viewed the same information elements in the same session, as revealed by log files. Our findings are consistent with the hypothesis that conventional systems require that the user view many screens and remember information between screens, causing the user to forget information and to have to access the information a second time. Other mechanisms (such as reduction in navigation over a population of users due to interface sharing, and information selection) may also contribute to increased efficiency in the experimental system. Systems that allow a composable approach that enables the user to gather together on the same screen any desired information elements may confer cognitive support benefits that can increase productive use of systems by reducing fragmented information. By reducing cognitive overload, it can also enhance the user experience.

Evaluating the usability of speech recognition to create clinical documentation using a commercial electronic health record.

PubMed

Hodgson, Tobias; Magrabi, Farah; Coiera, Enrico

2018-05-01

To conduct a usability study exploring the value of using speech recognition (SR) for clinical documentation tasks within an electronic health record (EHR) system. Thirty-five emergency department clinicians completed a system usability scale (SUS) questionnaire. The study was undertaken after participants undertook randomly allocated clinical documentation tasks using keyboard and mouse (KBM) or SR. SUS scores were analyzed and the results with KBM were compared to SR results. Significant difference in SUS scores between EHR system use with and without SR were observed (KBM 67, SR 61; P = 0.045; CI, 0.1 to 12.0). Nineteen of 35 participants scored higher for EHR with KBM, 11 higher for EHR with SR and 5 gave the same score for both. Factor analysis showed no significant difference in scores for the sub-element of usability (EHR with KBM 65, EHR with SR 62; P = 0.255; CI, -2.6 to 9.5). Scores for the sub-element of learnability were significantly different (KBM 72, SR 55; P < 0.001; CI, 9.8 to 23.5). A significant correlation was found between the perceived usability of the two system configurations (EHR with KBM or SR) and the efficiency of documentation (time to document) (P = 0.002; CI, 10.5 to -0.1) but not with safety (number of errors) (P = 0.90; CI, -2.3 to 2.6). SR was associated with significantly reduced overall usability scores, even though it is often positioned as ease of use technology. SR was perceived to impose larger costs in terms of learnability via training and support requirements for EHR based documentation when compared to using KBM. Lower usability scores were significantly associated with longer documentation times. The usability of EHR systems with any input modality is an area that requires continued development. The addition of an SR component to an EHR system may cause a significant reduction in terms of perceived usability by clinicians. Copyright © 2018 Elsevier B.V. All rights reserved.

A Standards-Based Architecture Proposal for Integrating Patient mHealth Apps to Electronic Health Record Systems

PubMed Central

Fontelo, P.; Rossi, E.; Ackerman, MJ

2015-01-01

Summary Background Mobile health Applications (mHealth Apps) are opening the way to patients’ responsible and active involvement with their own healthcare management. However, apart from Apps allowing patient’s access to their electronic health records (EHRs), mHealth Apps are currently developed as dedicated “island systems”. Objective Although much work has been done on patient’s access to EHRs, transfer of information from mHealth Apps to EHR systems is still low. This study proposes a standards-based architecture that can be adopted by mHealth Apps to exchange information with EHRs to support better quality of care. Methods Following the definition of requirements for the EHR/mHealth App information exchange recently proposed, and after reviewing current standards, we designed the architecture for EHR/mHealth App integration. Then, as a case study, we modeled a system based on the proposed architecture aimed to support home monitoring for congestive heart failure patients. We simulated such process using, on the EHR side, OpenMRS, an open source longitudinal EHR and, on the mHealth App side, the iOS platform. Results The integration architecture was based on the bi-directional exchange of standard documents (clinical document architecture rel2 – CDA2). In the process, the clinician “prescribes” the home monitoring procedures by creating a CDA2 prescription in the EHR that is sent, encrypted and de-identified, to the mHealth App to create the monitoring calendar. At the scheduled time, the App alerts the patient to start the monitoring. After the measurements are done, the App generates a structured CDA2-compliant monitoring report and sends it to the EHR, thus avoiding local storage. Conclusions The proposed architecture, even if validated only in a simulation environment, represents a step forward in the integration of personal mHealth Apps into the larger health-IT ecosystem, allowing the bi-directional data exchange between patients and healthcare professionals, supporting the patient’s engagement in self-management and self-care. PMID:26448794

Importance of multi-modal approaches to effectively identify cataract cases from electronic health records.

PubMed

Peissig, Peggy L; Rasmussen, Luke V; Berg, Richard L; Linneman, James G; McCarty, Catherine A; Waudby, Carol; Chen, Lin; Denny, Joshua C; Wilke, Russell A; Pathak, Jyotishman; Carrell, David; Kho, Abel N; Starren, Justin B

2012-01-01

There is increasing interest in using electronic health records (EHRs) to identify subjects for genomic association studies, due in part to the availability of large amounts of clinical data and the expected cost efficiencies of subject identification. We describe the construction and validation of an EHR-based algorithm to identify subjects with age-related cataracts. We used a multi-modal strategy consisting of structured database querying, natural language processing on free-text documents, and optical character recognition on scanned clinical images to identify cataract subjects and related cataract attributes. Extensive validation on 3657 subjects compared the multi-modal results to manual chart review. The algorithm was also implemented at participating electronic MEdical Records and GEnomics (eMERGE) institutions. An EHR-based cataract phenotyping algorithm was successfully developed and validated, resulting in positive predictive values (PPVs) >95%. The multi-modal approach increased the identification of cataract subject attributes by a factor of three compared to single-mode approaches while maintaining high PPV. Components of the cataract algorithm were successfully deployed at three other institutions with similar accuracy. A multi-modal strategy incorporating optical character recognition and natural language processing may increase the number of cases identified while maintaining similar PPVs. Such algorithms, however, require that the needed information be embedded within clinical documents. We have demonstrated that algorithms to identify and characterize cataracts can be developed utilizing data collected via the EHR. These algorithms provide a high level of accuracy even when implemented across multiple EHRs and institutional boundaries.

HITECH spurs EHR vendor competition and innovation, resulting in increased adoption.

PubMed

Joseph, Seth; Sow, Max; Furukawa, Michael F; Posnack, Steven; Chaffee, Mary Ann

2014-09-01

The Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted to increase electronic health record (EHR) adoption by providers and hospitals. Experts expressed skepticism about whether the program would indeed hasten adoption and could be implemented in time for the initial reporting period. Could EHR vendors meet the certification requirements, and could the industry innovate to meet small-practice needs? This study, in addition to documenting increased provider adoption, provides the first evidence of increased competitiveness and innovation in the EHR industry spurred by HITECH. For example, the number of EHR vendors certified for e-prescribing with Surescripts increased from 96 to 229 over the program's first 3 years. We also find that prescribers in small practices increasingly adopted lower-cost, Web-based e-prescribing and EHR applications at significantly higher rates (15%-35%) than did large practices (3%-4%), which generally have more human and capital resources to make significant investments. These findings suggest that EHR vendors were highly responsive to HITECH requirements and have been adapting their strategies to meet nuanced market needs, providing reason to be optimistic about the Programs' future.

"Why the hell do we need electronic health records?". EHR acceptance among physicians in private practice in Austria: a qualitative study.

PubMed

Hackl, W O; Hoerbst, A; Ammenwerth, E

2011-01-01

Progress in the medical sciences, together with related technologies, in the past has led to higher specialization and has created a strong need to exchange health information across institutional borders. The concept of electronic health records (EHR) was introduced to fulfill these needs. Remarkably, many EHR introduction projects ran into trouble, not least because they lacked the acceptance of EHR among physicians. Negative emotions, such as anxiety and fear due to a lack of information, may cause change barriers and hamper physicians' acceptance of such projects. The goal of this study was to gain deeper insight into the negative emotions related to the intended implementation of a mandatory national electronic health record system (called ELGA) in Austria among physicians in private practice. Qualitative, problem-centered interviews were conducted with eight physicians in private practice in the capital region of Tyrol. The methods of qualitative content analysis were used to analyze the data. Three hundred and twenty-eight passages in the interviews were selected, annotated, and paraphrased. These passages were assigned to 139 different primary categories. Finally, 18 main categories in the form of statements were derived. They were correlated and a theoretical model was formed to explain the genesis of the detected fears and anxiety related to the ELGA project. The results show that the physicians feel uninformed and snubbed. They fear unknown changes, increased costs, as well as workload and surveillance without obtaining any advantages from using electronic health records in their daily practice. Impartial information campaigns that are tailored to the physicians' needs and questions as along with a comprehensive cost-benefit analysis could benefit the physicians' opinion of EHRs.

Using multi-stakeholder alliances to accelerate the adoption of health information technology by physician practices.

PubMed

McHugh, Megan; Shi, Yunfeng; McClellan, Sean R; Shortell, Stephen M; Fareed, Naleef; Harvey, Jillian; Ramsay, Patricia; Casalino, Lawrence P

2016-06-01

Multi-stakeholder alliances - groups of payers, purchasers, providers, and consumers that work together to address local health goals - are frequently used to improve health care quality within communities. Under the Aligning Forces for Quality (AF4Q) initiative, multi-stakeholder alliances were given funding and technical assistance to encourage the use of health information technology (HIT) to improve quality. We investigated whether HIT adoption was greater in AF4Q communities than in other communities. Drawing upon survey data from 782 small and medium-sized physician practices collected as part of the National Study of Physician Organizations during July 2007 - March 2009 and January 2012-November 2013, we used weighted fixed effects models to detect relative changes in four measures representing three domains: use of electronic health records (EHRs), receipt of electronic information from hospitals, and patients' online access to their medical records. Improvement on a composite EHR adoption measure was 7.6 percentage points greater in AF4Q communities than in non-AF4Q communities, and the increase in the probability of adopting all five EHR capabilities was 23.9 percentage points greater in AF4Q communities. There was no significant difference in improvement in receipt of electronic information from hospitals or patients' online access to medical records between AF4Q and non-AF4Q communities. By linking HIT to quality improvement efforts, AF4Q alliances may have facilitated greater adoption of EHRs in small and medium-sized physician practices, but not receipt of electronic information from hospitals or patients' online access to medical records. Multi-stakeholder alliances charged with promoting HIT to advance quality improvement may accelerate adoption of EHRs. Copyright © 2016 Elsevier Inc. All rights reserved.

78 FR 52769 - Proposed Data Collections Submitted for Public Comment and Recommendations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-26

... from office-based physicians to measure progress in adopting electronic health records (EHRs) into their practices. Questions about the use of EHRs have been asked in the National Ambulatory Medical Care... survey, collects information on characteristics of physicians and their practices; the functionalities...

A Distributed Ensemble Approach for Mining Healthcare Data under Privacy Constraints

PubMed Central

Li, Yan; Bai, Changxin; Reddy, Chandan K.

2015-01-01

In recent years, electronic health records (EHRs) have been widely adapted at many healthcare facilities in an attempt to improve the quality of patient care and increase the productivity and efficiency of healthcare delivery. These EHRs can accurately diagnose diseases if utilized appropriately. While the EHRs can potentially resolve many of the existing problems associated with disease diagnosis, one of the main obstacles in effectively using them is the patient privacy and sensitivity of the medical information available in the EHR. Due to these concerns, even if the EHRs are available for storage and retrieval purposes, sharing of the patient records between different healthcare facilities has become a major concern and has hampered some of the effective advantages of using EHRs. Due to this lack of data sharing, most of the facilities aim at building clinical decision support systems using limited amount of patient data from their own EHR systems to provide important diagnosis related decisions. It becomes quite infeasible for a newly established healthcare facility to build a robust decision making system due to the lack of sufficient patient records. However, to make effective decisions from clinical data, it is indispensable to have large amounts of data to train the decision models. In this regard, there are conflicting objectives of preserving patient privacy and having sufficient data for modeling and decision making. To handle such disparate goals, we develop two adaptive distributed privacy-preserving algorithms based on a distributed ensemble strategy. The basic idea of our approach is to build an elegant model for each participating facility to accurately learn the data distribution, and then can transfer the useful healthcare knowledge acquired on their data from these participators in the form of their own decision models without revealing and sharing the patient-level sensitive data, thus protecting patient privacy. We demonstrate that our approach can successfully build accurate and robust prediction models, under privacy constraints, using the healthcare data collected from different geographical locations. We demonstrate the performance of our method using the Type-2 diabetes EHRs accumulated from multiple sources from all fifty states in the U.S. Our method was evaluated on diagnosing diabetes in the presence of insufficient number of patient records from certain regions without revealing the actual patient data from other regions. Using the proposed approach, we also discovered the important biomarkers, both universal and region-specific, and validated the selected biomarkers using the biomedical literature. PMID:26681811

A Distributed Ensemble Approach for Mining Healthcare Data under Privacy Constraints.

PubMed

Li, Yan; Bai, Changxin; Reddy, Chandan K

2016-02-10

In recent years, electronic health records (EHRs) have been widely adapted at many healthcare facilities in an attempt to improve the quality of patient care and increase the productivity and efficiency of healthcare delivery. These EHRs can accurately diagnose diseases if utilized appropriately. While the EHRs can potentially resolve many of the existing problems associated with disease diagnosis, one of the main obstacles in effectively using them is the patient privacy and sensitivity of the medical information available in the EHR. Due to these concerns, even if the EHRs are available for storage and retrieval purposes, sharing of the patient records between different healthcare facilities has become a major concern and has hampered some of the effective advantages of using EHRs. Due to this lack of data sharing, most of the facilities aim at building clinical decision support systems using limited amount of patient data from their own EHR systems to provide important diagnosis related decisions. It becomes quite infeasible for a newly established healthcare facility to build a robust decision making system due to the lack of sufficient patient records. However, to make effective decisions from clinical data, it is indispensable to have large amounts of data to train the decision models. In this regard, there are conflicting objectives of preserving patient privacy and having sufficient data for modeling and decision making. To handle such disparate goals, we develop two adaptive distributed privacy-preserving algorithms based on a distributed ensemble strategy. The basic idea of our approach is to build an elegant model for each participating facility to accurately learn the data distribution, and then can transfer the useful healthcare knowledge acquired on their data from these participators in the form of their own decision models without revealing and sharing the patient-level sensitive data, thus protecting patient privacy. We demonstrate that our approach can successfully build accurate and robust prediction models, under privacy constraints, using the healthcare data collected from different geographical locations. We demonstrate the performance of our method using the Type-2 diabetes EHRs accumulated from multiple sources from all fifty states in the U.S. Our method was evaluated on diagnosing diabetes in the presence of insufficient number of patient records from certain regions without revealing the actual patient data from other regions. Using the proposed approach, we also discovered the important biomarkers, both universal and region-specific, and validated the selected biomarkers using the biomedical literature.

Informatics and operations--let's get integrated.

PubMed

Marsolo, Keith

2013-01-01

The widespread adoption of commercial electronic health records (EHRs) presents a significant challenge to the field of informatics. In their current form, EHRs function as a walled garden and prevent the integration of outside tools and services. This impedes the widespread adoption and diffusion of research interventions into the clinic. In most institutions, EHRs are supported by clinical operations staff who are largely separate from their informatics counterparts. This relationship needs to change. Research informatics and clinical operations need to work more closely on the implementation and configuration of EHRs to ensure that they are used to collect high-quality data for research and improvement at the point of care. At the same time, the informatics community needs to lobby commercial EHR vendors to open their systems and design new architectures that allow for the integration of external applications and services.

Usability Testing of Two Ambulatory EHR Navigators.

PubMed

Hultman, Gretchen; Marquard, Jenna; Arsoniadis, Elliot; Mink, Pamela; Rizvi, Rubina; Ramer, Tim; Khairat, Saif; Fickau, Keri; Melton, Genevieve B

2016-01-01

Despite widespread electronic health record (EHR) adoption, poor EHR system usability continues to be a significant barrier to effective system use for end users. One key to addressing usability problems is to employ user testing and user-centered design. To understand if redesigning an EHR-based navigation tool with clinician input improved user performance and satisfaction. A usability evaluation was conducted to compare two versions of a redesigned ambulatory navigator. Participants completed tasks for five patient cases using the navigators, while employing a think-aloud protocol. The tasks were based on Meaningful Use (MU) requirements. The version of navigator did not affect perceived workload, and time to complete tasks was longer in the redesigned navigator. A relatively small portion of navigator content was used to complete the MU-related tasks, though navigation patterns were highly variable across participants for both navigators. Preferences for EHR navigation structures appeared to be individualized. This study demonstrates the importance of EHR usability assessments to evaluate group and individual performance of different interfaces and preferences for each design.

Distribution and clinical impact of functional variants in 50,726 whole-exome sequences from the DiscovEHR study.

PubMed

Dewey, Frederick E; Murray, Michael F; Overton, John D; Habegger, Lukas; Leader, Joseph B; Fetterolf, Samantha N; O'Dushlaine, Colm; Van Hout, Cristopher V; Staples, Jeffrey; Gonzaga-Jauregui, Claudia; Metpally, Raghu; Pendergrass, Sarah A; Giovanni, Monica A; Kirchner, H Lester; Balasubramanian, Suganthi; Abul-Husn, Noura S; Hartzel, Dustin N; Lavage, Daniel R; Kost, Korey A; Packer, Jonathan S; Lopez, Alexander E; Penn, John; Mukherjee, Semanti; Gosalia, Nehal; Kanagaraj, Manoj; Li, Alexander H; Mitnaul, Lyndon J; Adams, Lance J; Person, Thomas N; Praveen, Kavita; Marcketta, Anthony; Lebo, Matthew S; Austin-Tse, Christina A; Mason-Suares, Heather M; Bruse, Shannon; Mellis, Scott; Phillips, Robert; Stahl, Neil; Murphy, Andrew; Economides, Aris; Skelding, Kimberly A; Still, Christopher D; Elmore, James R; Borecki, Ingrid B; Yancopoulos, George D; Davis, F Daniel; Faucett, William A; Gottesman, Omri; Ritchie, Marylyn D; Shuldiner, Alan R; Reid, Jeffrey G; Ledbetter, David H; Baras, Aris; Carey, David J

2016-12-23

The DiscovEHR collaboration between the Regeneron Genetics Center and Geisinger Health System couples high-throughput sequencing to an integrated health care system using longitudinal electronic health records (EHRs). We sequenced the exomes of 50,726 adult participants in the DiscovEHR study to identify ~4.2 million rare single-nucleotide variants and insertion/deletion events, of which ~176,000 are predicted to result in a loss of gene function. Linking these data to EHR-derived clinical phenotypes, we find clinical associations supporting therapeutic targets, including genes encoding drug targets for lipid lowering, and identify previously unidentified rare alleles associated with lipid levels and other blood level traits. About 3.5% of individuals harbor deleterious variants in 76 clinically actionable genes. The DiscovEHR data set provides a blueprint for large-scale precision medicine initiatives and genomics-guided therapeutic discovery. Copyright © 2016, American Association for the Advancement of Science.

EHR implementation in South Africa: how do we get it right?

PubMed

Yogeswaran, Parimalaranie; Wright, Graham

2010-01-01

In an environment of expanding demand on the health care system to provide equitable, accessible and safe health care, usage of information communication technology is one of the strategies identified to fulfil such expectations. Electronic Health Record (EHR) is an important tool towards achieving better health care using such technology, although, across the world EHR implementation has experienced a high failure rate. Nevertheless South Africa has made a strategic decision to implement EHR system in the public health sector. An evaluation toolkit was developed, to measure the state of readiness of health institutions in South Africa in implementing EHR based on Kaplan and Norton's work on Balanced Score Card (BSC), and the subsequent variant model developed by Protti. A Critical Success Factor (CSF) scorecard to assess the state of readiness and a Balanced Score Card matrix to be used as a strategic framework was developed. These tools were validated using critiques by a panel of experts. The toolkit developed has the potential to assist the organization towards a better EHR implementation path.

The State of Open Source Electronic Health Record Projects: A Software Anthropology Study.

PubMed

Alsaffar, Mona; Yellowlees, Peter; Odor, Alberto; Hogarth, Michael

2017-02-24

Electronic health records (EHR) are a key tool in managing and storing patients' information. Currently, there are over 50 open source EHR systems available. Functionality and usability are important factors for determining the success of any system. These factors are often a direct reflection of the domain knowledge and developers' motivations. However, few published studies have focused on the characteristics of free and open source software (F/OSS) EHR systems and none to date have discussed the motivation, knowledge background, and demographic characteristics of the developers involved in open source EHR projects. This study analyzed the characteristics of prevailing F/OSS EHR systems and aimed to provide an understanding of the motivation, knowledge background, and characteristics of the developers. This study identified F/OSS EHR projects on SourceForge and other websites from May to July 2014. Projects were classified and characterized by license type, downloads, programming languages, spoken languages, project age, development status, supporting materials, top downloads by country, and whether they were "certified" EHRs. Health care F/OSS developers were also surveyed using an online survey. At the time of the assessment, we uncovered 54 open source EHR projects, but only four of them had been successfully certified under the Office of the National Coordinator for Health Information Technology (ONC Health IT) Certification Program. In the majority of cases, the open source EHR software was downloaded by users in the United States (64.07%, 148,666/232,034), underscoring that there is a significant interest in EHR open source applications in the United States. A survey of EHR open source developers was conducted and a total of 103 developers responded to the online questionnaire. The majority of EHR F/OSS developers (65.3%, 66/101) are participating in F/OSS projects as part of a paid activity and only 25.7% (26/101) of EHR F/OSS developers are, or have been, health care providers in their careers. In addition, 45% (45/99) of developers do not work in the health care field. The research presented in this study highlights some challenges that may be hindering the future of health care F/OSS. A minority of developers have been health care professionals, and only 55% (54/99) work in the health care field. This undoubtedly limits the ability of functional design of F/OSS EHR systems from being a competitive advantage over prevailing commercial EHR systems. Open source software seems to be a significant interest to many; however, given that only four F/OSS EHR systems are ONC-certified, this interest is unlikely to yield significant adoption of these systems in the United States. Although the Health Information Technology for Economic and Clinical Health (HITECH) act was responsible for a substantial infusion of capital into the EHR marketplace, the lack of a corporate entity in most F/OSS EHR projects translates to a marginal capacity to market the respective F/OSS system and to navigate certification. This likely has further disadvantaged F/OSS EHR adoption in the United States. ©Mona Alsaffar, Peter Yellowlees, Alberto Odor, Michael Hogarth. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 24.02.2017.

42 CFR 495.8 - Demonstration of meaningful use criteria.

Code of Federal Regulations, 2011 CFR

2011-10-01

... SERVICES (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY...), that during the EHR reporting period, the EP— (A) Used certified EHR technology, and specify the technology used; (B) Satisfied the required objectives and associated measures under § 495.6(d) and § 495.6(e...

Using routine clinical and administrative data to produce a dataset of attendances at Emergency Departments following self-harm.

PubMed

Polling, C; Tulloch, A; Banerjee, S; Cross, S; Dutta, R; Wood, D M; Dargan, P I; Hotopf, M

2015-07-16

Self-harm is a significant public health concern in the UK. This is reflected in the recent addition to the English Public Health Outcomes Framework of rates of attendance at Emergency Departments (EDs) following self-harm. However there is currently no source of data to measure this outcome. Routinely available data for inpatient admissions following self-harm miss the majority of cases presenting to services. We aimed to investigate (i) if a dataset of ED presentations could be produced using a combination of routinely collected clinical and administrative data and (ii) to validate this dataset against another one produced using methods similar to those used in previous studies. Using the Clinical Record Interactive Search system, the electronic health records (EHRs) used in four EDs were linked to Hospital Episode Statistics to create a dataset of attendances following self-harm. This dataset was compared with an audit dataset of ED attendances created by manual searching of ED records. The proportion of total cases detected by each dataset was compared. There were 1932 attendances detected by the EHR dataset and 1906 by the audit. The EHR and audit datasets detected 77% and 76 of all attendances respectively and both detected 82% of individual patients. There were no differences in terms of age, sex, ethnicity or marital status between those detected and those missed using the EHR method. Both datasets revealed more than double the number of self-harm incidents than could be identified from inpatient admission records. It was possible to use routinely collected EHR data to create a dataset of attendances at EDs following self-harm. The dataset detected the same proportion of attendances and individuals as the audit dataset, proved more comprehensive than the use of inpatient admission records, and did not show a systematic bias in those cases it missed.

Contribution of Clinical Archetypes, and the Challenges, towards Achieving Semantic Interoperability for EHRs.

PubMed

Tapuria, Archana; Kalra, Dipak; Kobayashi, Shinji

2013-12-01

The objective is to introduce 'clinical archetype' which is a formal and agreed way of representing clinical information to ensure interoperability across and within Electronic Health Records (EHRs). The paper also aims at presenting the challenges building quality labeled clinical archetypes and the challenges towards achieving semantic interoperability between EHRs. Twenty years of international research, various European healthcare informatics projects and the pioneering work of the openEHR Foundation have led to the following results. The requirements for EHR information architectures have been consolidated within ISO 18308 and adopted within the ISO 13606 EHR interoperability standard. However, a generic EHR architecture cannot ensure that the clinical meaning of information from heterogeneous sources can be reliably interpreted by receiving systems and services. Therefore, clinical models called 'clinical archetypes' are required to formalize the representation of clinical information within the EHR. Part 2 of ISO 13606 defines how archetypes should be formally represented. The current challenge is to grow clinical communities to build a library of clinical archetypes and to identify how evidence of best practice and multi-professional clinical consensus should best be combined to define archetypes at the optimal level of granularity and specificity and quality label them for wide adoption. Standardizing clinical terms within EHRs using clinical terminology like Systematized Nomenclature of Medicine Clinical Terms is also a challenge. Clinical archetypes would play an important role in achieving semantic interoperability within EHRs. Attempts are being made in exploring the design and adoption challenges for clinical archetypes.

Developing Teaching Strategies in the EHR Era: A Survey of GME Experts.

PubMed

Atwater, Amber R; Rudd, Mariah; Brown, Audrey; Wiener, John S; Benjamin, Robert; Lee, W Robert; Rosdahl, Jullia A

2016-10-01

There is limited information on the impact of widespread adoption of the electronic health record (EHR) on graduate medical education (GME). To identify areas of consensus by education experts, where the use of EHR impacts GME, with the goal of developing strategies and tools to enhance GME teaching and learning in the EHR environment. Information was solicited from experienced US physician educators who use EPIC EHR following 3 steps: 2 rounds of online surveys using the Delphi technique, followed by telephone interviews. The survey contained 3 stem questions and 52 items with Likert-scale responses. Consensus was defined by predetermined cutoffs. A second survey reassessed items for which consensus was not initially achieved. Common themes to improve GME in settings with an EHR were compiled from the telephone interviews. The panel included 19 physicians in 15 states in Round 1, 12 in Round 2, and 10 for the interviews. Ten items were found important for teaching and learning: balancing focus on EHR documentation with patient engagement achieved 100% consensus. Other items achieving consensus included adequate learning time, balancing EHR data with verbal history and physical examination, communicating clinical thought processes, hands-on EHR practice, minimizing data repetition, and development of shortcuts and templates. Teaching strategies incorporating both online software and face-to-face solutions were identified during the interviews. New strategies are needed for effective teaching and learning of residents and fellows, capitalizing on the potential of the EHR, while minimizing any unintended negative impact on medical education.

EHR adoption among doctors who treat the elderly.

PubMed

Yeager, Valerie A; Menachemi, Nir; Brooks, Robert G

2010-12-01

The purpose of this study is to examine Electronic Health Record (EHR) adoption among Florida doctors who treat the elderly. This analysis contributes to the EHR adoption literature by determining if doctors who disproportionately treat the elderly differ from their counterparts with respect to the utilization of an important quality-enhancing health information technology application. This study is based on a primary survey of a large, statewide sample of doctors practising in outpatient settings in Florida. Logistic regression analysis was used to determine whether doctors who treat a high volume of elderly (HVE) patients were different with respect to EHR adoption. Our analyses included responses from 1724 doctors. In multivariate analyses controlling for doctor age, training, computer sophistication, practice size and practice setting, HVE doctors were significantly less likely to adopt EHR. Specifically, compared with their counterparts, HVE doctors were observed to be 26.7% less likely to be utilizing an EHR system (OR=0.733, 95% CI 0.547-0.982). We also found that doctor age is negatively related to EHR adoption, and practice size and doctor computer savvy-ness is positively associated. Despite the fact that EHR adoption has improved in recent years, doctors in Florida who serve the elderly are less likely to adopt EHRs. As long as HVE doctors are adopting EHR systems at slower rates, the elderly patients treated by these doctors will be at a disadvantage with respect to potential benefits offered by this technology. © 2010 Blackwell Publishing Ltd.

Model Guided Design and Development Process for an Electronic Health Record Training Program

PubMed Central

He, Ze; Marquard, Jenna; Henneman, Elizabeth

2016-01-01

Effective user training is important to ensure electronic health record (EHR) implementation success. Though many previous studies report best practice principles and success and failure stories, current EHR training is largely empirically-based and often lacks theoretical guidance. In addition, the process of training development is underemphasized and underreported. A white paper by the American Medical Informatics Association called for models of user training for clinical information system implementation; existing instructional development models from learning theory provide a basis to meet this call. We describe in this paper our experiences and lessons learned as we adapted several instructional development models to guide our development of EHR user training. Specifically, we focus on two key aspects of this training development: training content and training process. PMID:28269940

The Hippocratic bargain and health information technology.

PubMed

Rothstein, Mark A

2010-01-01

The shift to longitudinal, comprehensive electronic health records (EHRs) means that any health care provider (e.g., dentist, pharmacist, physical therapist) or third-party user of the EHR (e.g., employer, life insurer) will be able to access much health information of questionable clinical utility and possibly of great sensitivity. Genetic test results, reproductive health, mental health, substance abuse, and domestic violence are examples of sensitive information that many patients would not want routinely available. The likely policy response is to give patients the ability to segment information in their EHRs and to sequester certain types of sensitive information, thereby limiting routine access to the totality of a patient's health record. This article explores the likely effect on the physician-patient relationship of patient-directed sequestration of sensitive health information, including the ethical and legal consequences.

From Prototype to Production: Lessons Learned from the Evolution of an EHR Educational Portal

PubMed Central

Borycki, Elizabeth M.; Armstrong, Brian; Kushniruk, Andre W.

2009-01-01

The use of electronic health records is rapidly increasing. However, the integration of this technology into the education of health professionals and health informaticians has largely remained to be explored. In this paper we describe an approach to providing remote access to electronic health records for use in health professional and health informatics education at the undergraduate and graduate levels. The University of Victoria EHR Educational Portal was designed by the authors to allow for remote Web-based access by students to a range of systems hosted on the portal. Architectural considerations and the evolution of the portal structure from prototype to production system are described. The paper also describes our initial applications of the approach in integrating EHRs into nursing, medical and health informatics educational programs. PMID:20351822

A long-term follow-up evaluation of electronic health record prescribing safety

PubMed Central

Abramson, Erika L; Malhotra, Sameer; Osorio, S Nena; Edwards, Alison; Cheriff, Adam; Cole, Curtis; Kaushal, Rainu

2013-01-01

Objective To be eligible for incentives through the Electronic Health Record (EHR) Incentive Program, many providers using older or locally developed EHRs will be transitioning to new, commercial EHRs. We previously evaluated prescribing errors made by providers in the first year following transition from a locally developed EHR with minimal prescribing clinical decision support (CDS) to a commercial EHR with robust CDS. Following system refinements, we conducted this study to assess the rates and types of errors 2 years after transition and determine the evolution of errors. Materials and methods We conducted a mixed methods cross-sectional case study of 16 physicians at an academic-affiliated ambulatory clinic from April to June 2010. We utilized standardized prescription and chart review to identify errors. Fourteen providers also participated in interviews. Results We analyzed 1905 prescriptions. The overall prescribing error rate was 3.8 per 100 prescriptions (95% CI 2.8 to 5.1). Error rates were significantly lower 2 years after transition (p<0.001 compared to pre-implementation, 12 weeks and 1 year after transition). Rates of near misses remained unchanged. Providers positively appreciated most system refinements, particularly reduced alert firing. Discussion Our study suggests that over time and with system refinements, use of a commercial EHR with advanced CDS can lead to low prescribing error rates, although more serious errors may require targeted interventions to eliminate them. Reducing alert firing frequency appears particularly important. Our results provide support for federal efforts promoting meaningful use of EHRs. Conclusions Ongoing error monitoring can allow CDS to be optimally tailored and help achieve maximal safety benefits. Clinical Trials Registration ClinicalTrials.gov, Identifier: NCT00603070. PMID:23578816

Rates, levels, and determinants of electronic health record system adoption: a study of hospitals in Riyadh, Saudi Arabia.

PubMed

Aldosari, Bakheet

2014-05-01

Outside a small number of OECD countries, little information exists regarding the rates, levels, and determinants of hospital electronic health record (EHR) system adoption. This study examines EHR system adoption in Riyadh, Saudi Arabia. Respondents from 22 hospitals were surveyed regarding the implementation, maintenance, and improvement phases of EHR system adoption. Thirty-seven items were graded on a three-point scale of preparedness/completion. Measured determinants included hospital size, level of care, ownership, and EHR system development team composition. Eleven of the hospitals had implemented fully functioning EHR systems, eight had systems in progress, and three had not adopted a system. Sixteen different systems were being used across the 19 adopting hospitals. Differential adoption levels were positively related to hospital size and negatively to the level of care (secondary versus tertiary). Hospital ownership (nonprofit versus private) and development team composition showed mixed effects depending on the particular adoption phase being considered. Adoption rates compare favourably with those reported from other countries and other districts in Saudi Arabia, but wide variations exist among hospitals in the levels of adoption of individual items. General weaknesses in the implementation phase concern the legacy of paper data systems, including document scanning and data conversion; in the maintenance phase concern updating/maintaining software; and in the improvement phase concern the communication and exchange of health information. This study is the first to investigate the level and determinants of EHR system adoption for public, other nonprofit, and private hospitals in Saudi Arabia. Wide interhospital variations in adoption bear implications for policy-making and funding intervention. Identified areas of weakness require action to increase the degree of adoption and usefulness of EHR systems. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.