501
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Is there a link between the hospital-acquired injurious fall rates in US acute care hospitals and these institutions' implementation levels of computerized systems? Comput Inform Nurs 2012; 29:721-9. [PMID: 21825973 DOI: 10.1097/ncn.0b013e31822b8672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Medicare no longer reimburses acute care hospitals for the costs of additional care required due to hospital-acquired injuries. Consequently, this study explored the effective computerized systems to inform practice for better interventions to reduce fall risk. It provided a correlation between type of computerized system and hospital-acquired injurious fall rates at acute care hospitals in California, Florida, and New York. It used multiple publicly available data sets, with the hospital as the unit of analysis. Descriptive and Pearson correlation analyses were used. The analysis included 462 hospitals. Significant correlations could be categorized into two groups: (1) meaningful computerized systems that were associated with lower injurious fall rates: the decision support systems for drug allergy alerts, drug-drug interaction alerts, and drug-laboratory interaction alerts; and (2) computerized systems that were associated with higher injurious fall rates: the decision support system for drug-drug interaction alerts and the computerized provider order entry system for radiology tests. Future research may include additional states, multiple years of data, and patient-level data to validate this study's findings. This effort may further inform policy makers and the public about effective clinical computerized systems provided to clinicians to improve their practice decisions and care outcomes.
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502
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DesRoches CM, Worzala C, Joshi MS, Kralovec PD, Jha AK. Small, nonteaching, and rural hospitals continue to be slow in adopting electronic health record systems. Health Aff (Millwood) 2012; 31:1092-9. [PMID: 22535503 DOI: 10.1377/hlthaff.2012.0153] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To achieve the goal of comprehensive health information record keeping and exchange among providers and patients, hospitals must have functioning electronic health record systems that contain patient demographics, care histories, lab results, and more. Using national survey data on US hospitals from 2011, the year federal incentives for the meaningful use of electronic health records began, we found that the share of hospitals with any electronic health record system increased from 15.1 percent in 2010 to 26.6 percent in 2011, and the share with a comprehensive system rose from 3.6 percent to 8.7 percent. The proportion able to meet our proxy criteria for meaningful use also rose; in 2011, 18.4 percent of hospitals had these functions in place in at least one unit and 11.2 percent had them across all clinical units. However, gaps in rates of adoption of at least a basic record system have increased substantially over the past four years based on hospital size, teaching status, and location. Small, nonteaching, and rural hospitals continue to adopt electronic health record systems more slowly than other types of hospitals. In sum, this is mixed news for policy makers, who should redouble their efforts among hospitals that appear to be moving slowly and ensure that policies do not further widen gaps in adoption. A more robust infrastructure for information exchange needs to be developed, and possibly a special program for the sizable minority of hospitals that have almost no health information technology at all.
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503
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Maiorana A, Steward WT, Koester KA, Pearson C, Shade SB, Chakravarty D, Myers JJ. Trust, confidentiality, and the acceptability of sharing HIV-related patient data: lessons learned from a mixed methods study about Health Information Exchanges. Implement Sci 2012; 7:34. [PMID: 22515736 PMCID: PMC3428648 DOI: 10.1186/1748-5908-7-34] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 04/19/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Concerns about the confidentiality of personal health information have been identified as a potential obstacle to implementation of Health Information Exchanges (HIEs). Considering the stigma and confidentiality issues historically associated with human immunodeficiency virus (HIV) disease, we examine how trust-in technology, processes, and people-influenced the acceptability of data sharing among stakeholders prior to implementation of six HIEs intended to improve HIV care in parts of the United States. Our analyses identify the kinds of concerns expressed by stakeholders about electronic data sharing and focus on the factors that ultimately facilitated acceptability of the new exchanges. METHODS We conducted 549 surveys with patients and 66 semi-structured interviews with providers and other stakeholders prior to implementation of the HIEs to assess concerns about confidentiality in the electronic sharing of patient data. The patient quantitative data were analyzed using SAS 9.2 to yield sample descriptive statistics. The analysis of the qualitative interviews with providers and other stakeholders followed an open-coding process, and convergent and divergent perspectives emerging from those data were examined within and across the HIEs. RESULTS We found widespread acceptability for electronic sharing of HIV-related patient data through HIEs. This acceptability appeared to be driven by growing comfort with information technologies, confidence in the security protocols utilized to protect data, trust in the providers and institutions who use the technologies, belief in the benefits to the patients, and awareness that electronic exchange represents an enhancement of data sharing already taking place by other means. HIE acceptability depended both on preexisting trust among patients, providers, and institutions and on building consensus and trust in the HIEs as part of preparation for implementation. The process of HIE development also resulted in forging shared vision among institutions. CONCLUSIONS Patients and providers are willing to accept the electronic sharing of HIV patient data to improve care for a disease historically seen as highly stigmatized. Acceptability depends on the effort expended to understand and address potential concerns related to data sharing and confidentiality, and on the trust established among stakeholders in terms of the nature of the systems and how they will be used.
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Affiliation(s)
- Andre Maiorana
- Center for AIDS Prevention Studies, AIDS Policy Research Center, University of California, 50 Beale St, suite 1300, San Francisco, CA 94105, USA.
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504
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Kohane IS, McMurry A, Weber G, MacFadden D, Rappaport L, Kunkel L, Bickel J, Wattanasin N, Spence S, Murphy S, Churchill S. The co-morbidity burden of children and young adults with autism spectrum disorders. PLoS One 2012; 7:e33224. [PMID: 22511918 PMCID: PMC3325235 DOI: 10.1371/journal.pone.0033224] [Citation(s) in RCA: 346] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 02/08/2012] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES Use electronic health records Autism Spectrum Disorder (ASD) to assess the comorbidity burden of ASD in children and young adults. STUDY DESIGN A retrospective prevalence study was performed using a distributed query system across three general hospitals and one pediatric hospital. Over 14,000 individuals under age 35 with ASD were characterized by their co-morbidities and conversely, the prevalence of ASD within these comorbidities was measured. The comorbidity prevalence of the younger (Age<18 years) and older (Age 18-34 years) individuals with ASD was compared. RESULTS 19.44% of ASD patients had epilepsy as compared to 2.19% in the overall hospital population (95% confidence interval for difference in percentages 13.58-14.69%), 2.43% of ASD with schizophrenia vs. 0.24% in the hospital population (95% CI 1.89-2.39%), inflammatory bowel disease (IBD) 0.83% vs. 0.54% (95% CI 0.13-0.43%), bowel disorders (without IBD) 11.74% vs. 4.5% (95% CI 5.72-6.68%), CNS/cranial anomalies 12.45% vs. 1.19% (95% CI 9.41-10.38%), diabetes mellitus type I (DM1) 0.79% vs. 0.34% (95% CI 0.3-0.6%), muscular dystrophy 0.47% vs 0.05% (95% CI 0.26-0.49%), sleep disorders 1.12% vs. 0.14% (95% CI 0.79-1.14%). Autoimmune disorders (excluding DM1 and IBD) were not significantly different at 0.67% vs. 0.68% (95% CI -0.14-0.13%). Three of the studied comorbidities increased significantly when comparing ages 0-17 vs 18-34 with p<0.001: Schizophrenia (1.43% vs. 8.76%), diabetes mellitus type I (0.67% vs. 2.08%), IBD (0.68% vs. 1.99%) whereas sleeping disorders, bowel disorders (without IBD) and epilepsy did not change significantly. CONCLUSIONS The comorbidities of ASD encompass disease states that are significantly overrepresented in ASD with respect to even the patient populations of tertiary health centers. This burden of comorbidities goes well beyond those routinely managed in developmental medicine centers and requires broad multidisciplinary management that payors and providers will have to plan for.
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Affiliation(s)
- Isaac S Kohane
- Center for Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America.
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505
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Dobrzykowski DD. Examining Heterogeneous Patterns of Electronic Health Records Use. INTERNATIONAL JOURNAL OF HEALTHCARE INFORMATION SYSTEMS AND INFORMATICS 2012. [DOI: 10.4018/jhisi.2012040101] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The basic use of Electronic Health Records (EHR) and the progression toward advanced EHR applications are key concerns facing leaders interested in integrating the healthcare delivery supply chain. Currently, substantial heterogeneity exists among hospitals in terms of EHR use and the progression toward advanced EHR applications. Understanding this heterogeneity is important as hospitals face pressure to adopt and achieve meaningful use of the technology. Contingency theory is tested herein to suggest that a hospital’s structural constraints may explain the heterogeneity among hospitals in terms of their EHR use. Data collected from 297 acute care hospitals in 47 states reveals that critical access hospitals may be slow to use EHR, even in basic applications. Conversely, major teaching hospitals appear to be early adopters, achieving advanced EHR use. These findings are important for hospital executives, Health Information Technology managers, and policymakers concerned with directing resources with an aim toward EHR integration.
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506
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DeMello JP, Deshpande SP. Factors Impacting Use of Information Technology by Physicians in Private Practice. INTERNATIONAL JOURNAL OF HEALTHCARE INFORMATION SYSTEMS AND INFORMATICS 2012. [DOI: 10.4018/jhisi.2012040102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This research examines the impact of various factors on the use of IT in clinical practice, prescriptions, and patient information. This was done using a national sample of 3425 physicians who worked in a solo or group practice in the United States. Besides the extent of use of electronic medical records by physicians and number of physicians in practice, none of the other factors consistently impacted the use of IT in clinical practice, prescriptions, and patient information, respectively. The results of this study highlight the need to develop specific strategies to increase the use of information technology in healthcare.
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507
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Abstract
BACKGROUND Hospital-acquired complications, such as nosocomial infection, falls, and venous thromboembolism, are well known to be frequent and morbid. Unfortunately, prevention remains challenging. Two widely touted prevention strategies-checklists and reminders-have inherent barriers that limit their use as general solutions to these endemic problems. Likewise, relying upon additional vigilance and efforts of those already caring for patients may guarantee that hospital-acquired complications persist, given the time pressures already constraining bedside clinicians. Consequently, we recommend a new type of clinical role in the hospital setting, the "Patient Safety Professional" (PSP), be considered to ensure that each patient receives individualized prevention strategies to minimize the hazards of hospitalization. THE ROLE OF THE PSP We envision the PSP would be an APRN who would assess assigned patients for hospital-acquired complications following explicit protocols relevant to a short list of safety targets; prioritize identified complications based on morbidity, mortality, and hospital costs; and develop and implement plans to decrease hospital-acquired complications, in consultation with physicians and staff nurses on the unit. We have recently hired such an individual at our hospital and describe-through several vignettes-what our PSP does on a daily basis. EVALUATION OF THE PSP The rollout, benefits, and costs of PSPs should be carefully evaluated before widespread dissemination is considered. Process measures and clinical outcomes should be monitored. Physician, nurse, and patient satisfaction also need to be assessed. CONCLUSIONS Far from replacing the duties of frontline physicians and nurses assigned to care for the patient, we believe that a PSP will strengthen the safety net for hospitalized patients and serve as an expert resource.
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508
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Development of a tool to manage patient health records in support of burn injury research. J Burn Care Res 2012; 32:654-9. [PMID: 21934627 DOI: 10.1097/bcr.0b013e318231c55a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Data captured in electronic medical records (EMRs) and paper charts have enormous potential for clinical research and to improve the quality of health care; however, accessing, organizing, and analyzing these data pose significant challenges. To address these challenges, this article reports development of a web-based application that provides for local clinical data capture as well as integration of patient data directly from an institutional EMR. A web-based system was created using an existing institutional application development framework. The application consists of a local clinical data repository, processes that integrate data from an EMR, and programs that enable end-user access, manual data capture, and analysis. Data are maintained in a relational database at the patient level in a time- oriented manner and by clinical data type. The application and data repository have been used to integrate and analyze a broad range of clinical data of 637 patients with burn injury. Research findings have shown that in addition to tracking clinical outcomes, laboratory data provide the ability to risk stratify patient populations to target high-risk individuals for case management and interventions. This effort validates the utility of web-based applications to collect local clinical data and integrate clinical data directly from an institutional EMR. This approach leverages institutionally collected clinical information and provides the flexibility to incorporate disparate data and accommodate system modifications as needed. Although the current efforts have focused on a cohort of patients with burn injury, the approach and system design are extendable to other patient types.
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509
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Encinosa WE, Bae J. Health information technology and its effects on hospital costs, outcomes, and patient safety. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2012; 48:288-303. [PMID: 22397059 DOI: 10.5034/inquiryjrnl_48.04.02] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Underlying many reforms in the Patient Protection and Affordable Care Act (ACA) is the use of electronic medical records (EMRs) to help contain costs. We use MarketScan claims data and American Hospital Association information technology (IT) data to examine whether EMRs can contain costs in the ACA's reforms to reduce patient safety events. We find EMRs do not reduce the rate of patient safety events. However, once an event occurs, EMRs reduce death by 34%, readmissions by 39%, and spending by $4,850 (16%), a cost offset of $1.75 per $1 spent on IT capital. Thus, EMRs contain costs by better coordinating care to rescue patients from medical errors once they occur.
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Affiliation(s)
- William E Encinosa
- Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, USA.
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510
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Ikezuagu M, Yang E, Daghstani A, Kaelber DC. Implementing Black Box Warnings (BBWs) in Health Information Systems: An Organizing Taxonomy Identifying Opportunities and Challenges. Appl Clin Inform 2012; 3:124-34. [PMID: 23616904 DOI: 10.4338/aci-2011-10-ra-0063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 02/24/2012] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To develop a practical approach for implementing clinical decision support (CDS) for medication black box warnings (BBWs) into health information systems (HIS). METHODS We reviewed all existing medication BBWs and organized them into a taxonomy that identifies opportunities and challenges for implementing CDS for BBWs into HIS. RESULTS Of the over 400 BBWs that currently exist, they can be organized into 4 categories with 9 sub-categories based on the types of information contained in the BBWs, who should be notified, and potential actions to that could be taken by the person receiving the BBW. Informatics oriented categories and sub-categories of BBWs include - interactions (13%) (drug-drug (4%) and drug-diagnosis (9%)), testing (21%) (baseline (9%) and on-going (12%)), notifications (29%) (drug prescribers (7%), drug dispensers (2%), drug administrators (9%), patients (10%), and third parties (1%)), and non-actionable (37%). This categorization helps identify BBWs for which CDS can be easily implemented into HIS today (such as drug-drug interaction BBWs), those that cannot be easily implemented into HIS today (such as non-actionable BBWs), and those where advanced and/or integrated HIS need to be in place to implement CDS for BBWs (such a drug dispensers BBWs). CONCLUSIONS HIS have the potential to improve patient safety by implementing CDS for BBWs. A key to building CDS for BBWs into HIS is developing a taxonomy to serve as an organizing roadmap for implementation. The informatics oriented BBWs taxonomy presented here identified types of BBWs in which CDS can be implemented easily into HIS currently (a minority of the BBWs) and those types of BBWs where CDS cannot be easily implemented today (a majority of BBWs).
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511
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Boo Y, Noh YA, Kim MG, Kim S. A study of the difference in volume of information in chief complaint and present illness between electronic and paper medical records. Health Inf Manag 2012; 41:11-6. [PMID: 22408111 DOI: 10.1177/183335831204100102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The introduction of an electronic medical record (EMR) has been rapidly accelerating in South Korea. The EMR was expected to improve quality of care, readability, availability, and the quality of data. However, the reluctance of healthcare providers to use the EMR may have caused a reduction of information recorded in EMRs. The purpose of this study was to identify whether there was any loss of information following the introduction of a narrative text-based EMR in the recording of chief complaint and present illness in inpatient medical records. Inpatient medical records of a university hospital were retrospectively evaluated for one month before and one month after the introduction of the EMR in June 2006. The volume of information for chief complaint and present illness was measured by number of words in Korean and normalised bytes. Change in volume of information was measured by two-way ANOVA and multiple regression analyses, controlling for doctors' gender, age, and grade/year of residents, patients' readmission status, reasons for admission and service department to assess any effect of the introduction of an EMR. Total numbers of paper-based medical records (PMRs) and EMRs for analysis were 1,159 and 1,122, respectively. Forty-three doctors participated in the study. Thirty-one (72%) doctors were less than 30 years of age. Number of words proved a better outcome measure (R²=22 for CC, R²=36 for PI) than normalised bytes (R²=18 for CC, R²=35 for PI) for measuring volume of information. Results showed that the volume of information in the chief complaint and present illness was not decreased after the introduction of the EMR, except when the dependent variable was measured by number of words in the present illness. The study showed that the introduction of the EMR did not reduce the volume of information documented for chief complaint and present illness in inpatient medical records. However, further studies are needed to identify how to control the probable loss of information as showed in present illness measured by number of words.
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Affiliation(s)
- Yookyung Boo
- College of Health Industry, Eulji University of Korea, Department of Healthcare Management, Gyeonggi-do, Korea
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512
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Creating content modules for Chinese EHR documents and their trial implementation in Wuwei City. J Med Syst 2012; 36:3665-75. [PMID: 22399068 DOI: 10.1007/s10916-012-9840-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 02/20/2012] [Indexed: 10/28/2022]
Abstract
Numerous and diverse paper-based health record documents are currently used in China, which are not only different from each other but are also inconsistent with national regulations. If these documents are made to be structured and electronically available, the health records information can be processed by computers to promote a shareable electronic health record (EHR) across organizations. As such, this work was intended to develop a set of content modules to be employed as reusable building blocks for converting the paper-based health records to structured EHR documents. Therefore, in this study, we developed 77 content modules based on the documents of national specifications and implemented them to Wuwei City as a trial. According to the EHR requirements of Wuwei, we added two new content modules in addition to the 77 existing content modules. We then successfully established an EHR system based on the new content modules in combination with the original content modules. This paper could contribute to the construction of structured Chinese EHR documents and provide some experiences as a reference for building EHR systems.
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513
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Galt K, Fuji K, Drincic A, Bramble J, Siracuse M, Paschal K, Abbott A. PDA Use by Physicians: Where Do They Fit with Emerging Technologies and Use of Electronic Health Records in Office Practices? JOURNAL OF HEALTHCARE ENGINEERING 2012. [DOI: 10.1260/2040-2295.3.1.163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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514
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Ragowsky A, Licker PS, Gefen D. Organizational IT Maturity (OITM): A Measure of Organizational Readiness and Effectiveness to Obtain Value from Its Information Technology. INFORMATION SYSTEMS MANAGEMENT 2012. [DOI: 10.1080/10580530.2012.662104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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515
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Wolf L, Harvell J, Jha AK. Hospitals Ineligible For Federal Meaningful-Use Incentives Have Dismally Low Rates Of Adoption Of Electronic Health Records. Health Aff (Millwood) 2012; 31:505-13. [DOI: 10.1377/hlthaff.2011.0351] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Larry Wolf
- Larry Wolf is a health information technology strategist at Kindred Healthcare, in Louisville, Kentucky
| | - Jennie Harvell
- Jennie Harvell is a senior policy analyst in the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, in Washington, D.C
| | - Ashish K. Jha
- Ashish K. Jha is an associate professor of health policy at the Harvard School of Public Health and an associate professor of medicine at Harvard Medical School, in Boston, Massachusetts
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516
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“Meaningful Use” of ambulatory EMR: Does it improve the quality and efficiency of health care? HEALTH POLICY AND TECHNOLOGY 2012. [DOI: 10.1016/j.hlpt.2012.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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517
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Sandhu E, Weinstein S, McKethan A, Jain SH. Secondary uses of electronic health record data: benefits and barriers. Jt Comm J Qual Patient Saf 2012; 38:34-40, 1. [PMID: 22324189 DOI: 10.1016/s1553-7250(12)38005-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In the primary use of health data, patient health information in electronic health records (EHRs) directly informs each individual's care. In secondary use, patient data would be aggregated to improve health care delivery, yet several technological and policy barriers may slow implementation-but may be amenable to intervention.
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Affiliation(s)
- Emir Sandhu
- Office of the National Coordinator for Health Information Technology, Washington, DC, USA
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518
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Lin YH, Chen RR, Guo SHM, Chiang SC, Chang HK. Sharing personal health information via service-oriented computing: a case of long-term care. J Med Syst 2012; 36:3563-71. [PMID: 22366977 DOI: 10.1007/s10916-012-9832-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 02/05/2012] [Indexed: 11/26/2022]
Abstract
Sharing personal health information among healthcare providers is a crucial business process not only for saving limited healthcare resources but also for increasing patient's healthcare quality. Building an effective personal health information sharing process from established healthcare systems is a challenge in terms of coordination different business operations among healthcare providers and restructuring technical details existed in different healthcare information systems. This study responds this challenge with a service-oriented approach and develops a business software application to describe how the challenge can be alleviated from both managerial and technical perspectives. The software application in this study depicts personal health information sharing process among different providers in a long-term care setting. The information sharing scenario is based on an industrial initiative, such as Integrating the Healthcare Enterprise (IHE) from healthcare domain and the technologies for implementing the scenario are Web Service technologies from Service-oriented computing paradigm. The implementation in this study can inform healthcare researchers and practitioners applying technologies from service-oriented computing to design and develop healthcare collaborative systems to meet the increasing need for personal health information sharing.
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Affiliation(s)
- Yung-Hsiu Lin
- Department of Information Management, Ta-Hwa Institute of Technology, Hsinchu, Taiwan
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519
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Use of digital patient photographs and electronic medical record data as diagnostic tools in Japan. J Med Syst 2012; 36:3321-6. [PMID: 22351112 DOI: 10.1007/s10916-012-9824-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 01/25/2012] [Indexed: 10/28/2022]
Abstract
An electronic medical record (EMR) system was introduced to the University of Miyazaki Hospital, in Japan, in 2006. This hospital is the only one in Japan to store digital photographs of patients within EMRs. In this paper, we report on the utility of these digital photographs for disease diagnosis. Digital photographs of patients were taken at the time of hospitalization, and have been used for patient identification by medical staff. More than 20,000 digital photographs have been saved, along with examination data and medical history classified by disease, since the introduction of EMR. In the first part of the present study, we analyzed the facial cheek color of patients using photographs taken at the time of hospitalization in relation to diagnoses in six disease categories that were considered to lead to characteristic facial skin characteristics. We verified the presence or absence of a characteristic color for each disease category. Next, we focused on four diseases, Analysis of the facial skin color of 1268 patients found the same patterns of characteristic color. Overall, we found significant differences in complexion according to disease type, based on the analysis of color from digital photos and other EMR information. We propose that color analysis data should become an additional item of information stored in EMRs.
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520
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Ash JS, Sittig DF, Guappone KP, Dykstra RH, Richardson J, Wright A, Carpenter J, McMullen C, Shapiro M, Bunce A, Middleton B. Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study. BMC Med Inform Decis Mak 2012; 12:6. [PMID: 22333210 PMCID: PMC3334687 DOI: 10.1186/1472-6947-12-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 02/14/2012] [Indexed: 02/08/2023] Open
Abstract
Background The purpose of this study was to identify recommended practices for computerized clinical decision support (CDS) development and implementation and for knowledge management (KM) processes in ambulatory clinics and community hospitals using commercial or locally developed systems in the U.S. Methods Guided by the Multiple Perspectives Framework, the authors conducted ethnographic field studies at two community hospitals and five ambulatory clinic organizations across the U.S. Using a Rapid Assessment Process, a multidisciplinary research team: gathered preliminary assessment data; conducted on-site interviews, observations, and field surveys; analyzed data using both template and grounded methods; and developed universal themes. A panel of experts produced recommended practices. Results The team identified ten themes related to CDS and KM. These include: 1) workflow; 2) knowledge management; 3) data as a foundation for CDS; 4) user computer interaction; 5) measurement and metrics; 6) governance; 7) translation for collaboration; 8) the meaning of CDS; 9) roles of special, essential people; and 10) communication, training, and support. Experts developed recommendations about each theme. The original Multiple Perspectives framework was modified to make explicit a new theoretical construct, that of Translational Interaction. Conclusions These ten themes represent areas that need attention if a clinic or community hospital plans to implement and successfully utilize CDS. In addition, they have implications for workforce education, research, and national-level policy development. The Translational Interaction construct could guide future applied informatics research endeavors.
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Affiliation(s)
- Joan S Ash
- Oregon Health & Science University, Portland, OR, USA.
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521
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Kerr CA, Neeman N, Davis RB, Schulze J, Libman H, Markson L, Aronson M, Bell SK. HIV quality of care assessment at an academic hospital: outcomes and lessons learned. Am J Med Qual 2012; 27:321-8. [PMID: 22326983 DOI: 10.1177/1062860611425714] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rapid changes in HIV treatment guidelines and antiretroviral therapy drug safety data add to the increasing complexity of caring for HIV-infected patients and amplify the need for continuous quality monitoring. The authors created an electronic HIV database of 642 patients who received care in the infectious disease (ID) and general medicine clinics in their academic center to monitor HIV clinical performance indicators. The main outcome measures of the study include process measures, including a description of how the database was constructed, and clinical outcomes, including HIV-specific quality improvement (QI) measures and primary care (PC) measures. Performance on HIV-specific QI measures was very high, but drug toxicity monitoring and PC-specific QI performance were deficient, particularly among ID specialists. Establishment of HIV QI data benchmarks as well as standards for how data will be measured and collected are needed and are the logical counterpart to treatment guidelines.
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522
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Shea CM, Weiner BJ, Belden CM. Using Latent Class Analysis to Identify Sophistication Categories of Electronic Medical Record Systems in U.S. Acute Care Hospitals. SOCIAL SCIENCE COMPUTER REVIEW 2012; 31:10.1177/0894439312448726. [PMID: 24244071 PMCID: PMC3826986 DOI: 10.1177/0894439312448726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Many believe that electronic medical record systems hold promise for improving the quality of health care services. The body of research on this topic is still in the early stages, however, in part because of the challenge of measuring the capabilities of electronic medical record systems. The purpose of this study was to identify classes of Electronic Medical Record (EMR) system sophistication in hospitals as well as hospital characteristics associated with the sophistication categories. The data used were from the American Hospital Association (AHA) and the Health Information Management and Systems Society (HIMSS). The sample included acute care hospitals in the United States with 50 beds or more. We used latent class analysis to identify the sophistication classes and logistic regression to identify relationships between these classes and hospital characteristics. Our study identifies cumulative categories of EMR sophistication: ancillary-based, ancillary/data aggregation, and ancillary-to-bedside. Rural hospital EMRs are likely to be ancillary-based, while hospitals in a network are likely to have either ancillary-based or ancillary-to-bedside EMRs. Future research should explore the effect of network membership on EMR system development.
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Affiliation(s)
- Christopher M Shea
- Department of Health Policy and Management, University of North Carolina-Chapel Hill
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523
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Mihalko M. Finding meaning in meaningful use: understanding the health information technology for economic and clinical health act and its impact on nursing practice. J Pediatr Nurs 2012; 27:88-9. [PMID: 22062327 DOI: 10.1016/j.pedn.2011.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Maria Mihalko
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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524
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525
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Tamersoy A, Loukides G, Nergiz ME, Saygin Y, Malin B. Anonymization of longitudinal electronic medical records. ACTA ACUST UNITED AC 2012; 16:413-23. [PMID: 22287248 DOI: 10.1109/titb.2012.2185850] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Electronic medical record (EMR) systems have enabled healthcare providers to collect detailed patient information from the primary care domain. At the same time, longitudinal data from EMRs are increasingly combined with biorepositories to generate personalized clinical decision support protocols. Emerging policies encourage investigators to disseminate such data in a deidentified form for reuse and collaboration, but organizations are hesitant to do so because they fear such actions will jeopardize patient privacy. In particular, there are concerns that residual demographic and clinical features could be exploited for reidentification purposes. Various approaches have been developed to anonymize clinical data, but they neglect temporal information and are, thus, insufficient for emerging biomedical research paradigms. This paper proposes a novel approach to share patient-specific longitudinal data that offers robust privacy guarantees, while preserving data utility for many biomedical investigations. Our approach aggregates temporal and diagnostic information using heuristics inspired from sequence alignment and clustering methods. We demonstrate that the proposed approach can generate anonymized data that permit effective biomedical analysis using several patient cohorts derived from the EMR system of the Vanderbilt University Medical Center.
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Affiliation(s)
- Acar Tamersoy
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN 37232, USA.
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526
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Fleurant M, Kell R, Jenter C, Volk LA, Zhang F, Bates DW, Simon SR. Factors associated with difficult electronic health record implementation in office practice. J Am Med Inform Assoc 2012; 19:541-4. [PMID: 22249965 DOI: 10.1136/amiajnl-2011-000689] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Little is known about physicians' perception of the ease or difficulty of implementing electronic health records (EHR). This study identified factors related to the perceived difficulty of implementing EHR. 163 physicians completed surveys before and after the implementation of EHR in an externally funded pilot program in three Massachusetts communities. Ordinal hierarchical logistic regression was used to identify baseline factors that correlated with physicians' report of difficulty with EHR implementation. Compared with physicians with ownership stake in their practices, physician employees were less likely to describe EHR implementation as difficult (adjusted OR 0.5, 95% CI 0.3 to 1.0). Physicians who perceived their staff to be innovative were also less likely to view EHR implementation as difficult (adjusted OR 0.4, 95% CI 0.2 to 0.8). Physicians who own their practice may need more external support for EHR implementation than those who do not. Innovative clinical support staff may ease the EHR implementation process and contribute to its success.
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Affiliation(s)
- Marshall Fleurant
- Boston Medical Center, Boston University School of Medicine, Section of General Internal Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA.
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527
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Detection of Adverse Drug Reaction Signals Using an Electronic Health Records Database: Comparison of the Laboratory Extreme Abnormality Ratio (CLEAR) Algorithm. Clin Pharmacol Ther 2012; 91:467-74. [PMID: 22237257 DOI: 10.1038/clpt.2011.248] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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528
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Hammoud MM, Margo K, Christner JG, Fisher J, Fischer SH, Pangaro LN. Opportunities and challenges in integrating electronic health records into undergraduate medical education: a national survey of clerkship directors. TEACHING AND LEARNING IN MEDICINE 2012; 24:219-224. [PMID: 22775785 DOI: 10.1080/10401334.2012.692267] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Few studies have reported on the utilization and the effect of electronic health records on the education of medical students. PURPOSE The purpose of this study was to describe the current use of electronic health records by medical students in the United States and explore the opportunities and challenges of integrating electronic health records into daily teaching of medical students. METHODS A survey with 24 questions regarding the use of electronic health records by medical students was developed by the Alliance for Clinical Educators and sent to clerkship directors across the United States. Both quantitative and qualitative responses were collected and analyzed to determine current access to and use of electronic health records by medical students. RESULTS This study found that an estimated 64% of programs currently allow student use of electronic health records, of which only two thirds allowed students to write notes within the electronic record. Overall, clerkship directors' opinions on the effects of electronic health records on medical student education were neutral, and despite acknowledging many advantages to electronic health records, there were many concerns raised regarding their use in education. CONCLUSIONS Medical students are using electronic health records at higher rates than physicians in practice. Although this is overall reassuring, educators have to be cautious about the limitations being placed on student's documentation in electronic health records as this can potentially have consequences on their training, and they need to explore ways to maximize the benefits of electronic health records in medical education.
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Affiliation(s)
- Maya M Hammoud
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA.
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529
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Abstract
Advances in medical science and technology, together with improved medical and nursing care, are continuously improving health outcomes in chronic illness, including epilepsy. The consequent increasing diagnostic and therapeutic complexity is placing a burgeoning strain on health care systems. In response, an international move to transform chronic disease management (CDM) aims to optimize the quality and safety of care while containing health care costs. CDM models recommend: integration of care across organizational boundaries that is supported with information and communication technology; patient self-management; and guideline implementation to promote standardized care. Evidence of the effectiveness of CDM models in epilepsy care is presented in this review article.
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530
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Fasola G, Aprile G, Aita M. A model to estimate human resource needs for the treatment of outpatients with cancer. J Oncol Pract 2012; 8:13-7. [PMID: 22548005 PMCID: PMC3266309 DOI: 10.1200/jop.2011.000326] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2011] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although personnel costs significantly affect cancer health care expenditures, little is known about the relationship between workload, human resource requirements, and associated costs. An empirical model to forecast staffing demand is described according to the yearly caseload of outpatients with cancer beginning active treatment and the number of personnel working hours. METHODS The oncology department at the University Hospital of Udine (Udine, Italy) is a computerized unit taking care of approximately 1,300 patients per year. Each clinical episode is centrally recorded. We queried the database for the total number of consultations per patient beginning treatment during 2006. With predefined bonds (ie, time limit set for each visit type and annual working hours per employee), we sought to estimate yearly per-patient hours of care and the number of personnel needed. RESULTS In 2006, each outpatient with cancer beginning active treatment generated an average of 16 clinical evaluations, which in turn translated into 8 and 16 hours of physician and nurse working time, respectively. Assuming an average of 1,672 annual working hours, a need for one physician and three nurses for every 600 patients could be estimated for every 200 novel patients. In the next year, the same caseload induced 4.5 consultations on average; using a similar approach, the demand for additional time and resources was calculated. CONCLUSION By means of a simple model combining predefined conditions with a centralized record of clinical episodes, we were able to provide a reasonable estimate of human resource requirements and a tool to forecast the staff expenditures of a cancer unit.
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531
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Park RW. A clinical research strategy using longitudinal observational data in the post-electronic health records era. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2012. [DOI: 10.5124/jkma.2012.55.8.711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
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532
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Building the foundations of an informatics agenda for global health - 2011 workshop report. Online J Public Health Inform 2012; 4:ojphi-04-8. [PMID: 23569628 PMCID: PMC3615805 DOI: 10.5210/ojphi.v4i1.4027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Strengthening the capacity of public health systems to protect and promote the health of the global population continues to be essential in an increasingly connected world. Informatics practices and principles can play an important role for improving global health response capacity. A critical step is to develop an informatics agenda for global health so that efforts can be prioritized and important global health issues addressed. With the aim of building a foundation for this agenda, the authors developed a workshop to examine the evidence in this domain, recognize the gaps, and document evidence-based recommendations. On 21 August 2011, at the 2011 Public Health Informatics Conference in Atlanta, GA, USA, a four-hour interactive workshop was conducted with 85 participants from 15 countries representing governmental organizations, private sector companies, academia, and non-governmental organizations. The workshop discussion followed an agenda of a plenary session - planning and agenda setting - and four tracks: Policy and governance; knowledge management, collaborative networks and global partnerships; capacity building; and globally reusable resources: metrics, tools, processes, templates, and digital assets. Track discussions examined the evidence base and the participants' experience to gather information about the current status, compelling and potential benefits, challenges, barriers, and gaps for global health informatics as well as document opportunities and recommendations. This report provides a summary of the discussions and key recommendations as a first step towards building an informatics agenda for global health. Attention to the identified topics and issues is expected to lead to measurable improvements in health equity, health outcomes, and impacts on population health. We propose the workshop report be used as a foundation for the development of the full agenda and a detailed roadmap for global health informatics activities based on further contribution from key stakeholders. The global health informatics agenda and roadmap can provide guidance to countries for developing and enhancing their individual and regional agendas.
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533
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Phan JH, Quo CF, Cheng C, Wang MD. Multiscale integration of -omic, imaging, and clinical data in biomedical informatics. IEEE Rev Biomed Eng 2012; 5:74-87. [PMID: 23231990 PMCID: PMC5859561 DOI: 10.1109/rbme.2012.2212427] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This paper reviews challenges and opportunities in multiscale data integration for biomedical informatics. Biomedical data can come from different biological origins, data acquisition technologies, and clinical applications. Integrating such data across multiple scales (e.g., molecular, cellular/tissue, and patient) can lead to more informed decisions for personalized, predictive, and preventive medicine. However, data heterogeneity, community standards in data acquisition, and computational complexity are big challenges for such decision making. This review describes genomic and proteomic (i.e., molecular), histopathological imaging (i.e., cellular/tissue), and clinical (i.e., patient) data; it includes case studies for single-scale (e.g., combining genomic or histopathological image data), multiscale (e.g., combining histopathological image and clinical data), and multiscale and multiplatform (e.g., the Human Protein Atlas and The Cancer Genome Atlas) data integration. Numerous opportunities exist in biomedical informatics research focusing on integration of multiscale and multiplatform data.
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Affiliation(s)
- John H Phan
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30332, USA.
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534
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Spencer DC, Choi D, English C, Girard D. The effects of electronic health record implementation on medical student educators. TEACHING AND LEARNING IN MEDICINE 2012; 24:106-110. [PMID: 22490089 DOI: 10.1080/10401334.2012.664513] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Electronic heath records (EHRs) are being rapidly adopted. Little attention has been paid to the effects of EHR implementation on teaching. PURPOSE The goal was to determine the effect of EHR implementation on medical student educators and to characterize features that might influence their responses. METHODS A survey of all clinical faculty at Oregon Health & Science University was taken. The authors inquired about the effect of EHR implementation on enthusiasm for teaching and characterized factors that might contribute to responses. RESULTS Nearly half of the faculty reported decreased enthusiasm for teaching following EHR implementation (48.2%). Most (65.1%) reported that the EHR distracted from teaching, and few saw its advantages. Most reported that EHR implementation led them to teach less (62.3%); the most enthusiastic teachers were most affected. CONCLUSIONS EHR implementation in an academic medical center has substantial effects on educators. Further work is needed to determine how to train medical educators and modify the EHR to best support teaching.
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Affiliation(s)
- David C Spencer
- Department of Neurology, Oregon Health & Science University, Portland, Oregon 97239, USA.
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535
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Schenarts PJ, Schenarts KD. Educational impact of the electronic medical record. JOURNAL OF SURGICAL EDUCATION 2012; 69:105-12. [PMID: 22208841 DOI: 10.1016/j.jsurg.2011.10.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 10/27/2011] [Indexed: 05/04/2023]
Abstract
INTRODUCTION The electronic medical record (EMR) is commonly thought to improve the safety and quality of care; however, there is scant information on the impact the EMR has on graduate medical education (GME). METHODS A review of English language literature was performed using MEDLINE and OVID databases using or combining the terms, EMR, GME, electronic health record, education, medical student, resident, clinical decisions support systems, quality, and safety. RESULTS The EMR has a negative effect on teacher and learner interactions, clinical reasoning, and has an inconsistent impact on resident workflow. Data on the impact of the EMR on patient safety, quality of care, and medical finances are mixed. DISCUSSION Based on the literature to date, the EMR has not had as dramatic an effect on patient outcomes is commonly believed. While the overall impact of the EMR on education seems to be negative, there are actions that can be taken to mitigate this impact.
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Affiliation(s)
- Paul J Schenarts
- Department of Surgery, Division of Surgical Education, Brody School of Medicine, East Carolina University, Greenville, North Carolina 27858, USA.
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536
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Lamb BW, Sevdalis N, Vincent C, Green JSA. Development and evaluation of a checklist to support decision making in cancer multidisciplinary team meetings: MDT-QuIC. Ann Surg Oncol 2011; 19:1759-65. [PMID: 22207050 DOI: 10.1245/s10434-011-2187-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND The quality of decision-making in cancer multidisciplinary team (MDT) meetings is variable, which can result in suboptimal clinical decision making. We developed MDT-QuIC, an evidence-based tool to support clinical decision making by MDTs, which was evaluated by key users. METHODS Following a literature review, factors important for high-quality clinical decision making were listed and then converted into a preliminary checklist by clinical and safety experts. Attitudes of MDT members toward the tool were evaluated via an online survey, before adjustments were made giving rise to a final version: MDT-QuIC. RESULTS The checklist was evaluated by 175 MDT members (surgeons = 38, oncologists = 40, specialist nurses = 62, and MDT coordinators = 35). Attitudes toward the checklist were generally positive (P < 0.001, 1-sample t test), although nurses were more positive than other groups regarding whether the checklist would improve their contribution in MDT meetings (P < 0.001, Mann-Whitney U test). Participants thought that the checklist could be used to prepare cases for MDT meetings, to structure and guide case discussions, or as a record of MDT discussion. Regarding who could use the checklist, 70% thought it should be used by the MDT chair, 54% by the MDT coordinator, and 38% thought all MDT members should use it. CONCLUSION We have developed and validated an evidence-based tool to support the quality of MDT decision making. MDT members were positive about the checklist and felt it may help to structure discussion, improve inclusivity, and patient centeredness. Further research is needed to assess its effect on patient care and outcomes.
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Affiliation(s)
- B W Lamb
- Department of Surgery and Cancer, Imperial College London, London, UK.
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537
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Adoption of electronic health records in Korean tertiary teaching and general hospitals. Int J Med Inform 2011; 81:196-203. [PMID: 22206619 DOI: 10.1016/j.ijmedinf.2011.12.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Revised: 12/02/2011] [Accepted: 12/02/2011] [Indexed: 11/23/2022]
Abstract
PURPOSE This study examined the current prevalence of electronic health records (EHRs) in Korea and identified the factors that impede or facilitate the adoption of EHRs. METHODS We surveyed all tertiary teaching and general hospitals in Korea. The degree to which EHR systems were adopted was evaluated using the previously defined definitions of 'comprehensive' and 'basic' EHRs based on their electronic functionality. The effects of teaching status, size, and location of hospitals on EHR adoption were examined. We also investigated factors that impeded or facilitated the adoption of EHR systems. RESULTS The response rate was 39.0% (122/313), and 37.2% (95% confidence interval [CI] 31.9-42.6%) of Korean tertiary teaching and general hospitals had either basic or comprehensive EHR systems (50.2% of tertiary teaching hospitals, 35.0% of general hospitals). However, only 5.0% (CI 2.6-7.4%) had comprehensive EHR systems. Most Korean tertiary teaching and general hospitals, i.e., 87.0% (95% CI, 83.3-90.7%), have implemented computerized provider order-entry (CPOE) systems for medications, with larger hospitals more likely than smaller ones to have adopted some sort of EHRs (p-value<0.001). However, the prevalence of these systems did not differ according to the location of the hospital (metropolitan vs. non-metropolitan). According to the survey data, the capital requirements and high maintenance costs of EHR systems were the major barriers to their adoption, and government reimbursement or incentives were the most requested facilitators of their adoption. CONCLUSION The rate at which EHR and CPOE for medications systems have been adopted by Korean tertiary teaching and general hospitals was higher than the rate of adoption by US hospitals. Financial aspects are reported to be the most important facilitators of and barriers to EHR adoption. Government financial support, especially to small hospitals, seems to be essential to promoting the adoption of EHRs by Korean hospitals.
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538
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539
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Spina JR, Glassman PA, Simon B, Lanto A, Lee M, Cunningham F, Good CB. Potential safety gaps in order entry and automated drug alerts: a nationwide survey of VA physician self-reported practices with computerized order entry. Med Care 2011; 49:904-10. [PMID: 21666510 DOI: 10.1097/mlr.0b013e318222a6f5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Understanding provider perceptions of and experiences with order entry and order checks (drug alerts) in an electronic prescribing system may help improve medication safety technology. DESIGN Cross-sectional, national survey of Veterans Administration physicians practicing in various specialties. MEASUREMENT Thirty-five question instrument was divided into 4 content domains. Response options included dichotomous, numeric, multiple choices, and Likert-like scales. Statistical methods included logistic regression. RESULTS The adjusted response rate was 1543 of 3588 (43%). Almost all providers (90%) felt that the VA electronic prescribing system, including its order checks, improved prescribing safety to some degree. Most respondents (72%) reported that they always or almost always document outside medications in a clinic note, although only 44% always or almost always entered outside medications in the non-VA medication data field. Most physicians (88%) who encountered serious allergic or adverse drug reactions reported either notifying a pharmacist or entering the information in the allergies/adverse reactions field. Generalists and physicians with higher numbers of prescriptions were more likely to enter relevant data into the electronic medical record (or notify a pharmacist, in the case of adverse reactions). In addition, 48% of providers described critical drug-drug interaction alerts as very useful; medical specialists found these less useful, whereas surgical specialists found these more useful when compared with generalists. LIMITATIONS Survey was conducted within a single healthcare system. CONCLUSION Computerized provider order entry and related order checks are perceived to improve prescribing safety; however, provider entry of some relevant information into the appropriate electronic fields may not be optimal.
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Affiliation(s)
- Jeffrey R Spina
- VA Greater Los Angeles Healthcare System, University of California Los Angeles, Los Angeles, USA.
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540
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Baier RR, Gardner RL, Buechner JS, Harris Y, Viner-Brown S, Gifford DS. Creating a survey to assess physicians' adoption of health information technology. Med Care Res Rev 2011; 69:231-45. [PMID: 22156836 DOI: 10.1177/1077558711423839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Information on state-level health information technology (HIT) adoption will become increasingly important with the implementation of incentive payments to accelerate uptake. Recognizing this, the Rhode Island Department of Health selected physician HIT adoption as a subject for its legislatively mandated quality reporting program. This article discusses the state's process for developing HIT adoption measures, including the importance of stakeholder involvement in the development of a survey and the difficulty of accurately defining electronic medical record (EMR) adoption. This article describes the challenges in defining "true" EMRs, which may be addressed, in part, by ensuring local consensus about EMR measures and by piloting the survey and measures, prior to public reporting or the calculation of a statewide baseline. It also presents results from the 2009 administration of this survey to all 3,883 Rhode Island-licensed physicians providing direct patient care.
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541
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The effect of hospital electronic health record adoption on nurse-assessed quality of care and patient safety. J Nurs Adm 2011; 41:466-72. [PMID: 22033316 DOI: 10.1097/nna.0b013e3182346e4b] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to examine the effect of having a basic electronic health record (EHR) on nurse-assessed quality of care, including patient safety. Few large-scale studies have examined how adoption of EHRs may be associated with quality of care. A cross-sectional, secondary analysis of nurse and hospital survey data was conducted. The final sample included 16,352 nurses working in 316 hospitals in 4 states. Logistic regression models were used to evaluate the relationship between basic EHR adoption and nurse-assessed quality of care outcomes. Nurses working in hospitals with basic EHRs consistently reported that poor patient safety and other quality outcomes occurred less frequently than reported by nurses working in hospitals without an EHR. Our findings suggest that the implementation of a basic EHR may result in improved and more efficient nursing care, better care coordination, and patient safety.
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542
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Kobayashi L, Boss RM, Gibbs FJ, Goldlust E, Hennedy MM, Monti JE, Siegel NA. Color-coding and human factors engineering to improve patient safety characteristics of paper-based emergency department clinical documentation. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2011; 4:79-88. [PMID: 21960193 DOI: 10.1177/193758671100400406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Investigators studied an emergency department (ED) physical chart system and identified inconsistent, small font labeling; a single-color scheme; and an absence of human factors engineering (HFE) cues. A case study and description of the methodology with which surrogate measures of chart-related patient safety were studied and subsequently used to reduce latent hazards are presented. BACKGROUND Medical records present a challenge to patient safety in EDs. Application of HFE can improve specific aspects of existing medical chart organization systems as they pertain to patient safety in acute care environments. METHODS During 10 random audits over 5 consecutive days (573 data points), 56 (9.8%) chart binders (range 0.0-23%) were found to be either misplaced or improperly positioned relative to other chart binders; 12 (21%) were in the critical care area. HFE principles were applied to develop an experimental chart binder system with alternating color-based chart groupings, simple and prominent identifiers, and embedded visual cues. RESULTS Post-intervention audits revealed significant reductions in chart binder location problems overall (p < 0.01), for Urgent Care A and B pods (6.4% to 1.2%; p < 0.05), Fast Track C pod (19.3% to 0.0%; p < 0.05) and Behavioral/Substance Abuse D pod (15.7% to 0.0%; p < 0.05) areas of the ED. The critical care room area did not display an improvement (11.4% to 13.2%; p = 0.40). CONCLUSIONS Application of HFE methods may aid the development, assessment, and modification of acute care clinical environments through evidence-based design methodologies and contribute to safe patient care delivery.
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Affiliation(s)
- Leo Kobayashi
- Rhode Island Hospital Medical Simulation Center, Providence, RI, USA.
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543
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Holden RJ. What stands in the way of technology-mediated patient safety improvements?: a study of facilitators and barriers to physicians' use of electronic health records. J Patient Saf 2011; 7:193-203. [PMID: 22064624 PMCID: PMC3220192 DOI: 10.1097/pts.0b013e3182388cfa] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES For electronic health record (EHR) systems to have a positive impact on patient safety, clinicians must be able to use these systems effectively after they are made available. This study's objective is to identify and describe facilitators and barriers to physicians' use of EHR systems. METHODS Twenty research interviews were conducted with attending physicians who were using EHR at 1 of 2 Midwest community hospitals and/or at their respective outpatient clinics. RESULTS Analyses yielded more than 200 perceived facilitators and barriers, comprising 19 distinct categories. Categories of facilitators/barriers related to user attribute included learning, typing proficiency, understanding the EHR system, motivation/initiative, and strategies/workarounds. Categories related to system attributes were supporting hardware/software and system speed, functionality, and usability. Categories related to support from others were formal technical support, formal training, and informal support from colleagues. Categories of organizational facilitators/barriers were time allowance and interinstitutional integration. Categories of environmental facilitators/barriers were physical space, electricity, wireless connectivity, and the social environment. CONCLUSIONS Together, the broad set of discovered facilitators and barriers confirms and expands prior research on the facilitators and barriers to health information technology use. The depth of reported information on each facilitator and barrier made possible by qualitative interview methods contributes to the theoretical understanding of facilitators and barriers to EHR use. Equally as important, this study provides an information base from which relevant policy and design interventions can be launched to improve the use of EHR systems and, thus, patient safety.
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Affiliation(s)
- Richard J Holden
- Departments of Medicine and Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee 37212, USA.
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544
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Pallin DJ, Sullivan AF, Espinola JA, Landman AB, Camargo CA. Increasing Adoption of Computerized Provider Order Entry, and Persistent Regional Disparities, in US Emergency Departments. Ann Emerg Med 2011; 58:543-550.e3. [DOI: 10.1016/j.annemergmed.2011.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 05/03/2011] [Accepted: 05/13/2011] [Indexed: 10/17/2022]
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545
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Bonacina S, Marceglia S, Pinciroli F. Barriers Against Adoption of Electronic Health Record in Italy. JOURNAL OF HEALTHCARE ENGINEERING 2011. [DOI: 10.1260/2040-2295.2.4.509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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546
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Deshmukh VG, Sower NB, Hunter CY, Mitchell JA. Integrating historical clinical and financial data for pharmacological research. BMC Med Res Methodol 2011; 11:151. [PMID: 22099213 PMCID: PMC3252280 DOI: 10.1186/1471-2288-11-151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 11/18/2011] [Indexed: 11/10/2022] Open
Abstract
Background Retrospective research requires longitudinal data, and repositories derived from electronic health records (EHR) can be sources of such data. With Health Information Technology for Economic and Clinical Health (HITECH) Act meaningful use provisions, many institutions are expected to adopt EHRs, but may be left with large amounts of financial and historical clinical data, which can differ significantly from data obtained from newer systems, due to lack or inconsistent use of controlled medical terminologies (CMT) in older systems. We examined different approaches for semantic enrichment of financial data with CMT, and integration of clinical data from disparate historical and current sources for research. Methods Snapshots of financial data from 1999, 2004 and 2009 were mapped automatically to the current inpatient pharmacy catalog, and enriched with RxNorm. Administrative metadata from financial and dispensing systems, RxNorm and two commercial pharmacy vocabularies were used to integrate data from current and historical inpatient pharmacy modules, and the outpatient EHR. Data integration approaches were compared using percentages of automated matches, and effects on cohort size of a retrospective study. Results During 1999-2009, 71.52%-90.08% of items in use from the financial catalog were enriched using RxNorm; 64.95%-70.37% of items in use from the historical inpatient system were integrated using RxNorm, 85.96%-91.67% using a commercial vocabulary, 87.19%-94.23% using financial metadata, and 77.20%-94.68% using dispensing metadata. During 1999-2009, 48.01%-30.72% of items in use from the outpatient catalog were integrated using RxNorm, and 79.27%-48.60% using a commercial vocabulary. In a cohort of 16304 inpatients obtained from clinical systems, 4172 (25.58%) were found exclusively through integration of historical clinical data, while 15978 (98%) could be identified using semantically enriched financial data. Conclusions Data integration using metadata from financial/dispensing systems and pharmacy vocabularies were comparable. Given the current state of EHR adoption, semantic enrichment of financial data and integration of historical clinical data would allow the repurposing of these data for research. With the push for HITECH meaningful use, institutions that are transitioning to newer EHRs will be able to use their older financial and clinical data for research using these methods.
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Affiliation(s)
- Vikrant G Deshmukh
- Department of Biomedical Informatics, School of Medicine, University of Utah, 26 South 2000 East Room 5775, Salt Lake City, UT 84112, USA.
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547
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Abstract
OBJECTIVES To provide an overview of electronic personal health information technology. DATA SOURCES Peer reviewed research studies, review articles, and web resources. CONCLUSION As technology develops and electronic health records become more common, patients and clinicians are working toward a safer, more personal form of health care delivery. IMPLICATIONS FOR NURSING PRACTICE Improving access and input to personal health information is still in its infancy, but with government funding, development of patient health records will continue to grow. Patients are the consumers of health care and are witness to the paradigm shift of access to health information and changes in information communication technology (ICT). For the oncology nurse, the transformation of health care and ICT will require nurses to educate patients and family members on available online resources for self management and health promotion.
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Affiliation(s)
- Christine A Caligtan
- Clinical Informatics Research& Development, Partners HealthCare System, Wellesley, MA 02481, USA.
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548
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López L, Green AR, Tan-McGrory A, King R, Betancourt JR. Bridging the digital divide in health care: the role of health information technology in addressing racial and ethnic disparities. Jt Comm J Qual Patient Saf 2011; 37:437-45. [PMID: 22013816 DOI: 10.1016/s1553-7250(11)37055-9] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Racial and ethnic disparities in health care have been consistently documented in the diagnosis, treatment, and outcomes of many common clinical conditions. There has been an acceleration of health information technology (HIT) implementation in the United States, with health care reform legislation including multiple provisions for collecting and using health information to improve and monitor quality and efficiency in health care. Despite an uneven and generally low level of implementation, research has demonstrated that HIT has the potential to improve quality of care and patient safety. If carefully designed and implemented, HIT also has the potential to eliminate disparities. HIT AND DISPARITIES Several root causes for disparities are amenable to interventions using HIT, particularly innovations in electronic health records, as well as strategies for chronic disease management. Recommendations regardinghealth care system, provider, and patient factors can help health care organizations address disparities as they adopt, expand, and tailor their HIT systems. In terms of health care system factors, organizations should (1) automate and standardize the collection of race/ethnicity and language data, (2) prioritize the use of the data for identifying disparities and tailoring improvement efforts, (3) focus HIT efforts to address fragmented care delivery for racial/ethnic minorities and limited-English-proficiency patients, (4) develop focused computerized clinical decision support systems for clinical areas with significant disparities, and (5) include input from racial/ethnic minorities and those with limited English proficiency in developing patient HIT tools to address the digital divide. CONCLUSIONS As investments are made in HIT, consideration must be given to the impact that these innovations have on the quality and cost of health care for all patients, including those who experience disparities.
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Affiliation(s)
- Lenny López
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, USA.
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549
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DuPree E, Anderson R, Nash IS. Improving Quality in Healthcare: Start With the Patient. ACTA ACUST UNITED AC 2011; 78:813-9. [DOI: 10.1002/msj.20297] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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550
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Xu H, Jiang M, Oetjens M, Bowton EA, Ramirez AH, Jeff JM, Basford MA, Pulley JM, Cowan JD, Wang X, Ritchie MD, Masys DR, Roden DM, Crawford DC, Denny JC. Facilitating pharmacogenetic studies using electronic health records and natural-language processing: a case study of warfarin. J Am Med Inform Assoc 2011; 18:387-91. [PMID: 21672908 DOI: 10.1136/amiajnl-2011-000208] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE DNA biobanks linked to comprehensive electronic health records systems are potentially powerful resources for pharmacogenetic studies. This study sought to develop natural-language-processing algorithms to extract drug-dose information from clinical text, and to assess the capabilities of such tools to automate the data-extraction process for pharmacogenetic studies. MATERIALS AND METHODS A manually validated warfarin pharmacogenetic study identified a cohort of 1125 patients with a stable warfarin dose, in which 776 patients were managed by Coumadin Clinic physicians, and the remaining 349 patients were managed by their providers. The authors developed two algorithms to extract weekly warfarin doses from both data sets: a regular expression-based program for semistructured Coumadin Clinic notes; and an advanced weekly dose calculator based on an existing medication information extraction system (MedEx) for narrative providers' notes. The authors then conducted an association analysis between an automatically extracted stable weekly dose of warfarin and four genetic variants of VKORC1 and CYP2C9 genes. The performance of the weekly dose-extraction program was evaluated by comparing it with a gold standard containing manually curated weekly doses. Precision, recall, F-measure, and overall accuracy were reported. Associations between known variants in VKORC1 and CYP2C9 and warfarin stable weekly dose were performed with linear regression adjusted for age, gender, and body mass index. RESULTS The authors' evaluation showed that the MedEx-based system could determine patients' warfarin weekly doses with 99.7% recall, 90.8% precision, and 93.8% accuracy. Using the automatically extracted weekly doses of warfarin, the authors successfully replicated the previous known associations between warfarin stable dose and genetic variants in VKORC1 and CYP2C9.
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Affiliation(s)
- Hua Xu
- Department of Biomedical Informatics, School of Medicine, Vanderbilt University, Nashville, Tennessee 37232, USA.
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