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Chishtie J, Sapiro N, Wiebe N, Rabatach L, Lorenzetti D, Leung AA, Rabi D, Quan H, Eastwood CA. Use of Epic Electronic Health Record System for Health Care Research: Scoping Review. J Med Internet Res 2023; 25:e51003. [PMID: 38100185 PMCID: PMC10757236 DOI: 10.2196/51003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/29/2023] [Accepted: 11/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Electronic health records (EHRs) enable health data exchange across interconnected systems from varied settings. Epic is among the 5 leading EHR providers and is the most adopted EHR system across the globe. Despite its global reach, there is a gap in the literature detailing how EHR systems such as Epic have been used for health care research. OBJECTIVE The objective of this scoping review is to synthesize the available literature on use cases of the Epic EHR for research in various areas of clinical and health sciences. METHODS We used established scoping review methods and searched 9 major information repositories, including databases and gray literature sources. To categorize the research data, we developed detailed criteria for 5 major research domains to present the results. RESULTS We present a comprehensive picture of the method types in 5 research domains. A total of 4669 articles were screened by 2 independent reviewers at each stage, while 206 articles were abstracted. Most studies were from the United States, with a sharp increase in volume from the year 2015 onwards. Most articles focused on clinical care, health services research and clinical decision support. Among research designs, most studies used longitudinal designs, followed by interventional studies implemented at single sites in adult populations. Important facilitators and barriers to the use of Epic and EHRs in general were identified. Important lessons to the use of Epic and other EHRs for research purposes were also synthesized. CONCLUSIONS The Epic EHR provides a wide variety of functions that are helpful toward research in several domains, including clinical and population health, quality improvement, and the development of clinical decision support tools. As Epic is reported to be the most globally adopted EHR, researchers can take advantage of its various system features, including pooled data, integration of modules and developing decision support tools. Such research opportunities afforded by the system can contribute to improving quality of care, building health system efficiencies, and conducting population-level studies. Although this review is limited to the Epic EHR system, the larger lessons are generalizable to other EHRs.
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Affiliation(s)
- Jawad Chishtie
- Center for Health Informatics, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Natalie Sapiro
- Center for Health Informatics, University of Calgary, Calgary, AB, Canada
| | - Natalie Wiebe
- Center for Health Informatics, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | | | - Diane Lorenzetti
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Health Sciences Library, University of Calgary, Calgary, AB, Canada
| | - Alexander A Leung
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Doreen Rabi
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Hude Quan
- Center for Health Informatics, University of Calgary, Calgary, AB, Canada
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Cathy A Eastwood
- Center for Health Informatics, University of Calgary, Calgary, AB, Canada
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
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Morrow JL, Szydlowski Pitman J, Elliott R, Simmons VC. How do we improve blood product administration audit rates. Transfusion 2022; 62:2163-2171. [DOI: 10.1111/trf.17104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/12/2022] [Accepted: 08/16/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Jessica L. Morrow
- Nurse Anesthesia Program Duke University School of Nursing Durham North Carolina USA
| | | | - Ryland Elliott
- Duke Nurse Anesthesiology Department Durham North Carolina USA
| | - Virginia C. Simmons
- Nurse Anesthesia Program Duke University School of Nursing Durham North Carolina USA
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Implementing a New Electronic Health Record System in a University Hospital: The Effect on Reported Medication Errors. Healthcare (Basel) 2022; 10:healthcare10061020. [PMID: 35742071 PMCID: PMC9222436 DOI: 10.3390/healthcare10061020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/24/2022] [Accepted: 05/29/2022] [Indexed: 11/16/2022] Open
Abstract
Closed-loop electronic medication management systems (EMMS) have been seen as a potential technology to prevent medication errors (MEs), although the research on them is still limited. The aim of this paper was to describe the changes in reported MEs in Helsinki University Hospital (HUS) during and after implementing an EPIC-based electronic health record system (APOTTI), with the first features of a closed-loop EMMS. MEs reported from January 2018 to May 2021 were analysed to identify changes in ME trends with quantitative analysis. Severe MEs were also analysed via qualitative content analysis. A total of 30% (n = 23,492/79,272) of all reported patient safety incidents were MEs. Implementation phases momentarily increased the ME reporting, which soon decreased back to the earlier level. Administration and dispensing errors decreased, but medication reconciliation, ordering, and prescribing errors increased. The ranking of the TOP 10 medications related to MEs remained relatively stable. There were 92 severe MEs related to APOTTI (43% of all severe MEs). The majority of these (55%, n = 53) were related to use and user skills, 24% (n = 23) were technical failures and flaws, and 21% (n = 21) were related to both. Using EMMS required major changes in the medication process and new technical systems and technology. Our medication-use process is approaching a closed-loop system, which seems to provide safer dispensing and administration of medications. However, medication reconciliation, ordering, and prescribing still need to be improved.
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Jiang L, Zhang G, Hao K, Xiang W, Zhang Q, Xie Y, Wang Z, Chen B, Du Y. Electronic transfusion consent and blood delivering pattern improve the management of blood bank in China. BMC Health Serv Res 2022; 22:561. [PMID: 35473708 PMCID: PMC9044836 DOI: 10.1186/s12913-022-07825-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/22/2022] [Indexed: 11/22/2022] Open
Abstract
Background The aim of this study was to improve the blood transfusion treatment consent accuracy, simplify the verification process, prolong the temperature control time before the blood transfusion, and save the blood transportation labor cost. Methods We designed the blood transfusion consent electronic signing process, which can generate personalized the text content and can automatically check the filling accuracy. The signal can be transmitted to the blood transfusion management system (TMS) to relieving the blood distribution. For blood delivering pattern, we established the blood transport center, recruited full-time nurses and used temperature-controlled blood transfer boxes to deliver blood in batches on a regular basis. Results A quarterly data analysis of blood transfusion quality showed a 100% blood transfusion consent accuracy after an electronic signing process was implemented. The average confirmation time savings between the electronic content and paper content was 26 min for the Department of Emergency (estimated difference 95% CI = 26 (20 to 36), p < 0.05). The blood delivering pattern reduced the time for each unit by leaving the average temperature control by 7.24 min (estimated difference 95% CI = 7.24 (6.92 to 7.56), p < 0.05). Furthermore, $3.67 was saved for the blood transportation labor cost for each unit as well. Conclusion Blood transfusion consent electronic signing process not only ensures the accuracy, but also saves the verification time. Moreover, the blood delivering pattern prolongs the blood temperature control time and saves blood transportation labor costs. Thus, these two improvements could enhance transfusion management. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07825-6.
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Affiliation(s)
- Luxi Jiang
- Laboratory Medicine Center, Department of Transfusion Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No.158 Shangtang Road, Hangzhou, Zhejiang, China
| | - Guobing Zhang
- XianJu People's Hospital, Zhejiang Southeast Campus of Zhejiang Provincial People's Hospital, No.53 Chengbei East Road, Xianju, Zhejiang, China.,Department of Quality Management, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No.158 Shangtang Road, Hangzhou, Zhejiang, China
| | - Ke Hao
- Laboratory Medicine Center, Department of Transfusion Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No.158 Shangtang Road, Hangzhou, Zhejiang, China
| | - Weiling Xiang
- Laboratory Medicine Center, Department of Transfusion Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No.158 Shangtang Road, Hangzhou, Zhejiang, China
| | - Qin Zhang
- Department of Quality Management, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No.158 Shangtang Road, Hangzhou, Zhejiang, China
| | - Yiwei Xie
- Laboratory Medicine Center, Department of Transfusion Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No.158 Shangtang Road, Hangzhou, Zhejiang, China
| | - Zhen Wang
- Laboratory Medicine Center, Department of Transfusion Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No.158 Shangtang Road, Hangzhou, Zhejiang, China.
| | - Bingyu Chen
- Laboratory Medicine Center, Department of Transfusion Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No.158 Shangtang Road, Hangzhou, Zhejiang, China.
| | - Yaoqiang Du
- Laboratory Medicine Center, Department of Transfusion Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No.158 Shangtang Road, Hangzhou, Zhejiang, China.
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Masror Roudsari D, Feizi S, Maghsudlu M. Nurses' hemovigilance knowledge and performance after teach-back, concept map, and lecture: A quasi-experimental study. Heliyon 2021; 7:e05982. [PMID: 33506134 PMCID: PMC7814151 DOI: 10.1016/j.heliyon.2021.e05982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/02/2020] [Accepted: 01/11/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives This study aimed to compare the effects of teaching by three methods of teach-back, concept map, and lecture on knowledge and performance of nurses in hemovigilance process. Methods This quasi-experimental study was performed on 108 Iranian nurses. In the lecture group, the educational intervention was conducted during a 4-hour session; and in the concept map and teach-back groups, it was performed in two 2-hour sessions. The nurses’ knowledge and performance were measured by “routine blood transfusion knowledge questionnaire (RBTKQ)” and “self-reporting performance-evaluator questionnaire”. Results After the interventions, knowledge was significantly higher in the teach-back and the concept map groups compared to the lecture group (p = 0.001), but the performance in the lecture group was higher than the other two groups (p = 0.01). No statistically significant differences were found between teach-back and concept map groups. Conclusion Teach-back and concept map methods were effective in improving the nurses’ hemovigilance knowledge, while the lecture was associated with a significant increase in their performance. Therefore, integrating the hemovigilance teaching methods is suggested.
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Affiliation(s)
- Daryadokht Masror Roudsari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Shahoo Feizi
- Student Research Committee, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Mahtab Maghsudlu
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
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Storch EK, Rogerson B, Eder AF. Trend in
ABO‐incompatible RBC
transfusion‐related fatalities reported to the
FDA
, 2000‐2019. Transfusion 2020; 60:2867-2875. [DOI: 10.1111/trf.16121] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/03/2020] [Accepted: 09/09/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Emily K. Storch
- Center for Biologics Evaluation and Research U.S. Food and Drug Administration Silver Spring Maryland USA
| | - Beth Rogerson
- Center for Biologics Evaluation and Research U.S. Food and Drug Administration Silver Spring Maryland USA
| | - Anne F. Eder
- Center for Biologics Evaluation and Research U.S. Food and Drug Administration Silver Spring Maryland USA
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Staples S, O'Callaghan C, Pavord S, Staves J, Murphy MF. How to verify patient identity and blood product compatibility using an electronic bedside transfusion system. Transfusion 2020; 60:2153-2155. [PMID: 32830320 DOI: 10.1111/trf.16028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022]
Abstract
Transfusion of an incorrect blood component is an important avoidable serious hazard of transfusion resulting from process errors. Our group and others have taken advantage of new technology and developed electronic transfusion systems for safe transfusion practice in a previous studies. They allow the clinical staff to correctly identify the patient and the blood product at the bedside, ensuring the right blood product is given to the right patient. This video is to demonstrate the process and not to promote any specific product. It is a follow up our previous video clip on electronic remote blood issue in a previous study. The process for correct patient identification originates from the wristband, which contains the patient identification details in a 2D barcode and is printed from the electronic patient record system. These details are associated with the blood sample through using a portable printer to produce a label for the sample tube. The patient details are scanned into the blood bank laboratory information system (LIS) and are then printed on a compatibility label by the LIS, which also contains a 2-dimensional barcode, and is then attached to the blood product. Following an initial visual check of these details by the clinical staff, the electronic bedside system requires that both the patient wristband barcode and the blood product compatibility barcode are scanned. This will electronically verify at the patient's bedside that the right unit is to be given to the right patient. This is the final step in ensuring end-to-end electronic control and safe transfusion practice.
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Affiliation(s)
- Sophie Staples
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Sue Pavord
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Julie Staves
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Michael F Murphy
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,NHS Blood & Transplant (NHSBT), Oxford, UK.,Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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Ri M, Kasai M, Kohno A, Kondo M, Sawa M, Kinoshita T, Sugiura I, Miura Y, Yamamoto K, Saito TI, Ozawa Y, Matsushita T, Kato H. A survey of blood transfusion errors in Aichi Prefecture in Japan: Identifying major lapses threatening the safety of transfusion recipients. Transfus Apher Sci 2020; 59:102735. [PMID: 32019735 DOI: 10.1016/j.transci.2020.102735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/18/2019] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite recent progress in blood systems, transfusion errors can occur at any time from the moment of collection through to the transfusion of blood and blood products. This study investigated the actual statuses of blood transfusion errors at institutions of all sizes in Aichi prefecture. MATERIALS AND METHODS We investigated 104 institutions that perform 98 % of the blood transfusions in Aichi prefecture, and investigated the errors (incidents/accidents) that occurred at these facilities over 6 months (April to September, 2017). Incident/accident data were collected from responses to questionnaires sent to each institution; these were classified according to the categories and risk levels. RESULTS Ninety-seven of the 104 institutions (93.3 %) responded to the questionnaire; a total of 688 incidents/accidents were reported. Most (682 cases; 99.2 %), were classified as risk level 2; however, 6 were level 3 and over, which included problems with autologous transfusion and inventory control. Approximately one-half of the incidents/accidents (394 cases; 57.3 %), were related to verification and the actual administration of blood products at the bedside; more than half of these incidents/accidents occurred at large-volume institutions. Meanwhile, a high frequency of incidents/accidents related to transfusion examination and labeling of blood products was observed at small- or medium-sized institutions. The reasons for most of these errors were simple mistakes and carelessness by the medical staff. CONCLUSIONS Our results emphasize the importance of education, operational training, and compliance instruction for all members of the medical staff despite advances in electronic devices meant to streamline transfusion procedures.
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Affiliation(s)
- Masaki Ri
- Aichi Prefectural Joint Committee of Blood Transfusion Therapy, Nagoya, Japan; Department of Blood Transfusion and Cell Therapy, Nagoya City University Hospital, Nagoya, Japan.
| | - Masanobu Kasai
- Aichi Prefectural Joint Committee of Blood Transfusion Therapy, Nagoya, Japan; Department of Hematology and Oncology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Akio Kohno
- Aichi Prefectural Joint Committee of Blood Transfusion Therapy, Nagoya, Japan; Department of Hematology and Oncology, Konan Kosei Hospital, Konan, Japan
| | - Masaru Kondo
- Aichi Prefectural Joint Committee of Blood Transfusion Therapy, Nagoya, Japan; Okazaki City Hospital, Okazaki, Japan
| | - Masashi Sawa
- Aichi Prefectural Joint Committee of Blood Transfusion Therapy, Nagoya, Japan; Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo, Japan
| | - Tomohiro Kinoshita
- Aichi Prefectural Joint Committee of Blood Transfusion Therapy, Nagoya, Japan; Japanese Red Cross Aichi Blood Center, Seto, Japan
| | - Isamu Sugiura
- Aichi Prefectural Joint Committee of Blood Transfusion Therapy, Nagoya, Japan; Blood Transfusion and Cell Therapy Center, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Yasuo Miura
- Aichi Prefectural Joint Committee of Blood Transfusion Therapy, Nagoya, Japan; Department of Transfusion Medicine and Cell Therapy, Fujita Health University Hospital, Toyoake, Japan
| | - Kazuhito Yamamoto
- Aichi Prefectural Joint Committee of Blood Transfusion Therapy, Nagoya, Japan; Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Toshiki I Saito
- Aichi Prefectural Joint Committee of Blood Transfusion Therapy, Nagoya, Japan; Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Yukiyasu Ozawa
- Aichi Prefectural Joint Committee of Blood Transfusion Therapy, Nagoya, Japan; Department of Hematology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Tadashi Matsushita
- Aichi Prefectural Joint Committee of Blood Transfusion Therapy, Nagoya, Japan; Department of Transfusion Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Hidefumi Kato
- Aichi Prefectural Joint Committee of Blood Transfusion Therapy, Nagoya, Japan; Department of Transfusion Medicine, Aichi Medical University Hospital, Nagakute, Japan
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