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Mörike F, Spiehl HL, Feufel MA. Workarounds in the Shadow System: An Ethnographic Study of Requirements for Documentation and Cooperation in a Clinical Advisory Center. HUMAN FACTORS 2024; 66:636-646. [PMID: 35471848 DOI: 10.1177/00187208221087013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Hospital information systems (HIS) are meant to manage complex work processes across healthcare organizations. We describe limitations of HIS to address local information requirements and how they are circumvented at different organizational levels. Results can be used to better support collaboration in socio-technical systems. BACKGROUND Workarounds describe a mismatch between a technology's purpose and its actual use, whereas shadow systems are unofficial IT systems circumventing limitations of official systems to support workflows. Boundary infrastructures are conceptualized as the entirety of all (in)formal digital and analog systems connecting different communities of practice in a socio-technical system. METHODS An ethnographic study with observations and semi-structured interviews was conducted and analyzed through categorization and iterative coding. RESULTS Several digital-analog workarounds are employed for documentation and a shared server functions as a shadow system to support workflows in ways the HIS cannot. For collaborative documentation, all (official and informal) information sources were used simultaneously as part of an interconnected boundary infrastructure. CONCLUSION Formal and informal IT systems are interconnected across different organizational levels and provide insights into unmet information requirements, effective and problematic work practices, and how to address them to improve system functioning. An integrated perspective on boundary infrastructures, workarounds, and shadow systems may advance system analysis, providing a more comprehensive picture of IT requirements than any concept alone. APPLICATION Workarounds and shadow systems highlight that HIS should support systemic and local needs. Customized interfaces in HIS to support search, access, and exchange of relevant data might help to mitigate current shortcomings.
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Affiliation(s)
- Frauke Mörike
- Technische Universität Berlin, Department of Psychology and Ergonomics (IPA), Division of Ergonomics, Berlin, Germany
| | - Hannah L Spiehl
- Technische Universität Berlin, Department of Psychology and Ergonomics (IPA), Division of Ergonomics, Berlin, Germany
| | - Markus A Feufel
- Technische Universität Berlin, Department of Psychology and Ergonomics (IPA), Division of Ergonomics, Berlin, Germany
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Chou YB, Kale AU, Lanzetta P, Aslam T, Barratt J, Danese C, Eldem B, Eter N, Gale R, Korobelnik JF, Kozak I, Li X, Li X, Loewenstein A, Ruamviboonsuk P, Sakamoto T, Ting DS, van Wijngaarden P, Waldstein SM, Wong D, Wu L, Zapata MA, Zarranz-Ventura J. Current status and practical considerations of artificial intelligence use in screening and diagnosing retinal diseases: Vision Academy retinal expert consensus. Curr Opin Ophthalmol 2023; 34:403-413. [PMID: 37326222 PMCID: PMC10399944 DOI: 10.1097/icu.0000000000000979] [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] [Indexed: 06/17/2023]
Abstract
PURPOSE OF REVIEW The application of artificial intelligence (AI) technologies in screening and diagnosing retinal diseases may play an important role in telemedicine and has potential to shape modern healthcare ecosystems, including within ophthalmology. RECENT FINDINGS In this article, we examine the latest publications relevant to AI in retinal disease and discuss the currently available algorithms. We summarize four key requirements underlining the successful application of AI algorithms in real-world practice: processing massive data; practicability of an AI model in ophthalmology; policy compliance and the regulatory environment; and balancing profit and cost when developing and maintaining AI models. SUMMARY The Vision Academy recognizes the advantages and disadvantages of AI-based technologies and gives insightful recommendations for future directions.
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Affiliation(s)
- Yu-Bai Chou
- Department of Ophthalmology, Taipei Veterans General Hospital
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Aditya U. Kale
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Paolo Lanzetta
- Department of Medicine – Ophthalmology, University of Udine
- Istituto Europeo di Microchirurgia Oculare, Udine, Italy
| | - Tariq Aslam
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester School of Health Sciences, Manchester, UK
| | - Jane Barratt
- International Federation on Ageing, Toronto, Canada
| | - Carla Danese
- Department of Medicine – Ophthalmology, University of Udine
- Department of Ophthalmology, AP-HP Hôpital Lariboisière, Université Paris Cité, Paris, France
| | - Bora Eldem
- Department of Ophthalmology, Hacettepe University, Ankara, Turkey
| | - Nicole Eter
- Department of Ophthalmology, University of Münster Medical Center, Münster, Germany
| | - Richard Gale
- Department of Ophthalmology, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Jean-François Korobelnik
- Service d’ophtalmologie, CHU Bordeaux
- University of Bordeaux, INSERM, BPH, UMR1219, F-33000 Bordeaux, France
| | - Igor Kozak
- Moorfields Eye Hospital Centre, Abu Dhabi, UAE
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin
| | - Xiaoxin Li
- Xiamen Eye Center, Xiamen University, Xiamen, China
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Paisan Ruamviboonsuk
- Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University, Kagoshima, Japan
| | - Daniel S.W. Ting
- Singapore National Eye Center, Duke-NUS Medical School, Singapore
| | - Peter van Wijngaarden
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | | | - David Wong
- Unity Health Toronto – St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Lihteh Wu
- Macula, Vitreous and Retina Associates of Costa Rica, San José, Costa Rica
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Chen JS, Baxter SL, van den Brandt A, Lieu A, Camp AS, Do JL, Welsbie DS, Moghimi S, Christopher M, Weinreb RN, Zangwill LM. Usability and Clinician Acceptance of a Deep Learning-Based Clinical Decision Support Tool for Predicting Glaucomatous Visual Field Progression. J Glaucoma 2023; 32:151-158. [PMID: 36877820 PMCID: PMC9996451 DOI: 10.1097/ijg.0000000000002163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/19/2023] [Indexed: 03/08/2023]
Abstract
PRCIS We updated a clinical decision support tool integrating predicted visual field (VF) metrics from an artificial intelligence model and assessed clinician perceptions of the predicted VF metric in this usability study. PURPOSE To evaluate clinician perceptions of a prototyped clinical decision support (CDS) tool that integrates visual field (VF) metric predictions from artificial intelligence (AI) models. METHODS Ten ophthalmologists and optometrists from the University of California San Diego participated in 6 cases from 6 patients, consisting of 11 eyes, uploaded to a CDS tool ("GLANCE", designed to help clinicians "at a glance"). For each case, clinicians answered questions about management recommendations and attitudes towards GLANCE, particularly regarding the utility and trustworthiness of the AI-predicted VF metrics and willingness to decrease VF testing frequency. MAIN OUTCOMES AND MEASURES Mean counts of management recommendations and mean Likert scale scores were calculated to assess overall management trends and attitudes towards the CDS tool for each case. In addition, system usability scale scores were calculated. RESULTS The mean Likert scores for trust in and utility of the predicted VF metric and clinician willingness to decrease VF testing frequency were 3.27, 3.42, and 2.64, respectively (1=strongly disagree, 5=strongly agree). When stratified by glaucoma severity, all mean Likert scores decreased as severity increased. The system usability scale score across all responders was 66.1±16.0 (43rd percentile). CONCLUSIONS A CDS tool can be designed to present AI model outputs in a useful, trustworthy manner that clinicians are generally willing to integrate into their clinical decision-making. Future work is needed to understand how to best develop explainable and trustworthy CDS tools integrating AI before clinical deployment.
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Affiliation(s)
- Jimmy S Chen
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA
| | - Sally L Baxter
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, CA
| | | | - Alexander Lieu
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute
| | - Andrew S Camp
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute
| | - Jiun L Do
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute
| | - Derek S Welsbie
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute
| | - Sasan Moghimi
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute
| | - Mark Christopher
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute
| | - Robert N Weinreb
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute
| | - Linda M Zangwill
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute
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Skuta GL, Ding K, Lum F, Coleman AL. An IRIS® Registry-Based Assessment of Primary Open-Angle Glaucoma Practice Patterns in Academic versus Non-Academic Settings. Am J Ophthalmol 2022; 242:228-242. [PMID: 35469787 DOI: 10.1016/j.ajo.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare patient demographic data; level of severity; and clinical, diagnostic, and surgical practice patterns in patients with primary open-angle glaucoma (POAG) in an academic setting (AS) versus non-academic setting (NAS) using the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight). METHODS A retrospective cohort study of IRIS® Registry data that included patients with POAG who were seen between January 2016 and December 2019 and had at least one year of follow-up. RESULTS Of 3,707,084 distinct eyes with POAG, 3% (109,920) were included in the academic subcohort and 97% (3,597,164) were included in the non-academic subcohort. Among the findings of greatest note (P < .0001 for all comparisons) were a higher proportion of eyes of Black patients, a higher proportion of eyes with level 3 severity, and a higher mean cup-to-disc ratio in eyes in the AS. The relative frequency of gonioscopy, pachymetry, and visual field testing in conjunction with new patient visits was also notably higher in the AS. For glaucoma surgical procedures, the greatest proportional differences in relative frequency were seen for tube shunt procedures (2.55-fold higher in the AS), iStent and Hydrus procedures (2.52-fold higher in the NAS), and endoscopic cyclophotocoagulation (5.80-fold higher in the NAS). CONCLUSIONS Based on IRIS® Registry data, notable differences appear to exist with regard to ethno-racial groups, glaucoma severity, and diagnostic and surgical practice patterns in AS versus NAS. By understanding these differences, potential opportunities exist in the development of educational programs related to clinical and surgical glaucoma care.
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Woodward MA, Maganti N, Niziol LM, Amin S, Hou A, Singh K. Development and Validation of a Natural Language Processing Algorithm to Extract Descriptors of Microbial Keratitis From the Electronic Health Record. Cornea 2021; 40:1548-1553. [PMID: 34029244 PMCID: PMC8578049 DOI: 10.1097/ico.0000000000002755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 03/17/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this article was to develop and validate a natural language processing (NLP) algorithm to extract qualitative descriptors of microbial keratitis (MK) from electronic health records. METHODS In this retrospective cohort study, patients with MK diagnoses from 2 academic centers were identified using electronic health records. An NLP algorithm was created to extract MK centrality, depth, and thinning. A random sample of patient with MK encounters were used to train the algorithm (400 encounters of 100 patients) and compared with expert chart review. The algorithm was evaluated in internal (n = 100) and external validation data sets (n = 59) in comparison with masked chart review. Outcomes were sensitivity and specificity of the NLP algorithm to extract qualitative MK features as compared with masked chart review performed by an ophthalmologist. RESULTS Across data sets, gold-standard chart review found centrality was documented in 64.0% to 79.3% of charts, depth in 15.0% to 20.3%, and thinning in 25.4% to 31.3%. Compared with chart review, the NLP algorithm had a sensitivity of 80.3%, 50.0%, and 66.7% for identifying central MK, 85.4%, 66.7%, and 100% for deep MK, and 100.0%, 95.2%, and 100% for thin MK, in the training, internal, and external validation samples, respectively. Specificity was 41.1%, 38.6%, and 46.2% for centrality, 100%, 83.3%, and 71.4% for depth, and 93.3%, 100%, and was not applicable (n = 0) to the external data for thinning, in the samples, respectively. CONCLUSIONS MK features are not documented consistently showing a lack of standardization in recording MK examination elements. NLP shows promise but will be limited if the available clinical data are missing from the chart.
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Affiliation(s)
- Maria A. Woodward
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Nenita Maganti
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Leslie M. Niziol
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - Sejal Amin
- Department of Ophthalmology, Henry Ford Health System, Detroit, Michigan
| | - Andrew Hou
- Department of Ophthalmology, Henry Ford Health System, Detroit, Michigan
| | - Karandeep Singh
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
- Departments of Learning Health Systems and Internal Medicine, University of Michigan, Ann Arbor, Michigan
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Radell JE, Tatum JN, Lin CT, Davidson RS, Pell J, Sieja A, Wu AY. Risks and rewards of increasing patient access to medical records in clinical ophthalmology using OpenNotes. Eye (Lond) 2021; 36:1951-1958. [PMID: 34611314 PMCID: PMC9500101 DOI: 10.1038/s41433-021-01775-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The implementation of OpenNotes and corresponding increase in patient access to medical records requires thorough assessment of the risks and benefits of note-sharing. Ophthalmology notes are unique among medical records in that they extensively utilize non-standardized abbreviations and drawings; they are often indecipherable even to highly-educated clinicians outside of ophthalmology. No studies to date have assessed ophthalmologist perceptions of OpenNotes. METHODS A cross-sectional study was conducted from 4/28 to 5/12/2016. A survey was distributed to 30 clinicians (25 ophthalmologists, three optometrists, two nurses) in the University of Colorado's Department of Ophthalmology to evaluate provider attitudes towards granting patients access to online medical records. RESULTS Many clinicians felt patients would have difficulty understanding their records and may be unnecessarily alarmed or offended by them. Some clinicians worried their workload would increase and feared having to change the way they document. Perceived benefits of OpenNotes included improving patient understanding of their medical conditions, strengthening patient-physician trust, and enhancing patient care. Many perceived risks and benefits of note-sharing were associated with conceptions of the ideal clinician-patient relationship. CONCLUSIONS Clinicians in ophthalmology perceived both benefits and consequences of increasing patient access to ophthalmic records, and there were significant correlations between these perceptions and their conceptions of the clinician-patient relationship. This is the first study to assess potential ophthalmology provider attitudes toward sharing ophthalmic records. Although limited in sample size and power, this study demonstrates some ways patient-accessible ophthalmic records can affect the clinical practice of ophthalmology and emphasizes the unique challenges of OpenNotes in ophthalmology.
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Affiliation(s)
- Jake E Radell
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Jasmine N Tatum
- Department of Psychiatry, Stanford University School of Medicine, Stanford, CA, USA
| | - Chen-Tan Lin
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Richard S Davidson
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jonathan Pell
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amber Sieja
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Albert Y Wu
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
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Abstract
PURPOSE To evaluate the reliability of manual annotation when quantifying cornea anatomical and microbial keratitis (MK) morphological features on slit-lamp photography (SLP) images. METHODS Prospectively enrolled patients with MK underwent SLP at initial encounter at 2 academic eye hospitals. Patients who presented with an epithelial defect (ED) were eligible for analysis. Features, which included ED, corneal limbus (L), pupil (P), stromal infiltrate (SI), white blood cell (WBC) infiltration at the SI edge, and hypopyon (H), were annotated independently by 2 physicians on SLP images. Intraclass correlation coefficients (ICCs) were applied for reliability assessment; dice similarity coefficients (DSCs) were used to investigate the area overlap between readers. RESULTS Seventy-five MK patients with an ED received SLP. DSCs indicate good to fair annotation overlap between graders (L = 0.97, P = 0.80, ED = 0.94, SI = 0.82, H = 0.82, WBC = 0.83) and between repeat annotations by the same grader (L = 0.97, P = 0.81, ED = 0.94, SI = 0.85, H = 0.84, WBC = 0.82). ICC scores showed good intergrader (L = 0.98, P = 0.78, ED = 1.00, SI = 0.67, H = 0.97, WBC = 0.86) and intragrader (L = 0.99, P = 0.92, ED = 0.99, SI = 0.94, H = 0.99, WBC = 0.92) reliabilities. When reliability statistics were recalculated for annotated SI area in the subset of cases where both graders agreed WBC infiltration was present/absent, intergrader ICC improved to 0.91 and DSC improved to 0.86 and intragrader ICC remained the same, whereas DSC improved to 0.87. CONCLUSIONS Manual annotation indicates usefulness of area quantification in the evaluation of MK. However, variability is intrinsic to the task. Thus, there is a need for optimization of annotation protocols. Future directions may include using multiple annotators per image or automated annotation software.
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Baxter SL, Saseendrakumar BR, Paul P, Kim J, Bonomi L, Kuo TT, Loperena R, Ratsimbazafy F, Boerwinkle E, Cicek M, Clark CR, Cohn E, Gebo K, Mayo K, Mockrin S, Schully SD, Ramirez A, Ohno-Machado L. Predictive Analytics for Glaucoma Using Data From the All of Us Research Program. Am J Ophthalmol 2021; 227:74-86. [PMID: 33497675 PMCID: PMC8184631 DOI: 10.1016/j.ajo.2021.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/02/2021] [Accepted: 01/06/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To (1) use All of Us (AoU) data to validate a previously published single-center model predicting the need for surgery among individuals with glaucoma, (2) train new models using AoU data, and (3) share insights regarding this novel data source for ophthalmic research. DESIGN Development and evaluation of machine learning models. METHODS Electronic health record data were extracted from AoU for 1,231 adults diagnosed with primary open-angle glaucoma. The single-center model was applied to AoU data for external validation. AoU data were then used to train new models for predicting the need for glaucoma surgery using multivariable logistic regression, artificial neural networks, and random forests. Five-fold cross-validation was performed. Model performance was evaluated based on area under the receiver operating characteristic curve (AUC), accuracy, precision, and recall. RESULTS The mean (standard deviation) age of the AoU cohort was 69.1 (10.5) years, with 57.3% women and 33.5% black, significantly exceeding representation in the single-center cohort (P = .04 and P < .001, respectively). Of 1,231 participants, 286 (23.2%) needed glaucoma surgery. When applying the single-center model to AoU data, accuracy was 0.69 and AUC was only 0.49. Using AoU data to train new models resulted in superior performance: AUCs ranged from 0.80 (logistic regression) to 0.99 (random forests). CONCLUSIONS Models trained with national AoU data achieved superior performance compared with using single-center data. Although AoU does not currently include ophthalmic imaging, it offers several strengths over similar big-data sources such as claims data. AoU is a promising new data source for ophthalmic research.
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Affiliation(s)
- Sally L Baxter
- From the Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, (S.L.B., B.R.S.), La Jolla, California; UCSD Health Department of Biomedical Informatics, University of California San Diego, (S.L.B., B.R.S., P.P., J.K., L.B., T.-T.K., L.O.-M.), La Jolla, California.
| | - Bharanidharan Radha Saseendrakumar
- From the Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, (S.L.B., B.R.S.), La Jolla, California; UCSD Health Department of Biomedical Informatics, University of California San Diego, (S.L.B., B.R.S., P.P., J.K., L.B., T.-T.K., L.O.-M.), La Jolla, California
| | - Paulina Paul
- UCSD Health Department of Biomedical Informatics, University of California San Diego, (S.L.B., B.R.S., P.P., J.K., L.B., T.-T.K., L.O.-M.), La Jolla, California
| | - Jihoon Kim
- UCSD Health Department of Biomedical Informatics, University of California San Diego, (S.L.B., B.R.S., P.P., J.K., L.B., T.-T.K., L.O.-M.), La Jolla, California
| | - Luca Bonomi
- UCSD Health Department of Biomedical Informatics, University of California San Diego, (S.L.B., B.R.S., P.P., J.K., L.B., T.-T.K., L.O.-M.), La Jolla, California
| | - Tsung-Ting Kuo
- UCSD Health Department of Biomedical Informatics, University of California San Diego, (S.L.B., B.R.S., P.P., J.K., L.B., T.-T.K., L.O.-M.), La Jolla, California
| | - Roxana Loperena
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee (R.L., F.R.)
| | - Francis Ratsimbazafy
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee (R.L., F.R.)
| | - Eric Boerwinkle
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas (E.B.)
| | - Mine Cicek
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (M.C.)
| | - Cheryl R Clark
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (C.R.C.)
| | - Elizabeth Cohn
- Hunter-Bellevue School of Nursing, Hunter College City University of New York, New York, New York (E.C.)
| | - Kelly Gebo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, Maryland
| | - Kelsey Mayo
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee (R.L., F.R.)
| | - Stephen Mockrin
- Life Sciences Division, Leidos, Inc, Frederick, (S.M.), Maryland
| | - Sheri D Schully
- All of Us Research Program, National Institutes of Health, Bethesda (K.M., S.S.), Bethesda, Maryland
| | - Andrea Ramirez
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (A.R.)
| | - Lucila Ohno-Machado
- UCSD Health Department of Biomedical Informatics, University of California San Diego, (S.L.B., B.R.S., P.P., J.K., L.B., T.-T.K., L.O.-M.), La Jolla, California; Division of Health Services Research and Development, Veterans Affairs San Diego Healthcare System, La Jolla, California (L.O.-M.), USA
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Palma JP, Hron JD, Luberti AA. Early experiences with combined fellowship training in clinical informatics. J Am Med Inform Assoc 2021; 27:788-792. [PMID: 32186718 DOI: 10.1093/jamia/ocaa015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/24/2020] [Accepted: 01/31/2020] [Indexed: 11/14/2022] Open
Abstract
Given the ubiquitous nature of information systems in modern health care, interest in the pursuit of formal training in clinical informatics is increasing. This interest is not restricted to generalists-informatics training is increasingly being sought by future subspecialists. The traditional structure of Accreditation Council on Graduate Medical Education subspecialty training requires completion of both clinical and clinical informatics fellowship programs, and understandably lacks appeal due to the time commitment required. One approach to encourage clinical informatics training is to integrate it with clinical fellowships in order to confer dual-board eligibility. In this perspective, we describe 3 successful petitions for combined training in clinical informatics in order to support other programs and the American Board of Preventive Medicine in establishing pathways for training subspecialists in clinical informatics.
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Affiliation(s)
- Jonathan P Palma
- Division of Systems Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Jonathan D Hron
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Anthony A Luberti
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Cole E, Valikodath NG, Maa A, Chan RVP, Chiang MF, Lee AY, Tu DC, Hwang TS. Bringing Ophthalmic Graduate Medical Education into the 2020s with Information Technology. Ophthalmology 2020; 128:349-353. [PMID: 33358411 DOI: 10.1016/j.ophtha.2020.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022] Open
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Eapen BR, Archer N, Sartipi K. LesionMap: A Method and Tool for the Semantic Annotation of Dermatological Lesions for Documentation and Machine Learning. JMIR DERMATOLOGY 2020. [DOI: 10.2196/18149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Diagnosis and follow-up of patients in dermatology rely on visual cues. Documentation of skin lesions in dermatology is time-consuming and inaccurate. Digital photography is resource-intensive, difficult to standardize, and has privacy concerns. We propose a simple method—LesionMap—and an electronic health software tool—LesionMapper—for semantically annotating dermatological lesions on a body wireframe. We discuss how the type, distribution, and progression of lesions can be represented in a standardized way. The tool is an open-source JavaScript package that can be integrated into web-based electronic medical records. We believe that LesionMapper will facilitate documentation in dermatology that can be used for machine learning in a privacy-preserving manner.
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Kumar A, Sundar D, Agarwal D. Commentary: Electronic medical record system - should complement but not replace traditional health care. Indian J Ophthalmol 2020; 68:432-433. [PMID: 32056995 PMCID: PMC7043144 DOI: 10.4103/ijo.ijo_1474_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Dheepak Sundar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Divya Agarwal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Lutz de Araujo A, Moreira TDC, Varvaki Rados DR, Gross PB, Molina-Bastos CG, Katz N, Hauser L, Souza da Silva R, Gadenz SD, Dal Moro RG, Cabral FC, Matturro L, Moraes Pagano CG, Faria AG, Falavigna M, da Silva Siqueira AC, Schor P, Gonçalves MR, Umpierre RN, Harzheim E. The use of telemedicine to support Brazilian primary care physicians in managing eye conditions: The TeleOftalmo Project. PLoS One 2020; 15:e0231034. [PMID: 32240268 PMCID: PMC7117761 DOI: 10.1371/journal.pone.0231034] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 03/14/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To determine whether teleophthalmology can help physicians in assessing and managing eye conditions and to ascertain which clinical conditions can be addressed by teleophthalmology in primary care setting. METHODS We evaluated the resolution capacity of TeleOftalmo, strategy implemented in the public health system of southern Brazil. Resolution capacity was defined as the ability to fully address patients' eye complaints in primary care with remote assistance from ophthalmologists. Data from tele-eye reports were collected over 14 months. Resolution capacity was compared across different age groups and different ocular conditions. RESULTS Overall, 8,142 patients had a tele-eye report issued in the study period. Resolution capacity was achieved in 5,748 (70.6%) patients. When stratified into age groups, the lowest capacity was 43.1% among subjects aged ≥65 years, while the highest was 89.7% among subjects aged 13-17 years (p<0.001). Refractive error (70.3%) and presbyopia (56.3%) were the most prevalent conditions followed by cataract (12.4%) and suspected glaucoma (7.6%). Resolution capacity was higher in cases of refractive error, presbyopia, spasm of accommodation and lid disorders than in patients diagnosed with other condition (p<0.001). CONCLUSIONS With telemedicine support, primary care physicians solved over two-thirds of patients' eye or vision complaints. Refractive errors had high case resolution rates, thus having a great impact on reducing the number of referrals to specialty care. Teleophthalmology adoption in primary-care settings as part of the workup of patients with eye or vision complaints promotes a more effective use of specialty centers and will hopefully reduce waiting times for specialty referral.
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Affiliation(s)
- Aline Lutz de Araujo
- Núcleo de Telessaúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Departamento de Oftalmologia e Ciências Visuais, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- * E-mail:
| | | | | | - Paula Blasco Gross
- Núcleo de Telessaúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Natan Katz
- Núcleo de Telessaúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Secretaria Municipal da Saúde, Prefeitura de Porto Alegre, Rio Grande do Sul, Brazil
| | - Lisiane Hauser
- Núcleo de Telessaúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rodolfo Souza da Silva
- Núcleo de Telessaúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Rafael Gustavo Dal Moro
- Núcleo de Telessaúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Felipe Cezar Cabral
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
- Secretaria Municipal da Saúde, Prefeitura de Porto Alegre, Rio Grande do Sul, Brazil
| | - Lucas Matturro
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | - Maicon Falavigna
- Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Paulo Schor
- Departamento de Oftalmologia e Ciências Visuais, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Marcelo Rodrigues Gonçalves
- Núcleo de Telessaúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Roberto Nunes Umpierre
- Núcleo de Telessaúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Erno Harzheim
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Ministério da Saúde, Brasília, Distrito Federal, Brazil
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Evaluation of Electronic Health Record Implementation in an Academic Oculoplastics Practice. Ophthalmic Plast Reconstr Surg 2019; 36:277-283. [PMID: 31809488 DOI: 10.1097/iop.0000000000001531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Despite increasing electronic health record (EHR) adoption, perceptions of EHRs are negative among ophthalmologists due to concerns about productivity, costs, and documentation. The authors evaluated the effects of EHR adoption in an oculoplastics practice, which had not been previously studied. METHODS Clinical volume, documentation time, time spent with patients, reimbursement, relative value units, and patient satisfaction were examined for 2 academic oculoplastics attendings between April 2018 and April 2019, with EHR implementation in September 2018. RESULTS The mean number of patients seen in a half-day clinic was 31.8 versus 27.7 (p = 0.018) pre- and post-EHR implementation, respectively. EHR implementation had no effect on total monthly reimbursement (p = 0.88) or total monthly relative value units (p = 0.54). Average reimbursement (p = 0.004) and relative value units (p = 0.001) per patient encounter were significantly greater with EHR use. Patient satisfaction scores improved (p = 0.018). Mean physician time per patient increased from 6.4 to 9.0 minutes (p < 0.001). Mean documentation time per patient increased from 1.7 to 3.6 minutes (p < 0.001). Average patient wait times decreased by 9 minutes (p = 0.03) with EHR use. No scribes were used. CONCLUSIONS EHR implementation was associated with decreased patient volume without significant differences in total reimbursement. Although EHR adoption was associated with increased physician time devoted to patients and greater time expenditure on documentation, patients experienced decreased wait times. This suggests that EHR use streamlined the overall clinic flow without sacrificing physicians' time with the patient. The author's findings suggest that EHR implementation can be accomplished in an academic oculoplastics setting without negative impact on patient experience or reimbursement considerations.
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Baxter SL, Marks C, Kuo TT, Ohno-Machado L, Weinreb RN. Machine Learning-Based Predictive Modeling of Surgical Intervention in Glaucoma Using Systemic Data From Electronic Health Records. Am J Ophthalmol 2019; 208:30-40. [PMID: 31323204 PMCID: PMC6888922 DOI: 10.1016/j.ajo.2019.07.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE To predict the need for surgical intervention in patients with primary open-angle glaucoma (POAG) using systemic data in electronic health records (EHRs). DESIGN Development and evaluation of machine learning models. METHODS Structured EHR data of 385 POAG patients from a single academic institution were incorporated into models using multivariable logistic regression, random forests, and artificial neural networks. Leave-one-out cross-validation was performed. Mean area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, and Youden index were calculated for each model to evaluate performance. Systemic variables driving predictions were identified and interpreted. RESULTS Multivariable logistic regression was most effective at discriminating patients with progressive disease requiring surgery, with an AUC of 0.67. Higher mean systolic blood pressure was associated with significantly increased odds of needing glaucoma surgery (odds ratio [OR] = 1.09, P < .001). Ophthalmic medications (OR = 0.28, P < .001), non-opioid analgesic medications (OR = 0.21, P = .002), anti-hyperlipidemic medications (OR = 0.39, P = .004), macrolide antibiotics (OR = 0.40, P = .03), and calcium blockers (OR = 0.43, P = .03) were associated with decreased odds of needing glaucoma surgery. CONCLUSIONS Existing systemic data in the EHR has some predictive value in identifying POAG patients at risk of progression to surgical intervention, even in the absence of eye-specific data. Blood pressure-related metrics and certain medication classes emerged as predictors of glaucoma progression. This approach provides an opportunity for future development of automated risk prediction within the EHR based on systemic data to assist with clinical decision-making.
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Affiliation(s)
- Sally L Baxter
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center and Shiley Eye Institute, University of California, San Diego, La Jolla, California, USA; UCSD Health Department of Biomedical Informatics, University of California, San Diego, La Jolla, California, USA
| | - Charles Marks
- UCSD Health Department of Biomedical Informatics, University of California, San Diego, La Jolla, California, USA; Interdisciplinary Research on Substance Use Joint Doctoral Program, University of California, San Diego and San Diego State University, San Diego, California, USA
| | - Tsung-Ting Kuo
- UCSD Health Department of Biomedical Informatics, University of California, San Diego, La Jolla, California, USA
| | - Lucila Ohno-Machado
- UCSD Health Department of Biomedical Informatics, University of California, San Diego, La Jolla, California, USA; Division of Health Services Research and Development, Veterans Administration San Diego Healthcare System, La Jolla, California, USA
| | - Robert N Weinreb
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center and Shiley Eye Institute, University of California, San Diego, La Jolla, California, USA.
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Kelly SR, Bryan SR, Sparrow JM, Crabb DP. Auditing service delivery in glaucoma clinics using visual field records: a feasibility study. BMJ Open Ophthalmol 2019; 4:e000352. [PMID: 31523719 PMCID: PMC6711463 DOI: 10.1136/bmjophth-2019-000352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/05/2019] [Accepted: 07/28/2019] [Indexed: 12/03/2022] Open
Abstract
Objective This study aimed to demonstrate that large-scale visual field (VF) data can be extracted from electronic medical records (EMRs) and to assess the feasibility of calculating metrics from these data that could be used to audit aspects of service delivery of glaucoma care. Method and analysis Humphrey visual field analyser (HFA) data were extracted from Medisoft EMRs from five regionally different clinics in England in November 2015, resulting in 602 439 records from 73 994 people. Target patients were defined as people in glaucoma clinics with measurable and sustained VF loss in at least one eye (HFA mean deviation (MD) outside normal limits ≥2 VFs). Metrics for VF reliability, stage of VF loss at presentation, speed of MD loss, predicted loss of sight years (bilateral VF impairment) and frequency of VFs were calculated. Results One-third of people (34.8%) in the EMRs had measurable and repeatable VF loss and were subject to analyses (n=25 760 patients). Median (IQR) age and presenting MD in these patients were 71 (61, 78) years and −6 (–10, –4) dB, respectively. In 19 264 patients with >4 years follow-up, median (IQR) MD loss was −0.2 (−0.8, 0.3) dB/year and median (IQR) intervals between VF examinations was 11 (8, 16) months. Metrics predicting loss of sight years and reliability of examinations varied between centres (p<0.001). Conclusion This study illustrates the feasibility of assessing aspects of health service delivery in glaucoma clinics through analysis of VF databases. Proposed metrics could be useful for blindness prevention from glaucoma in secondary care centres.
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Affiliation(s)
- Stephen R Kelly
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | - Susan R Bryan
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
| | - John M Sparrow
- Bristol Eye Hospital, Population Health Sciences, University of Bristol, Bristol, UK.,National Ophthalmology Database Audit, Royal College of Ophthalmologists, London, UK
| | - David P Crabb
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, London, UK
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Medicare Incentive Payments to United States Ophthalmologists for Use of Electronic Health Records: 2011-2016. Ophthalmology 2019; 126:928-934. [PMID: 30768941 DOI: 10.1016/j.ophtha.2019.01.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/03/2019] [Accepted: 01/29/2019] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate ophthalmologists' rate of attestation to meaningful use (MU) of their electronic health record (EHR) systems in the Medicare EHR Incentive Program and their continuity and success in receiving payments in comparison with other specialties. DESIGN Administrative database study. PARTICIPANTS Eligible professionals participating in the Medicare EHR Incentive Program. METHODS Based on publicly available data sources, subsets of payment and attestation data were created for ophthalmologists and for other specialties. The number of eligible professionals attesting was determined using the attestation data for each year and stage of the program. The proportion of attestations by EHR vendor was calculated using all attestations for each vendor. MAIN OUTCOME MEASURES Numbers of ophthalmologists attesting by year and stage of the Medicare EHR Incentive Program, incentive payments, and number of attestations by EHR vendor. RESULTS In the peak year of participation, 51.6% of ophthalmologists successfully attested to MU, compared with 37.1% of optometrists, 50.2% of dermatologists, 54.5% of otolaryngologists, and 64.4% of urologists. Across the 6 years of the program, ophthalmologists received an average of $17 942 in incentive payments compared with $11 105 for optometrists, $16 617 for dermatologists, $20 203 for otolaryngologists, and $23 821 for urologists. Epic and Nextgen were the most frequently used EHRs for attestation by ophthalmologists. CONCLUSIONS Ophthalmology as a specialty performed better than optometry and dermatology, but worse than otolaryngology and urology, in terms of the proportion of eligible professionals attesting to MU of EHRs. Ophthalmologists were more likely to remain in the program after their initial year of attestation compared with all eligible providers. The top 4 EHR vendors accounted for 50% of attestations by ophthalmologists.
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Data-Driven Scheduling for Improving Patient Efficiency in Ophthalmology Clinics. Ophthalmology 2018; 126:347-354. [PMID: 30312629 DOI: 10.1016/j.ophtha.2018.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/18/2018] [Accepted: 10/01/2018] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To improve clinic efficiency through development of an ophthalmology scheduling template developed using simulation models and electronic health record (EHR) data. DESIGN We created a computer simulation model of 1 pediatric ophthalmologist's clinic using EHR timestamp data, which was used to develop a scheduling template based on appointment length (short, medium, or long). We assessed its impact on clinic efficiency after implementation in the practices of 5 different pediatric ophthalmologists. PARTICIPANTS We observed and timed patient appointments in person (n = 120) and collected EHR timestamps for 2 years of appointments (n = 650). We calculated efficiency measures for 172 clinic sessions before implementation vs. 119 clinic sessions after implementation. METHODS We validated clinic workflow timings calculated from EHR timestamps and the simulation models based on them with observed timings. From simulation tests, we developed a new scheduling template and evaluated it with efficiency metrics before vs. after implementation. MAIN OUTCOME MEASURES Measurements of clinical efficiency (mean clinic volume, patient wait time, examination time, and clinic length). RESULTS Mean physician examination time calculated from EHR timestamps was 13.8±8.2 minutes and was not statistically different from mean physician examination time from in-person observation (13.3±7.3 minutes; P = 0.7), suggesting that EHR timestamps are accurate. Mean patient wait time for the simulation model (31.2±10.9 minutes) was not statistically different from the observed mean patient wait times (32.6±25.3 minutes; P = 0.9), suggesting that simulation models are accurate. After implementation of the new scheduling template, all 5 pediatric ophthalmologists showed statistically significant improvements in clinic volume (mean increase of 1-3 patients/session; P ≤ 0.05 for 2 providers; P ≤ 0.008 for 3 providers), whereas 4 of 5 had improvements in mean patient wait time (average improvements of 3-4 minutes/patient; statistically significant for 2 providers, P ≤ 0.008). All of the ophthalmologists' examination times remained the same before and after implementation. CONCLUSIONS Simulation models based on big data from EHRs can test clinic changes before real-life implementation. A scheduling template using predicted appointment length improves clinic efficiency and may generalize to other clinics. Electronic health records have potential to become tools for supporting clinic operations improvement.
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Abstract
Care providers today routinely obtain valuable clinical multimedia with mobile devices, scope cameras, ultrasound, and many other modalities at the point of care. Image capture and storage workflows may be heterogeneous across an enterprise, and as a result, they often are not well incorporated in the electronic health record. Enterprise Imaging refers to a set of strategies, initiatives, and workflows implemented across a healthcare enterprise to consistently and optimally capture, index, manage, store, distribute, view, exchange, and analyze all clinical imaging and multimedia content to enhance the electronic health record. This paper is intended to introduce Enterprise Imaging as an important initiative to clinical and informatics leadership, and outline its key elements of governance, strategy, infrastructure, common multimedia content, acquisition workflows, enterprise image viewers, and image exchange services.
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Emani S, Ting DY, Healey M, Lipsitz SR, Karson AS, Bates DW. Physician Beliefs about the Meaningful Use of the Electronic Health Record: A Follow-Up Study. Appl Clin Inform 2017; 8:1044-1053. [PMID: 29241244 DOI: 10.4338/aci-2017-05-ra-0079] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background There is continuing interest in how physicians are responding to the meaningful use of the electronic health record (EHR) incentive program. However, little research has been done on physician beliefs about the meaningful use of the EHR.
Objective This study aims to conduct a follow-up study of physician beliefs about the meaningful use of the EHR.
Methods Online survey of physicians at two academic medical centers (AMCs) in the northeast who were participating in the meaningful use of the EHR incentive program and were using an internally developed EHR was conducted.
Results Of the 2,033 physicians surveyed, 1,075 completed the survey for an overall response rate of 52.9%. Only one-fifth (20.5%) of the physicians agreed or strongly agreed that meaningful use of the EHR would help them improve quality of care, and only a quarter (25.2%) agreed or strongly agreed that the meaningful use of the EHR would improve the care that their organization delivers. Physician satisfaction with the outpatient EHR was the strongest predictor of self-efficacy with achieving stage 2 of the meaningful use of the EHR incentive program (odds ratio: 2.10, 95% confidence interval: 1.61, 2.75, p < 0.001). Physicians reported more negative beliefs in stage 2 than stage 1 across all belief items. For example, 28.1% agreed or strongly agreed that the meaningful use of the EHR would decrease medical errors in stage 2 as compared with 35.9% in stage 1 (p < 0.001).
Conclusion Only one-fifth of the physicians in our study believed that the meaningful use of the EHR would improve quality of care, patient-centeredness of care, or the care they personally provide. Primary care physicians expressed more negative beliefs about the meaningful use of the EHR in stage 2 than in stage 1. These findings show that physicians continue to express negative beliefs about the meaningful use of the EHR. These ongoing negative beliefs are concerning for both implementation and policy.
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Affiliation(s)
- Srinivas Emani
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - David Y Ting
- Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Michael Healey
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States.,Brigham and Women's Physicians Organization, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Stuart R Lipsitz
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Andrew S Karson
- Decision Support Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - David W Bates
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States.,Department of Healthcare Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States
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Park JSY, Sharma RA, Poulis B, Noble J. Barriers to electronic medical record implementation: a comparison between ophthalmology and other surgical specialties in Canada. Can J Ophthalmol 2017; 52:503-507. [PMID: 28985812 DOI: 10.1016/j.jcjo.2017.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/21/2017] [Accepted: 02/22/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE In the present study, the barriers limiting widespread adoption of electronic medical records (EMRs) among Canadian ophthalmologists were evaluated in comparison with physicians from other surgical specialities. The published literature regarding EMR use in ophthalmic practice was also reviewed. DESIGN Population-based, cross-sectional study. PARTICIPANTS A total of 1199 Canadian surgeons participating in the 2014 National Physician Survey (NPS). METHODS Data regarding speciality surgeons' adoption of EMR programs were extracted from the 2014 NPS, a nationwide survey of practicing physicians in Canada. The data were entered into a spreadsheet, and basic statistical analyses, including χ2 analyses, were performed to compare the responses of ophthalmologists to other surgeons. RESULTS Compared with other surgeons, ophthalmologists surveyed were significantly more likely to identify the following barriers to EMR adoption: "no suitable product for my practice" (p = 0.01), "too costly" (p = 0.0006), "too time consuming" (p < 0.0001), and "planning to retire soon" (p = 0.001). No statistically detectable differences were found between ophthalmologists and other surgeons for the following barriers: privacy concerns, reliability concerns, and lack of training. CONCLUSIONS The barriers that limit increased EMR adoption among Canadian ophthalmologists are different from those of other surgeons. This may be attributed to unique features of the field, including heavy reliance on hand-drawn figures in documentation, high patient volume, and the high costs associated with independent practice. Given the well-established benefits of EMR technology, consideration should be given to implementing strategies to mitigate these barriers. Additional research may help determine which specific improvements can be made to increase the use of EMR systems by ophthalmologists.
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Affiliation(s)
- John S Y Park
- The Faculty of Medicine, University of Ottawa, Ottawa, Ont
| | - Rahul A Sharma
- The Department of Ophthalmology, University of Ottawa, Ottawa, Ont
| | - Brett Poulis
- The Department of Ophthalmology, University of Calgary, Calgary, Alta
| | - Jason Noble
- The Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.
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Peissig P, Schwei KM, Kadolph C, Finamore J, Cancel E, McCarty CA, Okorie A, Thomas KL, Allen Pacheco J, Pathak J, Ellis SB, Denny JC, Rasmussen LV, Tromp G, Williams MS, Vrabec TR, Brilliant MH. Prototype Development: Context-Driven Dynamic XML Ophthalmologic Data Capture Application. JMIR Med Inform 2017; 5:e27. [PMID: 28903894 PMCID: PMC5617903 DOI: 10.2196/medinform.7465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/31/2017] [Accepted: 06/29/2017] [Indexed: 11/13/2022] Open
Abstract
Background The capture and integration of structured ophthalmologic data into electronic health records (EHRs) has historically been a challenge. However, the importance of this activity for patient care and research is critical. Objective The purpose of this study was to develop a prototype of a context-driven dynamic extensible markup language (XML) ophthalmologic data capture application for research and clinical care that could be easily integrated into an EHR system. Methods Stakeholders in the medical, research, and informatics fields were interviewed and surveyed to determine data and system requirements for ophthalmologic data capture. On the basis of these requirements, an ophthalmology data capture application was developed to collect and store discrete data elements with important graphical information. Results The context-driven data entry application supports several features, including ink-over drawing capability for documenting eye abnormalities, context-based Web controls that guide data entry based on preestablished dependencies, and an adaptable database or XML schema that stores Web form specifications and allows for immediate changes in form layout or content. The application utilizes Web services to enable data integration with a variety of EHRs for retrieval and storage of patient data. Conclusions This paper describes the development process used to create a context-driven dynamic XML data capture application for optometry and ophthalmology. The list of ophthalmologic data elements identified as important for care and research can be used as a baseline list for future ophthalmologic data collection activities.
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Affiliation(s)
- Peggy Peissig
- Marshfield Clinic Research Institute, Biomedical Informatics Research Center, Marshfield, WI, United States
| | - Kelsey M Schwei
- Marshfield Clinic Research Institute, Center for Oral and Systemic Health, Marshfield, WI, United States
| | - Christopher Kadolph
- Marshfield Clinic Research Institute, Biomedical Informatics Research Center, Marshfield, WI, United States
| | - Joseph Finamore
- Marshfield Clinic Research Institute, Biomedical Informatics Research Center, Marshfield, WI, United States
| | - Efrain Cancel
- Marshfield Clinic, Department of Ophthalmology, Marshfield, WI, United States
| | - Catherine A McCarty
- Essentia Institute of Rural Health, Center for Research and Education, Duluth, MN, United States
| | - Asha Okorie
- Marshfield Clinic, Department of Ophthalmology, Marshfield, WI, United States
| | - Kate L Thomas
- Marshfield Clinic Research Institute, Biomedical Informatics Research Center, Marshfield, WI, United States
| | | | - Jyotishman Pathak
- Weill Cornell Medical College, Healthcare Policy and Research, Cornell University, New York, NY, United States
| | - Stephen B Ellis
- Personalized Medicine Institute, Mount Sinai, New York, NY, United States
| | - Joshua C Denny
- School of Medicine, Biomedical Informatics, Vanderbilt University, Nashville, TN, United States
| | - Luke V Rasmussen
- Division of Health and Biomedical Informatics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Gerard Tromp
- Autism and Developmental Medicine Institute (ADMI), Geisinger, Danville, PA, United States
| | - Marc S Williams
- Genomic Medical Institute, Geisinger, Danville, PA, United States
| | - Tamara R Vrabec
- Department of Ophthalmology, Geisinger, Danville, PA, United States
| | - Murray H Brilliant
- Marshfield Clinic Research Foundation, Human Genetics, Marshfield, WI, United States
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Lim SB, Shahid H. Distribution and extent of electronic medical record utilisation in eye units across the United Kingdom: a cross-sectional study of the current landscape. BMJ Open 2017; 7:e012682. [PMID: 28515180 PMCID: PMC5541331 DOI: 10.1136/bmjopen-2016-012682] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Ophthalmology units across the UK vary widely in their adoption of electronic medical records (EMR). There is a lack of evidence to show the extent and progress of EMR adoption. The aim of this study was to capture a snapshot of the current landscape of EMR use, as a baseline for comparison in future studies. SETTING An electronic survey questionnaire was sent to all NHS ophthalmology Units in the UK. PARTICIPANTS A total of 104 National Health Service (NHS) ophthalmology units participated in the survey, which was carried out over 6 months from December 2013 to June 2014. PRIMARY AND SECONDARY OUTCOME MEASURES Respondents were asked about technology usage pertaining to specific processes in the clinic workflow. This allowed us to determine the extent of EMR usage and details about current use or planned implementation by each unit. RESULTS 77.6% (n=104) of NHS ophthalmology units responded. 45.3% (n=48) of units were currently using an EMR and a further 26.4% (n=28) of units plan to implement EMR within 2 years. 70.8% of units with a current EMR system use Medisoft. EMR is used by all clinicians in 37.5% and by all subspecialties offered at the unit in 27.0%. In 56.3%, new clinical notes are entered into EMR only by clinicians. All imaging devices are networked to EMR in 28.3%. In 46.7%, EMR is accessible by other specialties within the same hospital. 71.1% would recommend EMR to a colleague. CONCLUSIONS EMR has the potential to address current limitations of patient information transfer and sharing in ophthalmology. It is pleasing to see a significant proportion of units already engaging with EMR or having plans to do so in the near future. However, differing EMR systems and lack of remote access mean further optimisation of these record systems are needed to allow data transfer between units.
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Affiliation(s)
| | - Humma Shahid
- Department of Ophthalmology, Addenbrooke’s Hospital, Cambridge, UK
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Campbell JP, Ataer-Cansizoglu E, Bolon-Canedo V, Bozkurt A, Erdogmus D, Kalpathy-Cramer J, Patel SN, Reynolds JD, Horowitz J, Hutcheson K, Shapiro M, Repka MX, Ferrone P, Drenser K, Martinez-Castellanos MA, Ostmo S, Jonas K, Chan RVP, Chiang MF. Expert Diagnosis of Plus Disease in Retinopathy of Prematurity From Computer-Based Image Analysis. JAMA Ophthalmol 2017; 134:651-7. [PMID: 27077667 DOI: 10.1001/jamaophthalmol.2016.0611] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Published definitions of plus disease in retinopathy of prematurity (ROP) reference arterial tortuosity and venous dilation within the posterior pole based on a standard published photograph. One possible explanation for limited interexpert reliability for a diagnosis of plus disease is that experts deviate from the published definitions. OBJECTIVE To identify vascular features used by experts for diagnosis of plus disease through quantitative image analysis. DESIGN, SETTING, AND PARTICIPANTS A computer-based image analysis system (Imaging and Informatics in ROP [i-ROP]) was developed using a set of 77 digital fundus images, and the system was designed to classify images compared with a reference standard diagnosis (RSD). System performance was analyzed as a function of the field of view (circular crops with a radius of 1-6 disc diameters) and vessel subtype (arteries only, veins only, or all vessels). Routine ROP screening was conducted from June 29, 2011, to October 14, 2014, in neonatal intensive care units at 8 academic institutions, with a subset of 73 images independently classified by 11 ROP experts for validation. The RSD was compared with the majority diagnosis of experts. MAIN OUTCOMES AND MEASURES The primary outcome measure was the percentage of accuracy of the i-ROP system classification of plus disease, with the RSD as a function of the field of view and vessel type. Secondary outcome measures included the accuracy of the 11 experts compared with the RSD. RESULTS Accuracy of plus disease diagnosis by the i-ROP computer-based system was highest (95%; 95% CI, 94%-95%) when it incorporated vascular tortuosity from both arteries and veins and with the widest field of view (6-disc diameter radius). Accuracy was 90% or less when using only arterial tortuosity and 85% or less using a 2- to 3-disc diameter view similar to the standard published photograph. Diagnostic accuracy of the i-ROP system (95%) was comparable to that of 11 expert physicians (mean 87%, range 79%-99%). CONCLUSIONS AND RELEVANCE Experts in ROP appear to consider findings from beyond the posterior retina when diagnosing plus disease and consider tortuosity of both arteries and veins, in contrast with published definitions. It is feasible for a computer-based image analysis system to perform comparably with ROP experts, using manually segmented images.
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Affiliation(s)
- J Peter Campbell
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland
| | | | | | - Alican Bozkurt
- Cognitive Systems Laboratory, Northeastern University, Boston, Massachusetts
| | - Deniz Erdogmus
- Cognitive Systems Laboratory, Northeastern University, Boston, Massachusetts
| | - Jayashree Kalpathy-Cramer
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown
| | - Samir N Patel
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York
| | - James D Reynolds
- Department of Ophthalmology, Ross Eye Institute, State University of New York at Buffalo
| | - Jason Horowitz
- Department of Ophthalmology, Columbia University, New York, New York
| | - Kelly Hutcheson
- Department of Ophthalmology, Sidra Medical and Research Center, Doha, Qatar
| | | | - Michael X Repka
- Wilmer Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Kimberly Drenser
- Associated Retinal Consultants, Oakland University, Royal Oak, Michigan
| | | | - Susan Ostmo
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland
| | - Karyn Jonas
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago
| | - R V Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago
| | - Michael F Chiang
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland15Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
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Farzandipour M, Meidani Z, Riazi H, Sadeqi Jabali M. Task-specific usability requirements of electronic medical records systems: Lessons learned from a national survey of end-users. Inform Health Soc Care 2017; 43:280-299. [DOI: 10.1080/17538157.2017.1290639] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mehrdad Farzandipour
- Health Information Management Research Center, Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
| | - Zahra Meidani
- Health Information Management Research Center, Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Riazi
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Monireh Sadeqi Jabali
- Health Information Management Research Center, Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
- Esabne Maryam Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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Alnawaiseh M, Alten F, Huelsken G, Rentmeister G, Lange M, Claes T, Wente S, Kreuznacht D, Eter N, Roeder N. [Implementation of electronic health records at a tertiary care eye hospital]. Ophthalmologe 2016; 112:337-45. [PMID: 25501930 DOI: 10.1007/s00347-014-3124-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although electronic health records (EHR) were introduced into ophthalmology practices many years ago, paper-based medical records are still common in most tertiary care eye hospitals. MATERIAL AND METHODS We report on the implementation of an EHR system at the university eye hospital in Münster in the time period between January and December 2013. RESULTS Advantages of an EHR system in the setting of a university eye hospital include ubiquitous access to patient data, structurability as well as scientific interpretability. Data safety, personnel and financial investment and integration into existing hospital software systems represent the main challenges. CONCLUSION The EHR system will replace paper-based records in the future. In view of the high need for visualization and recording of medical findings, EHR software solutions seem promising particularly in ophthalmology.
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Affiliation(s)
- M Alnawaiseh
- Klinik für Augenheilkunde, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude D15, 48149, Münster, Deutschland,
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Ehrlich JR, Michelotti M, Blachley TS, Zheng K, Couper MP, Greenberg GM, Kileny S, Branford GL, Hanauer DA, Weizer JS. A Two-Year Longitudinal Assessment of Ophthalmologists' Perceptions after Implementing an Electronic Health Record System. Appl Clin Inform 2016; 7:930-945. [PMID: 27730248 DOI: 10.4338/aci-2016-05-ra-0075] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/17/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To understand the attitudes and perceptions of ophthalmologists toward an electronic health record (EHR) system, before and after its clinical implementation. METHODS Ophthalmologists at a single large academic ophthalmology department were surveyed longitudinally before and after implementation of a new EHR system. The survey measured ophthalmologists' attitudes toward implementation of a new EHR. Questions focused on satisfaction, efficiency, and documentation. All attending physicians (between 56 and 61 at various time points) in the University of Michigan Department of Ophthalmology and Visual Sciences were surveyed. We plotted positive responses to survey questions and assessed whether perceptions followed a J-curve with an initial decrease followed by an increase surpassing pre-implementation levels. RESULTS Survey responses were received from 32 (52%) ophthalmologists pre-implementation, and 28 (46%) at 3 months, 35 (57%) at 7 months, 40 (71%) at 13 months and 39 (67%) at 24 months post-implementation. After EHR implementation respondents were more likely to express concerns about their ability to create high-quality documentation (p<0.01) and the impact of an electronic health record on meaningful patient interaction (p<0.01). Physicians did not report a significant change in the amount of time spent documenting outside of regular clinical work hours (p=0.54) or on their clinic efficiency and workflow (p=0.97). There was no significant change in overall job satisfaction during the study period (p=0.69). We did not observe a J-curve for any of the survey responses analyzed. CONCLUSIONS As ophthalmology practices continue to transition to EHRs, adapting them to their specific culture and needs is important to maintain efficiency and user satisfaction. This study identifies areas of concern to ophthalmologists that may be addressed through education of physicians and customization of software as other practices move forward with EHR implementation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jennifer S Weizer
- Jennifer S. Weizer, MD, Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105, Fax: (734) 232-0865, Telephone: (734) 936-9503,
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Clunie DA, Dennison DK, Cram D, Persons KR, Bronkalla MD, Primo HR. Technical Challenges of Enterprise Imaging: HIMSS-SIIM Collaborative White Paper. J Digit Imaging 2016; 29:583-614. [PMID: 27576909 PMCID: PMC5023533 DOI: 10.1007/s10278-016-9899-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
This white paper explores the technical challenges and solutions for acquiring (capturing) and managing enterprise images, particularly those involving visible light applications. The types of acquisition devices used for various general-purpose photography and specialized applications including dermatology, endoscopy, and anatomic pathology are reviewed. The formats and standards used, and the associated metadata requirements and communication protocols for transfer and workflow are considered. Particular emphasis is placed on the importance of metadata capture in both order- and encounter-based workflow. The benefits of using DICOM to provide a standard means of recording and accessing both metadata and image and video data are considered, as is the role of IHE and FHIR.
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Affiliation(s)
- David A Clunie
- Pixelmed Publishing LLC., 943 Heiden Rd, Bangor, PA, 18013, USA.
| | - Don K Dennison
- Don K Dennison Solutions Inc., 205 Fern Cres, Waterloo, ON, N2V 2P9, Canada
| | - Dawn Cram
- Department of Information Technology, University of Miami Health System, Miami, FL, 33136, USA
| | - Kenneth R Persons
- Mayo Clinic and Foundation, 200 First St. SW, Pb 2-58, Rochester, MN, 55905, USA
| | - Mark D Bronkalla
- Merge Healthcare, 900 Walnut Ridge Drive, Hartland, WI, 53029, USA
| | - Henri Rik Primo
- Digital Health Services, Siemens Healthineers, 65 Valley Stream Parkway, Malvern, PA, 19355, USA
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Mbagwu M, French DD, Gill M, Mitchell C, Jackson K, Kho A, Bryar PJ. Creation of an Accurate Algorithm to Detect Snellen Best Documented Visual Acuity from Ophthalmology Electronic Health Record Notes. JMIR Med Inform 2016; 4:e14. [PMID: 27146002 PMCID: PMC4871992 DOI: 10.2196/medinform.4732] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 01/28/2016] [Accepted: 02/20/2016] [Indexed: 11/21/2022] Open
Abstract
Background Visual acuity is the primary measure used in ophthalmology to determine how well a patient can see. Visual acuity for a single eye may be recorded in multiple ways for a single patient visit (eg, Snellen vs. Jäger units vs. font print size), and be recorded for either distance or near vision. Capturing the best documented visual acuity (BDVA) of each eye in an individual patient visit is an important step for making electronic ophthalmology clinical notes useful in research. Objective Currently, there is limited methodology for capturing BDVA in an efficient and accurate manner from electronic health record (EHR) notes. We developed an algorithm to detect BDVA for right and left eyes from defined fields within electronic ophthalmology clinical notes. Methods We designed an algorithm to detect the BDVA from defined fields within 295,218 ophthalmology clinical notes with visual acuity data present. About 5668 unique responses were identified and an algorithm was developed to map all of the unique responses to a structured list of Snellen visual acuities. Results Visual acuity was captured from a total of 295,218 ophthalmology clinical notes during the study dates. The algorithm identified all visual acuities in the defined visual acuity section for each eye and returned a single BDVA for each eye. A clinician chart review of 100 random patient notes showed a 99% accuracy detecting BDVA from these records and 1% observed error. Conclusions Our algorithm successfully captures best documented Snellen distance visual acuity from ophthalmology clinical notes and transforms a variety of inputs into a structured Snellen equivalent list. Our work, to the best of our knowledge, represents the first attempt at capturing visual acuity accurately from large numbers of electronic ophthalmology notes. Use of this algorithm can benefit research groups interested in assessing visual acuity for patient centered outcome. All codes used for this study are currently available, and will be made available online at https://phekb.org.
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Affiliation(s)
- Michael Mbagwu
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
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EVALUATION OF A TELEMEDICINE MODEL TO FOLLOW UP PATIENTS WITH EXUDATIVE AGE-RELATED MACULAR DEGENERATION. Retina 2016; 36:279-84. [DOI: 10.1097/iae.0000000000000729] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lam JG, Lee BS, Chen PP. The effect of electronic health records adoption on patient visit volume at an academic ophthalmology department. BMC Health Serv Res 2016; 16:7. [PMID: 26762304 PMCID: PMC4712610 DOI: 10.1186/s12913-015-1255-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 12/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Electronic health records (EHRs) have become a mandated part of delivering health care in the United States. The purpose of this study is to report patient volume before and after the transition to EHR in an academic outpatient ophthalmology practice. METHODS Review of patient visits per half-day and number of support staff for established faculty ophthalmologists between July and October for five consecutive years beginning the year before EHR implementation. RESULTS Eight physicians met inclusion criteria for the study. The number of patient visits was lower in each year after EHR adoption compared to baseline p ≤ 0.027). Patient volume per provider was reduced an average of 16.9% over the 4 years (range 15.3-18.5%), and during the final year studied, no provider had returned to the pre-EHR number of patients per clinic session. Support staffing was unchanged (p > 0.2). CONCLUSIONS Adoption of EHR was associated with a significantly reduced number of patient visits per clinic session in an academic setting in which support staffing remained stable. Maintaining clinic volume and access in similar settings may require use of additional staffing.
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Affiliation(s)
- Jocelyn G Lam
- Department of Ophthalmology, University of Washington, 325 Ninth Ave, Box 359608, Seattle, WA, 98104, USA
| | - Bryan S Lee
- Department of Ophthalmology, University of Washington, 325 Ninth Ave, Box 359608, Seattle, WA, 98104, USA
| | - Philip P Chen
- Department of Ophthalmology, University of Washington, 325 Ninth Ave, Box 359608, Seattle, WA, 98104, USA.
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Bonetto M, Nicolò M, Gazzarata R, Fraccaro P, Rosa R, Musetti D, Musolino M, Traverso CE, Giacomini M. I-Maculaweb: A Tool to Support Data Reuse in Ophthalmology. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2015; 4:3800110. [PMID: 27170913 PMCID: PMC4862313 DOI: 10.1109/jtehm.2015.2513043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 07/31/2015] [Accepted: 12/11/2015] [Indexed: 11/26/2022]
Abstract
This paper intends to present a Web-based application to collect and manage clinical data and clinical trials together in a unique tool. I-maculaweb is a user-friendly Web-application designed to manage, share, and analyze clinical data from patients affected by degenerative and vascular diseases of the macula. The unique and innovative scientific and technological elements of this project are the integration with individual and population data, relevant for degenerative and vascular diseases of the macula. Clinical records can also be extracted for statistical purposes and used for clinical decision support systems. I-maculaweb is based on an existing multilevel and multiscale data management model, which includes general principles that are suitable for several different clinical domains. The database structure has been specifically built to respect laterality, a key aspect in ophthalmology. Users can add and manage patient records, follow-up visits, treatment, diagnoses, and clinical history. There are two different modalities to extract records: one for the patient’s own center, in which personal details are shown and the other for statistical purposes, where all center’s anonymized data are visible. The Web-platform allows effective management, sharing, and reuse of information within primary care and clinical research. Clear and precise clinical data will improve understanding of real-life management of degenerative and vascular diseases of the macula as well as increasing precise epidemiologic and statistical data. Furthermore, this Web-based application can be easily employed as an electronic clinical research file in clinical studies.
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Eguzkiza A, Trigo JD, Martínez-Espronceda M, Serrano L, Andonegui J. Formalize clinical processes into electronic health information systems: Modelling a screening service for diabetic retinopathy. J Biomed Inform 2015; 56:112-26. [DOI: 10.1016/j.jbi.2015.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 05/22/2015] [Accepted: 05/26/2015] [Indexed: 10/23/2022]
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Lim MC, Patel RP, Lee VS, Weeks PD, Barber MK, Watnik MR. The long-term financial and clinical impact of an electronic health record on an academic ophthalmology practice. J Ophthalmol 2015; 2015:329819. [PMID: 25810920 PMCID: PMC4354962 DOI: 10.1155/2015/329819] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 02/11/2015] [Accepted: 02/13/2015] [Indexed: 11/25/2022] Open
Abstract
Purpose. To examine financial and clinical work productivity outcomes associated with the use of the electronic health record (EHR). Methods. 191,360 billable clinical encounters were analyzed for 12 clinical providers over a 9-year study period during which an EHR was implemented. Main outcome measures were clinical revenues collected per provider and secondary outcomes were charge capture, patient visit coding levels, transcription costs, patient visit volume per provider, digital drawing, and digital imaging volume. Results. The difference in inflation adjusted net clinical revenue per provider per year did not change significantly in the period after EHR implementation (mean = $404,198; SD = $17,912) than before (mean = $411,420; SD = $39,366) (P = 0.746). Charge capture, the proportion of higher- and lower-level visit codes for new and established patients, and patient visits per provider remained stable. A total savings of $188,951 in transcription costs occurred over a 4-year time period post-EHR implementation. The rate of drawing the ophthalmic exam in the EHR was low (mean = 2.28%; SD = 0.05%) for all providers. Conclusions. This study did not show a clear financial gain after EHR implementation in an academic ophthalmology practice. Ophthalmologists do not rely on drawings to document the ophthalmic exam; instead, the ophthalmic exam becomes text-driven in a paperless world.
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Affiliation(s)
- Michele C. Lim
- UC Davis Health System Eye Center, UC Davis School of Medicine, 4860 Y Street, Suite 2400, Sacramento, CA 95817, USA
| | - Roma P. Patel
- UC Davis Health System Eye Center, UC Davis School of Medicine, 4860 Y Street, Suite 2400, Sacramento, CA 95817, USA
| | - Victor S. Lee
- UC Davis Health System Eye Center, UC Davis School of Medicine, 4860 Y Street, Suite 2400, Sacramento, CA 95817, USA
| | - Patricia D. Weeks
- UC Davis Health System Eye Center, UC Davis School of Medicine, 4860 Y Street, Suite 2400, Sacramento, CA 95817, USA
| | - Martha K. Barber
- UC Davis Health System Eye Center, UC Davis School of Medicine, 4860 Y Street, Suite 2400, Sacramento, CA 95817, USA
| | - Mitchell R. Watnik
- Department of Statistics and Biostatistics, California State University, East Bay
25800 Carlos Bee Boulevard, Hayward, CA 94542, USA
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Redd TK, Read-Brown S, Choi D, Yackel TR, Tu DC, Chiang MF. Electronic health record impact on productivity and efficiency in an academic pediatric ophthalmology practice. J AAPOS 2014; 18:584-9. [PMID: 25456030 PMCID: PMC4267903 DOI: 10.1016/j.jaapos.2014.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 06/24/2014] [Accepted: 08/25/2014] [Indexed: 11/15/2022]
Abstract
PURPOSE To measure the effect of electronic health record (EHR) implementation on productivity and efficiency in the pediatric ophthalmology division at an academic medical center. METHODS Four established providers were selected from the pediatric ophthalmology division at the Oregon Health & Science University Casey Eye Institute. Clinical volume was compared before and after EHR implementation for each provider. Time elapsed from chart open to completion (OTC time) and the proportion of charts completed during business hours were monitored for 3 years following implementation. RESULTS Overall there was an 11% decrease in clinical volume following EHR implementation, which was not statistically significant (P = 0.18). The mean OTC time ranged from 5.5 to 28.3 hours among providers in this study, and trends over time were variable among the four providers. Forty-four percent of all charts were closed outside normal business hours (30% on weekdays, 14% on weekends). CONCLUSIONS EHR implementation was associated with a negative impact on productivity and efficiency in our pediatric ophthalmology division.
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Affiliation(s)
- Travis K Redd
- Department of Ophthalmology, Portland, Oregon; Department of Public Health & Preventive Medicine, Portland, Oregon
| | | | - Dongseok Choi
- Department of Ophthalmology, Portland, Oregon; Department of Public Health & Preventive Medicine, Portland, Oregon; Community Dentistry, Oregon Health & Science University, Portland, Oregon
| | - Thomas R Yackel
- Department of Medical Informatics & Clinical Epidemiology, Portland, Oregon
| | - Daniel C Tu
- Department of Ophthalmology, Portland, Oregon; Operative Care Division, Portland Veterans Affairs Medical Center, Portland, Oregon
| | - Michael F Chiang
- Department of Ophthalmology, Portland, Oregon; Department of Medical Informatics & Clinical Epidemiology, Portland, Oregon.
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Pandit RR, Boland MV. Impact of digital imaging and communications in medicine workflow on the integration of patient demographics and ophthalmic test data. Ophthalmology 2014; 122:227-32. [PMID: 25439603 DOI: 10.1016/j.ophtha.2014.08.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/22/2014] [Accepted: 08/25/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To determine the impact of a Digital Imaging and Communications in Medicine (DICOM) workflow on the linkage of demographic information to ophthalmic testing data. DESIGN Evaluation of technology. PARTICIPANTS Six hundred ninety-nine visual field testing encounters performed by 6 ophthalmic technicians and the transfer error queue of 37 442 ophthalmic test results. METHODS At 3 months before and 6 and 18 months after implementation of a DICOM workflow, technicians recorded the work required to enter, confirm, or edit patient demographics in each visual field device. We also determined the proportion of imaging tests sent to an error queue for manual reconciliation because of incorrect demographic information before and 3, 6, and 18 months after the DICOM workflow was established. MAIN OUTCOME MEASURES The proportion of testing encounters for which staff had to enter, edit, or merge patient demographics and the proportion of misfiled images. RESULTS Staff entered, edited, or merged data for 48% of patients before implementation (n = 237). This decreased to 24% within 6 months and 20% within 18 months of implementing the DICOM archive (n = 230 and n = 232, respectively). Staff could locate a patient in a DICOM work list for 97% of encounters at 3 months and 99% at 18 months. Before implementation, 9.2% of the images required additional intervention to be associated with the correct patient (n = 3581). This decreased by 85% over 6 months to 1.4% (n = 9979; P < 0.01). There was an increase in the percentage of misfiled images between 6 and 18 months from 1.4% to 2.2% (n = 24 549; P < 0.01), representing an overall 76% decrease over 18 months relative to the pre-DICOM period. CONCLUSIONS Implementation of a DICOM-compatible workflow in an ophthalmology clinic reduced the need to enter or edit patient demographic information into imaging or testing devices by more than 50% and reduced the need to manage misfiled images by 76%. In a clinical environment that demands both efficiency and patient safety, the DICOM workflow is an important update to current practice.
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Affiliation(s)
- Ravi R Pandit
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Dana Center for Preventive Ophthalmology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Michael V Boland
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Emani S, Ting DY, Healey M, Lipsitz SR, Karson AS, Einbinder JS, Leinen L, Suric V, Bates DW. Physician beliefs about the impact of meaningful use of the EHR: a cross-sectional study. Appl Clin Inform 2014; 5:789-801. [PMID: 25298817 DOI: 10.4338/aci-2014-05-ra-0050] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 07/18/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND As adoption and use of electronic health records (EHRs) grows in the United States, there is a growing need in the field of applied clinical informatics to evaluate physician perceptions and beliefs about the impact of EHRs. The meaningful use of EHR incentive program provides a suitable context to examine physician beliefs about the impact of EHRs. OBJECTIVE Contribute to the sparse literature on physician beliefs about the impact of EHRs in areas such as quality of care, effectiveness of care, and delivery of care. METHODS A cross-sectional online survey of physicians at two academic medical centers (AMCs) in the northeast who were preparing to qualify for the meaningful use of EHR incentive program. RESULTS Of the 1,797 physicians at both AMCs who were preparing to qualify for the incentive program, 967 completed the survey for an overall response rate of 54%. Only 23% and 27% of physicians agreed or strongly agreed that meaningful use of the EHR will help them improve the care they personally deliver and improve quality of care respectively. Physician specialty was significantly associated with beliefs; e.g., 35% of primary care physicians agreed or strongly agreed that meaningful use will improve quality of care compared to 26% of medical specialists and 21% of surgical specialists (p=0.009). Satisfaction with outpatient EHR was also significantly related to all belief items. CONCLUSIONS Only about a quarter of physicians in our study responded positively that meaningful use of the EHR will improve quality of care and the care they personally provide. These findings are similar to and extend findings from qualitative studies about negative perceptions that physicians hold about the impact of EHRs. Factors outside of the regulatory context, such as physician beliefs, need to be considered in the implementation of the meaningful use of the EHR incentive program.
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Affiliation(s)
- S Emani
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA
| | - D Y Ting
- Massachusetts General Physicians Organization, Massachusetts General Hospital , Boston, MA, USA
| | - M Healey
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA ; Brigham and Women's Physicians Organization, Brigham and Women's Hospital , Boston, MA, USA
| | - S R Lipsitz
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA
| | - A S Karson
- Decision Support Unit, Massachusetts General Hospital, Harvard Medical School , Boston, MA, USA
| | - J S Einbinder
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA
| | - L Leinen
- Information Services, Partners HealthCare , Boston, MA, USA
| | - V Suric
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA
| | - D W Bates
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA ; Department of Healthcare Policy and Management, Harvard School of Public Health , Boston, MA, USA
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Sanders DS, Lattin DJ, Read-Brown S, Tu DC, Wilson DJ, Hwang TS, Morrison JC, Yackel TR, Chiang MF. Electronic Health Record Systems in Ophthalmology. Ophthalmology 2013; 120:1745-55. [DOI: 10.1016/j.ophtha.2013.02.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 02/05/2013] [Accepted: 02/13/2013] [Indexed: 11/28/2022] Open
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Chan P, Thyparampil PJ, Chiang MF. Accuracy and speed of electronic health record versus paper-based ophthalmic documentation strategies. Am J Ophthalmol 2013; 156:165-172.e2. [PMID: 23664152 DOI: 10.1016/j.ajo.2013.02.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 02/16/2013] [Accepted: 02/21/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE To compare accuracy and speed of keyboard and mouse electronic health record (EHR) documentation strategies with those of a paper documentation strategy. DESIGN Prospective cohort study. METHODS Three documentation strategies were developed: (1) keyboard EHR, (2) mouse EHR, and (3) paper. Ophthalmology trainees recruited for the study were presented with 5 clinical cases and documented findings using each strategy. For each case-strategy pair, findings and documentation time were recorded. Accuracy of each strategy was calculated based on sensitivity (fraction of findings in actual case that were documented by subject) and positive ratio (fraction of findings identified by subject that were present in the actual case). RESULTS Twenty subjects were enrolled. A total of 258 findings were identified in the 5 cases, resulting in 300 case-strategy pairs and 77 400 possible total findings documented. Sensitivity was 89.1% for the keyboard EHR, 87.2% for mouse EHR, and 88.6% for the paper strategy (no statistically significant differences). The positive ratio was 99.4% for the keyboard EHR, 98.9% for mouse EHR, and 99.9% for the paper strategy (P < .001 for mouse EHR vs paper; no significant differences between other pairs). Mean ± standard deviation documentation speed was significantly slower for the keyboard (2.4 ± 1.1 seconds/finding) and mouse (2.2 ± 0.7 seconds/finding) EHR compared with the paper strategy (2.0 ± 0.8 seconds/finding). Documentation speed of the mouse EHR strategy worsened with repetition. CONCLUSIONS No documentation strategy was perfectly accurate in this study. Documentation speed for both EHR strategies was slower than with paper. Further studies involving total physician time requirements for ophthalmic EHRs are required.
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Affiliation(s)
- Patrick Chan
- Department of Ophthalmology, Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Boland MV, Chiang MF, Lim MC, Wedemeyer L, Epley KD, McCannel CA, Silverstone DE, Lum F. Adoption of electronic health records and preparations for demonstrating meaningful use: an American Academy of Ophthalmology survey. Ophthalmology 2013; 120:1702-10. [PMID: 23806425 DOI: 10.1016/j.ophtha.2013.04.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 04/29/2013] [Accepted: 04/29/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To assess the current state of electronic health record (EHR) use by ophthalmologists, including adoption rate, user satisfaction, functionality, benefits, barriers, and knowledge of meaningful use criteria. DESIGN Population-based, cross-sectional study. PARTICIPANTS A total of 492 members of the American Academy of Ophthalmology (AAO). METHODS A random sample of 1500 AAO members were selected on the basis of their practice location and solicited to participate in a study of EHR use, practice management, and image management system use. Participants completed the survey via the Internet, phone, or fax. The survey included questions about the adoption of EHRs, available functionality, benefits, barriers, satisfaction, and understanding of meaningful use criteria and health information technology concepts. MAIN OUTCOME MEASURES Current adoption rate of EHRs, user satisfaction, benefits and barriers, and availability of EHR functionality. RESULTS Overall, 32% of the practices surveyed had already implemented an EHR, 15% had implemented an EHR for some of their physicians or were in the process of implementation, and another 31% had plans to do so within 2 years. Among those with an EHR in their practice, 49% were satisfied or extremely satisfied with their system, 42% reported increased or stable overall productivity, 19% reported decreased or stable overall costs, and 55% would recommend an EHR to a fellow ophthalmologist. For those with an electronic image management system, only 15% had all devices integrated, 33% had images directly uploaded into their system, and 12% had electronic association of patient demographics with the image. CONCLUSIONS The adoption of EHRs by ophthalmology practices more than doubled from 2007 to 2011. The satisfaction of ophthalmologists with their EHR and their perception of beneficial effects on productivity and costs were all lower in 2011 than in 2007. Knowledge about meaningful use is high, but the percentage of physicians actually receiving incentive payments is relatively low. Given the importance of imaging in ophthalmology, the shortcomings in current image management systems need to be addressed. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Michael V Boland
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
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Chen CL, Ishikawa H, Wollstein G, Ling Y, Bilonick RA, Kagemann L, Sigal IA, Schuman JS. Individual A-scan signal normalization between two spectral domain optical coherence tomography devices. Invest Ophthalmol Vis Sci 2013; 54:3463-71. [PMID: 23611992 DOI: 10.1167/iovs.12-11484] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE We developed a method to normalize optical coherence tomography (OCT) signal profiles from two spectral-domain (SD) OCT devices so that the comparability between devices increases. METHODS We scanned 21 eyes from 14 healthy and 7 glaucoma subjects with two SD-OCT devices on the same day, with equivalent cube scan patterns centered on the fovea (Cirrus HD-OCT and RTVue). Foveola positions were selected manually and used as the center for registration of the corresponding images. A-scan signals were sampled 1.8 mm from the foveola in the temporal, superior, nasal, and inferior quadrants. After oversampling and rescaling RTVue data along the Z-axis to match the corresponding Cirrus data format, speckle noise reduction and amplitude normalization were applied. For comparison between normalized A-scan profiles, mean absolute difference in amplitude in percentage was measured at each sampling point. As a reference, the mean absolute difference between two Cirrus scans on the same eye also was measured. RESULTS The mean residual of the A-scan profile amplitude was reduced significantly after signal normalization (12.7% vs. 6.2%, P < 0.0001, paired t-test). All four quadrants also showed statistically significant reduction (all P < 0.0001). Mean absolute difference after normalization was smaller than the one between two Cirrus scans. No performance difference was detected between health and glaucomatous eyes. CONCLUSIONS The reported signal normalization method successfully reduced the A-scan profile differences between two SD-OCT devices. This signal normalization processing may improve the direct comparability of OCT image analysis and measurement on various devices.
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Affiliation(s)
- Chieh-Li Chen
- UPMC Eye Center, Eye and Ear Institute, Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA
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Tsinopoulos IT, Lamprogiannis LP, Tsaousis KT, Mataftsi A, Symeonidis C, Chalvatzis NT, Dimitrakos SA. Surgical outcomes in phacoemulsification after application of a risk stratification system. Clin Ophthalmol 2013; 7:895-9. [PMID: 23717035 PMCID: PMC3663436 DOI: 10.2147/opth.s42726] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background The purpose of this study was to determine whether application of a risk stratification system during preoperative assessment of cataract patients and subsequent allocation of patients to surgeons with matching experience may reduce intraoperative complications. Methods Nine hundred and fifty-three consecutive patients (1109 eyes) undergoing phacoemulsification cataract surgery were assigned to two groups, ie, group A (n = 498 patients, 578 eyes) and group B (n = 455 patients, 531 eyes). Patients from group A were allocated to surgeons with varying experience with only a rough estimate of the complexity of their surgery. Patients from group B were assigned to three risk groups (no added risk, low risk, and moderate-high risk) according to risk factors established during their preoperative assessment and were respectively allocated to resident surgeons, low-volume surgeons, or high-volume surgeons. Data were collected and entered into a computerized database. The intraoperative complication rate was calculated for each group. Results The intraoperative complication rate was significantly lower in group B than in group A (group A, 5.88%; group B, 3.2%; P < 0.05). Patients from group B with no added risk and allocated to resident surgeons had a significantly lower rate of intraoperative complications than those from group A allocated to resident surgeons (group A, 7.2%; group B, 3.08%; P < 0.05). Conclusion Our study demonstrates that allocation of cataract patients to surgeons matched for experience according to a uniform and reliable preoperative assessment of their risk of complications allows for better surgical outcomes, especially for resident surgeons.
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Affiliation(s)
- Ioannis T Tsinopoulos
- Second Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
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A study of user requests regarding the fully electronic health record system at Seoul National University Bundang Hospital: Challenges for future electronic health record systems. Int J Med Inform 2013; 82:387-97. [DOI: 10.1016/j.ijmedinf.2012.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 06/11/2012] [Accepted: 08/19/2012] [Indexed: 11/20/2022]
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Ibrahim AAH, Carrim ZI, Mahomed I. Phakic YAG capsulotomy: the penny dropped after the nucleus. Clin Exp Ophthalmol 2013; 41:809-10. [PMID: 23566264 DOI: 10.1111/ceo.12115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 03/06/2013] [Indexed: 11/26/2022]
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Kaufmann MD, Desai S. Special requirements for electronic health records in dermatology. ACTA ACUST UNITED AC 2013; 31:160-2. [PMID: 22929352 DOI: 10.1016/j.sder.2012.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 06/17/2012] [Accepted: 06/27/2012] [Indexed: 11/29/2022]
Abstract
Government incentives and mandates to increase the meaningful use of electronic health records (EHR), with subsequent disincentives by Medicare, have made a significant push for dermatologists to adopt this technology into their practices. EHRs were originally developed for primary care physicians; however, owing to the unique features of dermatology, specialty-specific systems are a must. In this article, we discuss the special needs of dermatologists when choosing an EHR system.
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Affiliation(s)
- Mark D Kaufmann
- Department of Dermatology, Mount Sinai School of Medicine, New York, NY, USA
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Zvornicanin J, Zvornicanin E, Sabanovic Z. Ophthalmology and information technology in tuzla canton health care system. Acta Inform Med 2013; 20:90-3. [PMID: 23322959 PMCID: PMC3544322 DOI: 10.5455/aim.2012.20.90-93] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 03/30/2012] [Indexed: 11/30/2022] Open
Abstract
Purpose: To analyze organization of ophthalmology health care in Tuzla canton and use of information technologies(IT). Introduction: IT in ophthalmology is the technology required for the data processing and other information important for patient and essential for building an electronic health record(EHR). IT in ophthalmology should include the study, science, and solution sets for all aspects of data, information and knowledge management in health information processing. Material and methods: We have analyzed organization of ophthalmology health care in Tuzla canton. Data relevant for this research were acquired from annual reports of Tuzla Canton health ministry. All institutions and ambulances were visited and all health care professionals interviewed. A questionnaire was made which included questions for health care professionals about knowledge and use of computers, internet and information technology. Results: Ophthalmology health care in Tuzla canton has paper based medical record. There is no information system with any possibility to exchange data electronically. None of the medical devices is directly connected to the Internet and all data are typed, printed and delivered directly to the patient. All interviewed health care professionals agree that implementation of IT and EHR would contribute and improve work quality. Conclusion: Computer use and easy information access will make a qualitative difference in eye-care delivery in Tuzla canton. Implementation phase will be difficult because it will likely impact present style of practice. Strategy for implementation of IT in medicine in general must be made at the country level.
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Affiliation(s)
- Jasmin Zvornicanin
- Eye Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
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Job O, Bachmann LM, Schmid MK, Thiel MA, Ivic S. Assessing the efficacy of the electronic patient record system EDeR: implementation study--study protocol. BMJ Open 2013; 3:bmjopen-2012-002478. [PMID: 23578684 PMCID: PMC3641441 DOI: 10.1136/bmjopen-2012-002478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Despite many innovations in information technology, many clinics still rely on paper-based medical records. Critics, however, claim that they are hard to read, because of illegible handwriting, and uncomfortable to use. Moreover, a chronological overview is not always easily possible, content can be destroyed or get lost. There is an overall opinion that electronic medical records (EMRs) should solve these problems and improve physicians' efficiency, patients' safety and reduce the overall costs in practice. However, to date, the evidence supporting this view is sparse. METHODS AND ANALYSIS In this protocol, we describe a study exploring differences in speed and accuracy when searching clinical information using the paper-based patient record or the Elektronische DateneRfassung (EDeR). Designed as a randomised vignette study, we hypothesise that the EDeR increases efficiency, that is, reduces time on reading the patient history and looking for relevant examination results, helps finding mistakes and missing information quicker and more reliably. In exploratory analyses, we aim at exploring factors associated with a higher performance. ETHICS AND DISSEMINATION The ethics committee of the Canton Lucerne, Switzerland, approved this study. We presume that the implementation of the EMR software EDeR will have a positive impact on the efficiency of the doctors, which will result in an increase of consultations per day. We believe that the results of our study will provide a valid basis to quantify the added value of an EMR system in an ophthalmological environment.
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Affiliation(s)
- Oliver Job
- Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | | | - Martin K Schmid
- Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Michael A Thiel
- Eye Clinic, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Sandra Ivic
- Medignition Inc, Research Consultants, Zug, Switzerland
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