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Ebbers T, Takes RP, Smeele LE, Kool RB, van den Broek GB, Dirven R. The implementation of a multidisciplinary, electronic health record embedded care pathway to improve structured data recording and decrease electronic health record burden. Int J Med Inform 2024; 184:105344. [PMID: 38310755 DOI: 10.1016/j.ijmedinf.2024.105344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 02/09/2023] [Accepted: 01/17/2024] [Indexed: 02/06/2024]
Abstract
INTRODUCTION Theoretically, the added value of electronic health records (EHRs) is extensive. Reusable data capture in EHRs could lead to major improvements in quality measurement, scientific research, and decision support. To achieve these goals, structured and standardized recording of healthcare data is a prerequisite. However, time spent on EHRs by physicians is already high. This study evaluated the effect of implementing an EHR embedded care pathway with structured data recording on the EHR burden of physicians. MATERIALS AND METHODS Before and six months after implementation, consultations were recorded and analyzed with video-analytic software. Main outcome measures were time spent on specific tasks within the EHR, total consultation duration, and usability indicators such as required mouse clicks and keystrokes. Additionally, a validated questionnaire was completed twice to evaluate changes in physician perception of EHR system factors and documentation process factors. RESULTS Total EHR time in initial oncology consultations was significantly reduced by 3.7 min, a 27 % decrease. In contrast, although a decrease of 13 % in consultation duration was observed, no significant effect on EHR time was found in follow-up consultations. Additionally, perceptions of physicians regarding the EHR and documentation improved significantly. DISCUSSION Our results have shown that it is possible to achieve structured data capture while simultaneously reducing the EHR burden, which is a decisive factor in end-user acceptance of documentation systems. Proper alignment of structured documentation with workflows is critical for success. CONCLUSION Implementing an EHR embedded care pathway with structured documentation led to decreased EHR burden.
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Affiliation(s)
- Tom Ebbers
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Ludi E Smeele
- Department of Head and Neck Oncology and Surgery, Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
| | - Rudolf B Kool
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.
| | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Richard Dirven
- Department of Head and Neck Oncology and Surgery, Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
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Mohammed A, Lockey AS. Engaging, empowering and educating the waiting patient. Emerg Med J 2023:emermed-2022-212722. [PMID: 36941036 DOI: 10.1136/emermed-2022-212722] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 03/12/2023] [Indexed: 03/23/2023]
Abstract
While emergency departments are open to anyone without appointment, the need for prioritisation results in periods of waiting that are both wasteful and frustrating. However, value can be added to patient care by (1) engaging the waiting patient, (2) empowering the waiting patient and (3) educating the waiting patient. If these principles are implemented, they will benefit both the patient and the healthcare system.
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Affiliation(s)
- Amjid Mohammed
- Emergency Department, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Andrew S Lockey
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
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Garcia G, Crenner C. Comparing International Experiences With Electronic Health Records Among Emergency Medicine Physicians in the United States and Norway: Semistructured Interview Study. JMIR Hum Factors 2022; 9:e28762. [PMID: 34994702 PMCID: PMC8783275 DOI: 10.2196/28762] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 08/22/2021] [Accepted: 10/11/2021] [Indexed: 02/04/2023] Open
Abstract
Background The variability in physicians’ attitudes regarding electronic health records (EHRs) is widely recognized. Both human and technological factors contribute to user satisfaction. This exploratory study considers these variables by comparing emergency medicine physician experiences with EHRs in the United States and Norway. Objective This study is unique as it aims to compare individual experiences with EHRs. It creates an opportunity to expand perspective, challenge the unknown, and explore how this technology affects clinicians globally. Research often highlights the challenge that health information technology has created for users: Are the negative consequences of this technology shared among countries? Does it affect medical practice? What determines user satisfaction? Can this be measured internationally? Do specific factors account for similarities or differences? This study begins by investigating these questions by comparing cohort experiences. Fundamental differences between nations will also be addressed. Methods We used semistructured, participant-driven, in-depth interviews (N=12) for data collection in conjunction with ethnographic observations. The conversations were recorded and transcribed. Texts were then analyzed using NVivo software (QSR International) to develop codes for direct comparison among countries. Comprehensive understanding of the data required triangulation, specifically using thematic and interpretive phenomenological analysis. Narrative analysis ensured appropriate context of the NVivo (QSR International) query results. Results Each interview resulted in mixed discussions regarding the benefits and disadvantages of EHRs. All the physicians recognized health care’s dependence on this technology. In Norway, physicians perceived more benefits compared with those based in the United States. Americans reported fewer benefits and disproportionally high disadvantages. Both cohorts believed that EHRs have increased user workload. However, this was mentioned 2.6 times more frequently by Americans (United States [n=40] vs Norway [n=15]). Financial influences regarding health information technology use were of great concern for American physicians but rarely mentioned among Norwegian physicians (United States [n=37] vs Norway [n=6]). Technology dysfunctions were the most common complaint from Norwegian physicians. Participants from each country noted increased frustration among older colleagues. Conclusions Despite differences spanning geographical, organizational, and cultural boundaries, much is to be learned by comparing individual experiences. Both cohorts experienced EHR-related frustrations, although etiology differed. The overall number of complaints was significantly higher among American physicians. This study augments the idea that policy, regulation, and administration have compelling influence on user experience. Global EHR optimization requires additional investigation, and these results help to establish a foundation for future research.
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Affiliation(s)
- Gracie Garcia
- Department of History and Philosophy of Medicine, University of Kansas School of Medicine, Kansas City, KS, United States
| | - Christopher Crenner
- Department of History and Philosophy of Medicine, University of Kansas School of Medicine, Kansas City, KS, United States
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de Hoop T, Neumuth T. Evaluating Electronic Health Record Limitations and Time Expenditure in a German Medical Center. Appl Clin Inform 2021; 12:1082-1090. [PMID: 34937102 PMCID: PMC8695058 DOI: 10.1055/s-0041-1739519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES This study set out to obtain a general profile of physician time expenditure and electronic health record (EHR) limitations in a large university medical center in Germany. We also aim to illustrate the merit of a tool allowing for easier capture and prioritization of specific clinical needs at the point of care for which the current study will inform development in subsequent work. METHODS Nineteen physicians across six different departments participated in this study. Direct clinical observations were conducted with 13 out of 19 physicians for a total of 2,205 minutes, and semistructured interviews were conducted with all participants. During observations, time was measured for larger activity categories (searching information, reading information, documenting information, patient interaction, calling, and others). Semistructured interviews focused on perceived limitations, frustrations, and desired improvements regarding the EHR environment. RESULTS Of the observed time, 37.1% was spent interacting with the health records (9.0% searching, 7.7% reading, and 20.5% writing), 28.0% was spent interacting with patients corrected for EHR use (26.9% of time in a patient's presence), 6.8% was spent calling, and 28.1% was spent on other activities. Major themes of discontent were a spread of patient information, high and often repeated documentation burden, poor integration of (new) information into workflow, limits in information exchange, and the impact of such problems on patient interaction. Physicians stated limited means to address such issues at the point of care. CONCLUSION In the study hospital, over one-third of physicians' time was spent interacting with the EHR, environment, with many aspects of used systems far from optimal and no convenient way for physicians to address issues as they occur at the point of care. A tool facilitating easier identification and registration of issues, as they occur, may aid in generating a more complete overview of limitations in the EHR environment.
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Affiliation(s)
- Tom de Hoop
- Innovation Center Computer Assisted Surgery, Institute at the Faculty of Medicine, Leipzig University, Leipzig, Germany,Address for correspondence Tom de Hoop, MD University of Leipzig, Innovation Center Computer Assisted Surgery (ICCAS)Semmelweisstraße 14, 04103 LeipzigGermany
| | - Thomas Neumuth
- Innovation Center Computer Assisted Surgery, Institute at the Faculty of Medicine, Leipzig University, Leipzig, Germany
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Abstract
RATIONALE Implementation of electronic health records may improve the quality, accuracy, timeliness, and availability of documentation. Thus, our institution developed a system that integrated EEG ordering, scheduling, standardized reporting, and billing. Given the importance of user perceptions for successful implementation, we performed a quality improvement study to evaluate electroencephalographer satisfaction with the new EEG report system. METHODS We implemented an EEG report system that was integrated in an electronic health record. In this single-center quality improvement study, we surveyed electroencephalographers regarding overall acceptability, report standardization, workflow efficiency, documentation quality, and fellow education using a 0 to 5 scale (with 5 denoting best). RESULTS Eighteen electroencephalographers responded to the survey. The median score for recommending the overall system to a colleague was 5 (range 3-5), which indicated good overall satisfaction and acceptance of the system. The median scores for report standardization (4; 3-5) and workflow efficiency (4.5; 3-5) indicated that respondents perceived the system as useful and easy to use for documentation tasks. The median scores for quality of documentation (4.5; 1-5) and fellow education (4; 1-5) indicated that although most respondents believed the system provided good quality reports and helped with fellow education, a small number of respondents had substantially different views (ratings of 1). CONCLUSIONS Overall electroencephalographer satisfaction with the new EEG report system was high, as were the scores for perceived usefulness (assessed as standardization, documentation quality, and education) and ease of use (assessed as workflow efficiency). Future study is needed to determine whether implementation yields useful data for clinical research and quality improvement studies or improves EEG report standardization.
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Thomas K, Marcum J, Wagner A, Kohn MA. Impact of Scribes with Flow Coordination Duties on Throughput in an Academic Emergency Department. West J Emerg Med 2020; 21:653-659. [PMID: 32421515 PMCID: PMC7234711 DOI: 10.5811/westjem.2020.2.46110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/07/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction With the increasing influence of electronic health records in emergency medicine came concerns of decreasing operational efficiencies. Particularly worrisome was increasing patient length of stay (LOS). Medical scribes were identified to be in a good position to quickly address barriers to treatment delivery and patient flow. The objective of this study was to investigate patient LOS in the mid- and low-acuity zones of an academic emergency department (ED) with and without medical scribes. Methods A retrospective cohort study compared patient volume and average LOS between a cohort without scribes and a cohort after the implementation of a scribe-flow coordinator program. Patients were triaged to the mid-acuity Vertical Zone (primarily Emergency Severity Index [ESI] 3) or low-acuity Fast Track (primarily ESI 4 and 5) at a tertiary academic ED. Patients were stratified by treatment zone, acuity level, and disposition. Results The pre-intervention and post-intervention periods included 8900 patients and 9935 patients, respectively. LOS for patients discharged from the Vertical Zone decreased by 12 minutes from 235 to 223 minutes (p<0.0001, 95% confidence interval [CI], −17,−7) despite a 10% increase in patient volume. For patients admitted from the Vertical Zone, volume increased 13% and LOS remained almost the same, increasing from 225 to 228 minutes (p=0.532, 95% CI, −6,12). For patients discharged from the Fast Track, volume increased 14% and LOS increased six minutes, from 89 to 95 minutes (p<0.0001, 95% CI, 4,9). Predictably, only 1% of Fast Track patients were admitted. Conclusion Despite substantially increased volume, the use of scribes as patient flow facilitators in the mid-acuity zone was associated with decreased LOS. In the low-acuity zone, scribes were not shown to be as effective, perhaps because rapid patient turnover required them to focus on documentation.
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Affiliation(s)
- Keith Thomas
- Stanford Hospital and Clinics, Department of Emergency Medicine, Stanford, California
| | - Joshua Marcum
- Stanford Hospital and Clinics, Department of Emergency Medicine, Stanford, California
| | - Alexei Wagner
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Michael A Kohn
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
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Dittrich F, Back DA, Harren AK, Jäger M, Landgraeber S, Reinecke F, Beck S. A Possible Mobile Health Solution in Orthopedics and Trauma Surgery: Development Protocol and User Evaluation of the Ankle Joint App. JMIR Mhealth Uhealth 2020; 8:e16403. [PMID: 32130171 PMCID: PMC7066508 DOI: 10.2196/16403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/29/2019] [Accepted: 12/16/2019] [Indexed: 12/04/2022] Open
Abstract
Background Ankle sprains are one of the most frequent sports injuries. With respect to the high prevalence of ankle ligament injuries and patients’ young age, optimizing treatment and rehabilitation is mandatory to prevent future complications such as chronic ankle instability or osteoarthritis. Objective In modern times, an increasing amount of smartphone usage in patient care is evident. Studies investigating mobile health (mHealth)–based rehabilitation programs after ankle sprains are rare. The aim of this study was to expose any issues present in the development process of a medical app as well as associated risks and chances. Methods The development process of the Ankle Joint App was defined in chronological order using a protocol. The app’s quality was evaluated using the (user) German Mobile App Rating Scale (MARS-G) by voluntary foot and ankle surgeons (n=20) and voluntary athletes (n=20). Results A multidisciplinary development team built a hybrid app with a corresponding backend structure. The app’s content provides actual medical literature, training videos, and a log function. Excellent interrater reliability (interrater reliability=0.92; 95% CI 0.86-0.96) was obtained. The mean overall score for the Ankle Joint App was 4.4 (SD 0.5). The mean subjective quality scores were 3.6 (surgeons: SD 0.7) and 3.8 (athletes: SD 0.5). Behavioral change had mean scores of 4.1 (surgeons: SD 0.7) and 4.3 (athletes: SD 0.7). The medical gain value, rated by the surgeons only, was 3.9 (SD 0.6). Conclusions The data obtained demonstrate that mHealth-based rehabilitation programs might be a useful tool for patient education and collection of personal data. The achieved (user) MARS-G scores support a high quality of the tested app. Medical app development with an a priori defined target group and a precisely intended purpose, in a multidisciplinary team, is highly promising. Follow-up studies are required to obtain funded evidence for the ankle joints app’s effects on economical and medical aspects in comparison with established nondigital therapy paths.
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Affiliation(s)
- Florian Dittrich
- Department for Orthopaedics and Orthopaedic Surgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - David Alexander Back
- Clinic of Traumatology and Orthopedics, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Anna Katharina Harren
- Department of Plastic, Reconstructive & Aesthetic Surgery, Specialized Clinic Hornheide, Münster, Germany
| | - Marcus Jäger
- Department of Orthopaedics, Trauma and Recontructive Surgery, St. Marien Hospital Mülheim and Chair of Orthopaedics and Trauma Surgery, University of Duisburg-Essen, Essen, Germany
| | - Stefan Landgraeber
- Department for Orthopaedics and Orthopaedic Surgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Felix Reinecke
- Clinic of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Essen, Germany
| | - Sascha Beck
- Department for Orthopaedics and Orthopaedic Surgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany.,Sportsclinic Hellersen, Lüdenscheid, Germany
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Colleti Junior J, Andrade ABD, Carvalho WBD. Evaluation of the use of electronic medical record systems in Brazilian intensive care units. Rev Bras Ter Intensiva 2018; 30:338-346. [PMID: 30328987 PMCID: PMC6180478 DOI: 10.5935/0103-507x.20180057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/11/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To examine the prevalence of the use of electronic medical record systems in Brazilian intensive care units and the perceptions of intensive care physicians regarding the contribution of electronic medical record systems toward improving safety and quality in clinical practice. METHODS Using an online questionnaire, physicians working in Brazilian intensive care units answered questions about the use of electronic medical record systems in the hospitals in which they worked. They were asked about the types of electronic medical record systems used and their levels of satisfaction with these systems in terms of improving quality and safety. RESULTS Of the 4,772 invitations sent, 204 physicians responded to the questionnaire. Most used electronic medical record and prescription systems (92.6%), worked in private hospitals (43.1%), worked in general adult intensive care units (66.7%) and used Private System A (39.2%); most systems had been used for between 2 and 4 years (25.5%). Furthermore, the majority (84.6%) believed that the electronic system provided better quality than a paper system, and 76.7% believed that electronic systems provided greater safety than paper systems. CONCLUSION Electronic medical record systems seem to be widely used by the Brazilian intensive care physicians who responded to the questionnaire and, according to the data, seem to provide greater quality and safety than do paper records.
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Lorenzetti DL, Quan H, Lucyk K, Cunningham C, Hennessy D, Jiang J, Beck CA. Strategies for improving physician documentation in the emergency department: a systematic review. BMC Emerg Med 2018; 18:36. [PMID: 30558573 PMCID: PMC6297955 DOI: 10.1186/s12873-018-0188-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 10/12/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Physician chart documentation can facilitate patient care decisions, reduce treatment errors, and inform health system planning and resource allocation activities. Although accurate and complete patient chart data supports quality and continuity of patient care, physician documentation often varies in terms of timeliness, legibility, clarity and completeness. While many educational and other approaches have been implemented in hospital settings, the extent to which these interventions can improve the quality of documentation in emergency departments (EDs) is unknown. METHODS We conducted a systematic review to assess the effectiveness of approaches to improve ED physician documentation. Peer reviewed electronic databases, grey literature sources, and reference lists of included studies were searched to March 2015. Studies were included if they reported on outcomes associated with interventions designed to enhance the quality of physician documentation. RESULTS Nineteen studies were identified that report on the effectiveness of interventions to improve physician documentation in EDs. Interventions included audit/feedback, dictation, education, facilitation, reminders, templates, and multi-interventions. While ten studies found that audit/feedback, dictation, pharmacist facilitation, reminders, templates, and multi-pronged approaches did improve the quality of physician documentation across multiple outcome measures, the remaining nine studies reported mixed results. CONCLUSIONS Promising approaches to improving physician documentation in emergency department settings include audit/feedback, reminders, templates, and multi-pronged education interventions. Future research should focus on exploring the impact of implementing these interventions in EDs with and without emergency medical record systems (EMRs), and investigating the potential of emerging technologies, including EMR-based machine-learning, to promote improvements in the quality of ED documentation.
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Affiliation(s)
- Diane L Lorenzetti
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N4N1, Canada.
| | - Hude Quan
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N4N1, Canada
| | - Kelsey Lucyk
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N4N1, Canada
| | - Ceara Cunningham
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N4N1, Canada
| | - Deirdre Hennessy
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N4N1, Canada
| | - Jason Jiang
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N4N1, Canada
| | - Cynthia A Beck
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N4N1, Canada
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Denton CA, Soni HC, Kannampallil TG, Serrichio A, Shapiro JS, Traub SJ, Patel VL. Emergency Physicians' Perceived Influence of EHR Use on Clinical Workflow and Performance Metrics. Appl Clin Inform 2018; 9:725-733. [PMID: 30208497 DOI: 10.1055/s-0038-1668553] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Over the last decade, electronic health records (EHRs) have shaped clinical practice. In this article, we investigated the perceived effects of EHR use on clinical workflow and meaningful use (MU) performance metrics. MATERIALS AND METHODS Semistructured interviews were conducted with 20 (n = 20) physicians at two urban emergency departments. Interview questions focused on time spent on EHR use, changes in clinical practices with EHR use, and the effect of MU performance metrics on clinical workflow. Qualitative coding using grounded theory and descriptive analyses were performed to provide descriptive insights. RESULTS Physicians reported that EHRs improved their clinical workflow, especially on MU-related activities including door-to-doctor time and admit decision time. EHR use also affected physicians work efficiency, quality of care provided, and overall patient safety. CONCLUSION Physicians' perception of EHRs is likely to influence their practices. With negative perceptions of EHR usability problems, positive aspects of EHR use, including the influence on MU performance metrics, may be overridden.
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Affiliation(s)
- Courtney A Denton
- Center for Cognitive Studies in Medicine and Public Health, The New York Academy of Medicine, New York, New York, United States
| | - Hiral C Soni
- Department of Biomedical Informatics, Arizona State University, Phoenix, Arizona, United States
| | - Thomas G Kannampallil
- Department of Family Medicine, University of Illinois at Chicago, Illinois, United States
| | - Anna Serrichio
- Center for Cognitive Studies in Medicine and Public Health, The New York Academy of Medicine, New York, New York, United States
| | - Jason S Shapiro
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Stephen J Traub
- Department of Emergency Medicine, Mayo Clinic, Phoenix, Arizona, United States
| | - Vimla L Patel
- Center for Cognitive Studies in Medicine and Public Health, The New York Academy of Medicine, New York, New York, United States.,Department of Biomedical Informatics, Arizona State University, Phoenix, Arizona, United States
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Baumann LA, Baker J, Elshaug AG. The impact of electronic health record systems on clinical documentation times: A systematic review. Health Policy 2018; 122:827-836. [PMID: 29895467 DOI: 10.1016/j.healthpol.2018.05.014] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/23/2018] [Accepted: 05/25/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Effective management of hospital staff time is crucial to quality patient care. Recent years have seen widespread implementation of electronic health record (EHR) systems but the effect of this on documentation time is unknown. This review compares time spent on documentation tasks by hospital staff (physicians, nurses and interns) before and after EHR implementation. METHODS A systematic search identified 8153 potentially relevant citations. Studies examining proportion of total workload spent on documentation with ≥40 h of staff observation time were included. Meta-analysis was performed for physicians, nurses and interns comparing pre- and post-EHR results. Studies were weighted by person-hours observation time. RESULTS Twenty-eight studies met selection criteria. Seventeen were pre-EHR, nine post-EHR and two examined both periods. With implementation of EHR, physicians' documentation time increased from 16% (95% confidence interval (CI) 11-22%) to 28% (95% CI 19-37%), nurses from 9% (95% CI 6-12%) to 23% (95% CI 15-32%) and interns from 20% (95% CI 7-32%) to 26% (95% CI 10-42%). CONCLUSIONS There is a lack of long-term follow-up on the effects of EHR implementation. Initial adjustment to EHR appears to increase documentation time but there is some evidence that as staff become more familiar with the system, it may ultimately improve work flow.
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Affiliation(s)
- Lisa Ann Baumann
- University of Bremen, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany.
| | - Jannah Baker
- Menzies Centre for Health Policy, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia.
| | - Adam G Elshaug
- Menzies Centre for Health Policy, Sydney School of Public Health, The University of Sydney, NSW 2006, Australia.
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Perry WM, Hossain R, Taylor RA. Assessment of the Feasibility of automated, real-time clinical decision support in the emergency department using electronic health record data. BMC Emerg Med 2018; 18:19. [PMID: 29970009 PMCID: PMC6029277 DOI: 10.1186/s12873-018-0170-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 06/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of big data and machine learning within clinical decision support systems (CDSSs) has the potential to transform medicine through better prognosis, diagnosis and automation of tasks. Real-time application of machine learning algorithms, however, is dependent on data being present and entered prior to, or at the point of, CDSS deployment. Our aim was to determine the feasibility of automating CDSSs within electronic health records (EHRs) by investigating the timing, data categorization, and completeness of documentation of their individual components of two common Clinical Decision Rules (CDRs) in the Emergency Department. METHODS The CURB-65 severity score and HEART score were randomly selected from a list of the top emergency medicine CDRs. Emergency department (ED) visits with ICD-9 codes applicable to our CDRs were eligible. The charts were reviewed to determine the categorization components of the CDRs as structured and/or unstructured, median times of documentation, portion of charts with all data components documented as structured data, portion of charts with all structured CDR components documented before ED departure. A kappa score was calculated for interrater reliability. RESULTS The components of the CDRs were mainly documented as structured data for the CURB-65 severity score and HEART score. In the CURB-65 group, 26.8% of charts had all components documented as structured data, and 67.8% in the HEART score. Documentation of some CDR components often occurred late for both CDRs. Only 21 and 11% of patients had all CDR components documented as structured data prior to ED departure for the CURB-65 and HEART score groups, respectively. The interrater reliability for the CURB-65 score review was 0.75 and 0.65 for the HEART score. CONCLUSION Our study found that EHRs may be unable to automatically calculate popular CDRs-such as the CURB-65 severity score and HEART score-due to missing components and late data entry.
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Affiliation(s)
- Warren M. Perry
- Emergency Medicine Department, Yale School of Medicine, 464 Congress Avenue, Suite #260, New Haven, CT 06450 USA
- Emergency Department, Yale New Haven Hospital, 20 York Street, New Haven, CT 06510 USA
| | - Rubayet Hossain
- Emergency Medicine Department, Yale School of Medicine, 464 Congress Avenue, Suite #260, New Haven, CT 06450 USA
- Emergency Department, Yale New Haven Hospital, 20 York Street, New Haven, CT 06510 USA
| | - Richard A. Taylor
- Emergency Medicine Department, Yale School of Medicine, 464 Congress Avenue, Suite #260, New Haven, CT 06450 USA
- Emergency Department, Yale New Haven Hospital, 20 York Street, New Haven, CT 06510 USA
- Yale School of Medicine, Yale New Haven Hospital, 464 Congress Avenue, Suite #260, New Haven, CT 06450 USA
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Sarangarm D, Lamb G, Weiss S, Ernst A, Hewitt L. Implementation of electronic charting is not associated with significant change in physician productivity in an academic emergency department. JAMIA Open 2018; 1:227-232. [PMID: 31984335 PMCID: PMC6951977 DOI: 10.1093/jamiaopen/ooy022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 05/23/2018] [Accepted: 05/26/2018] [Indexed: 11/17/2022] Open
Abstract
Objectives To compare physician productivity and billing before and after implementation of electronic charting in an academic emergency department (ED). Materials and methods This retrospective, blinded, observational study compared the 6 months pre-implementation (January to June 2012) with the 6 months post-implementation 1 year later (January to June 2013). Thirty-one ED physicians were recruited, with each physician acting as his/her own control in a before-after design. Productivity was measured via total number of encounters and “productivity index” defined as worked relative value units divided by the clinical full-time equivalent. Values for charges, encounters, and productivity index were determined during each study period and separately for procedures, observational stays, and critical care. Results No differences were found for total productivity index per month (758 [623-876] pre-group vs. 756 [673-886] post-group; P = 0.30). There was, however, a 9% decrease in total encounters per month (138 [101-163] pre-group vs. 125 [99-159] post-group; P = 0.01). Significant decreases were seen across all observation stay categories. Conversely, significant increases were seen across all critical care categories. There was no difference in total charges per month. Discussion This is one of few studies to demonstrate minimal disruption in physician productivity after transitioning to electronic documentation. The reasons for these findings are likely multi-factorial. Conclusion In this study, implementation of electronic charting was not associated with decreases in productivity or billing for total ED care, but may be associated with increases for critical care and decreases for observational stays.
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Affiliation(s)
- Dusadee Sarangarm
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Gregory Lamb
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Steven Weiss
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Amy Ernst
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Lorraine Hewitt
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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Inokuchi R, Maehara H, Iwai S, Iwagami M, Sato H, Yamaguchi Y, Asada T, Yamamoto M, Nakamura K, Hiruma T, Doi K, Morimura N. Interface design dividing physical findings into medical and trauma findings facilitates clinical document entry in the emergency department: A prospective observational study. Int J Med Inform 2018; 112:143-148. [PMID: 29500012 DOI: 10.1016/j.ijmedinf.2018.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 01/21/2018] [Accepted: 01/24/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE The interface design and its effect on workflow are key determinants of the usability of electronic medical records (EMRs) in the emergency department (ED). However, whether the overall clinical care can be improved by dividing the interface design of physical findings into medical and trauma findings is unknown. We previously developed an EMR system in which the checkpoints were separated into different sections according to the body part. Herein, we modified this EMR system by remaking the interface design specifically for trauma patients, and evaluated its performance. METHODS This study was undertaken in a single-center ED between October 2014 and September 2015. In the modified EMR system, all trauma findings are displayed together on the screen, according to the Japan Advanced Trauma Evaluation and Care. We compared the time to final documentation entry and the length of ED stay between the previous (used in the first 6 months) and current systems (used in the latter 6 months). Furthermore, we stratified the patients by triage levels. RESULTS The study involved 2141 patients (934 and 1207 assessed using the previous and modified EMR systems, respectively). The modified EMR in trauma patients significantly decreased the time to final documentation entry from 131.5 [interquartile range, 86.8-207.3] to 115 [78.8-161] min (p = 0.049). When stratifying trauma patients by triage level, significantly shorter clinical documentation times were observed with the modified EMR system in levels 2 (emergency) and 3 (urgent). CONCLUSIONS Using different interfaces for trauma findings shortened the time for clinical documentation for trauma patients.
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Affiliation(s)
- Ryota Inokuchi
- Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Emergency and Critical Care Medicine, JR Tokyo General Hospital, Yoyogi, Shibuya-ku, Tokyo, Japan.
| | - Hiromu Maehara
- Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Emergency and Critical Care Medicine, JR Tokyo General Hospital, Yoyogi, Shibuya-ku, Tokyo, Japan
| | - Satoshi Iwai
- Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Masao Iwagami
- London School of Hygiene and Tropical Medicine, Keppel St., Bloomsbury, London WC1E 7HT, United Kingdom
| | - Hajime Sato
- Department of Health Policy and Technology Assessment, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama 351-0197, Japan
| | - Yoko Yamaguchi
- Department of Emergency and Critical Care Medicine, JR Tokyo General Hospital, Yoyogi, Shibuya-ku, Tokyo, Japan
| | - Toshifumi Asada
- Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Miyuki Yamamoto
- Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kensuke Nakamura
- Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Takahiro Hiruma
- Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kent Doi
- Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Naoto Morimura
- Department of Acute Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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15
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Feblowitz J, Takhar SS, Ward MJ, Ribeira R, Landman AB. A Custom-Developed Emergency Department Provider Electronic Documentation System Reduces Operational Efficiency. Ann Emerg Med 2017; 70:674-682.e1. [PMID: 28712608 PMCID: PMC5653416 DOI: 10.1016/j.annemergmed.2017.05.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 05/13/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE Electronic health record implementation can improve care, but may also adversely affect emergency department (ED) efficiency. We examine how a custom, ED provider, electronic documentation system (eDoc), which replaced paper documentation, affects operational performance. METHODS We analyzed retrospective operational data for 1-year periods before and after eDoc implementation in a single ED. We computed daily operational statistics, reflecting 60,870 pre- and 59,337 postimplementation patient encounters. The prespecified primary outcome was daily mean length of stay; secondary outcomes were daily mean length of stay for admitted and discharged patients and daily mean arrival time to disposition for admitted patients. We used a prespecified multiple regression model to identify differences in outcomes while controlling for prespecified confounding variables. RESULTS The unadjusted change in length of stay was 8.4 minutes; unadjusted changes in secondary outcomes were length of stay for admitted patients 11.4 minutes, length of stay for discharged patients 1.8 minutes, and time to disposition 1.8 minutes. With a prespecified regression analysis to control for variations in operational characteristics, there were significant increases in length of stay (6.3 minutes [95% confidence interval 3.5 to 9.1 minutes]) and length of stay for discharged patients (5.1 minutes [95% confidence interval 1.9 to 8.3 minutes]). There was no statistically significant change in length of stay for admitted patients or time to disposition. CONCLUSION In our single-center study, the isolated implementation of eDoc was associated with increases in overall and discharge length of stay. Our findings suggest that a custom-designed electronic provider documentation may negatively affect ED throughput. Strategies to mitigate these effects, such as reducing documentation requirements or adding clinical staff, scribes, or voice recognition, would be a valuable area of future research.
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Affiliation(s)
- Joshua Feblowitz
- Harvard Medical School and the Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
| | - Sukhjit S Takhar
- Harvard Medical School and the Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
| | - Michael J Ward
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Ryan Ribeira
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
| | - Adam B Landman
- Harvard Medical School and the Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Information Systems, Partners HealthCare, Somerville, MA.
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16
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Kevat A. Communication with patients and carers during consultations using electronic medical records: Ensuring preparedness for challenges and opportunities. J Paediatr Child Health 2016; 52:788. [PMID: 27439649 DOI: 10.1111/jpc.13161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Ajay Kevat
- Paediatric Respiratory Department, Monash Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
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17
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Inokuchi R, Sato H, Iwagami M, Komaru Y, Iwai S, Gunshin M, Nakamura K, Shinohara K, Kitsuta Y, Nakajima S, Yahagi N. Impact of a New Medical Record System for Emergency Departments Designed to Accelerate Clinical Documentation: A Crossover Study. Medicine (Baltimore) 2015; 94:e856. [PMID: 26131837 PMCID: PMC4504572 DOI: 10.1097/md.0000000000000856] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Recording information in emergency departments (EDs) constitutes a major obstacle to efficient treatment. A new electronic medical records (EMR) system focusing on clinical documentation was developed to accelerate patient flow. The aim of this study was to examine the impact of a new EMR system on ED length of stay and physician satisfaction.We integrated a new EMR system at a hospital already using a standard system. A crossover design was adopted whereby residents were randomized into 2 groups. Group A used the existing EMR system first, followed by the newly developed system, for 2 weeks each. Group B followed the opposite sequence. The time required to provide overall medical care, length of stay in ED, and degree of physician satisfaction were compared between the 2 EMR systems.The study involved 6 residents and 526 patients (277 assessed using the standard system and 249 assessed with the new system). Mean time for clinical documentation decreased from 133.7 ± 5.1 minutes to 107.5 ± 5.4 minutes with the new EMR system (P < 0.001). The time for overall medical care was significantly reduced in all patient groups except triage level 5 (nonurgent). The new EMR system significantly reduced the length of stay in ED for triage level 2 (emergency) patients (145.4 ± 13.6 minutes vs 184.3 ± 13.6 minutes for standard system; P = 0.047). As for the degree of physician satisfaction, there was a high degree of satisfaction in terms of the physical findings support system and the ability to capture images and enter negative findings.The new EMR system shortened the time for overall medical care and was associated with a high degree of resident satisfaction.
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Affiliation(s)
- Ryota Inokuchi
- From the Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Bunkyo-ku (RI, YK, SI, MG, KN, YK, SN, NY); Department of General and Emergency Medicine, JR Tokyo General Hospital, Yoyogi, Shibuya-ku, Tokyo (RI, YK, SI); Department of Health Policy and Technology Assessment, National Institute of Public Health, Wako, Saitama, Japan (HS); London School of Hygiene and Tropical Medicine, Bloomsbury, London, UK (MI); and Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, Koriyama, Fukushima, Japan (KS)
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Neri PM, Redden L, Poole S, Pozner CN, Horsky J, Raja AS, Poon E, Schiff G, Landman A. Emergency medicine resident physicians' perceptions of electronic documentation and workflow: a mixed methods study. Appl Clin Inform 2015; 6:27-41. [PMID: 25848411 DOI: 10.4338/aci-2014-08-ra-0065] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 12/15/2014] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To understand emergency department (ED) physicians' use of electronic documentation in order to identify usability and workflow considerations for the design of future ED information system (EDIS) physician documentation modules. METHODS We invited emergency medicine resident physicians to participate in a mixed methods study using task analysis and qualitative interviews. Participants completed a simulated, standardized patient encounter in a medical simulation center while documenting in the test environment of a currently used EDIS. We recorded the time on task, type and sequence of tasks performed by the participants (including tasks performed in parallel). We then conducted semi-structured interviews with each participant. We analyzed these qualitative data using the constant comparative method to generate themes. RESULTS Eight resident physicians participated. The simulation session averaged 17 minutes and participants spent 11 minutes on average on tasks that included electronic documentation. Participants performed tasks in parallel, such as history taking and electronic documentation. Five of the 8 participants performed a similar workflow sequence during the first part of the session while the remaining three used different workflows. Three themes characterize electronic documentation: (1) physicians report that location and timing of documentation varies based on patient acuity and workload, (2) physicians report a need for features that support improved efficiency; and (3) physicians like viewing available patient data but struggle with integration of the EDIS with other information sources. CONCLUSION We confirmed that physicians spend much of their time on documentation (65%) during an ED patient visit. Further, we found that resident physicians did not all use the same workflow and approach even when presented with an identical standardized patient scenario. Future EHR design should consider these varied workflows while trying to optimize efficiency, such as improving integration of clinical data. These findings should be tested quantitatively in a larger, representative study.
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Affiliation(s)
- P M Neri
- Clinical & Quality Analysis , Partners HealthCare System, Wellesley, MA
| | - L Redden
- Clinical & Quality Analysis , Partners HealthCare System, Wellesley, MA
| | - S Poole
- Brigham and Women's Hospital , Boston, MA ; Neil and Elise Wallace STRATUS Center for Medical Simulation ; Simulation Consulting , Phoenix, Arizona, USA
| | - C N Pozner
- Brigham and Women's Hospital , Boston, MA ; Neil and Elise Wallace STRATUS Center for Medical Simulation ; Harvard Medical School , Boston, MA
| | - J Horsky
- Brigham and Women's Hospital , Boston, MA ; Harvard Medical School , Boston, MA
| | - A S Raja
- Brigham and Women's Hospital , Boston, MA ; Harvard Medical School , Boston, MA
| | - E Poon
- Boston Medical Center, Boston University School of Medicine , Boston, MA
| | - G Schiff
- Brigham and Women's Hospital , Boston, MA ; Harvard Medical School , Boston, MA
| | - A Landman
- Brigham and Women's Hospital , Boston, MA ; Harvard Medical School , Boston, MA
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19
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Yamamoto LG. Reducing emergency department charting and ordering errors with a room number watermark on the electronic medical record display. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2014; 73:322-328. [PMID: 25337450 PMCID: PMC4203453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A survey of Emergency Department (ED) clinicians (ie, physicians, nurses and clinical assistants) at a single hospital in Honolulu, Hawai'i was conducted to assess the frequency of errors in charting, and entering orders on the wrong patient's chart in the electronic medical record (EMR), and clinician opinion was sought on whether a simple watermark of the patient's room number might help reduce the number of these EMR "wrong patient errors." ED clinicians (68 total surveys) were asked if and how often they charted in the wrong patient's chart or entered an order (physicians only) in the wrong patient's chart. Physicians had a combined self-reported average error rate of 1.3%. Mean rate of patient charting errors occurred at 0.5 errors and 0.4 errors per 100 hours, for nurses and clinical assistants, respectively. The majority (81%) of the 68 clinicians surveyed felt that a room number watermark would eliminate most of the wrong patient errors. In conclusion, charting on the wrong patient and order entry on the wrong patient type errors occur with varying frequencies amongst ED clinicians. Nearly all the clinicians believe that a room number watermark might be an effective strategy to reduce these errors.
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Affiliation(s)
- Loren G Yamamoto
- Emergency Department, Kapi'olani Medical Center for Women & Children, Department of Pediatrics, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI
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20
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Inokuchi R, Sato H, Nakamura K, Aoki Y, Shinohara K, Gunshin M, Matsubara T, Kitsuta Y, Yahagi N, Nakajima S. Motivations and barriers to implementing electronic health records and ED information systems in Japan. Am J Emerg Med 2014; 32:725-30. [PMID: 24792932 DOI: 10.1016/j.ajem.2014.03.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/20/2014] [Accepted: 03/20/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although electronic health record systems (EHRs) and emergency department information systems (EDISs) enable safe, efficient, and high-quality care, these systems have not yet been studied well. Here, we assessed (1) the prevalence of EHRs and EDISs, (2) changes in efficiency in emergency medical practices after introducing EHR and EDIS, and (3) barriers to and expectations from the EHR-EDIS transition in EDs of medical facilities with EHRs in Japan. MATERIALS AND METHODS A survey regarding EHR (basic or comprehensive) and EDIS implementation was mailed to 466 hospitals. We examined the efficiency after EHR implementation and perceived barriers and expectations regarding the use of EDIS with existing EHRs. The survey was completed anonymously. RESULTS Totally, 215 hospitals completed the survey (response rate, 46.1%), of which, 76.3% had basic EHRs, 4.2% had comprehensive EHRs, and 1.9% had EDISs. After introducing EHRs and EDISs, a reduction in the time required to access previous patient information and share patient information was noted, but no change was observed in the time required to produce medical records and the overall time for each medical care. For hospitals with EHRs, the most commonly cited barriers to EDIS implementation were inadequate funding for adoption and maintenance and potential adverse effects on workflow. The most desired function in the EHR-EDIS transition was establishing appropriate clinical guidelines for residents within their system. CONCLUSION To attract EDs to EDIS from EHR, systems focusing on decreasing the time required to produce medical records and establishing appropriate clinical guidelines for residents are required.
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Affiliation(s)
- Ryota Inokuchi
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hajime Sato
- Department of Health Policy and Technology Assessment, National Institute of Public Health 2-3-6 Minami, Wako, Saitama 351-0197, Japan.
| | - Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yuta Aoki
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kazuaki Shinohara
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima 963-8558, Japan
| | - Masataka Gunshin
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Takehiro Matsubara
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yoichi Kitsuta
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Naoki Yahagi
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Susumu Nakajima
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Ward MJ, Landman AB, Case K, Berthelot J, Pilgrim RL, Pines JM. The effect of electronic health record implementation on community emergency department operational measures of performance. Ann Emerg Med 2014; 63:723-30. [PMID: 24412667 DOI: 10.1016/j.annemergmed.2013.12.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 11/15/2013] [Accepted: 12/11/2013] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE We study the effect of an emergency department (ED) electronic health record implementation on the operational metrics of a diverse group of community EDs. METHODS We performed a retrospective before/after analysis of 23 EDs from a single management group that experienced ED electronic health record implementation (with the majority of electronic health records optimized specifically for ED use). We obtained electronic data for 4 length of stay measures (arrival to provider, admitted, discharged, and overall length of stay) and 4 measures of operational characteristics (left before treatment complete, significant returns, overall patient satisfaction, and provider efficiency). We compared the 6-month "baseline" period immediately before implementation with a "steady-state" period commencing 6 months after implementation for all 8 metrics. RESULTS For the length of stay measures, there were no differences in the arrival-to-provider interval (difference of -0.02 hours; 95% confidence interval [CI] of difference -0.12 to 0.08), admitted length of stay (difference of 0.10 hours; 95% CI of difference -0.17 to 0.37), discharged length of stay (difference of 0.07 hours; 95% CI of difference -0.07 to 0.22), and overall length of stay (difference of 0.11 hours; 95% CI of difference -0.04 to 0.27). For operational characteristics, there were no differences in the percentage who left before treatment was complete (difference of 0.24%; 95% CI of difference -0.47% to 0.95%), significant returns (difference of -0.04%; 95% CI of difference -0.48% to 0.39%), overall percentile patient satisfaction (difference of -0.02%; 95% CI of difference -2.35% to 2.30%), and provider efficiency (difference of -0.05 patients/hour; 95% CI of difference -0.11 to 0.02). CONCLUSION There is no meaningful difference in 8 measures of operational performance for community EDs experiencing optimized ED electronic health record implementation between a baseline and steady-state period.
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Affiliation(s)
- Michael J Ward
- Department of Emergency Medicine, Vanderbilt University, Nashville, TN.
| | - Adam B Landman
- Department of Emergency Medicine, Harvard Medical School, Brigham and Women's Hospital
| | - Karen Case
- Emergency Medicine Division, Schumacher Group
| | | | | | - Jesse M Pines
- Departments of Emergency Medicine and Health Policy, George Washington University Medical Center
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