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Acholonu RG, Raphael JL. The Influence of the Electronic Health Record on Achieving Equity and Eliminating Health Disparities for Children. Pediatr Ann 2022; 51:e112-e117. [PMID: 35293812 DOI: 10.3928/19382359-20220215-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The electronic health record (EHR) has been heralded as a transformative approach to modernizing health care and advancing health equity. Access to the EHR can facilitate shared clinical decision-making and improved communication with patients, families, and among health care providers. Recent legislative and regulatory efforts have been passed to increase the transparency as well as the initiatives to increase the meaningful use of the EHR. Yet despite these well-intended efforts, challenges to addressing health equity through the EHR persist. This article reviews three distinct challenges to addressing health equity related to the EHR. We discuss (1) both the implicit and explicit bias that exist in EHR documentation, (2) the gaps that remain between screening for social determinants of health and the effective inclusion and billing of that screening into the EHR, and (3) the disparities that exist with the use of patient portals. Addressing these three areas will enhance the opportunities to advance health equity through the use of the EHR and bring us one step closer to eliminating health disparities in pediatric health care. [Pediatr Ann. 2022;51(3):e112-e117.].
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Gadomski AM, Riley MR, Scribani M, Tallman N. Impact of "Learn the Signs. Act Early." Materials on Parental Engagement and Doctor Interaction Regarding Child Development. J Dev Behav Pediatr 2018; 39:693-700. [PMID: 30059418 DOI: 10.1097/dbp.0000000000000604] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To measure the effectiveness of the "Learn the Signs. Act Early." (LTSAE) educational materials in increasing parent engagement in developmental monitoring during well-child visits. METHODS Exit surveys and analysis of audio-taped well-child visits were compared pre- versus post-LTSAE exposure. Before the LTSAE, parents were exposed to usual pediatric clinic developmental surveillance practices. After the LTSAE, parents received LTSAE materials before well-child visits, received age-specific LTSAE checklists at the clinic visit, and were exposed to LTSAE posters in examination rooms. Pediatricians attended a didactic session on developmental screening and LTSAE materials. Children evenly distributed among the ages of 2, 4, 6, 9, 12, and 18 months and 2 and 3 years were consecutively recruited at their well-child visits. After the visit, all parents completed exit surveys that assessed 5 a priori outcomes: milestone awareness, level of concern if the child is late in reaching a milestone, likelihood of bringing up a concern to the doctor, level of confidence in knowing what to do if concerned, or talking about child development during the visit. A 25% visit subsample was audio-taped, transcribed, and coded for parental engagement and nurse/doctor response to parental concern. RESULTS No demographic differences were found between the 181 parents enrolled before the LTSAE and 182 after the LTSAE. LTSAE exposure was significantly higher after the LTSAE (p < 0.0001). After the LTSAE, parent awareness of the number of milestones increased (p = 0.03). Audiotape analysis showed that parents were more engaged in discussions about development post-LTSAE versus pre-LTSAE. CONCLUSION The LTSAE may improve developmental surveillance by increasing parent's awareness of and discussion about milestones.
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Affiliation(s)
- Anne M Gadomski
- Center for Evaluating Rural Interventions, Bassett Research Institute, Cooperstown, NY
| | - Moira R Riley
- Bassett Research Institute, Center for Biostatistics, Bassett Medical Center, Cooperstown, NY
| | - Melissa Scribani
- Bassett Research Institute, Center for Biostatistics, Bassett Medical Center, Cooperstown, NY
| | - Nancy Tallman
- Center for Evaluating Rural Interventions, Bassett Research Institute, Cooperstown, NY
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Wald JS, Haque SN, Rizk S, Webb JR, Brown S, Ebron S, Lehmann CU, Frisse M, Shorte VA, Lomotan EA, Dailey BA, Johnson KB. Enhancing Health IT Functionality for Children: The 2015 Children's EHR Format. Pediatrics 2018. [PMID: 29519956 DOI: 10.1542/peds.2016-3894] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Electronic health record (EHR) use throughout the United States has advanced considerably, but functionality to support the optimal care of children has been slower to develop and deploy. A previous team of experts systematically identified gaps in EHR functionality during collaborative work from 2010 to 2013 that produced the Children's EHR Format (Format), funded under the Children's Health Insurance Program Reauthorization Act of 2009, Public Law 111-3. After that, a team of practitioners, software developers, health policy leaders, and other stakeholders examined the Format's exhaustive list of 547 EHR functional requirements in 26 topic areas and found them to be valuable but in need of further refinement and prioritization. Work began in 2014 to develop a shortened high priority list of requirements and provide guidance to improve their use. Through a modified Delphi process that included key document review, selection criteria, multiple rounds of voting, and small group discussion, a multistakeholder work group identified and refined 47 items on the basis of earlier requirements to form the 2015 Children's EHR Format Priority List and developed 16 recommended uses of the Format. The full report of the Format enhancement activities is publicly available. In this article, we aim to promote awareness of these high priority EHR functional requirements for the care of children, sharpen industry focus on adopting these changes, and align all stakeholders in prioritizing specific health information technology functionalities including those essential for well-child preventive care, medication management, immunization tracking, and growth data for specific pediatric subgroups.
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Affiliation(s)
| | | | | | | | | | | | - Christoph U Lehmann
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mark Frisse
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Edwin A Lomotan
- Agency for Healthcare Research and Quality, Bethesda, Maryland; and
| | | | - Kevin B Johnson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
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Hanauer DA, Branford GL, Greenberg G, Kileny S, Couper MP, Zheng K, Choi SW. Two-year longitudinal assessment of physicians' perceptions after replacement of a longstanding homegrown electronic health record: does a J-curve of satisfaction really exist? J Am Med Inform Assoc 2018; 24:e157-e165. [PMID: 27375291 DOI: 10.1093/jamia/ocw077] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 04/19/2016] [Indexed: 11/12/2022] Open
Abstract
This report describes a 2-year prospective, longitudinal survey of attending physicians in 3 clinical areas (family medicine, general pediatrics, internal medicine) who experienced a transition from a homegrown electronic health record (EHR) to a vendor EHR. Participants were already highly familiar with using EHRs. Data were collected 1 month before and 3, 6, 13, and 25 months post implementation. Our primary goal was to determine if perceptions followed a J-curve pattern in which they initially dropped but eventually surpassed baseline measures. A J-curve was not found for any measures, including workflow, safety, communication, and satisfaction. Only the reminders and alerts measure dropped and then returned to baseline (U-curve); a few remained flatlined. Most dropped and remained below baseline (L-curve). The only measure that remained above baseline was documenting in the exam room with the patient. This study adds to the literature about current controversies surrounding EHR adoption and physician satisfaction.
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Affiliation(s)
- David A Hanauer
- Department of Pediatrics, University of Michigan Health System.,School of Information, University of Michigan
| | - Greta L Branford
- Department of Internal Medicine, University of Michigan Health System
| | - Grant Greenberg
- Department of Family Medicine, University of Michigan Health System
| | - Sharon Kileny
- Department of Pediatrics, University of Michigan Health System
| | - Mick P Couper
- Institute for Social Research, University of Michigan
| | - Kai Zheng
- School of Information, University of Michigan.,School of Public Health, University of Michigan
| | - Sung W Choi
- Department of Pediatrics, University of Michigan Health System.,Blood and Marrow Transplantation Program, University of Michigan Health System
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Shea CM, Turner K, White BA, Zhu Y, Rozier RG. Providers' preferences for pediatric oral health information in the electronic health record: a cross-sectional survey. BMC Pediatr 2018; 18:5. [PMID: 29325519 PMCID: PMC5765629 DOI: 10.1186/s12887-017-0979-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/28/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The majority of primary care physicians support integration of children's oral health promotion and disease prevention into their practices but can experience challenges integrating oral health services into their workflow. Most electronic health records (EHRs) in primary care settings do not include oral health information for pediatric patients. Therefore, it is important to understand providers' preferences for oral health information within the EHR. The objectives of this study are to assess (1) the relative importance of various elements of pediatric oral health information for primary care providers to have in the EHR and (2) the extent to which practice and provider characteristics are associated with these information preferences. METHODS We surveyed a sample of primary care physicians who conducted Medicaid well-child visits in North Carolina from August - December 2013. Using descriptive statistics, we analyzed primary care physicians' oral health information preferences relative to their information preferences for traditional preventive aspects of well-child visits. Furthermore, we analyzed associations between oral health information preferences and provider- and practice-level characteristics using an ordinary least squares regression model. RESULTS Fewer primary care providers reported that pediatric oral health information is "very important," as compared to more traditional elements of primary care information, such as tracking immunizations. However, the majority of respondents reported some elements of oral health information as being very important. Also, we found positive associations between the percentage of well child visits in which oral health screenings and oral health referrals are performed and the reported importance of having pediatric oral health information in the EHR. CONCLUSIONS Incorporating oral health information into the EHR may be desirable for providers, particularly those who perform oral health screenings and dental referrals.
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Affiliation(s)
- Christopher M. Shea
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC USA
| | - Kea Turner
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC USA
| | - B. Alex White
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC USA
- Department of Dental Ecology, University of North Carolina at Chapel Hill, School of Dentistry, Chapel Hill, NC USA
| | - Ye Zhu
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC USA
| | - R. Gary Rozier
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC USA
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Mennemeyer ST, Menachemi N, Rahurkar S, Ford EW. Impact of the HITECH Act on physicians' adoption of electronic health records. J Am Med Inform Assoc 2015; 23:375-9. [PMID: 26228764 DOI: 10.1093/jamia/ocv103] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/17/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The Health Information Technology for Economic and Clinical Health (HITECH) Act has distributed billions of dollars to physicians as incentives for adopting certified electronic health records (EHRs) through the meaningful use (MU) program ultimately aimed at improving healthcare outcomes. The authors examine the extent to which the MU program impacted the EHR adoption curve that existed prior to the Act. METHODS Bass and Gamma Shifted Gompertz (G/SG) diffusion models of the adoption of "Any" and "Basic" EHR systems in physicians' offices using consistent data series covering 2001-2013 and 2006-2013, respectively, are estimated to determine if adoption was stimulated during either a PrePay (2009-2010) period of subsidy anticipation or a PostPay (2011-2013) period when payments were actually made. RESULTS Adoption of Any EHR system may have increased by as much as 7 percentage points above the level predicted in the absence of the MU subsidies. This estimate, however, lacks statistical significance and becomes smaller or negative under alternative model specifications. No substantial effects are found for Basic systems. The models suggest that adoption was largely driven by "imitation" effects (q-coefficient) as physicians mimic their peers' technology use or respond to mandates. Small and often insignificant "innovation" effects (p-coefficient) are found suggesting little enthusiasm by physicians who are leaders in technology adoption. CONCLUSION The authors find weak evidence of the impact of the MU program on EHR uptake. This is consistent with reports that many current EHR systems reduce physician productivity, lack data sharing capabilities, and need to incorporate other key interoperability features (e.g., application program interfaces).
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Affiliation(s)
- Stephen T Mennemeyer
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nir Menachemi
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Saurabh Rahurkar
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eric W Ford
- Department of Health Policy, Bloomberg School of Public Health, Johns Hopkins University, Baltimore MD, USA
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Nakamura MM, Harper MB, Castro AV, Yu FB, Jha AK. Impact of the meaningful use incentive program on electronic health record adoption by US children's hospitals. J Am Med Inform Assoc 2015; 22:390-8. [PMID: 25755126 DOI: 10.1093/jamia/ocu045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE We determined adoption rates of pediatric-oriented electronic health record (EHR) features by US children's hospitals and assessed perceptions regarding the suitability of commercial EHRs for pediatric care and the influence of the meaningful use incentive program on implementation of pediatric-oriented features. MATERIALS AND METHODS We surveyed members of the Children's Hospital Association. We measured adoption of 19 pediatric-oriented features and asked whether commercial EHRs include key pediatric-focused capabilities. We inquired about the meaningful use program's relevance to pediatrics and its influence on EHR implementation priorities. RESULTS Of 164 general acute care children's hospitals, 100 (61%) responded to the survey. Rates of comprehensive (across all pediatric units) adoption ranged from 37% (age-, gender-, and weight-adjusted blood pressure percentiles and immunization contraindication warnings) to 87% (age in appropriate units). Implementation rates for several features varied significantly by children's hospital type. Nearly 60% of hospitals reported having EHRs that do not contain all features essential for high-quality care. A majority of hospitals indicated that the meaningful use program has had no effect on their adoption of pediatric features, while 26% said they have delayed or forgone incorporation of such features because of the program. CONCLUSIONS Children's hospitals are implementing pediatric-focused features, but a sizable proportion still finds their systems suboptimal for pediatric care. The meaningful use incentive program is failing to promote and in some cases delaying uptake of pediatric-oriented features.
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Affiliation(s)
- Mari M Nakamura
- Division of Infectious Diseases Division of General Pediatrics
| | - Marvin B Harper
- Division of Infectious Diseases Division of Emergency Medicine Information Services Department, Boston Children's Hospital, Boston, MA, USA
| | | | - Feliciano B Yu
- Division of Hospitalist Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Ashish K Jha
- Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA Division of General Medicine, Brigham and Women's Hospital, Boston, MA, USA Veterans Affairs Boston Healthcare System, Boston, MA, USA
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Teufel RJ, Kazley AS, Andrews AL, Ebeling MD, Basco WT. Electronic medical record adoption in hospitals that care for children. Acad Pediatr 2013; 13:259-63. [PMID: 23680343 DOI: 10.1016/j.acap.2013.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 01/28/2013] [Accepted: 01/30/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Hospitals that care for children face unique barriers in electronic medical records (EMR) use that may affect their ability to meaningfully use EMR. The purpose of this study was to investigate hospitals that care for children, both freestanding and adult hospitals with children's services, to determine progress toward advanced stages of EMR use. METHODS The American Hospital Association survey described hospitals across the United States. Healthcare Information and Management Systems Society 2006 and 2010 databases identified hospitals' EMR use. EMR stage was classified according to previous studies. Multivariable analysis was used to determine independent predictors of EMR use. RESULTS The analysis included 2794 hospitals. During the study time frame, a significant increase occurred for hospitals moving into any stage of EMR in adult hospitals with children's services (47% to 75%; P < .001), while improvements for freestanding children's hospitals were modest at best (46% to 59%; P = .3). Conversely, freestanding children's hospitals had the largest gain in advance stage 3 adoption (6% to 39%; P < .001) compared to adult hospitals with children's services (6% to 23%; P < .001). Freestanding children's hospitals were less likely to use pharmacy information systems but more likely to use computerized provider order entry. CONCLUSIONS In 2010, freestanding children's hospitals had the highest percentage use of advanced stage EMR (39%), but the lowest improvements in percentage of hospitals entering into any stage of adoption over the study period. This trend created a digital divide among freestanding children's hospitals that may improve with pediatric-specific electronic medication management products.
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Affiliation(s)
- Ronald J Teufel
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA.
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