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Boas PMV, Vieira LJEDS, da Silva GB, Lira GV, de Oliveira JGR. Implementation and use of electronic patient records in the Brazilian Air Force: a cross-sectional study1. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20231136. [PMID: 38716938 PMCID: PMC11068379 DOI: 10.1590/1806-9282.20231136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/05/2023] [Indexed: 05/12/2024]
Abstract
OBJECTIVE The objective was to analyze the implementation and use of the electronic patient record in the health services of the Brazilian Air Force. METHODS This is a cross-sectional study carried out with 234 physicians, between March and May 2021. The data collection instrument was sent by email. The electronic patient record was implemented in the Air Force approximately 3 years ago (64.5%), and about 81% of the physicians received training to operate it. RESULTS The most common records involve data related to consultations (90.1%) and interviews with physical examination (67.1%). Physicians cited that information storage (75.6%), agility, and feasibility of recording (55.1%) were the main advantages of the electronic patient record. As disadvantages, problems in electronic equipment (69.7%) and system errors (65%) were reported. Most participants considered that the implementation had a positive impact on work dynamics (75.6%) and productivity (66.7%), mainly regarding the components "Work processes" (57.3%) and "Amount of carried out activities" (21.4%). Keeping records was significantly associated with the job position (p<0.001), type of unit (p=0.008), time of implementation (p<0.001), and participation in training (p=0.028). CONCLUSION The implementation of the electronic patient record in the Air Force was recently done, and just over half of the physicians were trained prior to the implementation. The tool is considered compatible with work processes and has a positive effect on productivity.
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Boakye MD, Miyamoto S, Greenwood D, Kraschnewski J, Van Haitsma K, Boltz M. Pathway From Type 2 Diabetes Diagnosis to Action: How to Move People Forward. Diabetes Spectr 2023; 36:264-274. [PMID: 37583554 PMCID: PMC10425228 DOI: 10.2337/ds22-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
Seven self-care behaviors-healthy coping, healthy eating, being active, taking medication, monitoring, reducing risk, and problem-solving-are recommended for individuals with diabetes to achieve optimal health and quality of life. People newly diagnosed with type 2 diabetes may find it challenging to learn and properly incorporate all of these self-care behaviors into their life. This qualitative study explored the experiences and perceived immediate self-management and psychosocial support needs in individuals newly diagnosed with type 2 diabetes. Data analysis revealed the significant challenges individuals encounter after a type 2 diabetes diagnosis. Five main themes were identified: 1) type 2 diabetes diagnosis competes with other complex life challenges, 2) difficulty in performing behavior modification actions, 3) lack of support, 4) emergence of emotional and psychological issues, and 5) need for planned individualized follow-up support after a type 2 diabetes diagnosis. This study revealed a gap in care after type 2 diabetes diagnosis. Individualized support is needed to assist people in moving successfully from diagnosis to being well equipped with the knowledge and skills necessary to properly manage the condition.
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Affiliation(s)
- Michelle D.S. Boakye
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA
| | - Sheridan Miyamoto
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA
| | | | | | - Kimberly Van Haitsma
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA
| | - Marie Boltz
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA
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Al Ani M, Garas G, Hollingshead J, Cheetham D, Athanasiou T, Patel V. Which Electronic Health Record System Should We Use? A Systematic Review. Med Princ Pract 2022; 31:342-351. [PMID: 35584616 PMCID: PMC9485928 DOI: 10.1159/000525135] [Citation(s) in RCA: 4] [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] [Received: 10/09/2021] [Accepted: 05/16/2022] [Indexed: 11/19/2022] Open
Abstract
The UK government had intended to introduce a comprehensive Electronic Health Record (EHR) system in England by 2020. These EHRs would run across primary, secondary, and social care, linking data in a single digital platform. The objectives of this systematic review were to identify studies that compare EHR in terms of direct comparison between systems and to evaluate them using System and Software Quality Requirements and Evaluation (SQuaRE) ISO/IEC 25010. A systematic review was performed by searching Embase and Ovid MEDLINE databases between 1974 and April 2021. All original studies that appraised EHR systems and their providers were included. The main outcome measures were EHR system comparison and the eight characteristics of SQuaRE: functional suitability, performance efficiency, compatibility, usability, reliability, security, maintainability, and portability. A total of 724 studies were identified using the search criteria. After a review of titles and abstracts, this was filtered down to 40 studies as per the exclusion and inclusion criteria set out in our study. Seven studies compared more than one EHR. The following number of studies looked at the various aspects of the SQuaRE, respectively - 19 studies: functional suitability, performance efficiency: 18 studies, compatibility: 12 studies, usability: 25 studies, reliability: 6 studies, security: 2 studies, maintainability: 16 studies, portability: 13 studies. Epic was the most studied EHR system and one of the most implemented systems in the US market and one of the top ten in the UK. It is difficult to assess which is the most advantageous EHR system when they are assessed by SQuaRE's 8 characteristics for software evaluation.
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Affiliation(s)
- Mohammed Al Ani
- Department of Colorectal Surgery, West Hertfordshire Teaching Hospitals NHS Trust, Watford General Hospital, Watford, United Kingdom
| | - George Garas
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, United Kingdom
| | - James Hollingshead
- Department of Colorectal Surgery, West Hertfordshire Teaching Hospitals NHS Trust, Watford General Hospital, Watford, United Kingdom
| | - Drostan Cheetham
- Department of Colorectal Surgery, West Hertfordshire Teaching Hospitals NHS Trust, Watford General Hospital, Watford, United Kingdom
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, United Kingdom
| | - Vanash Patel
- Department of Colorectal Surgery, West Hertfordshire Teaching Hospitals NHS Trust, Watford General Hospital, Watford, United Kingdom
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, United Kingdom
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Alkureishi MA, Johnson T, Nichols J, Dhodapkar M, Czerwiec MK, Wroblewski K, Arora VM, Lee WW. Impact of an Educational Comic to Enhance Patient-Physician-Electronic Health Record Engagement: Prospective Observational Study. JMIR Hum Factors 2021; 8:e25054. [PMID: 33908891 PMCID: PMC8116991 DOI: 10.2196/25054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/06/2021] [Accepted: 03/18/2021] [Indexed: 01/16/2023] Open
Abstract
Background Electronic health record (EHR) use can impede or augment patient-physician communication. However, little research explores the use of an educational comic to improve patient-physician-EHR interactions. Objective To evaluate the impact of an educational comic on patient EHR self-advocacy behaviors to promote patient engagement with the EHR during clinic visits. Methods We conducted a prospective observational study with adult patients and parents of pediatric patients at the University of Chicago General Internal Medicine (GIM) and Pediatric Primary Care (PPC) clinics. We developed an educational comic highlighting EHR self-advocacy behaviors and distributed it to study participants during check-in for their primary care visits between May 2017 and May 2018. Participants completed a survey immediately after their visit, which included a question on whether they would be interested in a follow-up telephone interview. Of those who expressed interest, 50 participants each from the adult and pediatric parent cohorts were selected at random for follow-up telephone interviews 8 months (range 3-12 months) post visit. Results Overall, 71.0% (115/162) of adult patients and 71.6% (224/313) of pediatric parents agreed the comic encouraged EHR involvement. African American and Hispanic participants were more likely to ask to see the screen and become involved in EHR use due to the comic (adult P=.01, P=.01; parent P=.02, P=.006, respectively). Lower educational attainment was associated with an increase in parents asking to see the screen and to be involved (ρ=−0.18, P=.003; ρ=−0.19, P<.001, respectively) and in adults calling for physician attention (ρ=−0.17, P=.04), which was confirmed in multivariate analyses. Female GIM patients were more likely than males to ask to be involved (median 4 vs 3, P=.003). During follow-up phone interviews, 90% (45/50) of adult patients and all pediatric parents (50/50) remembered the comic. Almost half of all participants (GIM 23/50, 46%; PPC 21/50, 42%) recalled at least one best-practice behavior. At subsequent visits, adult patients reported increases in asking to see the screen (median 3 vs 4, P=.006), and pediatric parents reported increases in asking to see the screen and calling for physician attention (median 3 vs 4, Ps<.001 for both). Pediatric parents also felt that the comic had encouraged them to speak up and get more involved with physician computer use since the index visit (median 4 vs 4, P=.02) and that it made them feel more empowered to get involved with computer use at future visits (median 3 vs 4, P<.001). Conclusions Our study found that an educational comic may improve patient advocacy for enhanced patient-physician-EHR engagement, with higher impacts on African American and Hispanic patients and patients with low educational attainment.
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Affiliation(s)
- Maria A Alkureishi
- Department of Academic Pediatrics, University of Chicago, Chicago, IL, United States
| | - Tyrone Johnson
- Department of Internal Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Jacqueline Nichols
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Meera Dhodapkar
- Yale University School of Medicine, New Haven, CT, United States
| | - M K Czerwiec
- Center for Medical Humanities & Bioethics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kristen Wroblewski
- Department of Public Health Sciences, University of Chicago, Chicago, IL, United States
| | - Vineet M Arora
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Wei Wei Lee
- Department of Medicine, University of Chicago, Chicago, IL, United States
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Oliver D, Spada G, Colling C, Broadbent M, Baldwin H, Patel R, Stewart R, Stahl D, Dobson R, McGuire P, Fusar-Poli P. Real-world implementation of precision psychiatry: Transdiagnostic risk calculator for the automatic detection of individuals at-risk of psychosis. Schizophr Res 2021; 227:52-60. [PMID: 32571619 PMCID: PMC7875179 DOI: 10.1016/j.schres.2020.05.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Risk estimation models integrated into Electronic Health Records (EHRs) can deliver innovative approaches in psychiatry, but clinicians' endorsement and their real-world usability are unknown. This study aimed to investigate the real-world feasibility of implementing an individualised, transdiagnostic risk calculator to automatically screen EHRs and detect individuals at-risk for psychosis. METHODS Feasibility implementation study encompassing an in-vitro phase (March 2018 to May 2018) and in-vivo phase (May 2018 to April 2019). The in-vitro phase addressed implementation barriers and embedded the risk calculator (predictors: age, gender, ethnicity, index cluster diagnosis, age*gender) into the local EHR. The in-vivo phase investigated the real-world feasibility of screening individuals accessing secondary mental healthcare at the South London and Maudsley NHS Trust. The primary outcome was adherence of clinicians to automatic EHR screening, defined by the proportion of clinicians who responded to alerts from the risk calculator, over those contacted. RESULTS In-vitro phase: implementation barriers were identified/overcome with clinician and service user engagement, and the calculator was successfully integrated into the local EHR through the CogStack platform. In-vivo phase: 3722 individuals were automatically screened and 115 were detected. Clinician adherence was 74% without outreach and 85% with outreach. One-third of clinicians responded to the first email (37.1%) or phone calls (33.7%). Among those detected, cumulative risk of developing psychosis was 12% at six-month follow-up. CONCLUSION This is the first implementation study suggesting that combining precision psychiatry and EHR methods to improve detection of individuals with emerging psychosis is feasible. Future psychiatric implementation research is urgently needed.
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Affiliation(s)
- Dominic Oliver
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Giulia Spada
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Craig Colling
- National Institute for Health Research, Maudesley Biomedical Research Centre, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Matthew Broadbent
- National Institute for Health Research, Maudesley Biomedical Research Centre, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Helen Baldwin
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; National Institute for Health Research, Maudesley Biomedical Research Centre, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Rashmi Patel
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley Foundation Trust, London, United Kingdom
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Richard Dobson
- National Institute for Health Research, Maudesley Biomedical Research Centre, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Institute of Health Informatics Research, University College London, London, United Kingdom; Health Data Research UK London, University College London, London, United Kingdom
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; OASIS Service, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; National Institute for Health Research, Maudesley Biomedical Research Centre, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom; OASIS Service, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
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Poba-Nzaou P, Uwizeyemungu S, Liu X. Adoption and Performance of Complementary Clinical Information Technologies: Analysis of a Survey of General Practitioners. J Med Internet Res 2020; 22:e16300. [PMID: 32706715 PMCID: PMC7413273 DOI: 10.2196/16300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 04/12/2020] [Accepted: 05/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background The benefits from the combination of 4 clinical information systems (CISs)—electronic health records (EHRs), health information exchange (HIE), personal health records (PHRs), and telehealth—in primary care depend on the configuration of their functional capabilities available to clinicians. However, our empirical knowledge of these configurations and their associated performance implications is very limited because they have mostly been studied in isolation. Objective This study aims to pursue 3 objectives: (1) characterize general practitioners (GPs) by uncovering the typical profiles of combinations of 4 major CIS capabilities, (2) identify physician and practice characteristics that predict cluster membership, and (3) assess the variation in the levels of performance associated with each configuration. Methods We used data from a survey of GPs conducted throughout the European Union (N=5793). First, 4 factors, that is, EHRs, HIE, PHRs, and Telehealth, were created. Second, a cluster analysis helps uncover clusters of GPs based on the 4 factors. Third, we compared the clusters according to five performance outcomes using an analysis of variance (ANOVA) and a Tamhane T2 post hoc test. Fourth, univariate and multivariate multinomial logistic regressions were used to identify predictors of the clusters. Finally, with a multivariate multinomial logistic regression, among the clusters, we compared performance in terms of the number of patients treated (3 levels) over the last 2 years. Results We unveiled 3 clusters of GPs with different levels of CIS capability profiles: strong (1956/5793, 37.36%), medium (2764/5793, 47.71%), and weak (524/5793, 9.04%). The logistic regression analysis indicates that physicians (younger, female, and less experienced) and practice (solo) characteristics are significantly associated with a weak profile. The ANOVAs revealed a strong cluster associated with significantly high practice performance outcomes in terms of the quality of care, efficiency, productivity, and improvement of working processes, and two noncomprehensive medium and weak profiles associated with medium (equifinal) practice performance outcomes. The logistic regression analysis also revealed that physicians in the weak profile are associated with a decrease in the number of patients treated over the last 2 years. Conclusions Different CIS capability profiles may lead to similar equifinal performance outcomes. This underlines the importance of looking beyond the adoption of 1 CIS capability versus a cluster of capabilities when studying CISs. GPs in the strong cluster exhibit a comprehensive CIS capability profile and outperform the other two clusters with noncomprehensive profiles, leading to significantly high performance in terms of the quality of care provided to patients, efficiency of the practice, productivity of the practice, and improvement of working processes. Our findings indicate that medical practices should develop high capabilities in all 4 CISs if they have to maximize their performance outcomes because efforts to develop high capabilities selectively may only be in vain.
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Affiliation(s)
- Placide Poba-Nzaou
- Department of Organization and Human Resources, University of Quebec in Montreal, Montreal, QC, Canada
| | - Sylvestre Uwizeyemungu
- Accounting Department, University of Quebec in Trois-Rivières, Trois-Rivières, QC, Canada
| | - Xuecheng Liu
- Statistics Department, 12M Statistical Consulting Services, Montreal, QC, Canada
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Wall SA, Knauss B, Compston A, Redder E, Folefac E, Presley C, Rosko A. Multidisciplinary telemedicine and the importance of being seen. J Geriatr Oncol 2020; 11:1349-1351. [PMID: 32482554 PMCID: PMC7260477 DOI: 10.1016/j.jgo.2020.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sarah A Wall
- Division of Hematology, The Ohio State University, Columbus, OH, United States of America.
| | - Brittany Knauss
- The James Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Amy Compston
- The James Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Elyse Redder
- The James Comprehensive Cancer Center, Columbus, OH, United States of America
| | - Edmund Folefac
- Division of Medical Oncology, The Ohio State University, Columbus, OH, United States of America
| | - Carolyn Presley
- Division of Medical Oncology, The Ohio State University, Columbus, OH, United States of America
| | - Ashley Rosko
- Division of Hematology, The Ohio State University, Columbus, OH, United States of America
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Khoong EC, Cherian R, Matta GY, Lyles CR, Schillinger D, Ratanawongsa N. Perspectives of English, Chinese, and Spanish-Speaking Safety-Net Patients on Clinician Computer Use: Qualitative Analysis. J Med Internet Res 2019; 21:e13131. [PMID: 31120020 PMCID: PMC6549473 DOI: 10.2196/13131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/02/2019] [Accepted: 04/24/2019] [Indexed: 11/13/2022] Open
Abstract
Background Safety-net systems serve patients with limited health literacy and limited English proficiency (LEP) who face communication barriers. However, little is known about how diverse safety-net patients feel about increasing clinician electronic health record (EHR) use. Objective The aim of this study was to better understand how safety-net patients, including those with LEP, view clinician EHR use. Methods We conducted focus groups in English, Spanish, and Cantonese (N=37) to elicit patient perspectives on how clinicians use EHRs during clinic visits. Using a grounded theory approach, we coded transcripts to identify key themes. Results Across multiple language groups, participants accepted multitasking and silent clinician EHR use if focused on their care. However, participants desired more screen share and eye contact, especially when demonstrating physical concerns. All participants, including LEP participants, wanted clinicians to include them in EHR use. Conclusions Linguistically diverse patients accept the value of EHR use during outpatient visits but desire more eye contact, verbal warnings before EHR use, and screen-sharing. Safety-net health systems should support clinicians in completing EHR-related tasks during the visit using patient-centered strategies for all patients.
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Affiliation(s)
- Elaine C Khoong
- Division of General Internal Medicine, Department of Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
| | - Roy Cherian
- Division of General Internal Medicine, Department of Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States.,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
| | - George Y Matta
- School of Medicine, Boston University, Boston, MA, United States
| | - Courtney R Lyles
- Division of General Internal Medicine, Department of Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States.,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
| | - Dean Schillinger
- Division of General Internal Medicine, Department of Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States.,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
| | - Neda Ratanawongsa
- Division of General Internal Medicine, Department of Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States.,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, United States
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