The Integration of e-health into the Clinical Workflow – Electronic Health Record and Standardization Efforts

2012 ◽  
pp. 107-115 ◽  
Author(s):  
Roberta Gazzarata ◽  
Fabio Vergari ◽  
Jan-Marc Verlinden ◽  
Francesco Morandi ◽  
Simone Naso ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Health Record ◽  
Clinical Workflow ◽  
Electronic Health

scholarly journals How well is the electronic health record supporting the clinical tasks of hospital physicians? A survey of physicians at three Norwegian hospitals

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Thomas Roger Schopf ◽  
Bente Nedrebø ◽  
Karl Ove Hufthammer ◽  
Inderjit Kaur Daphu ◽  
Hallvard Lærum
Keyword(s):  
Health Care ◽  
Electronic Health Record ◽  
Electronic Health Record System ◽  
System Stability ◽  
Medical Decision ◽  
Health Record ◽  
Clinical Workflow ◽  
Online Questionnaire ◽  
Record System ◽  
Electronic Health

Abstract Background The electronic health record is expected to improve the quality and efficiency of health care. Many novel functionalities have been introduced in order to improve medical decision making and communication between health care personnel. There is however limited evidence on whether these new functionalities are useful. The aim of our study was to investigate how well the electronic health record system supports physicians in performing basic clinical tasks. Methods Physicians of three prominent Norwegian hospitals participated in the survey. They were asked, in an online questionnaire, how well the hospital’s electronic health record system DIPS supported 49 clinical tasks as well as how satisfied they were with the system in general, including the technical performance. Two hundred and eight of 402 physicians (52%) submitted a completely answered questionnaire. Results Seventy-two percent of the physicians had their work interrupted or delayed because the electronic health record hangs or crashes at least once a week, while 22% had experienced this problem daily. Fifty-three percent of the physicians indicated that the electronic health record is cumbersome to use and adds to their workload. The majority of physicians were satisfied with managing tests, e.g., requesting laboratory tests, reading test results and managing radiological investigations and electrocardiograms. Physicians were less satisfied with managing referrals. There was high satisfaction with some of the decision support functionalities available for prescribing drugs. This includes drug interaction alerts and drug allergy warnings, which are displayed automatically. However, physicians were less satisfied with other aspects of prescribing drugs, including getting an overview of the ongoing drug therapy. Conclusions In the survey physicians asked for improvements of certain electronic health record functionalities like medication, clinical workflow support including planning and better overviews. In addition, there is apparently a need to focus on system stability, number of logins, reliability and better instructions on available electronic health record features. Considerable development is needed in current electronic health record systems to improve usefulness and satisfaction.

scholarly journals Electronic health record usability: analysis of the user-centered design processes of eleven electronic health record vendors

2015 ◽  
Vol 22 (6) ◽  
pp. 1179-1182 ◽  
Author(s):  
Raj M Ratwani ◽  
Rollin J Fairbanks ◽  
A Zachary Hettinger ◽  
Natalie C Benda
Keyword(s):  
Electronic Health Record ◽  
Health Record ◽  
User Centered Design ◽  
Clinical Workflow ◽  
Health Records ◽  
Diverse Range ◽  
Usability Analysis ◽  
Electronic Health ◽  
Certification Requirements ◽  
User Centered

Abstract The usability of electronic health records (EHRs) continues to be a point of dissatisfaction for providers, despite certification requirements from the Office of the National Coordinator that require EHR vendors to employ a user-centered design (UCD) process. To better understand factors that contribute to poor usability, a research team visited 11 different EHR vendors in order to analyze their UCD processes and discover the specific challenges that vendors faced as they sought to integrate UCD with their EHR development. Our analysis demonstrates a diverse range of vendors’ UCD practices that fall into 3 categories: well-developed UCD, basic UCD, and misconceptions of UCD. Specific challenges to practicing UCD include conducting contextually rich studies of clinical workflow, recruiting participants for usability studies, and having support from leadership within the vendor organization. The results of the study provide novel insights for how to improve usability practices of EHR vendors.

scholarly journals The electronic health record audit file: the patient is waiting

2016 ◽  
Vol 24 (e1) ◽  
pp. e28-e34 ◽  
Author(s):  
Annemarie G Hirsch ◽  
J B Jones ◽  
Virginia R Lerch ◽  
Xiaoqin Tang ◽  
Andrea Berger ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Wait Time ◽  
Clinical Encounter ◽  
Health Record ◽  
Clinical Workflow ◽  
Waiting Room ◽  
Exam Room ◽  
Physician Time ◽  
Nurse Time ◽  
Electronic Health

Objective: We describe how electronic health record (EHR) audit files can be used to understand how time is spent in primary care (PC). Materials/methods: We used audit file data from the Geisinger Clinic to quantify elements of the clinical workflow and to determine how these times vary by patient and encounter factors. We randomly selected audit file records representing 36 437 PC encounters across 26 clinic locations. Audit file data were used to estimate duration and variance of: (1) time in the waiting room, (2) nurse time with the patient, (3) time in the exam room without a nurse or physician, and (4) physician time with the patient. Multivariate modeling was used to test for differences by patient and by encounter features. Results: On average, a PC encounter took 54.6 minutes, with 5 minutes of nurse time, 15.5 minutes of physician time, and the remaining 62% of the time spent waiting to see a clinician or check out. Older age, female sex, and chronic disease were associated with longer wait times and longer time with clinicians. Level of service and numbers of medications, procedures, and lab orders were associated with longer time with clinicians. Late check-in and same-day visits were associated with shorter wait time and clinician time. Conclusions: This study provides insights on uses of audit file data for workflow analysis during PC encounters. Discussion: Scalable ways to quantify clinical encounter workflow elements may provide the means to develop more efficient approaches to care and improve the patient experience.

scholarly journals Implementation of Surprise Question Assessments using the Electronic Health Record in Older Adults with Advanced CKD

Kidney360 ◽  
2021 ◽  
pp. 10.34067/KID.0007062020
Author(s):  
Natalie C. Ernecoff ◽  
Khaled Abdel-Kader ◽  
Mangi Cai ◽  
Jonathan Yabes ◽  
Nirav Shah ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Electronic Health Record ◽  
Best Practice ◽  
Health Record ◽  
Clinical Workflow ◽  
Goals Of Care ◽  
Prognostic Utility ◽  
Electronic Health ◽  
Best Practice Alert ◽  
Surprise Question

Background. The Surprise Question (SQ; "Would you be surprised if this patient died in the next 12 months?") is a validated prognostication tool for mortality and hospitalization among patients with advanced CKD. Barriers in clinical workflow have slowed SQ implementation into practice. Objectives. (1) To evaluate implementation outcomes following use of electronic health record (EHR) decision support to automate collection of the SQ. (2) To assess the prognostic utility of the SQ for mortality and hospitalization/emergency room (ER) visits. Methods. We developed and implemented a best practice alert (BPA) in the electronic health record (EHR) to identify nephrology outpatients > 60 years of age with an eGFR<30 ml/min. At appointment, the BPA prompted the physician to answer the SQ. We assessed the rate and timeliness of provider responses. We conducted a post-hoc open-ended survey to assess physician perceptions of SQ implementation. We assessed the SQ's prognostic utility in survival and time-to-hospital encounter (hospitalization/ER visit) analyses. Results. Among 510 patients for whom the BPA triggered, 95 (18.6%) had the SQ completed by 16 physicians. Among those completed, nearly all (97.9%) were on appointment day, and 61 (64.2%) the first time the BPA fired. Providers answered "No" for 27 (28.4%) and "Yes" for 68 (71.6%) patients. By 12 months, 6 (22.2%) "No" patients died; 3 (4.4%) "Yes" patients died (hazards ratio [HR] 2.86, ref:Yes, 95% CI[1.06, 7.69]). About 35% of "No" patients and 32% of "Yes" patients had a hospital encounter by 12 months (HR 1.85, ref:Yes, 95% CI[0.93, 3.69]). Physicians noted (1) they had goals-of-care conversations unprompted; (2) EHR-based interventions alone for goals-of-care are ineffective; and (3) more robust engagement is necessary. Conclusions. We successfully integrated the SQ into the EHR to aid in clinical practice. Additional implementation efforts are needed to encourage further integration of the SQ in clinical practice.

scholarly journals A systematic review of the use of the electronic health record for patient identification, communication, and clinical support in palliative care

JAMIA Open ◽  
2018 ◽  
Vol 1 (2) ◽  
pp. 294-303 ◽  
Author(s):  
Ruth A Bush ◽  
Alexa Pérez ◽  
Tanja Baum ◽  
Caroline Etland ◽  
Cynthia D Connelly
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Electronic Health Record ◽  
Original Research ◽  
Health Record ◽  
Clinical Workflow ◽  
Patient Identification ◽  
Patient Reported ◽  
Electronic Health ◽  
Prospective Longitudinal

Abstract Objectives Globally, healthcare systems are using the electronic health record (EHR) and elements of clinical decision support (CDS) to facilitate palliative care (PC). Examination of published results is needed to determine if the EHR is successfully supporting the multidisciplinary nature and complexity of PC by identifying applications, methodology, outcomes, and barriers of active incorporation of the EHR in PC clinical workflow. Methods A systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The data sources PubMed, CINAL, EBSCOhost, and Academic Search Premier were used to identify literature published 1999–2017 of human subject peer-reviewed articles in English containing original research about the EHR and PC. Results The search returned 433 articles, 30 of which met inclusion criteria. Most studies were feasibility studies or retrospective cohort analyses; one study incorporated prospective longitudinal mixed methods. Twenty-three of 30 (77%) were published after 2014. The review identified five major areas in which the EHR is used to support PC. Studies focused on CDS to: identify individuals who could benefit from PC; electronic advanced care planning (ACP) documentation; patient-reported outcome measures (PROMs) such as rapid, real-time pain feedback; to augment EHR PC data capture capabilities; and to enhance interdisciplinary communication and care. Discussion Beginning in 2015, there was a proliferation of articles about PC and EHRs, suggesting increasing incorporation of and research about the EHR with PC. This review indicates the EHR is underutilized for PC CDS, facilitating PROMs, and capturing ACPs.

scholarly journals Generating Clinical Notes for Electronic Health Record Systems

2010 ◽  
Vol 01 (03) ◽  
pp. 232-243 ◽  
Author(s):  
W.W. Stead ◽  
J.C. Denny ◽  
D. Giuse ◽  
N.M. Lorenzi ◽  
S.H. Brown ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
System Development ◽  
Healthcare Providers ◽  
Content Standards ◽  
Health Record ◽  
Clinical Documentation ◽  
Clinical Workflow ◽  
Clinical Notes ◽  
Computer Based ◽  
Electronic Health

SummaryClinical notes summarize interactions that occur between patients and healthcare providers. With adoption of electronic health record (EHR) and computer-based documentation (CBD) systems, there is a growing emphasis on structuring clinical notes to support reusing data for subsequent tasks. However, clinical documentation remains one of the most challenging areas for EHR system development and adoption. The current manuscript describes the Vanderbilt experience with implementing clinical documentation with an EHR system. Based on their experience rolling out an EHR system that supports multiple methods for clinical documentation, the authors recommend that documentation method selection be made on the basis of clinical workflow, note content standards and usability considerations, rather than on a theoretical need for structured data.

Provider Burnout as it relates to the Electronic Health Record and Clinical Workflow

2020 ◽  
Vol 64 (1) ◽  
pp. 598-602
Author(s):  
Jason J. Saleem ◽  
Meredith Price ◽  
Jacob M. Read ◽  
Ki-Hwan Bae ◽  
Monica Gentili ◽  
...  
Keyword(s):  
Family Medicine ◽  
Electronic Health Record ◽  
Sociotechnical Systems ◽  
Health Record ◽  
Structured Interviews ◽  
Contributing Factors ◽  
Clinical Workflow ◽  
Consistent Finding ◽  
Workflow Integration ◽  
Electronic Health

Provider burnout has reached epidemic levels, especially with primary care-oriented specialties such as Family Medicine. Guided by a sociotechnical systems perspective, we investigated contributing burnout factors that relate to the electronic health record (EHR) and clinical workflow in an academic healthcare institution. We conducted semi-structured interviews with 10 family medicine and geriatrics providers and administered EHR usability and workflow integration surveys. Findings are organized around recurrent, overarching themes: (1) Clinic Workflow, (2) Documentation, (3) EHR Workflow and Usability, (4) Patient Complexity, (5) Staffing, and (6) Technical Issues. The most consistent finding across all provider interviews was poor EHR usability as a contributing factor to burnout; especially the number of clicks needed to complete EHR tasks. This finding is supported by low usability and workflow integration survey ratings. Using a sociotechnical systems framework, we demonstrate social, technological, and environmental contributors to burnout and discuss potential interventions to mitigate these contributing factors.

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