Identifying best practices in electronic health record documentation to support interprofessional communication for the prevention of central line–associated bloodstream infections

With the aging United States population, healthcare costs have considerably increased and are expected to keep rising in the foreseeable future. In this paper, the authors propose an intelligent cloud-based electronic health record (ICEHR) system that has the potential to reduce medical errors and improve patients’ quality of life, in addition to reducing costs and increasing the productivity of healthcare organizations. They developed a set of best practices that encompass end-user policies and regulations, identity and access management, network resilience and service level agreements, advanced computational power, “Big Data” mining abilities, and other operational/managerial controls that are meant to improve the privacy and security of the ICEHR, and make it inherently compliant to healthcare regulations. These best practices serve as a framework that offers a single interconnection agreement between the cloud host and healthcare entities, and streamlines access to private patient information based on a unified set of access principles.

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Desiderata for the development of next-generation electronic health record phenotype libraries

GigaScience ◽

10.1093/gigascience/giab059 ◽

2021 ◽

Vol 10 (9) ◽

Author(s):

Martin Chapman ◽

Shahzad Mumtaz ◽

Luke V Rasmussen ◽

Andreas Karwath ◽

Georgios V Gkoutos ◽

...

Keyword(s):

Best Practices ◽

Electronic Health Record ◽

Health Record ◽

Next Generation ◽

Electronic Health Record Data ◽

High Quality ◽

Record Data ◽

Electronic Health ◽

Further Development

Abstract Background High-quality phenotype definitions are desirable to enable the extraction of patient cohorts from large electronic health record repositories and are characterized by properties such as portability, reproducibility, and validity. Phenotype libraries, where definitions are stored, have the potential to contribute significantly to the quality of the definitions they host. In this work, we present a set of desiderata for the design of a next-generation phenotype library that is able to ensure the quality of hosted definitions by combining the functionality currently offered by disparate tooling. Methods A group of researchers examined work to date on phenotype models, implementation, and validation, as well as contemporary phenotype libraries developed as a part of their own phenomics communities. Existing phenotype frameworks were also examined. This work was translated and refined by all the authors into a set of best practices. Results We present 14 library desiderata that promote high-quality phenotype definitions, in the areas of modelling, logging, validation, and sharing and warehousing. Conclusions There are a number of choices to be made when constructing phenotype libraries. Our considerations distil the best practices in the field and include pointers towards their further development to support portable, reproducible, and clinically valid phenotype design. The provision of high-quality phenotype definitions enables electronic health record data to be more effectively used in medical domains.

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Essential activities for electronic health record safety: A qualitative study

Health Informatics Journal ◽

10.1177/1460458219833109 ◽

2019 ◽

Vol 26 (4) ◽

pp. 3140-3151 ◽

Cited By ~ 2

Author(s):

Joan S Ash ◽

Hardeep Singh ◽

Adam Wright ◽

Dian Chase ◽

Dean F Sittig

Keyword(s):

Best Practices ◽

Electronic Health Record ◽

Rapid Assessment ◽

Clinical Decision ◽

Assessment Process ◽

Health Record ◽

Healthcare Organizations ◽

Safety Risks ◽

Electronic Health ◽

Clinical Systems

Electronic health record-caused safety risks are an unintended consequence of the implementation of clinical systems. To identify activities essential to assuring that the electronic health record is managed and used safely, we used the Rapid Assessment Process, a collection of qualitative methods. A multidisciplinary team conducted visits to five healthcare sites to learn about best practices. Although titles and roles were very different across sites, certain tasks considered necessary by our subjects were remarkably similar. We identified 10 groups of activities/tasks in three major areas. Area A, decision-making activities, included overseeing, planning, and reviewing to assure electronic health record safety. Area B, organizational learning activities, involved monitoring, testing, analyzing, and reporting. Finally, Area C, user-related activities, included training, communication, and building clinical decision support. To minimize electronic health record-related patient safety risks, leaders in healthcare organizations should ensure that these essential activities are performed.

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Implementation of a nationwide electronic health record (EHR)

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-09-2016-0136 ◽

2018 ◽

Vol 31 (2) ◽

pp. 116-130 ◽

Cited By ~ 12

Author(s):

Leonidas L. Fragidis ◽

Prodromos D. Chatzoglou

Keyword(s):

Best Practices ◽

Electronic Health Record ◽

Success Factors ◽

Implementation Process ◽

Success Factor ◽

Health Record ◽

System Implementation ◽

Content Type ◽

Electronic Health ◽

Specific Implementation

Purpose The purpose of this paper is to identify the best practices applied during the implementation process of a national electronic health record (EHR) system. Furthermore, the main goal is to explore the knowledge gained by experts from leading countries in the field of nationwide EHR system implementation, focusing on some of the main success factors and difficulties, or failures, of the various implementation approaches. Design/methodology/approach To gather the necessary information, an international survey has been conducted with expert participants from 13 countries (Denmark, Austria, Sweden, Norway, the UK, Germany, the Netherlands, Switzerland, Canada, the USA, Israel, New Zealand and South Korea), who had been playing varying key roles during the implementation process. Taking into consideration that each system is unique, with each own (different) characteristics and many stakeholders, the methodological approach followed was not oriented to offer the basis for comparing the implementation process, but rather, to allow us better understand some of the pros and cons of each option. Findings Taking into account the heterogeneity of each country’s financing mechanism and health system, the predominant EHR system implementation option is the middle-out approach. The main reasons which are responsible for adopting a specific implementation approach are usually political. Furthermore, it is revealed that the most significant success factor of a nationwide EHR system implementation process is the commitment and involvement of all stakeholders. On the other hand, the lack of support and the negative reaction to any change from the medical, nursing and administrative community is considered as the most critical failure factor. Originality/value A strong point of the current research is the inclusion of experts from several countries (13) spanning in four continents, identifying some common barriers, success factors and best practices stemming from the experience obtained from these countries, with a sense of unification. An issue that should never be overlooked or underestimated is the alignment between the functionality of the new EHR system and users’ requirements.

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Clinically excellent use of the electronic health record (Preprint)

10.2196/preprints.10426 ◽

2018 ◽

Author(s):

Leah Wolfe ◽

Margaret Smith Chisolm ◽

Fuad Bohsali

Keyword(s):

Best Practices ◽

Electronic Health Record ◽

Full Text ◽

English Language ◽

Interpersonal Skills ◽

Clinical Medicine ◽

Clinical Excellence ◽

Health Record ◽

Pubmed Database ◽

Electronic Health

UNSTRUCTURED The transition to the electronic health record (EHR) has brought forth a rapid cultural shift in the world of medicine, presenting both new challenges as well as opportunities for improving healthcare. As clinicians work to adapt to the changes imposed by the EHR, identification of best practices around the clinically excellent use of the EHR is needed. Using the domains of clinical excellence previously defined by the Johns Hopkins Miller Coulson Academy of Clinical Excellence (MCACE), this article aims to identify best practices around the clinically excellent use of the EHR. The authors searched the PubMed database, using keywords related to clinical excellence domains and the EHR, to capture the English-language, peer-reviewed literature published between January 1, 2000 and August 2, 2016. One author independently reviewed each article and extracted relevant data. The search identified 606 titles, the majority (n=393) in the domain of communication and interpersonal skills. Twenty-eight of the 606 titles were excluded from full-text review, primarily due to lack of availability of the full-text article. The 578 full-text articles reviewed were related to clinical excellence generally (n=3) or the specific domains of communication and interpersonal skills (n=380), diagnostic acumen (n=31), skillful negotiation of the health care system (n=4), scholarly approach to clinical practice (n=41), professionalism and humanism (n=2), knowledge (n=97), and passion for clinical medicine (n=20). Results suggest that - as familiarity and expertise is developed – clinicians are leveraging the EHR to provide clinically excellent care. Best practices identified included deliberate physical configuration of the clinical space to include sharing the screen with patients and limiting EHR use during difficult and emotional topics. Promising horizons for the EHR include the ability to augment participation in pragmatic trials, identify adverse drug effects, correlate genomic data to clinical outcomes, and follow data-driven guidelines. Clinician and patient satisfaction with the EHR has generally improved with time; and hopefully continued clinician and patient input will lead to a system that satisfies all.

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Interprofessional Communication Goes Up When the Electronic Health Record Goes Down

Journal of Surgical Education ◽

10.1016/j.jsurg.2018.08.024 ◽

2019 ◽

Vol 76 (2) ◽

pp. 512-518 ◽

Cited By ~ 6

Author(s):

Jane Y. Zhao ◽

Evan G. Kessler ◽

Weidun A. Guo

Keyword(s):

Electronic Health Record ◽

Health Record ◽

Interprofessional Communication ◽

Electronic Health

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Error by omission: A lack of integration across implementation and use in structuring health information technology contracts

Health Informatics Journal ◽

10.1177/1460458219898095 ◽

2020 ◽

Vol 26 (3) ◽

pp. 2202-2212

Author(s):

Thomas R Martin ◽

Hamlet Gasoyan ◽

David J Wierz

Keyword(s):

Information Technology ◽

Best Practices ◽

Electronic Health Record ◽

Health Information Technology ◽

Health Information ◽

Cost Of Care ◽

Assessment Process ◽

Healthcare Personnel ◽

Health Record ◽

Electronic Health

Limited work identifies best practices to assess functional electronic health record system performance when contracting for health information technology and information technology–related services. Without a set of best practices or specific contracting provisions to assess the performance of electronic health record systems, healthcare providers will not be able to fully leverage the performance of these systems to reduce the cost of care and improve patient outcomes. This work seeks to provide operational considerations and best practices when forming teams to negotiate health information technology system specifications in contracts. To better understand the contracting and performance assessment process, we conducted a cross-sectional survey of eligible healthcare personnel. Our study highlights a potential disconnect between respondents setting contract structure, knowledge of ongoing functional performance assessments in practice, and the relationship to those with direct system involvement to avoid potential legal risk.

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A framework for evaluating electronic health record vendor user-centered design and usability testing processes

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocw092 ◽

2016 ◽

Vol 24 (e1) ◽

pp. e35-e39 ◽

Cited By ~ 5

Author(s):

Raj M Ratwani ◽

A Zachary Hettinger ◽

Allison Kosydar ◽

Rollin J Fairbanks ◽

Michael L Hodgkins

Keyword(s):

Best Practices ◽

Human Factors ◽

Electronic Health Record ◽

Usability Testing ◽

End Users ◽

Health Record ◽

User Centered Design ◽

Electronic Health ◽

Certification Requirements ◽

User Centered

Objective: Currently, there are few resources for electronic health record (EHR) purchasers and end users to understand the usability processes employed by EHR vendors during product design and development. We developed a framework, based on human factors literature and industry standards, to systematically evaluate the user-centered design processes and usability testing methods used by EHR vendors. Materials and Methods: We reviewed current usability certification requirements and the human factors literature to develop a 15-point framework for evaluating EHR products. The framework is based on 3 dimensions: user-centered design process, summative testing methodology, and summative testing results. Two vendor usability reports were retrieved from the Office of the National Coordinator’s Certified Health IT Product List and were evaluated using the framework. Results: One vendor scored low on the framework (5 pts) while the other vendor scored high on the framework (15 pts). The 2 scored vendor reports demonstrate the framework’s ability to discriminate between the variabilities in vendor processes and to determine which vendors are meeting best practices. Discussion: The framework provides a method to more easily comprehend EHR vendors’ usability processes and serves to highlight where EHR vendors may be falling short in terms of best practices. The framework provides a greater level of transparency for both purchasers and end users of EHRs. Conclusion: The framework highlights the need for clearer certification requirements and suggests that the authorized certification bodies that examine vendor usability reports may need to be provided with clearer guidance.

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