Marked Impact of Revised Hepatitis C Screening Guidelines with Electronic Medical Record Prompt on Screening of the 'Baby Boomer Cohort' by Primary Care Physicians

Background: The increasing use of electronic medical records (EMRs) presents an opportunity to efficiently evaluate and improve quality of care for individuals with MS. Objectives: We aimed to establish an algorithm to identify individuals with MS within EMRs. Methods: We used a sample of 73,003 adult patients from 83 primary care physicians in Ontario using the Electronic Medical Record Administrative data Linked Database (EMRALD). A reference standard of 247 individuals with MS was identified through chart abstraction. The accuracy of identifying individuals with MS in an EMR was assessed using information in the cumulative patient profile (CPP), prescriptions and physician billing codes. Results: An algorithm identifying MS in the CPP performed well with 91.5% sensitivity, 100% specificity, 98.7% PPV and 100% NPV. The addition of prescriptions for MS-specific medications and physician billing code 340 used four times within any 12-month timeframe slightly improved the sensitivity to 92.3% with a PPV of 97.9%. Conclusions: Data within an EMR can be used to accurately identify patients with MS. This study has positive implications for clinicians, researchers and policy makers as it provides the potential to identify cohorts of MS patients in the primary care setting to examine quality of care.

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Primary Care Physicians’ Experience Using Advanced Electronic Medical Record Features to Support Chronic Disease Prevention and Management: Qualitative Study

JMIR Medical Informatics ◽

10.2196/13318 ◽

2019 ◽

Vol 7 (4) ◽

pp. e13318 ◽

Cited By ~ 1

Author(s):

Rana Melissa Rahal ◽

Jay Mercer ◽

Craig Kuziemsky ◽

Sanni Yaya

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Disease Prevention ◽

Medical Record ◽

Chronic Diseases ◽

Electronic Medical Record ◽

Primary Care Physicians ◽

Evaluation Framework ◽

Chronic Disease Prevention

Background Chronic diseases are the leading cause of death worldwide. In Canada, more than half of all health care spending is used for managing chronic diseases. Although studies have shown that the use of advanced features of electronic medical record (EMR) systems improves the quality of chronic disease prevention and management (CDPM), a 2012 international survey found that Canadian physicians were the least likely to use 2 or more EMR system functions. Some studies show that maturity vis-à-vis clinicians’ EMR use is an important factor when evaluating the use of advanced features of health information systems. The Clinical Adoption Framework (CAF), a common evaluation framework used to assess the success of EMR adoption, does not incorporate the process of maturing. Nevertheless, the CAF and studies that discuss the barriers to and facilitators of the adoption of EMR systems can be the basis for exploring the use of advanced EMR features. Objective This study aimed to explore the factors that primary care physicians in Ontario identified as influencing their use of advanced EMR features to support CDPM and to extend the CAF to include primary care physicians’ perceptions of how their use of EMRs for performing clinical tasks has matured. Methods Guided by the CAF, directed content analysis was used to explore the barriers and facilitating factors encountered by primary care physicians when using EMR features. Participants were primary care physicians in Ontario, Canada, who use EMRs. Data were coded using categories from the CAF. Results A total of 9 face-to-face interviews were conducted from January 2017 to July 2017. Dimensions from the CAF emerged from the data, and one new dimension was derived: physicians’ perception of their maturity of EMR use. Primary care physicians identified the following key factors that impacted their use of advanced EMR features: performance of EMR features, information quality of EMR features, training and technical support, user satisfaction, provider’s productivity, personal characteristics and roles, cost benefits of EMR features, EMR systems infrastructure, funding, and government leadership. Conclusions The CAF was extended to include physicians’ perceptions of how their use of EMR systems had matured. Most participants agreed that their use of EMR systems for performing clinical tasks had evolved since their adoption of the system and that certain system features facilitated their care for patients with chronic diseases. However, several barriers were identified and should be addressed to further enhance primary care physicians’ use of advanced EMR features to support CDPM.

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Evaluating a post-implementation electronic medical record training intervention for diabetes management in primary care

BMJ Health & Care Informatics ◽

10.1136/bmjhci-2019-100086 ◽

2019 ◽

Vol 26 (1) ◽

pp. e100086

Author(s):

Gurprit Kaur Randhawa ◽

Aviv Shachak ◽

Karen L Courtney ◽

Andre Kushniruk

Keyword(s):

Primary Care ◽

Medical Record ◽

Electronic Medical Record ◽

Health Informatics ◽

Primary Care Physicians ◽

Best Practice ◽

Diabetes Management ◽

Small Scale ◽

Control Group ◽

Video Tutorials

ObjectiveThis study evaluated the potential for electronic medical record (EMR) video tutorials to improve diabetes (type 1 and 2) care processes by primary care physicians (PCP) using OSCAR EMR.DesignA QUAN(qual) mixed methods approach with an embedded design was used for the overall research study. EMR video tutorials were developed based on the chronic care model (CCM), value-adding EMR use, best practice guidelines for designing software video tutorials and clinician-led EMR training.ResultsIn total, 18 PCPs from British Columbia, Canada, participated in the study. The video EMR intervention elicited a statistically significant increase in EMR advanced feature use for diabetes care, with a large effect size (ie, F(1,51)=6.808, p<0.001, partial η2=0.286).ConclusionThis small-scale efficacy study demonstrates the potential of CCM-based EMR video tutorials to improve EMR use for chronic diseases, such as diabetes. A larger-scale effectiveness study with a control group is needed to further validate the study findings and determine their generalisability. The demonstrated efficacy of the intervention suggests that EMR video tutorials may be a cost-effective, sustainable and scalable strategy for supporting EMR optimisation and the continuous learning and development of PCPs. Health informatics practitioners may develop video tutorials for their respective EMR/electronic health record software based on theory and best practices for video tutorial design. For patients, EMR video tutorials may lead to improved tracking of processes of care for diabetes, and potentially other chronic conditions.

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Primary Care Physicians' Perspectives on the Ethical Impact of the Electronic Medical Record

The Journal of the American Board of Family Medicine ◽

10.3122/jabfm.2020.01.190154 ◽

2020 ◽

Vol 33 (1) ◽

pp. 106-117 ◽

Cited By ~ 1

Author(s):

Tania Moerenhout ◽

Gary S. Fischer ◽

Marlies Saelaert ◽

An De Sutter ◽

Veerle Provoost ◽

...

Keyword(s):

Primary Care ◽

Medical Record ◽

Electronic Medical Record ◽

Primary Care Physicians

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Improving adherence to hepatitis C screening guidelines

BMJ Open Quality ◽

10.1136/bmjoq-2017-000108 ◽

2018 ◽

Vol 7 (2) ◽

pp. e000108 ◽

Cited By ~ 5

Author(s):

Jane Trinh ◽

Nicholas Turner

Keyword(s):

Hepatitis C ◽

Medical Record ◽

Electronic Medical Record ◽

Primary Care Clinic ◽

Improvement Project ◽

Care Clinic ◽

Screening Guidelines ◽

Post Hoc Analysis ◽

Hcv Screening ◽

Post Hoc

BackgroundHepatitis C (HCV) is a viral liver disease that can result in cirrhosis, hepatocellular carcinoma, liver transplantation or death. The Centers for Disease Control (CDC) estimates that 2.7–3.9 million Americans are living with HCV, yet the majority are unaware. Starting in 2013, both CDC and US Preventative Services Task Force guidelines agreed in recommending HCV screening for all those born between 1945 and 1965 yet many clinics have been slow to adopt screening.ObjectiveWe designed a quality improvement project seeking to improve HCV screening rates among patients seen for new or annual visits to ≥90% over a 3-year period in an academic primary care clinic.MethodsScreening rates were assessed through repeated review of charts (50 per cycle or 300 charts total, roughly 35% of eligible visits) as a series of interventions were executed. Sustainability was assessed by repeating an additional 50-chart analysis 1 year after completion of the study interventions. At the conclusion of the study, a post hoc analysis of socioeconomic factors was undertaken to determine whether gender, income or ethnicity might affect screening rates.ResultsOver 6 cycles of interventions, screening rates improved from 24% to ≥90%. Screening rates remained at 88% 1 year after completion of the interventions. The most effective interventions used reminders built into our electronic medical record and informed providers of their personal HCV screening rates relative to the clinic as a whole. Our post hoc analysis found that lower socioeconomic standing and white race were associated with reduced likelihood of screening.ConclusionsProvider adoption of new HCV screening guidelines can be markedly and sustainably increased with electronic medical record prompts as well as directed feedback informing providers of their personal screening rates compared with colleagues.

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Primary Care Physicians’ Experience Using Advanced Electronic Medical Record Features to Support Chronic Disease Prevention and Management: Qualitative Study (Preprint)

10.2196/preprints.13318 ◽

2019 ◽

Author(s):

Rana Melissa Rahal ◽

Jay Mercer ◽

Craig Kuziemsky ◽

Sanni Yaya

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Disease Prevention ◽

Medical Record ◽

Chronic Diseases ◽

Electronic Medical Record ◽

Primary Care Physicians ◽

Evaluation Framework ◽

Chronic Disease Prevention

BACKGROUND Chronic diseases are the leading cause of death worldwide. In Canada, more than half of all health care spending is used for managing chronic diseases. Although studies have shown that the use of advanced features of electronic medical record (EMR) systems improves the quality of chronic disease prevention and management (CDPM), a 2012 international survey found that Canadian physicians were the least likely to use 2 or more EMR system functions. Some studies show that maturity vis-à-vis clinicians’ EMR use is an important factor when evaluating the use of advanced features of health information systems. The Clinical Adoption Framework (CAF), a common evaluation framework used to assess the success of EMR adoption, does not incorporate the process of maturing. Nevertheless, the CAF and studies that discuss the barriers to and facilitators of the adoption of EMR systems can be the basis for exploring the use of advanced EMR features. OBJECTIVE This study aimed to explore the factors that primary care physicians in Ontario identified as influencing their use of advanced EMR features to support CDPM and to extend the CAF to include primary care physicians’ perceptions of how their use of EMRs for performing clinical tasks has matured. METHODS Guided by the CAF, directed content analysis was used to explore the barriers and facilitating factors encountered by primary care physicians when using EMR features. Participants were primary care physicians in Ontario, Canada, who use EMRs. Data were coded using categories from the CAF. RESULTS A total of 9 face-to-face interviews were conducted from January 2017 to July 2017. Dimensions from the CAF emerged from the data, and one new dimension was derived: physicians’ perception of their maturity of EMR use. Primary care physicians identified the following key factors that impacted their use of advanced EMR features: performance of EMR features, information quality of EMR features, training and technical support, user satisfaction, provider’s productivity, personal characteristics and roles, cost benefits of EMR features, EMR systems infrastructure, funding, and government leadership. CONCLUSIONS The CAF was extended to include physicians’ perceptions of how their use of EMR systems had matured. Most participants agreed that their use of EMR systems for performing clinical tasks had evolved since their adoption of the system and that certain system features facilitated their care for patients with chronic diseases. However, several barriers were identified and should be addressed to further enhance primary care physicians’ use of advanced EMR features to support CDPM.

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