Business: The Electronic Health Record: Front Line Experience

2011 ◽  
Vol 21 (1) ◽  
pp. 18-22
Author(s):  
Rosemary Griffin

National legislation is in place to facilitate reform of the United States health care industry. The Health Care Information Technology and Clinical Health Act (HITECH) offers financial incentives to hospitals, physicians, and individual providers to establish an electronic health record that ultimately will link with the health information technology of other health care systems and providers. The information collected will facilitate patient safety, promote best practice, and track health trends such as smoking and childhood obesity.

Author(s):  
Jason J. Saleem ◽  
Jennifer Herout

This paper reports the results of a literature review of health care organizations that have transitioned from one electronic health record (EHR) to another. Ten different EHR to EHR transitions are documented in the academic literature. In eight of the 10 transitions, the health care organization transitioned to Epic, a commercial EHR which is dominating the market for large and medium hospitals and health care systems. The focus of the articles reviewed falls into two main categories: (1) data migration from the old to new EHR and (2) implementation of the new EHR as it relates to patient safety, provider satisfaction, and other measures pre-and post-transition. Several conclusions and recommendations are derived from this review of the literature, which may be informative for healthcare organizations preparing to replace an existing EHR. These recommendations are likely broadly relevant to EHR to EHR transitions, regardless of the new EHR vendor.


2016 ◽  
Vol 23 (6) ◽  
pp. 1060-1067 ◽  
Author(s):  
Victor W Zhong ◽  
Jihad S Obeid ◽  
Jean B Craig ◽  
Emily R Pfaff ◽  
Joan Thomas ◽  
...  

Abstract Objective To develop an efficient surveillance approach for childhood diabetes by type across 2 large US health care systems, using phenotyping algorithms derived from electronic health record (EHR) data. Materials and Methods Presumptive diabetes cases <20 years of age from 2 large independent health care systems were identified as those having ≥1 of the 5 indicators in the past 3.5 years, including elevated HbA1c, elevated blood glucose, diabetes-related billing codes, patient problem list, and outpatient anti-diabetic medications. EHRs of all the presumptive cases were manually reviewed, and true diabetes status and diabetes type were determined. Algorithms for identifying diabetes cases overall and classifying diabetes type were either prespecified or derived from classification and regression tree analysis. Surveillance approach was developed based on the best algorithms identified. Results We developed a stepwise surveillance approach using billing code–based prespecified algorithms and targeted manual EHR review, which efficiently and accurately ascertained and classified diabetes cases by type, in both health care systems. The sensitivity and positive predictive values in both systems were approximately ≥90% for ascertaining diabetes cases overall and classifying cases with type 1 or type 2 diabetes. About 80% of the cases with “other” type were also correctly classified. This stepwise surveillance approach resulted in a >70% reduction in the number of cases requiring manual validation compared to traditional surveillance methods. Conclusion EHR data may be used to establish an efficient approach for large-scale surveillance for childhood diabetes by type, although some manual effort is still needed.


Author(s):  
Malini Krishnamurthi, Ph.D.

The United States Federal government looks toward information technology to curtail health care costs while increasing the quality of patient care through the adoption of electronic health record (EHR)systems. This paper examined the experience of a hospital with its EHR system in the context of the pandemic. Results showed that the hospital maintains a state-of-the-art health care system to provide quality care to its community and was responsive to the recent crisis. The results were consistent with other comparable hospitals examined in this study. The hospitals were successful in adopting EHR systems. They were able to identify gaps that could be filled with technology add-ons from different software vendors to improve their functionality and thereby provide better & timely patient care. Managing large volumes of data generated in the normal process of EHR operation and ensuring data privacy and security were the significant challenges faced and are likely to continue in the future.


Author(s):  
Kristen MacIver ◽  
Madison N. Ngafeeson

Since the enactment of the United States Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, there has been substantial progress in the diffusion of Electronic Health Record (EHR) systems in medical clinics throughout the United States. Many physicians, however, continue to resist adopting EHR technology despite several accepted, long-term benefits and available government sponsored financial incentives. The objective of this article is to provide insight into the question as to why physicians are resistant to adopting EHR technology. This article details several of the benefits of EHR systems and uses a systematic review of literature to critically analyze and detail the most common perceived physician barriers to the adoption of EHRs. With the awareness of the major physician barriers to the adoption of EHR technology, stakeholders and policy makers can address barriers and pursue actions to mitigate or reduce physician resistance to achieve nationwide diffusion targets and pursue initiatives to digitize all patient records.


Author(s):  
Kristen MacIver ◽  
Madison N. Ngafeeson

Since the enactment of the United States Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, there has been substantial progress in the diffusion of electronic health record (EHR) systems in medical clinics throughout the United States. Many physicians, however, continue to resist adopting EHR technology despite several accepted, long-term benefits and available government-sponsored financial incentives. The objective of this chapter is to provide insight into the question as to why physicians are resistant to adopting EHR technology. This chapter details several of the benefits of EHR systems and uses a systematic review of literature to critically analyze and detail the most common perceived physician barriers to the adoption of EHRs. With the awareness of the major physician barriers to the adoption of EHR technology, stakeholders and policymakers can address barriers and pursue actions to mitigate or reduce physician resistance to achieve nationwide diffusion targets and pursue initiatives to digitize all patient records.


2014 ◽  
Vol 68 (6) ◽  
pp. 419 ◽  
Author(s):  
Marjan Ghazisaeedi ◽  
Niloofar Mohammadzadeh ◽  
Reza Safdari

ACI Open ◽  
2019 ◽  
Vol 03 (01) ◽  
pp. e37-e43
Author(s):  
Maria C. Dolce ◽  
Jessica L. Parker ◽  
Scott Jason ◽  
Catherine R. Ramos ◽  
John D. DaSilva

Background Several large health care systems in the United States have pioneered the integration of dentistry into their medical care delivery models. To date, no studies or case reports on combining medical information into the dental electronic health record within U.S. academic dental centers were found in the extant literature. Objective This report details how we developed and implemented customized primary care elements into axiUm, a popular dental practice management software primarily used in dental schools, to facilitate medical–dental clinical integration. This work was undertaken to provide the infrastructure for nurse practitioners and dentists to deliver a holistic, integrated, person-centered approach to care. Methods A multidisciplinary design team used the Centers for Disease Control and Prevention's Framework for Patient-centered Health Risk Assessments, an evidence-based framework to guide the adaptation of the existing axiUm dental record. The design featured individual data fields to source data, generate reports, and analyze information to improve clinical care and operations. Results To date, medical information on more than 260 dental patients over 600 clinic visits has been documented in the adapted electronic health record. Conclusion The customization capability of axiUm facilitated efficient and effective development and implementation processes. Training and user support were essential for effective implementation and led to further system refinements.


Author(s):  
Michael J. Hassett ◽  
Christine Cronin ◽  
Terrence C. Tsou ◽  
Jason Wedge ◽  
Jessica Bian ◽  
...  

PURPOSE Collecting patient-reported outcomes (PROs) can improve symptom control and quality of life, enhance doctor-patient communication, and reduce acute care needs for patients with cancer. Digital solutions facilitate PRO collection, but without robust electronic health record (EHR) integration, effective deployment can be hampered by low patient and clinician engagement and high development and deployment costs. The important components of digital PRO platforms have been defined, but procedures for implementing integrated solutions are not readily available. METHODS As part of the NCI's IMPACT consortium, six health care systems partnered with Epic to develop an EHR-integrated, PRO-based electronic symptom management program (eSyM) to optimize postoperative recovery and well-being during chemotherapy. The agile development process incorporated user-centered design principles that required engagement from patients, clinicians, and health care systems. Whenever possible, the system used validated content from the public domain and took advantage of existing EHR capabilities to automate processes. RESULTS eSyM includes symptom surveys on the basis of the PRO-Common Terminology Criteria for Adverse Events (PRO-CTCAE) plus two global wellness questions; reminders and symptom self-management tip sheets for patients; alerts and symptom reports for clinicians; and population management dashboards. EHR dependencies include a secure Health Insurance Portability and Accountability Act-compliant patient portal; diagnosis, procedure and chemotherapy treatment plan data; registries that identify and track target populations; and the ability to create reminders, alerts, reports, dashboards, and charting shortcuts. CONCLUSION eSyM incorporates validated content and leverages existing EHR capabilities. Build challenges include the innate technical limitations of the EHR, the constrained availability of site technical resources, and sites' heterogenous EHR configurations and policies. Integration of PRO-based symptom management programs into the EHR could help overcome adoption barriers, consolidate clinical workflows, and foster scalability and sustainability. We intend to make eSyM available to all Epic users.


2018 ◽  
Author(s):  
Weam Alfayez ◽  
Arwa Alumran ◽  
Dr Saja A. Al-Rayes

BACKGROUND Many theories/ models adopted from behavioral sciences literature or developed within the field of information technologies could help in understanding the technology acceptance, usage, and effective adoption. OBJECTIVE The main aim of this paper is to review the different theories/ models that can help in understanding information technology/system acceptance and use, and to choose the most appropriate theoretical framework that could be applied to understand the factors influencing physicians’ use of the Electronic Health Record system (EHR) at King Fahd Military Medical Complex (KFMMC) in Dhahran city, Saudi Arabia. METHODS The theories/ models were reviewed using scientific databases. The inclusion criteria were if the theories/ models used to explain individual behaviors toward accepting and using of information technology including the once conducted within the healthcare. RESULTS The review showed that there were five theories/ models were used within information technology studies to understand the technology acceptance and used. There were Theory of Reasoned Action, Theory of Planned Behaviour, Innovation Diffusion Theory, Unified theory of acceptance and use of technology, and Technology Acceptance Model. Each has different explanatory power of technology use. The most appropriate theoretical framework to understand the reason behind physician use of the EHR at KFMMC would be the Technology Acceptance Model (TAM). TAM model could explain up to 75% of the variation in the behavioral intention (acceptance), and up to 62% of the variation in the actual use. It is the gold standard for assessing the usage of health technologies and systems. In fact, the TAM model is one of the core models used to explore the physician’s perceptions of the Electronic Health Record system adoption. CONCLUSIONS This review showed that there are different theories available in the literature can be used to justify the reason behind electronic health record acceptance. TAM is one of the effective, simplest models used to understand the factors influencing physicians to use the EHR-system. Further studies need to apply the TAM model to check its ability in explaining the reason behind EHR within different hospitals in Saudi Arabia


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