scholarly journals Creation and Use of an Electronic Health Record Reporting Database to Improve a Laboratory Test Utilization Program

2018 ◽  
Vol 09 (03) ◽  
pp. 519-527 ◽  
Author(s):  
Danielle Kurant ◽  
Jason Baron ◽  
Genti Strazimiri ◽  
Kent Lewandrowski ◽  
Joseph Rudolf ◽  
...  
Keyword(s):  
Information System ◽  
Laboratory Test ◽  
Electronic Health Record ◽  
Health Care Systems ◽  
Management Program ◽  
Health Record ◽  
Laboratory Information System ◽  
Utilization Management ◽  
Laboratory Utilization ◽  
Electronic Health

Objectives Laboratory-based utilization management programs typically rely primarily on data derived from the laboratory information system to analyze testing volumes for trends and utilization concerns. We wished to examine the ability of an electronic health record (EHR) laboratory orders database to improve a laboratory utilization program. Methods We obtained a daily file from our EHR containing data related to laboratory test ordering. We then used an automated process to import this file into a database to facilitate self-service queries and analysis. Results The EHR laboratory orders database has proven to be an important addition to our utilization management program. We provide three representative examples of how the EHR laboratory orders database has been used to address common utilization issues. We demonstrate that analysis of EHR laboratory orders data has been able to provide unique insights that cannot be obtained by review of laboratory information system data alone. Further, we provide recommendations on key EHR data fields of importance to laboratory utilization efforts. Conclusion We demonstrate that an EHR laboratory orders database may be a useful tool in the monitoring and optimization of laboratory testing. We recommend that health care systems develop and maintain a database of EHR laboratory orders data and integrate this data with their laboratory utilization programs.

scholarly journals The Benefits and Challenges of an Interfaced Electronic Health Record and Laboratory Information System: Effects on Laboratory Processes

2017 ◽  
Vol 141 (3) ◽  
pp. 410-417 ◽  
Author(s):  
Athena K. Petrides ◽  
Ida Bixho ◽  
Ellen M. Goonan ◽  
David W. Bates ◽  
Shimon Shaykevich ◽  
...  
Keyword(s):  
Information System ◽  
Electronic Health Record ◽  
Government Regulation ◽  
Turnaround Time ◽  
Health Record ◽  
Laboratory Information System ◽  
Before And After ◽  
Electronic Health ◽  
Ordered Data ◽  
The Impact

Context.— A recent government regulation incentivizes implementation of an electronic health record (EHR) with computerized order entry and structured results display. Many institutions have also chosen to interface their EHR with their laboratory information system (LIS). Objective.— To determine the impact of an interfaced EHR-LIS on laboratory processes. Design.— We analyzed several different processes before and after implementation of an interfaced EHR-LIS: the turnaround time, the number of stat specimens received, venipunctures per patient per day, preanalytic errors in phlebotomy, the number of add-on tests using a new electronic process, and the number of wrong test codes ordered. Data were gathered through the LIS and/or EHR. Results.— The turnaround time for potassium and hematocrit decreased significantly (P = .047 and P = .004, respectively). The number of stat orders also decreased significantly, from 40% to 7% for potassium and hematocrit, respectively (P < .001 for both). Even though the average number of inpatient venipunctures per day increased from 1.38 to 1.62 (P < .001), the average number of preanalytic errors per month decreased from 2.24 to 0.16 per 1000 specimens (P < .001). Overall there was a 16% increase in add-on tests. The number of wrong test codes ordered was high and it was challenging for providers to correctly order some common tests. Conclusions.— An interfaced EHR-LIS significantly improved within-laboratory turnaround time and decreased stat requests and preanalytic phlebotomy errors. Despite increasing the number of add-on requests, an electronic add-on process increased efficiency and improved provider satisfaction. Laboratories implementing an interfaced EHR-LIS should be cautious of its effects on test ordering and patient venipunctures per day.

scholarly journals eSyM: An Electronic Health Record–Integrated Patient-Reported Outcomes–Based Cancer Symptom Management Program Used by Six Diverse Health Systems

2022 ◽  
Author(s):  
Michael J. Hassett ◽  
Christine Cronin ◽  
Terrence C. Tsou ◽  
Jason Wedge ◽  
Jessica Bian ◽  
...  
Keyword(s):  
Health Care ◽  
Electronic Health Record ◽  
Symptom Management ◽  
Patient Reported Outcomes ◽  
Health Care Systems ◽  
Management Program ◽  
Health Record ◽  
Patient Reported ◽  
Care Systems ◽  
Electronic Health

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.

Business: The Electronic Health Record: Front Line Experience

2011 ◽  
Vol 21 (1) ◽  
pp. 18-22
Author(s):  
Rosemary Griffin
Keyword(s):  
Health Care ◽  
Information Technology ◽  
Electronic Health Record ◽  
Financial Incentives ◽  
Best Practice ◽  
Health Care Systems ◽  
The United States ◽  
Health Record ◽  
Health Trends ◽  
Electronic Health

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.

Transitioning from one Electronic Health Record (EHR) to Another: A Narrative Literature Review

2018 ◽  
Vol 62 (1) ◽  
pp. 489-493 ◽  
Author(s):  
Jason J. Saleem ◽  
Jennifer Herout
Keyword(s):  
Health Care ◽  
Literature Review ◽  
Electronic Health Record ◽  
Health Care Systems ◽  
Health Care Organization ◽  
Data Migration ◽  
Health Record ◽  
Care Organization ◽  
Healthcare Organizations ◽  
Electronic Health

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.

scholarly journals Real-Time Intraoperative Consultation Reporting in the Electronic Health Record

2020 ◽  
Vol 154 (3) ◽  
pp. 387-393
Author(s):  
Molly E Klein ◽  
Joseph W Rudolf ◽  
Maryna Tarbunova ◽  
Tanya Jorden ◽  
Susanna R Clark ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Real Time ◽  
Laboratory Medicine ◽  
Clinical Impact ◽  
Final Report ◽  
Health Record ◽  
Laboratory Information System ◽  
Surgical Team ◽  
Operative Note ◽  
Electronic Health

Abstract Objectives We sought to make pathologists’ intraoperative consultation (IOC) results immediately available to the surgical team, other clinicians, and laboratory medicine colleagues to improve communication and decrease postanalytic errors. Methods We created an IOC report in our stand-alone laboratory information system that could be signed out prior to, and independent of, the final report, and transfer immediately to the electronic health record (EHR) as a preliminary diagnosis. We evaluated two metrics: preliminary (IOC) result review in the EHR by clinicians and postanalytic errors. Results We assessed 2,886 IOC orders from the first 22 months after implementation. Clinicians reviewed 1,956 (68%) of the IOC results while in preliminary status, including 1,399 (48%) within the first 24 hours. We evaluated 150 cases preimplementation and 300 cases postimplementation for discrepancies between the pathologist’s IOC result and the IOC result recorded by the surgeon in the operative note. Discrepancies dropped from 12 of 150 preimplementation to 6 of 150 and 7 of 150 in postimplementation years 1 and 2. One of the 25 discrepancies had a major clinical impact. Conclusions Real-time reporting of IOC results to the EHR reliably transmits results immediately to clinical teams. This strategy reduces but does not eliminate postanalytic interpretive errors by clinical teams.

scholarly journals From screening to ascertainment of the primary outcome using electronic health records: Challenges in the STRIDE trial

2020 ◽  
Vol 17 (4) ◽  
pp. 346-350
Author(s):  
Denise Esserman
Keyword(s):  
Electronic Health Records ◽  
Electronic Health Record ◽  
Health Care Systems ◽  
Health Record ◽  
Electronic Health Record Data ◽  
Health Records ◽  
Record Data ◽  
Care Systems ◽  
Electronic Health ◽  
Data Elements

Electronic health record data are a rich resource and can be utilized to answer a wealth of research questions. It is important when using electronic health record data in clinical trials that systems be put in place and vetted prior to enrollment to ensure data elements can be collected consistently across all health care systems. It is often overlooked how something conceptualized on paper (e.g. use of the electronic health record in a study) can be difficult to implement in practice. This article discusses some of the challenges in using electronic health records in the conduct of the STRIDE (Strategies to Reduce Injuries and Develop Confidence in Elders) trial, how we handled those challenges, and the lessons we learned for the conduct of future trials looking to employ the electronic health record.

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