scholarly journals The Financial and Clinical Impact of an Electronic Health Record Integrated Pathway in Elective Colon Surgery

2020 ◽  
Vol 11 (01) ◽  
pp. 095-103
Author(s):  
Jonathan S. Austrian ◽  
Frank Volpicelli ◽  
Simon Jones ◽  
Mitchell A. Bernstein ◽  
Jane Padikkala ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Electronic Health Record ◽  
Enhanced Recovery ◽  
Colon Surgery ◽  
Control Group ◽  
Health Record ◽  
Elective Colorectal Surgery ◽  
Electronic Health ◽  
Elective Colon Surgery ◽  
Elective Colon

Abstract Background Enhanced Recovery after Surgery (ERAS) pathways have been shown to reduce length of stay, but there have been limited evaluations of novel electronic health record (EHR)-based pathways. Compliance with ERAS in real-world settings has been problematic. Objective This article evaluates a novel ERAS electronic pathway (E-Pathway) activity integrated with the EHR for patients undergoing elective colorectal surgery. Methods We performed a retrospective cohort study of surgical patients age ≥ 18 years hospitalized from March 1, 2013 to August 31, 2016. The primary cohort consisted of patients admitted for elective colon surgery. We also studied a control group of patients undergoing other elective procedures. The E-Pathway was implemented on March 2, 2015. The primary outcome was variable costs per case. Secondary outcomes were observed to expected length of stay and 30-day readmissions. Results We included 823 (470 and 353 in the pre- and postintervention, respectively) colon surgery patients and 3,415 (1,819 and 1,596 in the pre- and postintervention) surgical control patients in the study. Among the colon surgery cohort, there was statistically significant (p = 0.040) decrease in costs of 1.28% (95% confidence interval [CI] 0.06–2.48%) per surgical encounter per month over the 18-month postintervention period, amounting to a total savings of $2,730 per patient at the 1-year postintervention period. The surgical control group had a nonsignificant (p = 0.231) decrease in monthly costs of 0.57% (95% CI 1.51 to – 0.37%) postintervention. For the 30-day readmission rates, there were no statistically significant changes in either cohort. Conclusion Our study is the first to report on the reduced costs after implementation of a novel sophisticated E-Pathway for ERAS. E-Pathways can be a powerful vehicle to support ERAS adoption.

Integrating a safety smart list into the electronic health record decreases intensive care unit length of stay and cost

2020 ◽  
Vol 57 ◽  
pp. 246-252
Author(s):  
Daniel L. Lemkin ◽  
Benoit Stryckman ◽  
Joel E. Klein ◽  
Jason W. Custer ◽  
William Bame ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Electronic Health Record ◽  
Unit Length ◽  
Intensive Care Unit Length ◽  
Health Record ◽  
Electronic Health

scholarly journals ERAS® Program in a Portuguese Hospital: Results from Elective Colorectal Surgery after One Year of Implementation

2020 ◽  
Vol 33 (9) ◽  
pp. 568
Author(s):  
André Carrão ◽  
Daniel Ribeiro ◽  
Maria Manso ◽  
Joana Oliveira ◽  
Luís Féria ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Length Of Stay ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Bowel Function ◽  
Control Group ◽  
Elective Colorectal Surgery ◽  
Improve Patient

Introduction: The Enhanced Recovery After Surgery® program comprises the implementation of various perioperative measures that reduce surgical stress and ultimately improve patient recovery and outcome. The purpose of this study is to evaluate the first-year compliance and clinical outcomes after implementation of the Enhanced Recovery After Surgery® program in elective colorectal surgery in our hospital.Material and Methods: An analysis was performed on the 210 patients who underwent elective colorectal surgery from May 2016 to December 2017. The group of patients that underwent surgery after the protocol implementation (Enhanced Recovery After Surgery® group) was compared to a conventional care control group (pre- Enhanced Recovery After Surgery® group). Differences between the two groups were adjusted using Propensity Score matching. The main outcomes were length of stay, return of bowel function, complications and mortality. The evolution of compliance with Enhanced Recovery After Surgery® principles was also analyzed.Results: After propensity score matching, 112 patients were included in the present study: 56 patients formed the pre-Enhanced Recovery After Surgery® group and 56 the Enhanced Recovery After Surgery® group. The overall adherence to the protocol increased from 35.7% to 80.8%. There was a decrease in length of stay, time to return of bowel function and medical complications.Discussion: The Enhanced Recovery After Surgery® program is safe and seems to shorten length of stay and improve patient recovery and clinical outcome.Conclusion: This study showed that the implementation of the Enhanced Recovery After Surgery® program was possible in Hospital Beatriz Ângelo, with a positive impact in the immediate postoperative recovery of colorectal patients.

Enhanced Ambulatory Electronic Health Record Training for Residents: Prospective Cohort Study. (Preprint)

2019 ◽  
Author(s):  
Shawn Y. Ong ◽  
Jesse O'Shea ◽  
Julie R. Rosenbaum
Keyword(s):  
Internal Medicine ◽  
Electronic Health Record ◽  
Control Group ◽  
Health Record ◽  
Orientation Programs ◽  
Course Content ◽  
Boot Camps ◽  
Ambulatory Training ◽  
Electronic Health ◽  
The Impact

BACKGROUND Physicians spend a significant amount of time with Electronic Health Record (EHR) systems but receive inadequate training. Prior studies have shown benefit from intern orientation programs such as “boot camps” for clinical knowledge or skills but few have examined courses for enhanced EHR orientation. OBJECTIVE To improve EHR clinic workflow processes and assess the impact of a structured course on intern confidence and preparedness. METHODS One faculty and two resident physicians spent approximately 30 hours creating a four-hour course curriculum, which was taught to a group of incoming Internal Medicine interns in June and July 2017. The interns completed a course feedback survey along with self-reported outpatient EHR workflow process confidence surveys at 1, 6, and 12 months. A control group also completed the same confidence surveys at the same intervals. RESULTS A total of 15 out of 18 Internal Medicine interns (83%) took the course. All 15 reported they learned useful information and had increased overall confidence. A majority (93%) agreed the course would allow them to provide better care for their patients and that the course content was best delivered by a physician. Most interns (80%) agreed the course should be a required part of internship. Confidence scores in eight major workflow areas significantly increased after the course and persisted throughout intern year. A control group of interns had low initial confidence scores that increased at 6 and 12 months. CONCLUSIONS A 4-hour targeted EHR ambulatory training course was feasible, highly rated, and increased workflow confidence scores for the first 6 months.

scholarly journals Electronic health record alerts enhance mass screening for chronic hepatitis B

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Eric Chak ◽  
Chin-Shang Li ◽  
Moon S. Chen ◽  
Scott MacDonald ◽  
Christopher Bowlus
Keyword(s):  
At Risk ◽  
Chronic Hepatitis ◽  
Hepatitis B ◽  
Electronic Health Record ◽  
Chronic Hepatitis B ◽  
Control Group ◽  
Health Record ◽  
Electronic Alerts ◽  
Electronic Health ◽  
And Control

Abstract To measure the effect of an electronic health record (EHR) alert on chronic hepatitis B (CHB) screening among at-risk Asian and Pacific Islanders (API). API patients who had not yet completed hepatitis B surface antigen (HBsAg) testing were identified by a novel EHR-based population health tool. At-risk API patients in Cohort 1 (primarily privately insured) and Cohort 2 (includes Medicare and/or Medicaid) were randomized to alert activation in their electronic medical charts or not. In total, 8299 API were found to be deficient in HBsAg completion at baseline within our health system. In Cohort 1, 1542 patients and 1568 patients were randomized to the alert and control respectively. In Cohort 2, 2599 patients and 2590 patients were randomized to the alert and control respectively. For both cohorts combined, 389 HBsAg tests were completed in the alert group compared to 177 HBsAg tests in the control group (p < 0.0001; OR = 2.3; 95% CI 1.94–2.80), but there was no increased detection of HBsAg positivity from the alert (15 versus 13 respectively, p = 0.09; OR = 0.5; 95% CI 0.24–1.09). Our results demonstrate that personalized, automated electronic alerts increase screening for CHB, but more comprehensive measures are needed to detect HBsAg positive patients. NIH Trial Registry Number: NCT04240678.

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.

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