scholarly journals Best Paper Selection

2021 ◽  
Vol 30 (01) ◽  
pp. 103-104
Keyword(s):  
Primary Care ◽  
Health Status ◽  
Skin Cancer ◽  
Health Informatics ◽  
Digital Health ◽  
Health Record ◽  
Health Records ◽  
After Hours ◽  
Electronic Health ◽  
Primary Care Clinicians

Adler-Milstein J, Zhao W, Willard-Grace R, Knox M, Grumbach K. Electronic health records and burnout: Time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7647261/ Brewer LC, Fortuna KL, Jones C, Walker R, Hayes SN, Patten CA, Cooper LA. Back to the Future: Achieving Health Equity Through Health Informatics and Digital Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6996775/ Reading Turchioe M, Grossman LV, Myers AC, Baik D, Goyal P, Masterson Creber RM. Visual analogies, not graphs, increase patients' comprehension of changes in their health status. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309237 Tschandl P, Rinner C, Apalla Z, Argenziano G, Codella N, Halpern A, Janda M, Lallas A, Longo C, Josep Malvehy J, Paoli J, Puig S, Rosendahl C, Soyer HP, Zalaudek I, Kittler H. Human-computer collaboration for skin cancer recognition. https://www.nature.com/articles/s41591-020-0942-0

scholarly journals CM-SHARE: Development, Integration, and Adoption of an Electronic Health Record–Linked Digital Health Solution to Support Care for Diabetes in Primary Care

2019 ◽  
Vol 37 (4) ◽  
pp. 338-346
Author(s):  
James B. Jones ◽  
Shuting Liang ◽  
Hannah M. Husby ◽  
Jake K. Delatorre-Reimer ◽  
Cory A. Mosser ◽  
...  
Keyword(s):  
Primary Care ◽  
Electronic Health Record ◽  
Digital Health ◽  
Health Record ◽  
Electronic Health

scholarly journals Factors Associated With Electronic Health Record Usage Among Primary Care Physicians After Hours: Retrospective Cohort Study

10.2196/13779 ◽  
2019 ◽  
Vol 6 (3) ◽  
pp. e13779 ◽  
Author(s):  
Selasi Attipoe ◽  
Yungui Huang ◽  
Sharon Schweikhart ◽  
Steve Rust ◽  
Jeffrey Hoffman ◽  
...  
Keyword(s):  
Primary Care ◽  
Electronic Health Records ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Published Data ◽  
Health Records ◽  
Dominant Source ◽  
Factors Associated ◽  
After Hours ◽  
Electronic Health

Background There is limited published data on variation in physician usage of electronic health records (EHRs), particularly after hours. Research in this area could provide insight into the effects of EHR-related workload on physicians. Objective This study sought to examine factors associated with after-hours EHR usage among primary care physicians. Methods Electronic health records usage information was collected from primary care pediatricians in a large United States hospital. Inclusion criteria consisted solely of being a primary care physician who started employment with the hospital before the study period, so all eligible primary care physicians were included without sampling. Mixed effects statistical modeling was used to investigate the effects of age, gender, workload, normal-hour usage, week to week variation, and provider-to-provider variation on the after-hour usage of EHRs. Results There were a total of 3498 weekly records obtained on 50 physicians, of whom 22% were male and 78% were female. Overall, more EHR usage during normal work hours was associated with decreased usage after hours. The more work relative value units generated by physicians, the more time they spent interacting with EHRs after hours (β=.04, P<.001) and overall (ie, during normal hours and after hours) (β=.24, P<.001). Gender was associated with total usage time, with females spending more time than males (P=.03). However, this association was not observed with after-hours EHR usage. provider-to-provider variation was the largest and most dominant source of variation in after-hour EHR usage, which accounted for 52% of variance of total EHR usage. Conclusion The present study found that there is a considerable amount of variability in EHR use among primary care physicians, which suggested that many factors influence after-hours EHR usage by physicians. However, provider-to-provider variation was the largest and most dominant source of variation in after-hours EHR usage. While the results are intuitive, future studies should consider the effect of EHR use variations on workload efficiency.

scholarly journals Factors Associated With Electronic Health Record Usage Among Primary Care Physicians After Hours: Retrospective Cohort Study (Preprint)

2019 ◽  
Author(s):  
Selasi Attipoe ◽  
Yungui Huang ◽  
Sharon Schweikhart ◽  
Steve Rust ◽  
Jeffrey Hoffman ◽  
...  
Keyword(s):  
Primary Care ◽  
Electronic Health Records ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Published Data ◽  
Health Records ◽  
Dominant Source ◽  
Factors Associated ◽  
After Hours ◽  
Electronic Health

BACKGROUND There is limited published data on variation in physician usage of electronic health records (EHRs), particularly after hours. Research in this area could provide insight into the effects of EHR-related workload on physicians. OBJECTIVE This study sought to examine factors associated with after-hours EHR usage among primary care physicians. METHODS Electronic health records usage information was collected from primary care pediatricians in a large United States hospital. Inclusion criteria consisted solely of being a primary care physician who started employment with the hospital before the study period, so all eligible primary care physicians were included without sampling. Mixed effects statistical modeling was used to investigate the effects of age, gender, workload, normal-hour usage, week to week variation, and provider-to-provider variation on the after-hour usage of EHRs. RESULTS There were a total of 3498 weekly records obtained on 50 physicians, of whom 22% were male and 78% were female. Overall, more EHR usage during normal work hours was associated with decreased usage after hours. The more work relative value units generated by physicians, the more time they spent interacting with EHRs after hours (β=.04, <italic>P</italic>&lt;.001) and overall (ie, during normal hours and after hours) (β=.24, <italic>P</italic>&lt;.001). Gender was associated with total usage time, with females spending more time than males (<italic>P</italic>=.03). However, this association was not observed with after-hours EHR usage. provider-to-provider variation was the largest and most dominant source of variation in after-hour EHR usage, which accounted for 52% of variance of total EHR usage. CONCLUSION The present study found that there is a considerable amount of variability in EHR use among primary care physicians, which suggested that many factors influence after-hours EHR usage by physicians. However, provider-to-provider variation was the largest and most dominant source of variation in after-hours EHR usage. While the results are intuitive, future studies should consider the effect of EHR use variations on workload efficiency.

scholarly journals Electronic health records and burnout: Time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians

2020 ◽  
Vol 27 (4) ◽  
pp. 531-538 ◽  
Author(s):  
Julia Adler-Milstein ◽  
Wendi Zhao ◽  
Rachel Willard-Grace ◽  
Margae Knox ◽  
Kevin Grumbach
Keyword(s):  
Primary Care ◽  
Electronic Health Record ◽  
Academic Medical Center ◽  
Maslach Burnout Inventory ◽  
Health Record ◽  
Full Time ◽  
Full Time Equivalent ◽  
After Hours ◽  
Electronic Health ◽  
High Exhaustion

Abstract Objectives The study sought to determine whether objective measures of electronic health record (EHR) use—related to time, volume of work, and proficiency—are associated with either or both components of clinician burnout: exhaustion and cynicism. Materials and Methods We combined Maslach Burnout Inventory survey measures (94% response rate; 122 of 130 clinicians) with objective, vendor-defined EHR use measures from log files (time after hours on clinic days; time on nonclinic days; message volume; composite measures of efficiency and proficiency). Data were collected in early 2018 from all primary care clinics of a large, urban, academic medical center. Multivariate regression models measured the association between each burnout component and each EHR use measure. Results One-third (34%) of clinicians had high cynicism and 51% had high emotional exhaustion. Clinicians in the top 2 quartiles of EHR time after hours on scheduled clinic days (those above the sample median of 68 minutes per clinical full-time equivalent per week) had 4.78 (95% confidence interval [CI], 1.1-20.1; P = .04) and 12.52 (95% CI, 2.6-61; P = .002) greater odds of high exhaustion. Clinicians in the top quartile of message volume (&gt;307 messages per clinical full-time equivalent per week) had 6.17 greater odds of high exhaustion (95% CI, 1.1-41; P = .04). No measures were associated with high cynicism. Discussion EHRs have been cited as a contributor to clinician burnout, and self-reported data suggest a relationship between EHR use and burnout. As organizations increasingly rely on objective, vendor-defined EHR measures to design and evaluate interventions to reduce burnout, our findings point to the measures that should be targeted. Conclusions Two specific EHR use measures were associated with exhaustion.

scholarly journals 338Modelling the population distribution of patient-reported outcomes using electronic health records: a UK study

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Dahai Yu ◽  
Kelvin Jordan ◽  
James Bailey ◽  
George Peat ◽  
Ross Wilkie
Keyword(s):  
Primary Care ◽  
Health Status ◽  
Electronic Health Records ◽  
Prediction Models ◽  
Population Level ◽  
High Impact ◽  
Health Records ◽  
Final Model ◽  
Patient Reported ◽  
Electronic Health

Abstract Background Patient Reported Outcome Measures (PROM) collected in surveys allow understanding of the health at the population-level. We aimed to test the feasibility of estimating health status as measured by PROMs through ecological prediction models which use local linked survey and primary care electronic health records (EHR) and applying the models to national EHR. Methods 3,710 musculoskeletal consulters registered in 11 general practiced in North Staffordshire, UK and consented the linkage of their survey PROM (high impact pain, (HICP)) with EHR were included in this study. HICP was modelled by EHR predictors covering demographic, lifestyle risk factors, musculoskeletal diagnostic/problems, analgesic prescriptions, comorbidities, and deprivation. Final set of predictors were selected through backward elimination (p &gt; 0.1). Individual-level prediction models (binary logistic regression) were fitted and evaluated in terms of model fit statistics (AIC, BIC, R-square), discrimination (C-statistics) and calibration-slope with internal validation. The final model was cross-mapped to a national UK primary EHR database (Clinical Practice Research Database) to obtain national population estimates of high impact pain. Results The C-statistics and calibration-slope of the final model was 0.77 (95% confidence interval: 0.70-0.79) and 1.00 (0.92-1.08), respectively. The estimated HICP was 51.2% overall among 49,788 UK musculoskeletal consulters and matched hypothesised variation by gender, age, deprivation and geographical regions. Conclusions Estimation of population-level health status as measured by PROM using EHR appears feasible and has potential application in assessing health inequalities. Further independent external validation studies are warranted. Key messages Primary care EHR data could be modelled to predict population-level PROMs.

scholarly journals Electronic Health Record Effects on Work-Life Balance and Burnout Within the I3 Population Collaborative

2017 ◽  
Vol 9 (4) ◽  
pp. 479-484 ◽  
Author(s):  
Sandy L. Robertson ◽  
Mark D. Robinson ◽  
Alfred Reid
Keyword(s):  
Primary Care ◽  
Electronic Health Record ◽  
Work Life ◽  
Work Life Balance ◽  
Health Record ◽  
Life Balance ◽  
Practice Size ◽  
After Hours ◽  
Electronic Health ◽  
The Relationship

ABSTRACT Background  Physician burnout is a problem that often is attributed to the use of the electronic health record (EHR). Objective  To estimate the prevalence of burnout and work-life balance satisfaction in primary care residents and teaching physicians, and to examine the relationship between these outcomes, EHR use, and other practice and individual factors. Methods  Residents and faculty in 19 primary care programs were anonymously surveyed about burnout, work-life balance satisfaction, and EHR use. Additional items included practice size, specialty, EHR characteristics, and demographics. A logistic regression model identified independent factors associated with burnout and work-life balance satisfaction. Results  In total, 585 of 866 surveys (68%) were completed, and 216 (37%) respondents indicated 1 or more symptoms of burnout, with 162 (75%) attributing burnout to the EHR. A total of 310 of 585 (53%) reported dissatisfaction with work-life balance, and 497 (85%) indicated that use of the EHR affected their work-life balance. Respondents who spent more than 6 hours weekly after hours in EHR work were 2.9 times (95% confidence interval [CI] 1.9–4.4) more likely to report burnout and 3.9 times (95% CI 1.9–8.2) more likely to attribute burnout to the EHR. They were 0.33 times (95% CI 0.22–0.49) as likely to report work-life balance satisfaction, and 3.7 times (95% CI 2.1–6.7) more likely to attribute their work-life balance satisfaction to the EHR. Conclusions  More after-hours time spent on the EHR was associated with burnout and less work-life satisfaction in primary care residents and faculty.

Digital Health Interventions to Enhance Prevention in Primary Care: A Scoping Review (Preprint)

2021 ◽  
Author(s):  
Van C Willis ◽  
Kelly Jean Thomas Craig ◽  
Yalda Yabbarpour ◽  
Elisabeth L Scheufele ◽  
Yull E Arriaga ◽  
...  
Keyword(s):  
Primary Care ◽  
Electronic Health Record ◽  
Scoping Review ◽  
Subgroup Analysis ◽  
Care Management ◽  
Digital Health ◽  
Health Interventions ◽  
Health Record ◽  
Primary Care Settings ◽  
Electronic Health

BACKGROUND Digital transformation of primary care practices, including the use digital health interventions (DHIs), has yet to be systematically evaluated. OBJECTIVE To identify and describe the scope and use of current DHIs for preventive care in primary care settings. METHODS A scoping review to identify literature published from 2014 to 2020 was conducted across multiple databases using keywords and MeSH terms covering primary care professionals AND prevention and care management AND digital health. A subgroup analysis identified relevant studies conducted in US primary care settings excluding DHIs that use the electronic health record (EHR) as a retrospective data capture tool. Technology descriptions, outcomes (e.g., healthcare performance and implementation science), and study quality as per Oxford Levels of Evidence were abstracted. RESULTS The search yielded 5,274 citations of which 1,060 full-texts were identified. Following a subgroup analysis, 241 articles met inclusion criteria. Studies primarily examined DHIs among health information technology including EHRs (69%), clinical decision support (41%), telehealth (37%), or multiple technologies (61%). DHIs were predominantly used for tertiary prevention (55%). Of the core primary care functions, comprehensiveness was addressed most frequently (87%). DHI users were providers (85%), patients (46%), or multiples (37%). Reported outcomes were primarily clinical (70%) and statistically significant improvements were common (69%). Results were summarized across five topics for the most novel/distinct DHIs: population-centered, patient-centered, care access expansion, panel-centered (dashboarding), and application-driven DHIs. Quality of the included studies was moderate-to-low. CONCLUSIONS Preventive DHIs used in primary care settings demonstrated meaningful improvements in both clinical and non-clinical outcomes across user types; however, adoption and implementation in the US was limited to primarily electronic health record-centric platforms and users were mainly clinicians receiving alerts regarding care management for their patients. Evaluation of negative results, effects on health disparities, and many other gaps remain to be explored.

scholarly journals Physician Burnout and Timing of Electronic Health Record Use

ACI Open ◽  
2020 ◽  
Vol 04 (01) ◽  
pp. e1-e8 ◽  
Author(s):  
Mark A. Micek ◽  
Brian Arndt ◽  
Wen-Jan Tuan ◽  
Elizabeth Trowbridge ◽  
Shannon M. Dean ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Electronic Health Record ◽  
Work Hours ◽  
Care Practice ◽  
Health Record ◽  
Physician Burnout ◽  
After Hours ◽  
Electronic Health ◽  
The Relationship

Abstract Background Rates of burnout among physicians have been high in recent years. The electronic health record (EHR) is implicated as a major cause of burnout. Objective This article aimed to determine the association between physician burnout and timing of EHR use in an academic internal medicine primary care practice. Methods We conducted an observational cohort study using cross-sectional and retrospective data. Participants included primary care physicians in an academic outpatient general internal medicine practice. Burnout was measured with a single-item question via self-reported survey. EHR time was measured using retrospective automated data routinely captured within the institution's EHR. EHR time was separated into four categories: weekday work-hours in-clinic time, weekday work-hours out-of-clinic time, weekday afterhours time, and weekend/holiday after-hours time. Ordinal regression was used to determine the relationship between burnout and EHR time categories. Results EHR use during in-clinic sessions was related to burnout in both bivariate (odds ratio [OR] = 1.04, 95% confidence interval [CI]: 1.01, 1.06; p = 0.007) and adjusted (OR = 1.07, 95% CI: 1.03, 1.1; p = 0.001) analyses. No significant relationships were found between burnout and after-hours EHR use. Conclusion In this small single-institution study, physician burnout was associated with higher levels of in-clinic EHR use but not after-hours EHR use. Improved understanding of the variability of in-clinic EHR use, and the EHR tasks that are particularly burdensome to physicians, could help lead to interventions that better integrate EHR demands with clinical care and potentially reduce burnout. Further studies including more participants from diverse clinical settings are needed to further understand the relationship between burnout and after-hours EHR use.

Extended use of electronic health records by primary care physicians: Does the electronic health record artefact matter?

2017 ◽  
Vol 25 (1) ◽  
pp. 71-82 ◽  
Author(s):  
Louis Raymond ◽  
Guy Paré ◽  
Marie Marchand
Keyword(s):  
Primary Care ◽  
Electronic Health Record ◽  
Primary Care Physicians ◽  
Decisive Role ◽  
Population Data ◽  
Health Record ◽  
Functional Capability ◽  
Health Records ◽  
Software Products ◽  
Electronic Health

The deployment of electronic health record systems is deemed to play a decisive role in the transformations currently being implemented in primary care medical practices. This study aims to characterize electronic health record systems from the perspective of family physicians. To achieve this goal, we conducted a survey of physicians practising in private clinics located in Quebec, Canada. We used valid responses from 331 respondents who were found to be representative of the larger population. Data provided by the physicians using the top three electronic health record software products were analysed in order to obtain statistically adequate sub-sample sizes. Significant differences were observed among the three products with regard to their functional capability. The extent to which each of the electronic health record functionalities are used by physicians also varied significantly. Our results confirm that the electronic health record artefact ‘does matter’, its clinical functionalities explaining why certain physicians make more extended use of their system than others.

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