scholarly journals A Collaborative Partnership between the Multicenter Handoff Collaborative and an Electronic Health Record Vendor

2021 ◽  
Vol 12 (03) ◽  
pp. 647-654
Author(s):  
Bommy Hong Mershon ◽  
Andrea Vannucci ◽  
Trent Bryson ◽  
Felix Lin ◽  
Philip E. Greilich ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Electronic Health Record ◽  
Working Group ◽  
Transitions Of Care ◽  
Health Record ◽  
Software Usability ◽  
Critical Elements ◽  
Care Processes ◽  
Electronic Health

Abstract Objectives The operating room is a specialized, complex environment with many factors that can impede effective communication during transitions of care between anesthesia clinicians. We postulated that an efficient, accessible, standardized tool for intraoperative handoffs built into standard workflow would improve communication and handoff safety. Most institutions now use an electronic health record (EHR) system for patient care and have independently designed intraoperative handoff tools, but these home-grown tools are not scalable to other organizations and lack vendor-supported features. The goal of this project was to create a standardized, intraoperative handoff tool supported by EHR functionality. Methods The Multicenter Handoff Collaborative, with support from the Anesthesia Patient Safety Foundation, created a working group of frontline anesthesia experts to collaborate with a development team from the EHR vendor (Epic Systems) to design a standardized intraoperative handoff tool. Over 2 years, the working group identified the critical elements for the tool and software usability, and the EHR team designed a standardized intraoperative handoff tool that is accessible to any institution using this EHR. Results The first iteration of the intraoperative handoff tool was released in August 2019, with a second version in February 2020. The tool is standardized but customizable by individual institutions. Conclusion We demonstrate that work on complex health care processes critical to patient safety, such as handoffs, can be performed on a national scale through cross-industry collaboration. Frontline experts can partner with health care industry vendors to design, build, and release a product on an accelerated timeline.

scholarly journals A Novel Patient Values Tab for the Electronic Health Record: A User-Centered Design Approach

10.2196/21615 ◽  
2021 ◽  
Vol 23 (2) ◽  
pp. e21615
Author(s):  
Anjali Varma Desai ◽  
Chelsea L Michael ◽  
Gilad J Kuperman ◽  
Gregory Jordan ◽  
Haley Mittelstaedt ◽  
...  
Keyword(s):  
Health Care ◽  
Electronic Health Record ◽  
User Experience ◽  
Working Group ◽  
Medical Oncology ◽  
Health Record ◽  
User Centered Design ◽  
Electronic Health ◽  
Patient Values ◽  
User Centered

Background The COVID-19 pandemic has shined a harsh light on a critical deficiency in our health care system: our inability to access important information about patients’ values, goals, and preferences in the electronic health record (EHR). At Memorial Sloan Kettering Cancer Center (MSK), we have integrated and systematized health-related values discussions led by oncology nurses for newly diagnosed cancer patients as part of routine comprehensive cancer care. Such conversations include not only the patient’s wishes for care at the end of life but also more holistic personal values, including sources of strength, concerns, hopes, and their definition of an acceptable quality of life. In addition, health care providers use a structured template to document their discussions of patient goals of care. Objective To provide ready access to key information about the patient as a person with individual values, goals, and preferences, we undertook the creation of the Patient Values Tab in our center’s EHR to display this information in a single, central location. Here, we describe the interprofessional, interdisciplinary, iterative process and user-centered design methodology that we applied to build this novel functionality as well as our initial implementation experience and plans for evaluation. Methods We first convened a working group of experts from multiple departments, including medical oncology, health informatics, information systems, nursing informatics, nursing education, and supportive care, and a user experience designer. We conducted in-depth, semistructured, audiorecorded interviews of over 100 key stakeholders. The working group sought consensus on the tab’s main content, homing in on high-priority areas identified by the stakeholders. The core content was mapped to various EHR data sources. We established a set of high-level design principles to guide our process. Our user experience designer then created wireframes of the tab design. The designer conducted usability testing with physicians, nurses, and other health professionals. Data validation testing was conducted. Results We have already deployed the Patient Values Tab to a pilot sample of users in the MSK Gastrointestinal Medical Oncology Service, including physicians, advanced practice providers, nurses, and administrative staff. We have early evidence of the positive impact of this EHR innovation. Audit logs show increasing use. Many of the initial user comments have been enthusiastically positive, while others have provided constructive suggestions for additional tab refinements with respect to format and content. Conclusions It is our challenge and obligation to enrich the EHR with information about the patient as a person. Realization of this capability is a pressing public health need requiring the collaboration of technological experts with a broad range of clinical leaders, users, patients, and families to achieve solutions that are both principled and practical. Our new Patient Values Tab represents a step forward in this important direction.

scholarly journals A Novel Patient Values Tab for the Electronic Health Record: A User-Centered Design Approach (Preprint)

2020 ◽  
Author(s):  
Anjali Varma Desai ◽  
Chelsea L Michael ◽  
Gilad J Kuperman ◽  
Gregory Jordan ◽  
Haley Mittelstaedt ◽  
...  
Keyword(s):  
Health Care ◽  
Electronic Health Record ◽  
User Experience ◽  
Working Group ◽  
Medical Oncology ◽  
Health Record ◽  
User Centered Design ◽  
Electronic Health ◽  
Patient Values ◽  
User Centered

BACKGROUND The COVID-19 pandemic has shined a harsh light on a critical deficiency in our health care system: our inability to access important information about patients’ values, goals, and preferences in the electronic health record (EHR). At Memorial Sloan Kettering Cancer Center (MSK), we have integrated and systematized health-related values discussions led by oncology nurses for newly diagnosed cancer patients as part of routine comprehensive cancer care. Such conversations include not only the patient’s wishes for care at the end of life but also more holistic personal values, including sources of strength, concerns, hopes, and their definition of an acceptable quality of life. In addition, health care providers use a structured template to document their discussions of patient goals of care. OBJECTIVE To provide ready access to key information about the patient as a person with individual values, goals, and preferences, we undertook the creation of the Patient Values Tab in our center’s EHR to display this information in a single, central location. Here, we describe the interprofessional, interdisciplinary, iterative process and user-centered design methodology that we applied to build this novel functionality as well as our initial implementation experience and plans for evaluation. METHODS We first convened a working group of experts from multiple departments, including medical oncology, health informatics, information systems, nursing informatics, nursing education, and supportive care, and a user experience designer. We conducted in-depth, semistructured, audiorecorded interviews of over 100 key stakeholders. The working group sought consensus on the tab’s main content, homing in on high-priority areas identified by the stakeholders. The core content was mapped to various EHR data sources. We established a set of high-level design principles to guide our process. Our user experience designer then created wireframes of the tab design. The designer conducted usability testing with physicians, nurses, and other health professionals. Data validation testing was conducted. RESULTS We have already deployed the Patient Values Tab to a pilot sample of users in the MSK Gastrointestinal Medical Oncology Service, including physicians, advanced practice providers, nurses, and administrative staff. We have early evidence of the positive impact of this EHR innovation. Audit logs show increasing use. Many of the initial user comments have been enthusiastically positive, while others have provided constructive suggestions for additional tab refinements with respect to format and content. CONCLUSIONS It is our challenge and obligation to enrich the EHR with information about the patient as a person. Realization of this capability is a pressing public health need requiring the collaboration of technological experts with a broad range of clinical leaders, users, patients, and families to achieve solutions that are both principled and practical. Our new Patient Values Tab represents a step forward in this important direction.

scholarly journals Transitions from One Electronic Health Record to Another: Challenges, Pitfalls, and Recommendations

2020 ◽  
Vol 11 (05) ◽  
pp. 742-754
Author(s):  
Chunya Huang ◽  
Ross Koppel ◽  
John D. McGreevey ◽  
Catherine K. Craven ◽  
Richard Schreiber
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Electronic Health Record ◽  
Care Delivery ◽  
Mesh Term ◽  
Unintended Consequences ◽  
Health Record ◽  
Medical Subject Headings ◽  
Extensive Experience ◽  
Electronic Health

Abstract Objective We address the challenges of transitioning from one electronic health record (EHR) to another—a near ubiquitous phenomenon in health care. We offer mitigating strategies to reduce unintended consequences, maximize patient safety, and enhance health care delivery. Methods We searched PubMed and other sources to identify articles describing EHR-to-EHR transitions. We combined these references with the authors' extensive experience to construct a conceptual schema and to offer recommendations to facilitate transitions. Results Our PubMed query retrieved 1,351 citations: 43 were relevant for full paper review and 18 met the inclusion criterion of focus on EHR-to-EHR transitions. An additional PubMed search yielded 1,014 citations, for which we reviewed 74 full papers and included 5. We supplemented with additional citations for a total of 70 cited. We distinguished 10 domains in the literature that overlap yet present unique and salient opportunities for successful transitions and for problem mitigation. Discussion There is scant literature concerning EHR-to-EHR transitions. Identified challenges include financial burdens, personnel resources, patient safety threats from limited access to legacy records, data integrity during migration, cybersecurity, and semantic interoperability. Transition teams must overcome inadequate human infrastructure, technical challenges, security gaps, unrealistic providers' expectations, workflow changes, and insufficient training and support—all factors affecting potential clinician burnout. Conclusion EHR transitions are remarkably expensive, laborious, personnel devouring, and time consuming. The paucity of references in comparison to the topic's salience reinforces the necessity for this type of review and analysis. Prudent planning may streamline EHR transitions and reduce expenses. Mitigating strategies, such as preservation of legacy data, managing expectations, and hiring short-term specialty consultants can overcome some of the greatest hurdles. A new medical subject headings (MeSH) term for EHR transitions would facilitate further research on this topic.

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.

What Can Human Factors Contribute to Improve Electronic Health Record Usability and Patient Safety?

2012 ◽  
Author(s):  
Robert Schumacher ◽  
Robert North ◽  
Matthew Quinn ◽  
Emily S. Patterson ◽  
Laura G. Militello ◽  
...  
Keyword(s):  
Patient Safety ◽  
Human Factors ◽  
Electronic Health Record ◽  
Health Record ◽  
Electronic Health

Uji Validitas Dan Reliabilitas Kuesioner Pengukuran Kompetensi Sistem Informasi Keperawatan: NICAT Dalam Bahasa Indonesia

2019 ◽  
Vol 8 (1) ◽  
pp. 39-43
Author(s):  
Stephanie Dwi Guna ◽  
Yureya Nita
Keyword(s):  
Patient Safety ◽  
Electronic Health Record ◽  
Assessment Tool ◽  
Competency Assessment ◽  
Health Record ◽  
Nursing Informatics ◽  
Cronbach’S Alpha ◽  
Cronbach's Alpha ◽  
Electronic Health ◽  
Bahasa Indonesia

Integrasi Teknologi Informasi (TI) di bidang kesehatan terbukti meningkatkan kualitas pelayanan kesehatan dengan meningkatkan patient safety serta mempercepat waktu layanan. Salah satu inovasi TI di bidang kesehatan yaitu rekam medik elektronik (electronic health record). Rekam medik jenis ini sudah umum digunakan di negara maju namun masih jarang digunakan di negara berkembang termasuk Indonesia. Sebelum pengimplementasian suatu sistem informasi baru di pelayanan kesehatan, perlu dipastikan bahwa user dapat mengoperasikannya dengan baik sehingga hasil dari sistem tersebut optimal. Perawat sebagai tenaga kesehatan dengan jumlah paling banyak di suatu pelayanan kesehatan seperti Rumah Sakit merupakan user terbesar bila rekam medik elektronik ini diterapkan.  Oleh karena itu diperlukan suatu alat untuk mengukur kemampuan atau literasi sistem informasi keperawatan (SIK). Salah satu alat ukur kompetensi SIK yaitu NICAT (Nursing Informatics Competency Assessment Tool) yang memiliki 3 bagian serta 30 item pertanyaan. Penulis melakukan alih bahasa pada kuesioner ini, kemudian melakukan uji validitas dan reliabilitas. Jumlah sampel pada penelitian ini yaitu 233 perawat di salah satu Rumah Sakit Pemerintah di Pekanbaru, Indonesia. Hasil uji validitas pada 30 item dengan r tabel 0.128 menunjukkan r hitung diatas nilai tersebut dengan Cronbach’s Alpha 0,975. Dapat disimpulkan kuesioner pengukuran kemampuan SIK (NICAT versi Bahasa Indonesia) telah valid dan reliabel sehingga dapat digunakan mengukur kemampuan SIK perawat Indonesia.

scholarly journals Electronic Health Record Acceptance by Physicians: A Single Hospital Experience in Daily Practice

2021 ◽  
Vol 1 (1) ◽  
pp. 6-17
Author(s):  
Andrija Pavlovic ◽  
Nina Rajovic ◽  
Jasmina Pavlovic Stojanovic ◽  
Debora Akinyombo ◽  
Milica Ugljesic ◽  
...  
Keyword(s):  
Health Care ◽  
Logistic Regression ◽  
Electronic Health Record ◽  
Technology Acceptance ◽  
Daily Practice ◽  
Ease Of Use ◽  
Future Research ◽  
Health Record ◽  
Cross Sectional ◽  
Electronic Health

Introduction: Potential benefits of implementing an electronic health record (EHR) to increase the efficiency of health services and improve the quality of health care are often obstructed by the unwillingness of the users themselves to accept and use the available systems. Aim: The aim of this study was to identify factors that influence the acceptance of the use of an EHR by physicians in the daily practice of hospital health care. Material and Methods: The cross-sectional study was conducted among physicians in the General Hospital Pancevo, Serbia. An anonymous questionnaire, developed according to the technology acceptance model (TAM), was used for the assessment of EHR acceptance. The response rate was 91%. Internal consistency was assessed by Cronbach’s alpha coefficient. A logistic regression analysis was used to identify the factors influencing the acceptance of the use of EHR. Results: The study population included 156 physicians. The mean age was 46.4 ± 10.4 years, 58.8% participants were female. Half of the respondents (50.1%) supported the use of EHR in comparison to paper patient records. In multivariate logistic regression modeling of social and technical factors, ease of use, usefulness, and attitudes towards use of EHR as determinants of the EHR acceptance, the following predictors were identified: use of a computer outside of the office for reading daily newspapers (p = 0.005), EHR providing a greater amount of valuable information (p = 0.007), improvement in the productivity by EHR use (p < 0.001), and a statement that using EHR is a good idea (p = 0.014). Overall the percentage of correct classifications in the model was 83.9%. Conclusion: In this research, determinants of the EHR acceptance were assessed in accordance with the TAM, providing an overall good model fit. Future research should attempt to add other constructs to the TAM in order to fully identify all determinants of physician acceptance of EHR in the complex environment of different health systems.

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.

Implementation and evaluation of Stanford Health Care store-and-forward teledermatology consultation workflow built within an existing electronic health record system

2018 ◽  
Vol 26 (3) ◽  
pp. 125-131 ◽  
Author(s):  
Grace E Kim ◽  
Olga K Afanasiev ◽  
Chris O’Dell ◽  
Christopher Sharp ◽  
Justin M Ko
Keyword(s):  
Health Care ◽  
Electronic Health Record ◽  
Primary Care Physicians ◽  
Health Record ◽  
Record System ◽  
Privacy Concerns ◽  
Successful Model ◽  
Dermatology Clinic ◽  
Electronic Health ◽  
Store And Forward

Introduction Teledermatology services that function separately from patients’ primary electronic health record (EHR) can lead to fragmented care, poor provider communication, privacy concerns and billing challenges. This study addresses these challenges by developing PhotoCareMD, a store-and-forward (SAF) teledermatology consultation workflow built entirely within an existing Epic-based EHR. Methods Thirty-six primary care physicians (PCPs) from eight outpatient clinics submitted 215 electronic consults (eConsults) for 211 patients to a Stanford Health Care dermatologist via PhotoCareMD. Comparisons were made with in-person referrals for this same dermatologist prior to initiation of PhotoCareMD. Results Compared to traditional in-person dermatology clinic visits, eConsults decreased the time to diagnosis and treatment from 23 days to 16 hours. The majority (73%) of eConsults were resolved electronically. In-person referrals from PhotoCareMD (27%) had a 50% lower cancellation rate compared with traditional referrals (11% versus 22%). The average in-person visit and documentation was 25 minutes compared with 8 minutes for an eConsult. PhotoCareMD saved 13 additional clinic hours to be made available to the dermatologist over the course of the pilot. At four patients per hour, this opens 52 dermatology clinic slots. Over 96% of patients had a favourable experience and 95% felt this service saved them time. Among PCPs, 100% would recommend PhotoCareMD to their colleagues and 95% said PhotoCareMD was a helpful educational tool. Discussion An internal SAF teledermatology workflow can be effectively implemented to increase access to and quality of dermatologic care. Our workflow can serve as a successful model for other hospitals and specialties.

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