Resident Physician Experience and Duration of Electronic Health Record Use

2021 ◽  
Vol 12 (04) ◽  
pp. 721-728
Author(s):  
A. Jay Holmgren ◽  
Brenessa Lindeman ◽  
Eric W. Ford
Keyword(s):  
Care Delivery ◽  
Well Being ◽  
Early Career ◽  
Ambulatory Setting ◽  
Care Experience ◽  
Resident Physicians ◽  
Physician Time ◽  
After Hours ◽  
Electronic Health ◽  
The Impact

Abstract Background Electronic health records (EHRs) demand a significant amount of physician time for documentation, orders, and communication during care delivery. Resident physicians already work long hours as they gain experience and develop both clinical and socio-technical skills. Objectives Measure how much time resident physicians spend in the EHR during clinic hours and after-hours, and how EHR usage changes as they gain experience over a 12-month period. Methods Longitudinal descriptive study where participants were 622 resident physicians across postgraduate year cohorts (of 948 resident physicians at the institution, 65.6%) working in an ambulatory setting from July 2017 to June 2018. Time spent in the EHR per patient, patients records documented per day, and proportion of EHR time spent after-hours were the outcome, while the number of months of ambulatory care experience was the predictor. Results Resident physicians spent an average of 45.6 minutes in the EHR per patient, with 13.5% of that time spent after-hours. Over 12 months of ambulatory experience, resident physicians reduced their EHR time per patient and saw more patients per day, but the proportion of EHR time after-hours did not change. Conclusion Resident physicians spend a significant amount of time working in the EHR, both during and after clinic hours. While residents improve efficiency in reducing EHR time per patient, they do not reduce the proportion of EHR time spent after-hours. Concerns over the impact of EHRs on physician well-being should include recognition of the burden of EHR usage on early-career physicians.

scholarly journals The Impact of Disruption of the Care Delivery System by Commercial Laboratory Testing in a Children's Health Care System

2018 ◽  
Vol 143 (1) ◽  
pp. 115-121 ◽  
Author(s):  
Beverly B. Rogers ◽  
James L. Adams ◽  
Alexis B. Carter ◽  
Francine Uwindatwa ◽  
Cynthia B. Brawley ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Median Time ◽  
Laboratory Testing ◽  
Care Delivery ◽  
Reference Laboratory ◽  
Health Record ◽  
Multiple Sources ◽  
Electronic Health Record Data ◽  
Electronic Health ◽  
The Impact

Context.— Disruption of outpatient laboratory services by routing the samples to commercial reference laboratories may seem like a cost-saving measure by the payers, but results in hidden costs in quality and resources to support this paradigm. Objective.— To identify differences when outpatient tests are performed at the Children's Healthcare of Atlanta (Children's) Hospital lab compared to a commercial reference lab, and the financial costs to support the reference laboratory testing. Design.— Outpatient testing was sent to 3 different laboratories specified by the payer. Orders were placed in the Children's electronic health record, blood samples were drawn by the Children's phlebotomists, samples were sent to the testing laboratory, and results appeared in the electronic health record. Data comparing the time to result, cancelled samples, and cost to sustain the system of ordering and reporting were drawn from multiple sources, both electronic and manual. Results.— The median time from phlebotomy to result was 0.7 hours for testing at the Children's lab and 20.72 hours for the commercial lab. The median time from result posting to caregiver acknowledgment was 5.4 hours for the Children's lab and 18 hours for the commercial lab. The commercial lab cancelled 2.7% of the tests; the Children's lab cancelled 0.8%. The financial cost to support online ordering and reporting for testing performed at commercial labs was approximately $640,000 per year. Conclusions.— Tangible monetary costs, plus intangible costs related to delayed results, occur when the laboratory testing system is disrupted.

scholarly journals Impact of COronaVirus Disease -2019 (COVID-19) pandemic on Haemodialysis care delivery pattern in Karnataka, India- a cross-sectional, questionnaire based survey.

2020 ◽  
Author(s):  
Anupama Y J ◽  
Arvind Conjeevaram ◽  
Ravindra Prabhu A ◽  
Manjunath Doshetty ◽  
Sanjay Srinivasa ◽  
...  
Keyword(s):  
Care Delivery ◽  
National Policy ◽  
Well Being ◽  
Care Providers ◽  
Movement Restriction ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Dialysis Facilities ◽  
The Impact

The COVID-19 pandemic has disrupted health care delivery globally. Patients on in-centre haemodialysis(HD) are particularly affected due to their multiple hospital visits and the need for uninterrupted care for their well-being and survival. We studied the impact of the pandemic and the national policy for pandemic control on the HD care delivery in Karnataka state in India in April 2020, when the first and second national lockdown were in place. An online, questionnaire based survey of dialysis facilities was conducted and the responses analysed. The questions were pertaining to the key areas such as changes in number of dialysis treatments, frequency, duration, expenses, transportation to and from dialysis units, impact on availability of consumables, effect on dialysis personnel and on machine maintenance. 62 centres participated. Median of dialysis treatments for the months of March and April 2020 were 695.5 and 650 respectively. Reduction in dialysis treatments was noted in 29(46.8%) facilities , decreased frequency reported by 60 centres. In at least 35(56.5%) centres, dialysis patients had to bear increased expenses. Cost and availability of dialysis consumables were affected in 40(64.5%) and 55(88.7%) centres respectively. Problems with transportation and movement restriction were the two key factors affecting both patients and dialysis facilities.This survey documents the collateral impact of COVID -19 on the vulnerable group of patients on HD, even when not affected by COVID. It identifies the key areas of challenges faced by the patients and the facilities and implores the care-providers for finding newer avenues for mitigation of the problems. Key words: COVID-19, India, Haemodialysis , dialysis care delivery, questionnaire-based survey

Continuing Entomological Research During the Covid-19 Pandemic

2021 ◽  
Vol 32 (3) ◽  
pp. 114-119
Author(s):  
Sotiria Boutsi ◽  
Heather Campbell ◽  
Eugenia Fezza ◽  
Ross George ◽  
Cindayniah Godfrey ◽  
...  
Keyword(s):  
Public Health ◽  
Research Group ◽  
Well Being ◽  
Early Career ◽  
Widening Participation ◽  
Public Health Campaign ◽  
Health Campaign ◽  
Health Measures ◽  
Research Activities ◽  
The Impact

In response to the global COVID-19 pandemic, the UK has experienced three national lockdowns and a public health campaign designed to stop the spread of the virus. The first national lockdown, starting in March 2020, led to the closure of university campuses, and laboratories having to pause practical research and move research student supervision online. During this time, laboratories had to develop way for research activities to resume whilst also complying with public health measures. The entomology group at Harper Adams University is in the Agriculture and Environment Department and forms part of the Centre for Integrated Pest Management. At present our group consists of seven staff members, ranging from early career researchers to those with over 20 years of experience in academia and industry, who collectively supervise 10 PhD students at varying stages of their research. Two of these students are completing their research at an external institute. The group carries out research across multiple sites, office buildings, research laboratories, including the Jean Jackson Entomology Laboratory (https://www.infraportal.org.uk/node/1880), as well as field and glasshouse facilities. Here we provide a narrative account of the challenges in maintaining an active research group during a year of highly restricted activities. We begin by outlining the impact that national lockdowns and public health measures had on researchers working on PhD projects through to larger UKRI and levy-funded multi-institute, multi-year projects. We address four key areas: i) maintaining productivity, ii) student-supervisor interactions, iii) accessibility and widening participation and iv) well-being and mental health. We then outline how lessons learnt from lockdown can inform best practice for a research group. Many aspects will be useful for researchers working part-time, flexible hours, remotely or at multiple sites, but we emphasise that the aim of this contribution is to share our personal experiences and not to cover every theme in what is an extremely complex set of global circumstances.

Health Care Needs of Children in the Foster Care System

PEDIATRICS ◽  
2000 ◽  
Vol 106 (Supplement_3) ◽  
pp. 909-918 ◽  
Author(s):  
Mark D. Simms ◽  
Howard Dubowitz ◽  
Moira A. Szilagyi
Keyword(s):  
Health Care ◽  
Foster Care ◽  
Parent Education ◽  
Continuity Of Care ◽  
Care Delivery ◽  
Well Being ◽  
The United States ◽  
Developmental Problems ◽  
Children In Foster Care ◽  
The Impact

Nearly 750 000 children are currently in foster care in the United States. Recent trends in foster care include reliance on extended family members to care for children in kinship care placements, increased efforts to reduce the length of placement, acceleration of termination of parental rights proceedings, and emphasis on adoption. It is not clear what impact welfare reform may have on the number of children who may require foster care placement. Although most children enter foster care with medical, mental health, or developmental problems, many do not receive adequate or appropriate care while in placement. Psychological and emotional problems, in particular, may worsen rather than improve. Multiple barriers to adequate health care for this population exist. Health care practitioners can help to improve the health and well-being of children in foster care by performing timely and thorough admission evaluations, providing continuity of care, and playing an active advocacy role. Potential areas for health services research include study of the impact of different models of health care delivery, the role of a medical home in providing continuity of care, the perception of the foster care experience by the child, children's adjustment to foster care, and foster parent education on health outcomes.

scholarly journals The Effect of Electronic Health Record Usability Redesign on Annual Screening Rates in an Ambulatory Setting

2020 ◽  
Vol 11 (04) ◽  
pp. 580-588
Author(s):  
Robert P. Pierce ◽  
Bernie R. Eskridge ◽  
LeAnn Rehard ◽  
Brandi Ross ◽  
Margaret A. Day ◽  
...  
Keyword(s):  
Usability Testing ◽  
Error Rates ◽  
Drug Misuse ◽  
Ambulatory Setting ◽  
Interrupted Time Series Analysis ◽  
Improvement Project ◽  
System Usability Scale ◽  
Electronic Health ◽  
The Impact ◽  
User Centered

Abstract Objectives Improving the usability of electronic health records (EHR) continues to be a focus of clinicians, vendors, researchers, and regulatory bodies. To understand the impact of usability redesign of an existing, site-configurable feature, we evaluated the user interface (UI) used to screen for depression, alcohol and drug misuse, fall risk, and the existence of advance directive information in ambulatory settings. Methods As part of a quality improvement project, based on heuristic analysis, the existing UI was redesigned. Using an iterative, user-centered design process, several usability defects were corrected. Summative usability testing was performed as part of the product development and implementation cycle. Clinical quality measures reflecting rolling 12-month rates of screening were examined over 8 months prior to the implementation of the redesigned UI and 9 months after implementation. Results Summative usability testing demonstrated improvements in task time, error rates, and System Usability Scale scores. Interrupted time series analysis demonstrated significant improvements in all screening rates after implementation of the redesigned UI compared with the original implementation. Conclusion User-centered redesign of an existing site-specific UI may lead to significant improvements in measures of usability and quality of patient care.

scholarly journals Structural distress: experiences of moral distress related to structural stigma during the COVID-19 pandemic

2021 ◽  
Author(s):  
Javeed Sukhera ◽  
Chetana Kulkarni ◽  
Taryn Taylor
Keyword(s):  
Health Equity ◽  
Teaching And Learning ◽  
Moral Distress ◽  
Health Workers ◽  
Well Being ◽  
Future Research ◽  
Structured Interviews ◽  
Policy And Practice ◽  
Resident Physicians ◽  
The Impact

Abstract Introduction The COVID-19 pandemic has taken a significant toll on the health of structurally vulnerable patient populations as well as healthcare workers. The concepts of structural stigma and moral distress are important and interrelated, yet rarely explored or researched in medical education. Structural stigma refers to how discrimination towards certain groups is enacted through policy and practice. Moral distress describes the tension and conflict that health workers experience when they are unable to fulfil their duties due to circumstances outside of their control. In this study, the authors explored how resident physicians perceive moral distress in relation to structural stigma. An improved understanding of such experiences may provide insights into how to prepare future physicians to improve health equity. Methods Utilizing constructivist grounded theory methodology, 22 participants from across Canada including 17 resident physicians from diverse specialties and 5 faculty members were recruited for semi-structured interviews from April–June 2020. Data were analyzed using constant comparative analysis. Results Results describe a distinctive form of moral distress called structural distress, which centers upon the experience of powerlessness leading resident physicians to go above and beyond the call of duty, potentially worsening their psychological well-being. Faculty play a buffering role in mitigating the impact of structural distress by role modeling vulnerability and involving residents in policy decisions. Conclusion These findings provide unique insights into teaching and learning about the care of structurally vulnerable populations and faculty’s role related to resident advocacy and decision-making. The concept of structural distress may provide the foundation for future research into the intersection between resident well-being and training related to health equity.

scholarly journals Measures of electronic health record use in outpatient settings across vendors

2020 ◽  
Author(s):  
Sally L Baxter ◽  
Nate C Apathy ◽  
Dori A Cross ◽  
Christine Sinsky ◽  
Michelle R Hribar
Keyword(s):  
Electronic Health Record ◽  
Care Delivery ◽  
Well Being ◽  
Health Record ◽  
Standardized Measures ◽  
Current State ◽  
Patient Health ◽  
Electronic Health ◽  
Outpatient Settings ◽  
Core Measures

Abstract Electronic health record (EHR) log data capture clinical workflows and are a rich source of information to understand variation in practice patterns. Variation in how EHRs are used to document and support care delivery is associated with clinical and operational outcomes, including measures of provider well-being and burnout. Standardized measures that describe EHR use would facilitate generalizability and cross-institution, cross-vendor research. Here, we describe the current state of outpatient EHR use measures offered by various EHR vendors, guided by our prior conceptual work that proposed seven core measures to describe EHR use. We evaluate these measures and other reporting options provided by vendors for maturity and similarity to previously proposed standardized measures. Working toward improved standardization of EHR use measures can enable and accelerate high-impact research on physician burnout and job satisfaction as well as organizational efficiency and patient health.

scholarly journals Impact of Covid-19 on clinical care and lived experience of systemic sclerosis: An international survey from EURORDIS-Rare Diseases Europe

2021 ◽  
pp. 239719832199992
Author(s):  
Michael Hughes ◽  
John D Pauling ◽  
Andrew Moore ◽  
Jennifer Jones
Keyword(s):  
Systemic Sclerosis ◽  
Lived Experience ◽  
Online Survey ◽  
Care Delivery ◽  
Clinical Care ◽  
Immunosuppressive Treatment ◽  
Well Being ◽  
Personal Threat ◽  
The Individual ◽  
The Impact

Introduction: Outcomes related to Covid-19 in systemic sclerosis patients could be influenced by internal organ involvement and/or immunosuppressive treatment, leading to efforts to shield patients from Covid-19 transmission. We examined the impact of Covid-19 on the lived experience of systemic sclerosis with regards to other aspects of daily living including occupation and emotional well-being. Method: Individuals with systemic sclerosis or relatives/carers participated in an online survey, disseminated through international patient associations and social media pages, designed to examine the impact of Covid-19 on living with a rare disease. Results: Responses from 121 individuals (98% were patients with systemic sclerosis) from 14 countries were evaluable. Covid-19 was considered a probable/definite personal threat (93%) or threat for the individual they care for (100%). Approximately two-thirds of responders reported either cancellation or postponement/delay to appointments, diagnostic tests, medical therapies at home (e.g. infusions), surgery or transplant, psychiatry follow-up or rehabilitation services. Twenty-six percent reported at least one systemic sclerosis medicine/treatment had been unavailable, and 6% had to either stop taking usual medications or use an alternative. Most reported online consultations/telemedicine via phone (88%) and online (96%) as being ‘fairly’ or ‘very’ useful. Respondents reported tensions among family members (45%) and difficulty overcoming problems (48%). Restrictions on movement left around two-thirds feeling isolated (61%), unhappy and/or depressed (64%), although the majority (85%) reported a strengthening of the family unit. Conclusion: Covid-19 has resulted in significant impact on the clinical-care and emotional well-being of systemic sclerosis patients. Changes to clinical care delivery have been well-received by patients including telemedicine consultations.

Psychiatry after-hours: factors impacting workload and workflow

2021 ◽  
pp. 103985622098403
Author(s):  
Alisha Thomson ◽  
Brett McDermott
Keyword(s):  
Well Being ◽  
University Hospital ◽  
Sources Of Information ◽  
Multiple Sources ◽  
Phone Calls ◽  
Wide Range ◽  
After Hours ◽  
The Impact ◽  
Essential Service ◽  
Night Shifts

Objective: The study evaluated the workload and workflow of registrars engaged in a psychiatry after-hours roster, quantified their perceptions of this experience and provided recommendations for system redesign. Method: Multiple sources of information, including medical student observers and telephone logs, quantified the tasks performed during shifts. Registrars completed a satisfaction questionnaire. Results: After-hours shifts often started with a lack of attendance of key clinicians at handover. Tasks handed over and completed during shifts varied; there was very little difference between evening, weekends and night shifts except for the higher likelihood of seclusion reviews on weekends. Registrars experienced a significant and complex workload including emergency department and ward reviews, and admissions. Workflow interruptions were frequent; the high number of phone calls and critical incidence warrant further investigation. Registrars were confident in their own ability, but had less confidence in other key clinicians. Many registrars did not discuss after-hours work during supervision. Conclusions: The after-hours experience of psychiatry registrars at a university hospital is arduous and includes a wide range of clinical tasks. This activity is an essential service provision undertaking as well as a training activity. This must be weighed against the impact of after-hours work on registrar well-being.

scholarly journals E-HEALTH OPPORTUNITIES FOR THE LOW AND MIDDLE-INCOME COUNTRIES Authors

2020 ◽  
pp. 158-163
Keyword(s):  
Health Workforce ◽  
Well Being ◽  
Health Data ◽  
Middle Income ◽  
Modern Approach ◽  
Middle Income Countries ◽  
Health Initiatives ◽  
Electronic Health ◽  
The Impact ◽  
Low And Middle Income

Across the world, there is a critical expansion in digital technology through all fields, including health. Electronic health (e-Health) is the future of healthcare. E-Health could help in building better healthcare systems since it can be adopted to enhance communications, train the health workforce, assist in job-related tasks and supervision. Additionally, precision medicine (PM), which is a modern approach in low and middle-income countries (LMICs), could facilitate addressing chronic diseases. Such techniques could promote innovative public health interventions that will improve population well-being worldwide to satisfy the indicators of sustainable development goal number-3 (SDG-3) that stresses on ensuring healthy lives and promoting welfare for all. However, e-Health data could be both a gain and a challenge for LMICs. A transformational and synergetic strategy is necessary to adopt these techniques as it would sustainably minimize the expanses of healthcare. Yet, national adoption of e- Health is gradually progressing in several LMICs. This review highlights the recent advances and future applications of mobile health and its impact on people's lives in the LMICs. It also displays perceptiveness towards the best practice for scaling electronic health (e-Health) initiatives in the LMICs guided by adapted experience from real case studies and exploring the impact on designing and deploying future health initiatives, especially for improving the health workforce. Finally, It suggests a structure for data governance policy to limit the hazards of breaching or abusing health data in e-Health platforms.

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