The impact of electronic health record functions on patterns of depression treatment in primary care

We examine the impact of electronic health record (EHR) adoption on charge capture—the ability of providers to properly ensure that billable services are accurately recorded and reported for payment. Drawing on billing and practice management data from a large, integrated pediatric primary care network that was previously a paper-based organization, monthly encounter, charge, and collection data were collected from 2008 through 2013. Two-level fixed effects models were built to test the impact of EHR adoption on charge capture. The introduction of the EHR to the pediatric primary care network was independently associated with an $11.09 increase in average per patient charges, an $11.49 increase in average per patient collections, and an improvement in physicians’ charge-to-collection ratios. Despite high initial outlays and operating costs related to EHR adoption, these results suggest organizations may recoup many of these costs over the long term.

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The Impact of the Electronic Health Record on an Academic Pediatric Primary Care Center

Journal of Ambulatory Care Management ◽

10.1097/jac.0b013e3181ac9667 ◽

2009 ◽

Vol 32 (3) ◽

pp. 180-187 ◽

Cited By ~ 28

Author(s):

Zeina M. Samaan ◽

Melissa D. Klein ◽

Mona E. Mansour ◽

Thomas G. DeWitt

Keyword(s):

Primary Care ◽

Electronic Health Record ◽

Care Center ◽

Pediatric Primary Care ◽

Health Record ◽

Primary Care Center ◽

Electronic Health ◽

The Impact

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Use of certain electronic health record features is associated with improved primary care quality measures

PsycEXTRA Dataset ◽

10.1037/e667672010-010 ◽

2010 ◽

Keyword(s):

Primary Care ◽

Electronic Health Record ◽

Quality Measures ◽

Care Quality ◽

Health Record ◽

Primary Care Quality ◽

Electronic Health

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Management of a parenteral opioid shortage using ASHP guidelines

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxaa425 ◽

2021 ◽

Vol 78 (5) ◽

pp. 426-435

Author(s):

Peter Vo ◽

Daniel A Sylvia ◽

Loay Milibari ◽

John Ryan Stackhouse ◽

Paul Szumita ◽

...

Keyword(s):

Electronic Health Record ◽

Drug Product ◽

Health Record ◽

Large Hospital ◽

Hospital Administrators ◽

Utilization Data ◽

Electronic Health ◽

Opioid Medications ◽

American Society ◽

The Impact

Abstract Purpose Management of an acute shortage of parenteral opioid products at a large hospital through prescribing interventions and other guideline-recommended actions is described. Summary In early 2018, many hospitals were faced with a shortage of parenteral opioids that was predicted to last an entire year. The American Society of Health-System Pharmacists (ASHP) has published guidelines on managing drug product shortages. This article describes the application of these guidelines to manage the parenteral opioid shortage and the impact on opioid dispensing that occurred in 2018. Our approach paralleled that recommended in the ASHP guidelines. Daily dispensing reports generated from automated dispensing cabinets and from the electronic health record were used to capture dispenses of opioid medications. Opioid prescribing and utilization data were converted to morphine milligram equivalents (MME) to allow clinical leaders and hospital administrators to quickly evaluate opioid inventories and consumption. Action steps included utilization of substitute opioid therapies and conversion of opioid patient-controlled analgesia (PCA) and opioid infusions to intravenous bolus dose administration. Parenteral opioid supplies were successfully rationed so that surgical and elective procedures were not canceled or delayed. During the shortage, opioid dispensing decreased in the inpatient care areas from approximately 2.0 million MME to 1.4 million MME and in the operating rooms from 0.56 MME to 0.29 million MME. The combination of electronic health record alerts, increased utilization of intravenous acetaminophen and liposomal bupivacaine, and pharmacist interventions resulted in a 67% decline in PCA use and a 65% decline in opioid infusions. Conclusion A multidisciplinary response is necessary for effective management of drug shortages through implementation of strategies and practices for notifying clinicians of shortages and identifying optimal alternative therapies.

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Approaches for combining primary care electronic health record data from multiple sources: a systematic review of observational studies

BMJ Open ◽

10.1136/bmjopen-2020-037405 ◽

2020 ◽

Vol 10 (10) ◽

pp. e037405

Author(s):

Daniel Dedman ◽

Melissa Cabecinha ◽

Rachael Williams ◽

Stephen J W Evans ◽

Krishnan Bhaskaran ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

Electronic Health Record ◽

Observational Studies ◽

Meta Analysis ◽

Data Sources ◽

Health Record ◽

Two Stage ◽

One Stage ◽

Electronic Health

ObjectiveTo identify observational studies which used data from more than one primary care electronic health record (EHR) database, and summarise key characteristics including: objective and rationale for using multiple data sources; methods used to manage, analyse and (where applicable) combine data; and approaches used to assess and report heterogeneity between data sources.DesignA systematic review of published studies.Data sourcesPubmed and Embase databases were searched using list of named primary care EHR databases; supplementary hand searches of reference list of studies were retained after initial screening.Study selectionObservational studies published between January 2000 and May 2018 were selected, which included at least two different primary care EHR databases.Results6054 studies were identified from database and hand searches, and 109 were included in the final review, the majority published between 2014 and 2018. Included studies used 38 different primary care EHR data sources. Forty-seven studies (44%) were descriptive or methodological. Of 62 analytical studies, 22 (36%) presented separate results from each database, with no attempt to combine them; 29 (48%) combined individual patient data in a one-stage meta-analysis and 21 (34%) combined estimates from each database using two-stage meta-analysis. Discussion and exploration of heterogeneity was inconsistent across studies.ConclusionsComparing patterns and trends in different populations, or in different primary care EHR databases from the same populations, is important and a common objective for multi-database studies. When combining results from several databases using meta-analysis, provision of separate results from each database is helpful for interpretation. We found that these were often missing, particularly for studies using one-stage approaches, which also often lacked details of any statistical adjustment for heterogeneity and/or clustering. For two-stage meta-analysis, a clear rationale should be provided for choice of fixed effect and/or random effects or other models.

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