Optimization of the Order Menu in the Electronic Health Record Facilitates Test Patterns Consistent With Recommendations in the Choosing Wisely Initiative

2019 ◽  
Vol 153 (1) ◽  
pp. 94-98 ◽  
Author(s):  
Courtney Barry ◽  
Steven Kaufman ◽  
David Feinstein ◽  
Nami Kim ◽  
Snehal Gandhi ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Primary Care Providers ◽  
Choosing Wisely ◽  
Screening Tests ◽  
Evidence Based ◽  
Health Record ◽  
Care Providers ◽  
Electronic Health ◽  
Manual Review ◽  
Total Orders

Abstract Objectives Thyroid and rheumatologic autoimmune testing are areas where evidence-based guidance from specialty organizations and Choosing Wisely support utilizing screening tests for autoimmune and thyroid disorders prior to more specialized testing. Adjustment of the orderable options in the electronic health record (EHR) can influence ordering patterns without requiring manual review or additional effort by the clinician. Methods The menu was adjusted to reflect recommendations from Choosing Wisely to favor screening tests that automatically reflex to specialized testing on primary care providers’ preference lists. Effectiveness was evaluated by reviewing total orders for individual tests. Results Shifts in ordering from individual screening tests (antinuclear antibody and thyrotropin) to ones that reflexed to specialized testing were observed in parallel with significant reductions in the corresponding specialized testing. Conclusions Optimization of the EHR laboratory ordering menu can be used to shift ordering patterns toward Choosing Wisely recommendations.

scholarly journals Development of a Cancer Care Summary Through the Electronic Health Record

2016 ◽  
Vol 12 (2) ◽  
pp. e231-e240 ◽  
Author(s):  
Laurie L. Carr ◽  
Pearlanne Zelarney ◽  
Sarah Meadows ◽  
Jeffrey A. Kern ◽  
M. Bronwyn Long ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Cancer Care ◽  
Query Language ◽  
Primary Care Providers ◽  
Urgent Care ◽  
Health Record ◽  
Patient Portal ◽  
Care Providers ◽  
Improvement Project ◽  
Electronic Health

Introduction: Our objective was to improve communication concerning lung cancer patients by developing and distributing a Cancer Care Summary that would provide clinically useful information about the patient’s diagnosis and care to providers in diverse settings. Methods: We designed structured, electronic forms for the electronic health record (EHR), detailing tumor staging, classification, and treatment. To ensure completeness and accuracy of the information, we implemented a data quality cycle, composed of reports that are reviewed by oncology clinicians. The data from the EHR forms are extracted into a structured query language database system on a daily basis, from which the Summaries are derived. We conducted focus groups regarding the utility, format, and content of the Summary. Cancer Care Summaries are automatically generated 4 months after a patient’s date of diagnosis, then every 6 months for those receiving treatment, and on an as-needed basis for urgent care or hospital admission. Results: The product of our improvement project is the Cancer Care Summary. To date, 102 individual patient Summaries have been generated. These documents are automatically entered into the National Jewish Health (NJH) EHR, attached to correspondence to primary care providers, available to patients as electronic documents on the NJH patient portal, and faxed to emergency departments and admitting physicians on patient evaluation. Conclusion: We developed a sustainable tool to improve cancer care communication. The Cancer Care Summary integrates information from the EHR in a timely manner and distributes the information through multiple avenues.

scholarly journals Using a certified electronic health record technology platform to screen, test and refer patients with prediabetes

JAMIA Open ◽  
2021 ◽  
Vol 4 (4) ◽  
Author(s):  
Kate Kirley ◽  
Tamkeen Khan ◽  
Gina Aquino ◽  
Ameldia Brown ◽  
Scott Meier ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Diabetes Prevention Program ◽  
Screen Test ◽  
Primary Care Providers ◽  
Baseline Period ◽  
Health Record ◽  
Patient Portal ◽  
Care Providers ◽  
Conversion Rates ◽  
Electronic Health

Abstract The objective of this study was to determine if certified electronic health record technology (CEHRT) can be used to identify and refer patients with prediabetes to lifestyle change programs (LCPs) recognized by the National Diabetes Prevention Program (DPP). This pilot utilized a prediabetes registry, patient portal, and clinical decision support to increase referrals. Data from 36 primary care providers showed 4930 patients were eligible for DPP LCP, 293 referrals were generated, compared to 20 referrals in the baseline period, and 116 patients enrolled. Referral to enrollment conversion rates were 41% in the study period and 69% in the post-study 1-year period. CEHRT functionalities can support systematic identification and management of prediabetes. The referral rate increased 7-fold compared to the baseline period, with high referral to enrollment conversion rates. CEHRT coupled with active provider engagement can serve as a tool to identify prediabetes patients and facilitate LCP referrals and enrollment.

scholarly journals Visualization of Electronic Health Record Data for Decision-Making in Diabetes and Congestive Heart Failure

ACI Open ◽  
2020 ◽  
Vol 04 (01) ◽  
pp. e35-e43
Author(s):  
Shira H. Fischer ◽  
Charles Safran ◽  
Krzysztof Z. Gajos ◽  
Adam Wright
Keyword(s):  
Decision Making ◽  
Electronic Health Record ◽  
Primary Care Providers ◽  
Difficulty Level ◽  
Health Record ◽  
Care Providers ◽  
Electronic Health Record Data ◽  
Record Data ◽  
Electronic Health ◽  
The Impact

Abstract Objective The aim of this study is to study the impact of graphical representation of health record data on physician decision-making to inform the design of health information technology. Materials and Methods We conducted a within participants crossover design study using a simulated electronic health record (EHR) in which we presented cases with and without visualized data designed to highlight important clinical trends or relationships, followed by assessment of the impact on decision-making about next steps for patients with chronic diseases. We then asked whether trends were observed and about usability and satisfaction using validated usability questions and asked open-ended questions as well. Time to answer questions was also collected. Results Twenty-one primary care providers participated in the study, including five for testing only and sixteen for the full study. Questions about clinical assessment or next actions were answered correctly 55% of the time. Regarding objective trends in the data, participants described noticing the trends 85% of the time. Differences in noticing trends or difficulty level of questions were not statistically significant. Satisfaction with the tool was high and participants agreed strongly that it helped them make better decisions without adding to the time it took. Discussion The simulation allowed us to test the impact of a visualization on clinician practice in a realistic setting. Designers of EHRs should consider the ways information presentation can affect decision-making. Conclusion Testing visualization tools can be done in a clinically realistic context. Providers desire visualizations and believe that they help them make better and faster decisions.

scholarly journals Does integrating nonurgent, clinically significant radiology alerts within the electronic health record impact closed-loop communication and follow-up?

2015 ◽  
Vol 23 (2) ◽  
pp. 333-338 ◽  
Author(s):  
Stacy D O’Connor ◽  
Anuj K Dalal ◽  
V Anik Sahni ◽  
Ronilda Lacson ◽  
Ramin Khorasani
Keyword(s):  
Electronic Health Record ◽  
Closed Loop ◽  
Academic Medical Center ◽  
Primary Care Providers ◽  
Fisher Exact Test ◽  
Health Record ◽  
Care Providers ◽  
Electronic Health ◽  
Clinically Significant

Abstract Objective To assess whether integrating critical result management software—Alert Notification of Critical Results (ANCR)—with an electronic health record (EHR)-based results management application impacts closed-loop communication and follow-up of nonurgent, clinically significant radiology results by primary care providers (PCPs). Materials and Methods This institutional review board-approved study was conducted at a large academic medical center. Postintervention, PCPs could acknowledge nonurgent, clinically significant ANCR-generated alerts (“alerts”) within ANCR or the EHR. Primary outcome was the proportion of alerts acknowledged via EHR over a 24-month postintervention. Chart abstractions for a random sample of alerts 12 months preintervention and 24 months postintervention were reviewed, and the follow-up rate of actionable alerts (eg, performing follow-up imaging, administering antibiotics) was estimated. Pre- and postintervention rates were compared using the Fisher exact test. Postintervention follow-up rate was compared for EHR-acknowledged alerts vs ANCR. Results Five thousand nine hundred and thirty-one alerts were acknowledged by 171 PCPs, with 100% acknowledgement (consistent with expected ANCR functionality). PCPs acknowledged 16% (688 of 4428) of postintervention alerts in the EHR, with the remaining in ANCR. Follow-up was documented for 85 of 90 (94%; 95% CI, 88%-98%) preintervention and 79 of 84 (94%; 95% CI, 87%-97%) postintervention alerts ( P > .99). Postintervention, 11 of 14 (79%; 95% CI, 52%-92%) alerts were acknowledged via EHR and 68 of 70 (97%; 95% CI, 90%-99%) in ANCR had follow-up ( P = .03). Conclusions Integrating ANCR and EHR provides an additional workflow for acknowledging nonurgent, clinically significant results without significant change in rates of closed-loop communication or follow-up of alerts.

scholarly journals Primary Care Providers’ Opening of Time-Sensitive Alerts Sent to Commercial Electronic Health Record InBaskets

2017 ◽  
Vol 32 (11) ◽  
pp. 1210-1219 ◽  
Author(s):  
Sarah L. Cutrona ◽  
Hassan Fouayzi ◽  
Laura Burns ◽  
Rajani S. Sadasivam ◽  
Kathleen M. Mazor ◽  
...  
Keyword(s):  
Primary Care ◽  
Electronic Health Record ◽  
Primary Care Providers ◽  
Health Record ◽  
Care Providers ◽  
Electronic Health

scholarly journals Electronic Health Record Alert-Related Workload as a Predictor of Burnout in Primary Care Providers

2017 ◽  
Vol 08 (03) ◽  
pp. 686-697 ◽  
Author(s):  
Elise Russo ◽  
Hardeep Singh ◽  
Megan Gregory
Keyword(s):  
Primary Care ◽  
Electronic Health Record ◽  
Health Care Professionals ◽  
Medical Center ◽  
Primary Care Providers ◽  
Three Dimensions ◽  
Organizational Level ◽  
Health Record ◽  
Care Providers ◽  
Electronic Health

SummaryBackground: Electronic health records (EHRs) have been shown to increase physician workload. One EHR feature that contributes to increased workload is asynchronous alerts (also known as inbox notifications) related to test results, referral responses, medication refill requests, and messages from physicians and other health care professionals. This alert-related workload results in negative cognitive outcomes, but its effect on affective outcomes, such as burnout, has been under-studied.Objectives: To examine EHR alert-related workload (both objective and subjective) as a predictor of burnout in primary care providers (PCPs), in order to ultimately inform interventions aimed at reducing burnout due to alert workload.Methods: A cross-sectional questionnaire and focus group of 16 PCPs at a large medical center in the southern United States.Results: Subjective, but not objective, alert workload was related to two of the three dimensions of burnout, including physical fatigue (p = 0.02) and cognitive weariness (p = 0.04), when controlling for organizational tenure. To reduce alert workload and subsequent burnout, participants indicated a desire to have protected time for alert management, fewer unnecessary alerts, and improvements to the EHR system.Conclusions: Burnout associated with alert workload may be in part due to subjective differences at an individual level, and not solely a function of the objective work environment. This suggests the need for both individual and organizational-level interventions to improve alert workload and subsequent burnout. Additional research should confirm these findings in larger, more representative samples.Citation: Gregory ME, Russo E, Singh H. Electronic health record alert-related workload as a predictor of burnout in primary care providers. Appl Clin Inform 2017; 8: 686–697 https://doi.org/10.4338/ACI-2017-01-RA-0003

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