scholarly journals Embedding Patient Priorities Care in an Age-Friendly Health System

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 687-687
Author(s):  
Aanand Naik ◽  
Lea Kiefer ◽  
Angela Catic ◽  
Lillian Dindo
Keyword(s):  
Older Adults ◽  
Electronic Health Record ◽  
Health System ◽  
Training Program ◽  
Healthcare Professionals ◽  
Audit And Feedback ◽  
Health Record ◽  
Clinician Training ◽  
Multiple Morbidities ◽  
Case Based

Abstract Background: Patient Priorities Care (PPC) is an innovative approach to improving care for older adults with multiple morbidities. We developed a PPC training program for healthcare professionals and describe preliminary results. Methods: We implemented PPC in a geriatrics clinic. 20 staff and trainees participated on 1) how to identify patient priorities, 2) documentation in the electronic health record (EHR), and 3) strategies to align care with priorities; and received case-based audit and feedback. Results: 250 patients participated in PPC encounters. The EHR template was subsequently integrated within an Age Friendly Health System (AFHS) note. Clinicians have integrated this AFHS template for all encounters. Conclusion: PPC is a feasible approach to the care of older adults with multiple morbidities following a structured clinician training program. PPC can be effectively incorporated into the “Matter Most” component of AFHS.

scholarly journals Targeted Outpatient Fluoroquinolone Intervention utilizing an Integrated Electronic Health Record in the Bureau of Prisons

2020 ◽  
Vol 41 (S1) ◽  
pp. s402-s402
Author(s):  
Deborah Long ◽  
Alisha Edmunds ◽  
Tyler Campbell ◽  
Michael Long
Keyword(s):  
Electronic Health Record ◽  
Antimicrobial Stewardship ◽  
Singular System ◽  
Audit And Feedback ◽  
Health Record ◽  
Prospective Audit ◽  
Short Period ◽  
Electronic Health ◽  
Prospective Audit And Feedback ◽  
Bureau Of Prisons

Background: Fluoroquinolones are the perfect target for antimicrobial stewardship programs (ASPs) due to their broad-spectrum nature, poor safety profile, and frequent misuse. In April 2019, the Bureau of Prisons (BOP) created a national antimicrobial stewardship clinical pharmacist consultant program. One of the program’s main initiatives was to screen active fluoroquinolone prescriptions for appropriateness and work with providers to tailor therapy as needed. Since July 2019, pharmacist consultants have utilized a singular system-wide electronic health record (EHR) to conduct fluoroquinolone prospective audit and feedback targeting all BOP sites across the country. The objective was to assess the national impact of prospective audit and feedback on outpatient fluoroquinolone prescriptions utilizing pharmacist consultants and an integrated EHR. Method: Reviews were conducted in a federal correctional setting including 122 BOP sites with an average daily population of 167,308 inmates. The ASP consisted of 7 pharmacists, each assigned a region across the country. Consultant pharmacists were in charge of conducting daily fluoroquinolone reviews within 72 hours of the prescription being written, utilizing a singular system-wide EHR to gain remote access to newly prescribed prescriptions along with all other pertinent information (ie, clinical notes, patient profiles, laboratory, and radiology). Interventions were sent via e-mail. Total fluoroquinolone prescriptions per 1,000 inmates during the preintervention period (July 1, 2018, to September 30, 2018) were compared to the postintervention period (July 1, 2019, to September 30, 2019), after the development of the clinical consultant program. Data were also collected during the 3-month postintervention period to include total fluoroquinolone prescriptions reviewed, total recommendations sent, percentage of recommendations accepted, and intervention types. Results: In total, 833 fluoroquinolone prescriptions of 1, 264 total prescriptions written (66%)were reviewed over the 3-month postintervention period. In total,192 interventions were recommended (23%). Of the interventions recommended, 65 (34%) were accepted. The most common intervention was to stop therapy (41%), followed by changing antibiotic (37%), and shorten therapy duration (8%). Total outpatient fluoroquinolone prescriptions decreased by 1.5 prescriptions per 1,000 patients after the intervention. Conclusions: Pharmacist-driven prospective audit and feedback on a national scale utilizing a singular system-wide EHR resulted in an overall decrease in outpatient fluoroquinolone prescriptions over short period of time.Funding: NoneDisclosures: None

scholarly journals Health System Implementation of a Tobacco Quitline eReferral

2019 ◽  
Vol 10 (04) ◽  
pp. 735-742 ◽  
Author(s):  
Eve Angeline Hood-Medland ◽  
Susan L. Stewart ◽  
Hien Nguyen ◽  
Mark Avdalovic ◽  
Scott MacDonald ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Health System ◽  
Best Practice ◽  
Health Record ◽  
System Implementation ◽  
Electronic Health Record Data ◽  
Outpatient Group ◽  
Primary Care Specialty ◽  
Electronic Health ◽  
Order Set

Abstract Background Proactive referrals through electronic orders (eReferrals) can increase patient connection with tobacco quitlines. More information is needed on “real-world” implementation of electronic health record tools to promote tobacco cessation while minimizing provider burden. Objectives This paper examines the health system implementation of an eReferral to a tobacco quitline without best practice alerts in primary care, specialty, and hospital settings in an academic health system. Methods This is a prospective implementation study of a health system tobacco eReferral to a state quitline that was completed with an approach to minimize provider cognitive burden. Data are drawn from electronic health record data at University of California, Davis Health Systems (March 2013–February 2016). Results Over 3 years, 16,083 encounters with smokers resulted in 1,137 eReferral orders (7.1%). Treatment reach was 1.6% for quitline services and 2.3% for outpatient group classes. While the group classes were offered to outpatient smokers, the eReferral order was included in an outpatient order set and eventually an automated inpatient discharge order set; no provider alerts were implemented. Referrals were sustained and doubled after inpatient order set implementation. Among all first time eReferral patients, 12.2% had a 6 to 12 month follow-up visit at which they were documented as nonsmoking. Conclusion This study demonstrates a quitline eReferral order can be successfully implemented and sustained with minimal promotion, without provider alerts and in conjunction with group classes. Reach and effectiveness were similar to previously described literature.

scholarly journals Rethinking the electronic health record through the quadruple aim: time to align its value with the health system

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Hassane Alami ◽  
Pascale Lehoux ◽  
Marie-Pierre Gagnon ◽  
Jean-Paul Fortin ◽  
Richard Fleet ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Health System ◽  
Health Record ◽  
Quadruple Aim ◽  
Electronic Health

scholarly journals Implementation of a Behavioral Economics Electronic Health Record (BE-EHR) Module to Reduce Overtreatment of Diabetes in Older Adults

2020 ◽  
Vol 35 (11) ◽  
pp. 3254-3261
Author(s):  
Hayley M. Belli ◽  
Sara K. Chokshi ◽  
Roshini Hegde ◽  
Andrea B. Troxel ◽  
Saul Blecker ◽  
...  
Keyword(s):  
Older Adults ◽  
Behavioral Economics ◽  
Electronic Health Record ◽  
Health Record ◽  
Electronic Health

scholarly journals The complex case of EHRs: examining the factors impacting the EHR user experience

2019 ◽  
Vol 26 (7) ◽  
pp. 673-677 ◽  
Author(s):  
Michael A Tutty ◽  
Lindsey E Carlasare ◽  
Stacy Lloyd ◽  
Christine A Sinsky
Keyword(s):  
Electronic Health Record ◽  
Health System ◽  
User Experience ◽  
End Users ◽  
Complex Case ◽  
Health Record ◽  
System Leadership ◽  
Electronic Health ◽  
Face Time ◽  
Administrative Tasks

Abstract Physicians can spend more time completing administrative tasks in their electronic health record (EHR) than engaging in direct face time with patients. Increasing rates of burnout associated with EHR use necessitate improvements in how EHRs are developed and used. Although EHR design often bears the brunt of the blame for frustrations expressed by physicians, the EHR user experience is influenced by a variety of factors, including decisions made by entities other than the developers and end users, such as regulators, policymakers, and administrators. Identifying these key influences can help create a deeper understanding of the challenges in developing a better EHR user experience. There are multiple opportunities for regulators, policymakers, EHR developers, payers, health system leadership, and users each to make changes to collectively improve the use and efficacy of EHRs.

Measuring Functional Status in Hospitalized Older Adults Through Electronic Health Record Documentation

2018 ◽  
Vol 111 (4) ◽  
pp. 220-225 ◽  
Author(s):  
Liron Sinvani ◽  
Andrzej Kozikowski ◽  
Vidhi Patel ◽  
Colm Mulvany ◽  
Christopher Smilios ◽  
...  
Keyword(s):  
Older Adults ◽  
Electronic Health Record ◽  
Functional Status ◽  
Health Record ◽  
Electronic Health ◽  
Hospitalized Older Adults

scholarly journals A Case-Based Clinician Training Program for Treating Tobacco Use in College Students

2006 ◽  
Vol 121 (5) ◽  
pp. 557-562 ◽  
Author(s):  
Abigail C. Halperin ◽  
L. Anne Thompson ◽  
Jennifer C. Hymer ◽  
Amber K. Peterson ◽  
Beti Thompson
Keyword(s):  
College Students ◽  
Training Program ◽  
Tobacco Use ◽  
Clinician Training ◽  
Case Based

scholarly journals Patient Portal Use, Perceptions of Electronic Health Record Value, and Self-Rated Primary Care Quality Among Older Adults: Cross-sectional Survey (Preprint)

2020 ◽  
Author(s):  
Dori A Cross ◽  
Zachary Levin ◽  
Minakshi Raj
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Electronic Health Record ◽  
Care Quality ◽  
Health Record ◽  
Patient Portal ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Value Perception ◽  
Primary Care Quality

BACKGROUND Older adults are increasingly accessing information and communicating using patient-facing portals available through their providers’ electronic health record (EHR). Most theories of technology acceptance and use suggest that patients’ overall satisfaction with care should be independent of their chosen level of portal engagement. However, achieving expected benefits of portal use depends on demonstrated support from providers to meet these expectations. This is especially true among older adults, who may require more guidance. However, little is known about whether misalignment of expectations around technology-facilitated care is associated with lower perceptions of care quality. OBJECTIVE The aims of this study were to analyze whether older adults’ assessment of primary care quality differs across levels of patient portal engagement and whether perceptions of how well their provider uses the EHR to support care moderates this relationship. METHODS We conducted a cross-sectional survey analysis of 158 older adults over the age of 65 (average age 71.4 years) across Michigan using a 13-measure composite of self-assessed health care quality. Portal use was categorized as none, moderate (use of 1-3 functionalities), or extensive (use of 4-7 functionalities). EHR value perception was measured by asking respondents how they felt their doctor’s EHR use improved the patient–provider relationship. RESULTS Moderate portal users, compared to those who were extensive users, had lower estimated care quality (–0.214 on 4-point scale; <i>P</i>=.03). Differences between extensive portal users and nonportal users were not significant. Quality perception was only particularly low among moderate portal users with low EHR value perception; those with high EHR value perception rated quality similarly to other portal user groups. CONCLUSIONS Older adults who are moderate portal users are the least satisfied with their care, and the most sensitive to perceptions of how well their provider uses the EHR to support the relationship. Encouraging portal use without compromising perceptions of quality requires thinking beyond patient-focused education. Achieving value from use of patient-facing technologies with older adults is contingent upon matched organizational investments that support technology-enabled care delivery. Providers and staff need policies and practices that demonstrate technology adeptness. Older adults may need more tailored signaling and accommodation for technology to be maximally impactful.

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