Measures of electronic health record use in outpatient settings across vendors

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.

Download Full-text

Assessing HIPAA Compliance of Open Source Electronic Health Record Applications

International Journal of Information Security and Privacy ◽

10.4018/ijisp.2021040109 ◽

2021 ◽

Vol 15 (2) ◽

pp. 181-195

Author(s):

Hossain Shahriar ◽

Hisham M. Haddad ◽

Maryam Farhadi

Keyword(s):

Electronic Health Record ◽

Open Source ◽

Medical Decision ◽

Patient Treatment ◽

Health Record ◽

Technical Requirements ◽

Patient Health ◽

Treatment Plans ◽

Electronic Health ◽

Quality In Healthcare

Electronic health record (EHR) applications are digital versions of paper-based patient health information. EHR applications are increasingly being adopted in many countries. They have resulted in improved quality in healthcare, convenient access to histories of patient medication and clinic visits, easier follow up of patient treatment plans, and precise medical decision-making process. The goal of this paper is to identify HIPAA technical requirements, evaluate two open source EHR applications (OpenEMR and OpenClinic) for security vulnerabilities using two open-source scanner tools (RIPS and PHP VulnHunter), and map the identified vulnerabilities to HIPAA technical requirements.

Download Full-text

Addressing Burnout Syndrome From a Critical Care Specialty Organization Perspective

AACN Advanced Critical Care ◽

10.4037/aacnacc2020579 ◽

2020 ◽

Vol 31 (2) ◽

pp. 158-166

Author(s):

Kathryn L. Cochran ◽

Kathleen Doo ◽

Allison Squires ◽

Tina Shah ◽

Seppo Rinne ◽

...

Keyword(s):

Health Care ◽

Electronic Health Record ◽

High Stress ◽

Well Being ◽

American Thoracic Society ◽

Burnout Syndrome ◽

Health Record ◽

Cross Sectional ◽

Electronic Health ◽

At Home

Background: Health care specialty organizations are an important resource for their membership; however, it is not clear how specialty societies should approach combating stress and burnout on an organizational scale. Objective: To understand the prevalence of burnout syndrome in American Thoracic Society members, identify specialty-specific risk factors, and generate strategies for health care societies to combat burnout. Methods: Cross-sectional, mixed-methods survey in a sample of 2018 American Thoracic Society International Conference attendees to assess levels of burnout syndrome, work satisfaction, and stress. Results: Of the 130 respondents, 69% reported high stress, 38% met burnout criteria, and 20% confirmed chaotic work environments. Significant associations included sex and stress level; clinical time and at-home electronic health record work; and US practice and at-home electronic health record work. There were no significant associations between burnout syndrome and the selected demographics. Participants indicated patient care as the most meaningful aspect of work, whereas the highest contributors to burnout were workload and electronic health record documentation. Importantly, most respondents were unaware of available resources for burnout. Conclusions: Health care specialty societies have access to each level of the health system, creating an opportunity to monitor trends, disseminate resources, and influence the direction of efforts to reduce workplace stress and enhance clinician well-being.

Download Full-text

Macroscopic Modeling of Information Flow in an Agent-Based Electronic Health Record System

Architectural Design of Multi-Agent Systems ◽

10.4018/978-1-59904-108-7.ch016 ◽

2011 ◽

pp. 305-334

Author(s):

Ben Tse

Keyword(s):

Electronic Health Record ◽

Electronic Health Record System ◽

Health Record ◽

Record System ◽

Macroscopic Modeling ◽

Agent Based ◽

Individual Level ◽

Patient Health ◽

Electronic Health ◽

The Individual

This chapter presents an architecture, or general framework, for an agent-based electronic health record system (ABEHRS) to provide health information access and retrieval among different medical services facilities. The agent system’s behaviors are analyzed using the simulation approach and the mathematical modeling approach. The key concept promoted by ABEHRS is to allow patient health records to autonomously move through the computer network uniting scattered and distributed data into one consistent and complete data set or patient health record. ABEHRS is an example of multi-agent swarm system, which is composed of many simple agents and a system that is able to self-organize. The ultimate goal is that the reader should appreciate the benefits of using mobile agents and the importance of studying agent behaviors at the system level and at the individual level.

Download Full-text

Measuring Electronic Health Record Use in Primary Care: A Scoping Review

Applied Clinical Informatics ◽

10.1055/s-0037-1615807 ◽

2018 ◽

Vol 09 (01) ◽

pp. 015-033 ◽

Cited By ~ 8

Author(s):

Michael Huang ◽

Candace Gibson ◽

Amanda Terry

Keyword(s):

Primary Care ◽

Electronic Health Record ◽

Scoping Review ◽

Web Sites ◽

Health Record ◽

Current State ◽

Level Of Use ◽

Ehr Adoption ◽

Electronic Health ◽

Citation Databases

Background Simple measures of electronic health record (EHR) adoption may be inadequate to evaluate EHR use; and positive outcomes associated with EHRs may be better gauged when varying degrees of EHR use are taken into account. In this article, we aim to assess the current state of the literature regarding measuring EHR use. Objective This article conducts a scoping review of the literature to identify and classify measures of primary care EHR use with a focus on the Canadian context. Methods We conducted a scoping review. Multiple citation databases were searched, as well as gray literature from relevant Web sites. Resulting abstracts were screened for inclusion. Included full texts were reviewed by two authors. Data from the articles were extracted; we synthesized the findings. Subsequently, we reviewed these results with seven EHR stakeholders in Canada. Results Thirty-seven articles were included. Eighteen measured EHR function use individually, while 19 incorporated an overall level of use. Eight frameworks for characterizing overall EHR use were identified. Conclusion There is a need to create standardized frameworks for assessing EHR use.

Download Full-text

Metrics for assessing physician activity using electronic health record log data

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocz223 ◽

2020 ◽

Vol 27 (4) ◽

pp. 639-643 ◽

Cited By ~ 10

Author(s):

Christine A Sinsky ◽

Adam Rule ◽

Genna Cohen ◽

Brian G Arndt ◽

Tait D Shanafelt ◽

...

Keyword(s):

Electronic Health Record ◽

Health Record ◽

Clinical Environment ◽

Log Data ◽

Multiple Dimensions ◽

Time Work ◽

Physician Time ◽

Electronic Health ◽

Practice Efficiency ◽

Core Measures

Abstract Electronic health record (EHR) log data have shown promise in measuring physician time spent on clinical activities, contributing to deeper understanding and further optimization of the clinical environment. In this article, we propose 7 core measures of EHR use that reflect multiple dimensions of practice efficiency: total EHR time, work outside of work, time on documentation, time on prescriptions, inbox time, teamwork for orders, and an aspirational measure for the amount of undivided attention patients receive from their physicians during an encounter, undivided attention. We also illustrate sample use cases for these measures for multiple stakeholders. Finally, standardization of EHR log data measure specifications, as outlined here, will foster cross-study synthesis and comparative research.

Download Full-text

Are specific elements of electronic health record use associated with clinician burnout more than others?

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocaa092 ◽

2020 ◽

Vol 27 (9) ◽

pp. 1401-1410

Author(s):

Ross W Hilliard ◽

Jacqueline Haskell ◽

Rebekah L Gardner

Keyword(s):

Confidence Interval ◽

Electronic Health Record ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Well Being ◽

Health Record ◽

Face To Face ◽

Efficiency Measures ◽

Electronic Health ◽

Copy And Paste

Abstract Objective The study sought to examine the association between clinician burnout and measures of electronic health record (EHR) workload and efficiency, using vendor-derived EHR action log data. Materials and Methods We combined data from a statewide clinician survey on burnout with Epic EHR data from the ambulatory sites of 2 large health systems; the combined dataset included 422 clinicians. We examined whether specific EHR workload and efficiency measures were independently associated with burnout symptoms, using multivariable logistic regression and controlling for clinician characteristics. Results Clinicians with the highest volume of patient call messages had almost 4 times the odds of burnout compared with clinicians with the fewest (adjusted odds ratio, 3.81; 95% confidence interval, 1.44-10.14; P = .007). No other workload measures were significantly associated with burnout. No efficiency variables were significantly associated with burnout in the main analysis; however, in a subset of clinicians for whom note entry data were available, clinicians in the top quartile of copy and paste use were significantly less likely to report burnout, with an adjusted odds ratio of 0.22 (95% confidence interval, 0.05-0.93; P = .039). Discussion High volumes of patient call messages were significantly associated with clinician burnout, even when accounting for other measures of workload and efficiency. In the EHR, “patient calls” encompass many of the inbox tasks occurring outside of face-to-face visits and likely represent an important target for improving clinician well-being. Conclusions Our results suggest that increased workload is associated with burnout and that EHR efficiency tools are not likely to reduce burnout symptoms, with the exception of copy and paste.

Download Full-text

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

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2017-0529-oa ◽

2018 ◽

Vol 143 (1) ◽

pp. 115-121 ◽

Cited By ~ 2

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.

Download Full-text

The Perceptions of and Factors Associated With the Adoption of the Electronic Health Record Sharing System Among Patients and Physicians: Cross-Sectional Survey (Preprint)

10.2196/preprints.17452 ◽

2019 ◽

Author(s):

Martin CS Wong ◽

Junjie Huang ◽

Paul SF Chan ◽

Veeleah Lok ◽

Colette Leung ◽

...

Keyword(s):

Health Care ◽

Electronic Health Record ◽

Service Providers ◽

Care Delivery ◽

Health Care Service ◽

Health Record ◽

Public And Private ◽

Major Barrier ◽

Factors Associated ◽

Electronic Health

BACKGROUND The electronic health record sharing system (eHRSS) was implemented as a new health care delivery platform to facilitate two-way communication between the public and private sectors in Hong Kong. OBJECTIVE This study aimed to investigate the perceptions of and factors associated with the adoption of eHRSS among patients, the general public, and private physicians. METHODS Telephone interviews were conducted in 2018 by using a simple random sampling strategy from a list of patients who had enrolled in the eHRSS and a territory-wide telephone directory for nonenrolled residents. We completed 2000 surveys (1000 each for enrolled and nonenrolled individuals). Private physicians completed self-administered questionnaires, including 762 valid questionnaires from 454 enrolled physicians and 308 nonenrolled physicians. RESULTS Most participants (707/1000, 70.70%) were satisfied with the overall performance of the eHRSS. Regarding registration status, most nonenrolled patients (647/1000, 64.70%) reported that “no recommendation from their physicians and family members” was the major barrier, whereas more than half of the physicians (536/1000, 53.60%) expressed concerns on “additional workload due to use of eHRSS.” A multivariate regression analysis showed that patients were more likely to register when they reported “other service providers could view the medical records” (adjusted odds ratio [aOR] 6.09, 95% CI 4.87-7.63; P<.001) and “friends’ or family’s recommendation or assistance in registration” (aOR 3.51, 95% CI 2.04-6.03; P=.001). Physicians were more likely to register when they believed that the eHRSS could improve the quality of health care service (aOR 4.70, 95% CI 1.77-12.51; P=.002) and were aware that the eHRSS could reduce duplicated tests and treatments (aOR 4.16, 95% CI 1.73-9.97; P=.001). CONCLUSIONS Increasing the possibility of viewing patients' personal medical record, expanding the sharable data scope for patients, and highlighting the benefits of the system for physicians could be effective to enhance the adoption of the eHRSS.

Download Full-text