scholarly journals Adherence to recommended electronic health record safety practices across eight health care organizations

2018 ◽  
Vol 25 (7) ◽  
pp. 913-918 ◽  
Author(s):  
Dean F Sittig ◽  
Mandana Salimi ◽  
Ranjit Aiyagari ◽  
Colin Banas ◽  
Brian Clay ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Health Care Organizations ◽  
National Policy ◽  
Health Record ◽  
Health It ◽  
Clinical Communication ◽  
Safety Assurance ◽  
Ehr Adoption ◽  
Electronic Health ◽  
System Interfaces

Abstract Objective The Safety Assurance Factors for EHR Resilience (SAFER) guides were released in 2014 to help health systems conduct proactive risk assessment of electronic health record (EHR)- safety related policies, processes, procedures, and configurations. The extent to which SAFER recommendations are followed is unknown. Methods We conducted risk assessments of 8 organizations of varying size, complexity, EHR, and EHR adoption maturity. Each organization self-assessed adherence to all 140 unique SAFER recommendations contained within 9 guides (range 10–29 recommendations per guide). In each guide, recommendations were organized into 3 broad domains: “safe health IT” (total 45 recommendations); “using health IT safely” (total 80 recommendations); and “monitoring health IT” (total 15 recommendations). Results The 8 sites fully implemented 25 of 140 (18%) SAFER recommendations. Mean number of “fully implemented” recommendations per guide ranged from 94% (System Interfaces—18 recommendations) to 63% (Clinical Communication—12 recommendations). Adherence was higher for “safe health IT” domain (82.1%) vs “using health IT safely” (72.5%) and “monitoring health IT” (67.3%). Conclusions Despite availability of recommendations on how to improve use of EHRs, most recommendations were not fully implemented. New national policy initiatives are needed to stimulate implementation of these best practices.

scholarly journals Drivers of expectations: Why are Norwegian general practitioners skeptical of a prospective electronic health record?

2021 ◽  
Vol 27 (1) ◽  
pp. 146045822098729
Author(s):  
Morten Hertzum ◽  
Gunnar Ellingsen ◽  
Line Melby
Keyword(s):  
Electronic Health Record ◽  
General Practitioners ◽  
Current System ◽  
Implementation Process ◽  
Health Record ◽  
Early Implementation ◽  
Ehr Adoption ◽  
Electronic Health

While expectations are well-known drivers of electronic health record (EHR) adoption, the drivers of expectations are more elusive. On the basis of interviews with general practitioners (GPs), we investigate how the early implementation process drives their expectations of an EHR that is being implemented in Norway. The GPs’ expectations of the prospective EHR are driven by (a) satisfying experiences with their current system, (b) the transfer of others’ experiences with the prospective EHR, (c) a sense of alignment, or lack thereof, with those in charge of the implementation process, (d) uncertainty about the inclusion of GP needs, and (e) competing technological futures. To manage expectations, starting early is important. Mismanaged expectations produce a need for convincing people to reverse their expectations. This appears to be the situation in Norway, where the GPs are currently skeptical of the prospective EHR.

scholarly journals Continuing Patient Care during Electronic Health Record Downtime

2019 ◽  
Vol 10 (03) ◽  
pp. 495-504
Author(s):  
Ethan Larsen ◽  
Daniel Hoffman ◽  
Carlos Rivera ◽  
Brian M. Kleiner ◽  
Christian Wernz ◽  
...  
Keyword(s):  
Quantitative Analysis ◽  
Electronic Health Record ◽  
Clinical Laboratory ◽  
Normal Operation ◽  
Contingency Planning ◽  
Health Record ◽  
Safety Assurance ◽  
Hospital Operations ◽  
Recorded Data ◽  
Electronic Health

Introduction Electronic health record (EHR) downtime is any period during which the EHR system is fully or partially unavailable. These periods are operationally disruptive and pose risks to patients. EHR downtime has not sufficiently been studied in the literature, and most hospitals are not adequately prepared. Objective The objective of this study was to assess the operational implications of downtime with a focus on the clinical laboratory, and to derive recommendations for improved downtime contingency planning. Methods A hybrid qualitative–quantitative study based on historic performance data and semistructured interviews was performed at two mid-Atlantic hospitals. In the quantitative analysis, paper records from downtime events were analyzed and compared with normal operations. To enrich this quantitative analysis, interviews were conducted with 17 hospital employees, who had experienced several downtime events, including a hospital-wide EHR shutdown. Results During downtime, laboratory testing results were delayed by an average of 62% compared with normal operation. However, the archival data were incomplete due to inconsistencies in the downtime paper records. The qualitative interview data confirmed that delays in laboratory result reporting are significant, and further uncovered that the delays are often due to improper procedural execution, and incomplete or incorrect documentation. Interviewees provided a variety of perspectives on the operational implications of downtime, and how to best address them. Based on these insights, recommendations for improved downtime contingency planning were derived, which provide a foundation to enhance Safety Assurance Factors for EHR Resilience guides. Conclusion This study documents the extent to which downtime events are disruptive to hospital operations. It further highlights the challenge of quantitatively assessing the implication of downtimes events, due to a lack of otherwise EHR-recorded data. Organizations that seek to improve and evaluate their downtime contingency plans need to find more effective methods to collect data during these times.

scholarly journals An Analysis of Patient Safety Incident Reports Associated with Electronic Health Record Interoperability

2017 ◽  
Vol 08 (02) ◽  
pp. 593-602 ◽  
Author(s):  
Katharine Adams ◽  
Jessica Howe ◽  
Allan Fong ◽  
Joseph Puthumana ◽  
Kathryn Kellogg ◽  
...  
Keyword(s):  
Patient Safety ◽  
Electronic Health Record ◽  
Health Record ◽  
Health It ◽  
Specific Patient ◽  
It Systems ◽  
Safety Incident ◽  
Patient Safety Incident ◽  
Incident Reports ◽  
Electronic Health

SummaryBackground: With the widespread use of electronic health records (EHRs) for many clinical tasks, interoperability with other health information technology (health IT) is critical for the effective delivery of care. While it is generally recognized that poor interoperability negatively impacts patient care, little is known about the specific patient safety implications. Understanding the patient safety implications will help prioritize interoperability efforts around architectures and standards.Objectives: Our objectives were to (1) identify patient safety incident reports that reflect EHR interoperability challenges with other health IT, and (2) perform a detailed analysis of these reports to understand the health IT systems involved, the clinical care processes impacted, whether the incident occurred within or between provider organizations, and the reported severity of the patient safety events.Methods: From a database of 1.735 million patient safety event (PSE) reports spanning multiple provider organizations, 2625 reports that were indicated as being health IT related by the event reporter were reviewed to identify EHR interoperability related reports. Through a rigorous coding process 209 EHR interoperability related events were identified and coded.Results: The majority of EHR interoperability PSE reports involved interfacing with pharmacy systems (i.e. medication related), followed by laboratory, and radiology. Most of the interoperability challenges in these clinical areas were associated with the EHR receiving information from other health IT systems as opposed to the EHR sending information to other systems. The majority of EHR interoperability challenges were within a provider organization and while many of the safety events reached the patient, only a few resulted in patient harm.Conclusions: Interoperability efforts should prioritize systems in pharmacy, laboratory, and radiology. Providers should recognize the need to improve EHRs interfacing with other health IT systems within their own organization.Citation: Adams KT, Howe JL, Fong A, Puthumana JS, Kellogg KM, Gaunt M, Ratwani RM. An analysis of patient safety incident reports associated with electronic health record interoperability. Appl Clin Inform 2017; 8: 593–602 https://doi.org/10.4338/ACI-2017-01-RA-0014

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

2018 ◽  
Vol 09 (01) ◽  
pp. 015-033 ◽  
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.

scholarly journals Safety Assurance Factors for Electronic Health Record Resilience (SAFER): study protocol

2013 ◽  
Vol 13 (1) ◽  
Author(s):  
Hardeep Singh ◽  
Joan S Ash ◽  
Dean F Sittig
Keyword(s):  
Electronic Health Record ◽  
Study Protocol ◽  
Health Record ◽  
Safety Assurance ◽  
Electronic Health

Beyond One-Off Integrations: A Commercial, Substitutable, Reusable, Standards-Based, Electronic Health Record–Connected App (Preprint)

2018 ◽  
Author(s):  
Kenneth D Mandl ◽  
Daniel Gottlieb ◽  
Alyssa Ellis
Keyword(s):  
Electronic Health Record ◽  
Diffusion Of Innovation ◽  
Market Competition ◽  
Application Programming Interface ◽  
The United States ◽  
Health Record ◽  
Health It ◽  
Medical Apps ◽  
Open Api ◽  
Electronic Health

UNSTRUCTURED The Substitutable Medical Apps and Reusable Technology (SMART) Health IT project launched in 2010 to facilitate the development of medical apps that are scalable and substitutable. SMART defines an open application programming interface (API) specification that enables apps to connect to electronic health record systems and data warehouses without custom integration efforts. The SMART-enabled version of the Meducation app, developed by Polyglot, has been implemented at scores of hospitals and clinics in the United States, nation-wide. After expanding their product’s reach by relying on a universal, open API for integrations, the team estimates that one project manager can handle up to 20 simultaneous implementations. The app is made available through the SMART App Gallery, an open app store that supports discovery of apps and, because the apps are substitutable, market competition. This case illustrates how a universal open API for patient and clinician-facing health IT systems supported and accelerated commercial success for a start-up company. Giving end users a wide and ever-growing choice of apps that leverage data generated by the health care system and patients at home through a universal, open API is a promising and generalizable approach for rapid diffusion of innovation across health systems.

scholarly journals Safety Assurance Factors for Electronic Health Record Resilience (SAFER) Guidelines

2015 ◽  
Vol 139 (10) ◽  
pp. 1201-1204 ◽  
Author(s):  
Douglas J. Hartman ◽  
Liron Pantanowitz
Keyword(s):  
Electronic Health Record ◽  
Health Record ◽  
Safety Assurance ◽  
Electronic Health

Measuring the Impact of Electronic Health Record Adoption on Charge Capture

2016 ◽  
Vol 74 (5) ◽  
pp. 582-594 ◽  
Author(s):  
Nicholas Edwardson ◽  
Bita A. Kash ◽  
Ramkumar Janakiraman
Keyword(s):  
Primary Care ◽  
Electronic Health Record ◽  
Fixed Effects ◽  
Pediatric Primary Care ◽  
Health Record ◽  
Care Network ◽  
Collection Data ◽  
Ehr Adoption ◽  
Electronic Health ◽  
The Impact

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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