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

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.

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Suspected Underdiagnosis of Respiratory Syncytial Virus in a Large Health System: Early Findings From Electronic Health Record Data Exploration and Conversations With a Hospitalist

Journal of Patient-Centered Research and Reviews ◽

10.17294/2330-0698.1507 ◽

2017 ◽

Vol 4 (3) ◽

pp. 166-167

Author(s):

Jessica Liu ◽

Heather Law ◽

Sarah Robinson ◽

Richard Liu ◽

Lisa Dean ◽

...

Keyword(s):

Respiratory Syncytial Virus ◽

Electronic Health Record ◽

Health System ◽

Data Exploration ◽

Health Record ◽

Electronic Health Record Data ◽

Record Data ◽

Electronic Health ◽

Syncytial Virus

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Health System Implementation of a Tobacco Quitline eReferral

Applied Clinical Informatics ◽

10.1055/s-0039-1697593 ◽

2019 ◽

Vol 10 (04) ◽

pp. 735-742 ◽

Cited By ~ 2

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.

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

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-020-1048-9 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 5

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

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Model-Based Algorithms for Detecting Peripheral Artery Disease Using Administrative Data From an Electronic Health Record Data System: Algorithm Development Study

JMIR Medical Informatics ◽

10.2196/18542 ◽

2020 ◽

Vol 8 (8) ◽

pp. e18542 ◽

Cited By ~ 2

Author(s):

Elizabeth Hope Weissler ◽

Steven J Lippmann ◽

Michelle M Smerek ◽

Rachael A Ward ◽

Aman Kansal ◽

...

Keyword(s):

Electronic Health Record ◽

Health System ◽

Administrative Data ◽

Peripheral Artery Disease ◽

Health Record ◽

Peripheral Artery ◽

Model Based ◽

Diagnosis Codes ◽

Electronic Health ◽

Artery Disease

Background Peripheral artery disease (PAD) affects 8 to 10 million Americans, who face significantly elevated risks of both mortality and major limb events such as amputation. Unfortunately, PAD is relatively underdiagnosed, undertreated, and underresearched, leading to wide variations in treatment patterns and outcomes. Efforts to improve PAD care and outcomes have been hampered by persistent difficulties identifying patients with PAD for clinical and investigatory purposes. Objective The aim of this study is to develop and validate a model-based algorithm to detect patients with peripheral artery disease (PAD) using data from an electronic health record (EHR) system. Methods An initial query of the EHR in a large health system identified all patients with PAD-related diagnosis codes for any encounter during the study period. Clinical adjudication of PAD diagnosis was performed by chart review on a random subgroup. A binary logistic regression to predict PAD was built and validated using a least absolute shrinkage and selection operator (LASSO) approach in the adjudicated patients. The algorithm was then applied to the nonsampled records to further evaluate its performance. Results The initial EHR data query using 406 diagnostic codes yielded 15,406 patients. Overall, 2500 patients were randomly selected for ground truth PAD status adjudication. In the end, 108 code flags remained after removing rarely- and never-used codes. We entered these code flags plus administrative encounter, imaging, procedure, and specialist flags into a LASSO model. The area under the curve for this model was 0.862. Conclusions The algorithm we constructed has two main advantages over other approaches to the identification of patients with PAD. First, it was derived from a broad population of patients with many different PAD manifestations and treatment pathways across a large health system. Second, our model does not rely on clinical notes and can be applied in situations in which only administrative billing data (eg, large administrative data sets) are available. A combination of diagnosis codes and administrative flags can accurately identify patients with PAD in large cohorts.

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A Novel Patient Values Tab for the Electronic Health Record: A User-Centered Design Approach

Journal of Medical Internet Research ◽

10.2196/21615 ◽

2021 ◽

Vol 23 (2) ◽

pp. e21615

Author(s):

Anjali Varma Desai ◽

Chelsea L Michael ◽

Gilad J Kuperman ◽

Gregory Jordan ◽

Haley Mittelstaedt ◽

...

Keyword(s):

Health Care ◽

Electronic Health Record ◽

User Experience ◽

Working Group ◽

Medical Oncology ◽

Health Record ◽

User Centered Design ◽

Electronic Health ◽

Patient Values ◽

User Centered

Background The COVID-19 pandemic has shined a harsh light on a critical deficiency in our health care system: our inability to access important information about patients’ values, goals, and preferences in the electronic health record (EHR). At Memorial Sloan Kettering Cancer Center (MSK), we have integrated and systematized health-related values discussions led by oncology nurses for newly diagnosed cancer patients as part of routine comprehensive cancer care. Such conversations include not only the patient’s wishes for care at the end of life but also more holistic personal values, including sources of strength, concerns, hopes, and their definition of an acceptable quality of life. In addition, health care providers use a structured template to document their discussions of patient goals of care. Objective To provide ready access to key information about the patient as a person with individual values, goals, and preferences, we undertook the creation of the Patient Values Tab in our center’s EHR to display this information in a single, central location. Here, we describe the interprofessional, interdisciplinary, iterative process and user-centered design methodology that we applied to build this novel functionality as well as our initial implementation experience and plans for evaluation. Methods We first convened a working group of experts from multiple departments, including medical oncology, health informatics, information systems, nursing informatics, nursing education, and supportive care, and a user experience designer. We conducted in-depth, semistructured, audiorecorded interviews of over 100 key stakeholders. The working group sought consensus on the tab’s main content, homing in on high-priority areas identified by the stakeholders. The core content was mapped to various EHR data sources. We established a set of high-level design principles to guide our process. Our user experience designer then created wireframes of the tab design. The designer conducted usability testing with physicians, nurses, and other health professionals. Data validation testing was conducted. Results We have already deployed the Patient Values Tab to a pilot sample of users in the MSK Gastrointestinal Medical Oncology Service, including physicians, advanced practice providers, nurses, and administrative staff. We have early evidence of the positive impact of this EHR innovation. Audit logs show increasing use. Many of the initial user comments have been enthusiastically positive, while others have provided constructive suggestions for additional tab refinements with respect to format and content. Conclusions It is our challenge and obligation to enrich the EHR with information about the patient as a person. Realization of this capability is a pressing public health need requiring the collaboration of technological experts with a broad range of clinical leaders, users, patients, and families to achieve solutions that are both principled and practical. Our new Patient Values Tab represents a step forward in this important direction.

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Impact of CancelRx on Discontinuation of Controlled Substance Prescriptions

10.1101/2021.01.12.21249700 ◽

2021 ◽

Author(s):

Taylor L. Watterson ◽

Jamie A Stone ◽

Aaron Gilson ◽

Roger Brown ◽

Ka Z Xiong ◽

...

Keyword(s):

Electronic Health Record ◽

Health System ◽

Secondary Data ◽

Interrupted Time Series ◽

Health Record ◽

Interrupted Time Series Analysis ◽

Pharmacy Records ◽

Controlled Substance ◽

Electronic Health ◽

Over Time

ObjectiveTo assess how controlled substance medication discontinuations were communicated over timeData SourcesSecondary data from a midwestern academic health system electronic health record and pharmacy platform were collected 12-months prior to CancelRx implementation and for 12-months post implementation.Study DesignThe study utilized an interrupted time series analysis (ITSA) to capture the proportion of controlled substance medications that were cancelled in the clinic’s electronic health record and also cancelled in the pharmacy’s dispensing software. The ITSA plotted the proportion of successful cancellation messages over time, particularly after the health system’s implementation of CancelRx, a novel technology.Data Collection/ExtractionData were extracted from the EHR and pharmacy records for patients aged 18+ who had a controlled substance discontinued by a health system provider. Information collected included patient demographics, drug information (name, dose), and dates discontinued in the clinic and pharmacy records.Principal FindingsAfter CancelRx implementation there was a significant increase in the proportion of discontinued controlled substance medications that were communicated to the pharmacy.ConclusionsThis study demonstrates the role that technology can play in promoting controlled substance policy and medication safety.

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