scholarly journals Establishing a multidisciplinary initiative for interoperable electronic health record innovations at an academic medical center

JAMIA Open ◽  
2021 ◽  
Vol 4 (3) ◽  
Author(s):  
Kensaku Kawamoto ◽  
Polina V Kukhareva ◽  
Charlene Weir ◽  
Michael C Flynn ◽  
Claude J Nanjo ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
User Satisfaction ◽  
Clinical Care ◽  
Academic Medical Center ◽  
Critical Role ◽  
Lessons Learned ◽  
Evaluation Framework ◽  
Health Record ◽  
Digital Innovation ◽  
Electronic Health

Abstract Objective To establish an enterprise initiative for improving health and health care through interoperable electronic health record (EHR) innovations. Materials and Methods We developed a unifying mission and vision, established multidisciplinary governance, and formulated a strategic plan. Key elements of our strategy include establishing a world-class team; creating shared infrastructure to support individual innovations; developing and implementing innovations with high anticipated impact and a clear path to adoption; incorporating best practices such as the use of Fast Healthcare Interoperability Resources (FHIR) and related interoperability standards; and maximizing synergies across research and operations and with partner organizations. Results University of Utah Health launched the ReImagine EHR initiative in 2016. Supportive infrastructure developed by the initiative include various FHIR-related tooling and a systematic evaluation framework. More than 10 EHR-integrated digital innovations have been implemented to support preventive care, shared decision-making, chronic disease management, and acute clinical care. Initial evaluations of these innovations have demonstrated positive impact on user satisfaction, provider efficiency, and compliance with evidence-based guidelines. Return on investment has included improvements in care; over $35 million in external grant funding; commercial opportunities; and increased ability to adapt to a changing healthcare landscape. Discussion Key lessons learned include the value of investing in digital innovation initiatives leveraging FHIR; the importance of supportive infrastructure for accelerating innovation; and the critical role of user-centered design, implementation science, and evaluation. Conclusion EHR-integrated digital innovation initiatives can be key assets for enhancing the EHR user experience, improving patient care, and reducing provider burnout.

scholarly journals Genomic Information for Clinicians in the Electronic Health Record: Lessons Learned from ClinGen and eMERGE

2019 ◽  
Author(s):  
Marc S Williams ◽  
Casey Overby Taylor ◽  
Nephi A Walton ◽  
Scott R Goehringer ◽  
Samuel Aronson ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Clinical Decision Making ◽  
Clinical Care ◽  
Genomic Medicine ◽  
Clinical Decision ◽  
Lessons Learned ◽  
Health Record ◽  
Sustainable Solutions ◽  
Electronic Health ◽  
Credible Information

Genomic knowledge is being translated into clinical care. To fully realize the value, it is critical to place credible information in the hands of clinicians in time to support clinical decision-making. The electronic health record is an essential component of clinician workflow. Utilizing the electronic health record to present information to support the use of genomic medicine in clinical care to improve outcomes represents a tremendous opportunity. However, there are numerous barriers that prevent the effective use of the electronic health record for this purpose. The electronic health record working groups of the electronic MEdical Records and GEnomics network (eMERGE) and the Clinical Genome Resource (ClinGen) project, along with other groups, have been defining these barriers, to allow the development of solutions that can be tested using implementation pilots. In this paper, we present ‘lessons learned’ from these efforts to inform future efforts leading to the development of effective and sustainable solutions that will support the realization of genomic medicine.

scholarly journals Implementation of the Randomized Embedded Multifactorial Adaptive Platform for COVID-19 (REMAP-COVID) trial in a US health system—lessons learned and recommendations

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Keyword(s):  
Electronic Health Record ◽  
Health System ◽  
Clinical Care ◽  
Regulatory Compliance ◽  
Lessons Learned ◽  
Health Record ◽  
Trial Management ◽  
Learning Health System ◽  
Management Procedures ◽  
Electronic Health

Abstract Background The Randomized Embedded Multifactorial Adaptive Platform for COVID-19 (REMAP-COVID) trial is a global adaptive platform trial of hospitalized patients with COVID-19. We describe implementation at the first US site, the UPMC health system, and offer recommendations for implementation at other sites. Methods To implement REMAP-COVID, we focused on six major areas: engaging leadership, trial embedment, remote consent and enrollment, regulatory compliance, modification of traditional trial management procedures, and alignment with other COVID-19 studies. Results We recommend aligning institutional and trial goals and sharing a vision of REMAP-COVID implementation as groundwork for learning health system development. Embedment of trial procedures into routine care processes, existing institutional structures, and the electronic health record promotes efficiency and integration of clinical care and clinical research. Remote consent and enrollment can be facilitated by engaging bedside providers and leveraging institutional videoconferencing tools. Coordination with the central institutional review board will expedite the approval process. Protocol adherence, adverse event monitoring, and data collection and export can be facilitated by building electronic health record processes, though implementation can start using traditional clinical trial tools. Lastly, establishment of a centralized institutional process optimizes coordination of COVID-19 studies. Conclusions Implementation of the REMAP-COVID trial within a large US healthcare system is feasible and facilitated by multidisciplinary collaboration. This investment establishes important groundwork for future learning health system endeavors. Trial registration NCT02735707. Registered on 13 April 2016.

scholarly journals Diabetes and Hypertension Quality Measurement in Four Safety-Net Sites

2014 ◽  
Vol 05 (03) ◽  
pp. 757-772 ◽  
Author(s):  
R. Benkert ◽  
P. Dennehy ◽  
J. White ◽  
A. Hamilton ◽  
C. Tanner ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Quality Measurement ◽  
Safety Net ◽  
Lessons Learned ◽  
Health Record ◽  
Partnership Model ◽  
Safety Net Clinics ◽  
Electronic Health ◽  
Query Algorithms

SummaryBackground: In this new era after the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, the literature on lessons learned with electronic health record (EHR) implementation needs to be revisited.Objectives: Our objective was to describe what implementation of a commercially available EHR with built-in quality query algorithms showed us about our care for diabetes and hypertension populations in four safety net clinics, specifically feasibility of data retrieval, measurements over time, quality of data, and how our teams used this data.Methods: A cross-sectional study was conducted from October 2008 to October 2012 in four safety-net clinics located in the Midwest and Western United States. A data warehouse that stores data from across the U.S was utilized for data extraction from patients with diabetes or hypertension diagnoses and at least two office visits per year. Standard quality measures were collected over a period of two to four years. All sites were engaged in a partnership model with the IT staff and a shared learning process to enhance the use of the quality metrics.Results: While use of the algorithms was feasible across sites, challenges occurred when attempting to use the query results for research purposes. There was wide variation of both process and outcome results by individual centers. Composite calculations balanced out the differences seen in the individual measures. Despite using consistent quality definitions, the differences across centers had an impact on numerators and denominators. All sites agreed to a partnership model of EHR implementation, and each center utilized the available resources of the partnership for Center-specific quality initiatives.Conclusions: Utilizing a shared EHR, a Regional Extension Center-like partnership model, and similar quality query algorithms allowed safety-net clinics to benchmark and improve the quality of care across differing patient populations and health care delivery models.Citation: Benkert R, Dennehy P, White J, Hamilton A, Tanner C, Pohl JM. Diabetes and hypertension quality measurement in four safety-net sites: Lessons learned after implementation of the same commercial electronic health record. Appl Clin Inf 2014; 5: 757–772http://dx.doi.org/10.4338/ACI-2014-03-RA-0019

scholarly journals Local Investment in Training Drives Electronic Health Record User Satisfaction

2019 ◽  
Vol 10 (02) ◽  
pp. 331-335 ◽  
Author(s):  
Christopher Longhurst ◽  
Taylor Davis ◽  
Amy Maneker ◽  
H. Eschenroeder ◽  
Rachel Dunscombe ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
User Satisfaction ◽  
Health Record ◽  
Electronic Health

scholarly journals Electronic Health Record Adoption – Maybe It’s not about the Money

2011 ◽  
Vol 02 (04) ◽  
pp. 460-471 ◽  
Author(s):  
A. Skinner ◽  
J. Windle ◽  
L. Grabenbauer
Keyword(s):  
Electronic Health Record ◽  
Patient Care ◽  
Resistance To Change ◽  
Medical Center ◽  
Academic Medical Center ◽  
Care Physician ◽  
Health Record ◽  
Record System ◽  
Intuitive Interfaces ◽  
Electronic Health

SummaryObjective: The slow adoption of electronic health record (EHR) systems has been linked to physician resistance to change and the expense of EHR adoption. This qualitative study was conducted to evaluate benefits, and clarify limitations of two mature, robust, comprehensive EHR Systems by tech-savvy physicians where resistance and expense are not at issue.Methods: Two EHR systems were examined – the paperless VistA / Computerized Patient Record System used at the Veterans‘ Administration, and the General Electric Centricity Enterprise system used at an academic medical center. A series of interviews was conducted with 20 EHR-savvy multi-institutional internal medicine (IM) faculty and house staff. Grounded theory was used to analyze the transcribed data and build themes. The relevance and importance of themes were constructed by examining their frequency, convergence, and intensity.Results: Despite eliminating resistance to both adoption and technology as drivers of acceptance, these two robust EHR’s are still viewed as having an adverse impact on two aspects of patient care, physician workflow and team communication. Both EHR’s had perceived strengths but also significant limitations and neither were able to satisfactorily address all of the physicians’ needs.Conclusion: Difficulties related to physician acceptance reflect real concerns about EHR impact on patient care. Physicians are optimistic about the future benefits of EHR systems, but are frustrated with the non-intuitive interfaces and cumbersome data searches of existing EHRs.

scholarly journals Transition to a new electronic health record and pediatric medication safety: lessons learned in pediatrics within a large academic health system

2018 ◽  
Vol 25 (7) ◽  
pp. 848-854 ◽  
Author(s):  
Kimberly Whalen ◽  
Emily Lynch ◽  
Iman Moawad ◽  
Tanya John ◽  
Denise Lozowski ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Medication Safety ◽  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Lessons Learned ◽  
Future Research ◽  
Health Record ◽  
Electronic Health ◽  
Roll Out

Abstract Objective While the electronic health record (EHR) has become a standard of care, pediatric patients pose a unique set of risks in adult-oriented systems. We describe medication safety and implementation challenges and solutions in the pediatric population of a large academic center transitioning its EHR to Epic. Methods Examination of the roll-out of a new EHR in a mixed neonatal, pediatric and adult tertiary care center with staggered implementation. We followed the voluntarily reported medication error rate for the neonatal and pediatric subsets and specifically monitored the first 3 months after the roll-out of the new EHR. Data was reviewed and compiled by theme. Results After implementation, there was a 5-fold increase in the overall number of medication safety reports; by the third month the rate of reported medication errors had returned to baseline. The majority of reports were near misses. Three major safety themes arose: (1) enterprise logic in rounding of doses and dosing volumes; (2) ordering clinician seeing a concentration and product when ordering medications; and (3) the need for standardized dosing units through age contexts created issues with continuous infusions and pump library safeguards. Conclusions Future research and work need to be focused on standards and guidelines on implementing an EHR that encompasses all age contexts.

scholarly journals Overcoming barriers to implementing patient-reported outcomes in an electronic health record: a case report

2015 ◽  
Vol 23 (1) ◽  
pp. 74-79 ◽  
Author(s):  
Christopher A Harle ◽  
Alyson Listhaus ◽  
Constanza M Covarrubias ◽  
Siegfried OF Schmidt ◽  
Sean Mackey ◽  
...  
Keyword(s):  
Case Report ◽  
Electronic Health Record ◽  
Patient Reported Outcomes ◽  
System Development ◽  
Lessons Learned ◽  
Health Record ◽  
Patient Reported ◽  
Electronic Health ◽  
Clinical Tools ◽  
The Right

Abstract In this case report, the authors describe the implementation of a system for collecting patient-reported outcomes and integrating results in an electronic health record. The objective was to identify lessons learned in overcoming barriers to collecting and integrating patient-reported outcomes in an electronic health record. The authors analyzed qualitative data in 42 documents collected from system development meetings, written feedback from users, and clinical observations with practice staff, providers, and patients. Guided by the Unified Theory on the Adoption and Use of Information Technology, 5 emergent themes were identified. Two barriers emerged: (i) uncertain clinical benefit and (ii) time, work flow, and effort constraints. Three facilitators emerged: (iii) process automation, (iv) usable system interfaces, and (v) collecting patient-reported outcomes for the right patient at the right time. For electronic health record-integrated patient-reported outcomes to succeed as useful clinical tools, system designers must ensure the clinical relevance of the information being collected while minimizing provider, staff, and patient burden.

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