scholarly journals The influence of a Sprint optimization and training intervention on time spent in the electronic health record (EHR)

JAMIA Open ◽  
2021 ◽  
Vol 4 (3) ◽  
Author(s):  
Amber Sieja ◽  
Melanie D Whittington ◽  
Vanessa Paul Patterson ◽  
Katie Markley ◽  
Heather Holmstrom ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Interrupted Time Series ◽  
Health Record ◽  
Full Time ◽  
Full Time Equivalent ◽  
Post Intervention ◽  
Time Savings ◽  
Electronic Health ◽  
The Impact ◽  
And Training

Abstract Objective We report the influence of Sprint electronic health record (EHR) training and optimization on clinician time spent in the EHR. Materials and Methods We studied the Sprint process in one academic internal medicine practice with 26 providers. Program offerings included individualized training sessions, and the ability to clean up, fix, or build new EHR tools during the 2-week intervention. EHR usage log data were available for 24 clinicians, and the average clinical full-time equivalent was 0.44. We used a quasi-experimental study design with an interrupted time series specification, with 8 months of pre- and 12 months of post-intervention data to evaluate clinician time spent in the EHR. Results We discovered a greater than 6 h per day reduction in clinician time spent in the EHR at the clinic level. At the individual clinician level, we demonstrated a time savings of 20 min per clinician per day among those who attended at least 2 training sessions. Discussion We can promote EHR time savings for clinicians who engage in robust EHR training and optimization programs. To date, programs have shown a positive correlation between participation and subjective EHR satisfaction, efficiency, or time saved. The impact of EHR training and optimization on objective time savings remains elusive. By measuring time in the EHR, this study contributes to an ongoing conversation about the resources and programs needed to decrease clinician EHR time. Conclusions We have demonstrated that Sprint is associated with time savings for clinicians for up to 6 months. We suggest that an investment in EHR optimization and training can pay dividends in clinician time saved.

scholarly journals Measuring Electronic Health Record Use in the Pediatric ICU Using Audit-Logs and Screen Recordings

2021 ◽  
Vol 12 (04) ◽  
pp. 737-744
Author(s):  
Amrita Sinha ◽  
Lindsay A. Stevens ◽  
Felice Su ◽  
Natalie M. Pageler ◽  
Daniel S. Tawfik
Keyword(s):  
Electronic Health Record ◽  
Pediatric Intensive Care ◽  
Clinical Activity ◽  
Inpatient Setting ◽  
Health Record ◽  
Full Time ◽  
Care Providers ◽  
Provider Type ◽  
Full Time Equivalent ◽  
Electronic Health

Abstract Background Time spent in the electronic health record (EHR) has been identified as an important unit of measure for health care provider clinical activity. The lack of validation of audit-log based inpatient EHR time may have resulted in underuse of this data in studies focusing on inpatient patient outcomes, provider efficiency, provider satisfaction, etc. This has also led to a dearth of clinically relevant EHR usage metrics consistent with inpatient provider clinical activity. Objective The aim of our study was to validate audit-log based EHR times using observed EHR-times extracted from screen recordings of EHR usage in the inpatient setting. Methods This study was conducted in a 36-bed pediatric intensive care unit (PICU) at Lucile Packard Children's Hospital Stanford between June 11 and July 14, 2020. Attending physicians, fellow physicians, hospitalists, and advanced practice providers with ≥0.5 full-time equivalent (FTE) for the prior four consecutive weeks and at least one EHR session recording were included in the study. Citrix session recording player was used to retrospectively review EHR session recordings that were captured as the provider interacted with the EHR. Results EHR use patterns varied by provider type. Audit-log based total EHR time correlated strongly with both observed total EHR time (r = 0.98, p < 0.001) and observed active EHR time (r = 0.95, p < 0.001). Each minute of audit-log based total EHR time corresponded to 0.95 (0.87–1.02) minutes of observed total EHR time and 0.75 (0.67–0.83) minutes of observed active EHR time. Results were similar when stratified by provider role. Conclusion Our study found inpatient audit-log based EHR time to correlate strongly with observed EHR time among pediatric critical care providers. These findings support the use of audit-log based EHR-time as a surrogate measure for inpatient provider EHR use, providing an opportunity for researchers and other stakeholders to leverage EHR audit-log data in measuring clinical activity and tracking outcomes of workflow improvement efforts longitudinally and across provider groups.

Education and devices to prevent blood and body fluid exposures

2019 ◽  
Vol 70 (1) ◽  
pp. 38-44 ◽  
Author(s):  
S Cheetham ◽  
H Ngo ◽  
J Liira ◽  
E Lee ◽  
C Pethrick ◽  
...  
Keyword(s):  
Body Fluid ◽  
Interrupted Time Series ◽  
Hospital Staff ◽  
Incidence Rates ◽  
Full Time ◽  
Interrupted Time Series Analysis ◽  
Short Term ◽  
Full Time Equivalent ◽  
Post Intervention ◽  
The Impact

Abstract Background Healthcare workers are at risk of blood and body fluid exposures (BBFE) while delivering care to patients. Despite recent technological advances such as safety-engineered devices (SEDs), these injuries continue to occur in healthcare facilities worldwide. Aims To assess the impact of an education and SEDs workplace programme on rates of reported exposures. Methods A retrospective cohort study, utilizing interrupted time series analysis to examine reported exposures between 2005 and 2015 at a 600-bed hospital in Perth, Western Australia. The hospital wards were divided into four cohorts. Results A total of 2223 records were available for analysis. The intervention was most effective for the first cohort, with significant improvements both short-term (reduction of 12 (95% CI 7–17) incidents per 1000 full-time equivalent (FTE) hospital staff) and long-term (reduction of 2 (CI 0.6–4) incidents per 1000 FTE per year). Less significant or consistent impacts were observed for the other three cohorts. Overall, the intervention decreased BBFE exposure rates at the hospital level from 19 (CI 18–20) incidents per 1000 FTE pre-intervention to 11 (CI 10–12) incidents per 1000 FTE post-intervention, a 41% reduction. No exposures resulted in a blood-borne virus infection. Conclusions The intervention was most effective in reducing exposures at a time when incidence rates were increasing. The overall effect was short-term and did not further reduce an already stabilized trend, which was likely due to improved safety awareness and practice, induced by the first cohort intervention.

scholarly journals Electronic health records and burnout: Time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians

2020 ◽  
Vol 27 (4) ◽  
pp. 531-538 ◽  
Author(s):  
Julia Adler-Milstein ◽  
Wendi Zhao ◽  
Rachel Willard-Grace ◽  
Margae Knox ◽  
Kevin Grumbach
Keyword(s):  
Primary Care ◽  
Electronic Health Record ◽  
Academic Medical Center ◽  
Maslach Burnout Inventory ◽  
Health Record ◽  
Full Time ◽  
Full Time Equivalent ◽  
After Hours ◽  
Electronic Health ◽  
High Exhaustion

Abstract Objectives The study sought to determine whether objective measures of electronic health record (EHR) use—related to time, volume of work, and proficiency—are associated with either or both components of clinician burnout: exhaustion and cynicism. Materials and Methods We combined Maslach Burnout Inventory survey measures (94% response rate; 122 of 130 clinicians) with objective, vendor-defined EHR use measures from log files (time after hours on clinic days; time on nonclinic days; message volume; composite measures of efficiency and proficiency). Data were collected in early 2018 from all primary care clinics of a large, urban, academic medical center. Multivariate regression models measured the association between each burnout component and each EHR use measure. Results One-third (34%) of clinicians had high cynicism and 51% had high emotional exhaustion. Clinicians in the top 2 quartiles of EHR time after hours on scheduled clinic days (those above the sample median of 68 minutes per clinical full-time equivalent per week) had 4.78 (95% confidence interval [CI], 1.1-20.1; P = .04) and 12.52 (95% CI, 2.6-61; P = .002) greater odds of high exhaustion. Clinicians in the top quartile of message volume (&gt;307 messages per clinical full-time equivalent per week) had 6.17 greater odds of high exhaustion (95% CI, 1.1-41; P = .04). No measures were associated with high cynicism. Discussion EHRs have been cited as a contributor to clinician burnout, and self-reported data suggest a relationship between EHR use and burnout. As organizations increasingly rely on objective, vendor-defined EHR measures to design and evaluate interventions to reduce burnout, our findings point to the measures that should be targeted. Conclusions Two specific EHR use measures were associated with exhaustion.

scholarly journals Harnessing the Electronic Health Record to Actively Support Providers with Guideline-Directed Telemetry Use

2021 ◽  
Vol 12 (05) ◽  
pp. 996-1001
Author(s):  
Maya Narayanan ◽  
Helene Starks ◽  
Eric Tanenbaum ◽  
Ellen Robinson ◽  
Paul R. Sutton ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Acute Care ◽  
Low Cost ◽  
Heart Association ◽  
Evidence Based ◽  
Health Record ◽  
Post Intervention ◽  
Support Providers ◽  
Electronic Health ◽  
The Impact

Abstract Background Overuse of cardiac telemetry monitoring (telemetry) can lead to alarm fatigue, discomfort for patients, and unnecessary medical costs. Currently there are evidence-based recommendations describing appropriate telemetry use, but many providers are unaware of these guidelines. Objectives At our multihospital health system, our goal was to support providers in ordering telemetry on acute care in accordance with evidence-based guidelines and discontinuing telemetry when it was no longer medically indicated. Methods We implemented a multipronged electronic health record (EHR) intervention at two academic medical centers, including: (1) an order set requiring providers to choose an indication for telemetry with a recommended duration based on American Heart Association guidelines; (2) an EHR-generated reminder page to the primary provider recommending telemetry discontinuation once the guideline-recommended duration for telemetry is exceeded; and (3) documentation of telemetry interpretation by telemetry technicians in the notes section of the EHR. To determine the impact of the intervention, we compared number of telemetry orders actively discontinued prior to discharge and telemetry duration 1 year pre- to 1 year post-intervention on acute care medicine services. We evaluated sustainability at years 2 and 3. Results Implementation of the EHR initiative resulted in a statistically significant increase in active discontinuation of telemetry orders prior to discharge: 15% (63.4–78.7%) at one site and 13% at the other (64.1–77.4%) with greater improvements on resident teams. Fewer acute care medicine telemetry orders were placed on medicine services across the system (1,503–1,305) despite an increase in admissions and the average duration of telemetry decreased at both sites (62 to 47 hours, p < 0.001 and 73 to 60, p < 0.001, respectively). Improvements were sustained 2 and 3 years after intervention. Conclusion Our study showed that a low-cost, multipart, EHR-based intervention with active provider engagement and no additional education can decrease telemetry usage on acute care medicine services.

scholarly journals Disrupted and Restored Patient Experience With Transition to New Electronic Health Record System

2021 ◽  
Vol 8 ◽  
pp. 237437352110340
Author(s):  
Dajun Tian ◽  
Christine M. Hoehner ◽  
Keith F. Woeltje ◽  
Lan Luong ◽  
Michael A. Lane
Keyword(s):  
Health Care ◽  
Electronic Health Record ◽  
Patient Experience ◽  
Healthcare Providers ◽  
Interrupted Time Series ◽  
Hospital Staff ◽  
Health Record ◽  
Record System ◽  
Electronic Health ◽  
The Impact

Transitioning from one electronic health record (EHR) system to another is of the most disruptive events in health care and research about its impact on patient experience for inpatient is limited. This study aimed to assess the impact of transitioning EHR on patient experience measured by the Hospital Consumer Assessment of Healthcare Providers and Systems composites and global items. An interrupted time series study was conducted to evaluate quarter-specific changes in patient experience following implementation of a new EHR at a Midwest health care system during 2017 to 2018. First quarter post-implementation was associated with statistically significant decreases in Communication with Nurses (−1.82; 95% CI, −3.22 to −0.43; P = .0101), Responsiveness of Hospital Staff (−2.73; 95% CI, −4.90 to −0.57; P = .0131), Care Transition (−2.01; 95% CI, −3.96 to −0.07; P = .0426), and Recommend the Hospital (−2.42; 95% CI, −4.36 to −0.49; P = .0142). No statistically significant changes were observed in the transition, second, or third quarters post-implementation. Patient experience scores returned to baseline level after two quarters and the impact from EHR transition appeared to be temporary.

scholarly journals Management of a parenteral opioid shortage using ASHP guidelines

2021 ◽  
Vol 78 (5) ◽  
pp. 426-435
Author(s):  
Peter Vo ◽  
Daniel A Sylvia ◽  
Loay Milibari ◽  
John Ryan Stackhouse ◽  
Paul Szumita ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Drug Product ◽  
Health Record ◽  
Large Hospital ◽  
Hospital Administrators ◽  
Utilization Data ◽  
Electronic Health ◽  
Opioid Medications ◽  
American Society ◽  
The Impact

Abstract Purpose Management of an acute shortage of parenteral opioid products at a large hospital through prescribing interventions and other guideline-recommended actions is described. Summary In early 2018, many hospitals were faced with a shortage of parenteral opioids that was predicted to last an entire year. The American Society of Health-System Pharmacists (ASHP) has published guidelines on managing drug product shortages. This article describes the application of these guidelines to manage the parenteral opioid shortage and the impact on opioid dispensing that occurred in 2018. Our approach paralleled that recommended in the ASHP guidelines. Daily dispensing reports generated from automated dispensing cabinets and from the electronic health record were used to capture dispenses of opioid medications. Opioid prescribing and utilization data were converted to morphine milligram equivalents (MME) to allow clinical leaders and hospital administrators to quickly evaluate opioid inventories and consumption. Action steps included utilization of substitute opioid therapies and conversion of opioid patient-controlled analgesia (PCA) and opioid infusions to intravenous bolus dose administration. Parenteral opioid supplies were successfully rationed so that surgical and elective procedures were not canceled or delayed. During the shortage, opioid dispensing decreased in the inpatient care areas from approximately 2.0 million MME to 1.4 million MME and in the operating rooms from 0.56 MME to 0.29 million MME. The combination of electronic health record alerts, increased utilization of intravenous acetaminophen and liposomal bupivacaine, and pharmacist interventions resulted in a 67% decline in PCA use and a 65% decline in opioid infusions. Conclusion A multidisciplinary response is necessary for effective management of drug shortages through implementation of strategies and practices for notifying clinicians of shortages and identifying optimal alternative therapies.

Improving physician wellness through electronic health record education

2021 ◽  
pp. 009121742110346
Author(s):  
Elizabette Johnson ◽  
Elizabeth Roth
Keyword(s):  
Electronic Health Record ◽  
Statistical Significance ◽  
Resident Physician ◽  
Health Record ◽  
Physician Burnout ◽  
Paired Data ◽  
Post Intervention ◽  
Physician Wellness ◽  
Resident Wellness ◽  
Electronic Health

Objective Our goal is to improve the wellness of our Family Medicine residents now and in the future by educating them on more efficient use of our electronic health record (EHR). Resident physician burnout is a significant problem and is correlated with time spent using an EHR after work hours. Family physicians have the highest rate of burnout of all specialties, and the EHR is a significant contributor to this burnout. Studies have shown that increased EHR education can improve job satisfaction. Method Over 5 months, we provided weekly brief (15 minute) educational sessions covering 6 topics twice and a one-hour individualized meeting of each resident physician with an EHR trainer. We evaluated our intervention with wellness surveys and objective measures of EHR efficiency both pre and post intervention. We further evaluated efficiency by comparing pre and post-intervention values of the following: average keystrokes, mouseclicks, accelerator use, minutes per encounter and percent closed encounters at month’s end. Results Resident questionnaires showed lessons increased knowledge and intention to use EHR accelerators, but this was not statistically significant. Analysis of objective data showed most efficiency metrics worsened, though most not to a degree that was statistically significant. Residents reported subjective increases in efficiency, and paired data from wellness surveys showed an overall decrease in burnout post-intervention vs. baseline. Conclusions Much of the data in this pilot study does not reach statistical significance, but is highly suggestive that increased EHR training can improve at least perceived efficiency and thereby resident wellness.

scholarly journals Estimating the Impact of Diabetes Mellitus on Worker Productivity Using Self-Report, Electronic Health Record and Human Resource Data

2018 ◽  
Vol 60 (11) ◽  
pp. e569-e574 ◽  
Author(s):  
David C. Tabano ◽  
Melissa L. Anderson ◽  
Debra P. Ritzwoller ◽  
Arne Beck ◽  
Nikki Carroll ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Electronic Health Record ◽  
Human Resource ◽  
Self Report ◽  
Health Record ◽  
Worker Productivity ◽  
Electronic Health ◽  
Resource Data ◽  
The Impact

scholarly journals The Development and Piloting of the Ambulatory Electronic Health Record Evaluation Tool: Lessons Learned

2021 ◽  
Vol 12 (01) ◽  
pp. 153-163
Author(s):  
Zoe Co ◽  
A. Jay Holmgren ◽  
David C. Classen ◽  
Lisa P. Newmark ◽  
Diane L. Seger ◽  
...  
Keyword(s):  
Decision Support ◽  
Electronic Health Record ◽  
Medication Safety ◽  
Medication Reconciliation ◽  
The United States ◽  
Health Record ◽  
Evaluation Tool ◽  
Safety Test ◽  
Electronic Health ◽  
The Impact

Abstract Background Substantial research has been performed about the impact of computerized physician order entry on medication safety in the inpatient setting; however, relatively little has been done in ambulatory care, where most medications are prescribed. Objective To outline the development and piloting process of the Ambulatory Electronic Health Record (EHR) Evaluation Tool and to report the quantitative and qualitative results from the pilot. Methods The Ambulatory EHR Evaluation Tool closely mirrors the inpatient version of the tool, which is administered by The Leapfrog Group. The tool was piloted with seven clinics in the United States, each using a different EHR. The tool consists of a medication safety test and a medication reconciliation module. For the medication test, clinics entered test patients and associated test orders into their EHR and recorded any decision support they received. An overall percentage score of unsafe orders detected, and order category scores were provided to clinics. For the medication reconciliation module, clinics demonstrated how their EHR electronically detected discrepancies between two medication lists. Results For the medication safety test, the clinics correctly alerted on 54.6% of unsafe medication orders. Clinics scored highest in the drug allergy (100%) and drug–drug interaction (89.3%) categories. Lower scoring categories included drug age (39.3%) and therapeutic duplication (39.3%). None of the clinics alerted for the drug laboratory or drug monitoring orders. In the medication reconciliation module, three (42.8%) clinics had an EHR-based medication reconciliation function; however, only one of those clinics could demonstrate it during the pilot. Conclusion Clinics struggled in areas of advanced decision support such as drug age, drug laboratory, and drub monitoring. Most clinics did not have an EHR-based medication reconciliation function and this process was dependent on accessing patients' medication lists. Wider use of this tool could improve outpatient medication safety and can inform vendors about areas of improvement.

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