USE OF EVIDENCE-BASED PRACTICE AND THE ELECTRONIC HEALTH RECORD (EHR) TO IMPROVE CLINICAL OUTCOME OF PRESSURE ULCERS ACROSS A SYSTEM (TRINITY HEALTH)

Abstract Tobacco smoking is an important risk factor for cancer incidence, an effect modifier for cancer treatment, and a negative prognostic factor for disease outcomes. Inadequate implementation of evidence-based smoking cessation treatment in cancer centers, a consequence of numerous patient-, provider-, and system-level barriers, contributes to tobacco-related morbidity and mortality. This study provides data for a paradigm shift from a frequently used specialist referral model to a point-of-care treatment model for tobacco use assessment and cessation treatment for outpatients at a large cancer center. The point-of-care model is enabled by a low-burden strategy, the Electronic Health Record-Enabled Evidence-Based Smoking Cessation Treatment program, which was implemented in the cancer center clinics on June 2, 2018. Five-month pre- and post-implementation data from the electronic health record (EHR) were analyzed. The percentage of cancer patients assessed for tobacco use significantly increased from 48% to 90% (z = 126.57, p < .001), the percentage of smokers referred for cessation counseling increased from 0.72% to 1.91% (z = 3.81, p < .001), and the percentage of smokers with cessation medication significantly increased from 3% to 17% (z = 17.20, p < .001). EHR functionalities may significantly address barriers to point-of-care treatment delivery, improving its consistent implementation and thereby increasing access to and quality of smoking cessation care for cancer center patients.

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Development of a Web-Based Nonoperative Small Bowel Obstruction Treatment Pathway App

Applied Clinical Informatics ◽

10.1055/s-0040-1715478 ◽

2020 ◽

Vol 11 (04) ◽

pp. 535-543

Author(s):

Heather Lyu ◽

Caitlin Manca ◽

Casey McGrath ◽

Jennifer Beloff ◽

Nina Plaks ◽

...

Keyword(s):

Small Bowel ◽

Electronic Health Record ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Bowel Resection ◽

Adhesive Small Bowel Obstruction ◽

Evidence Based ◽

Health Record ◽

Time To Surgery ◽

Electronic Health

Abstract Objective An electronic pathway for the management of adhesive small bowel obstruction (SBO) was built and implemented on top of the electronic health record. The aims of this study are to describe the development of the electronic pathway and to report early outcomes. Methods The electronic SBO pathway was designed and implemented at a single institution. All patients admitted to a surgical service with a diagnosis of adhesive SBO were enrolled. Outcomes were compared across three time periods: (1) patients not placed on either pathway from September 2013 through December 2014, (2) patients enrolled in the paper pathway from January 2017 through January 2018, and (3) patients enrolled in the electronic pathway from March through October 2018. The electronic SBO pathway pulls real-time data from the electronic health record to prepopulate the evidence-based algorithm. Outcomes measured included length of stay (LOS), time to surgery, readmission, surgery, and need for bowel resection. Comparative analyses were completed with Pearson's chi-squared, analysis of variance, and Kruskal–Wallis tests. Results There were 46 patients enrolled in the electronic pathway compared with 93 patients on the paper pathway, and 101 nonpathway patients. Median LOS was lower in both pathway cohorts compared with those not on either pathway (3 days [range 1–11] vs. 3 days [range 1–27] vs. 4 days [range 1–13], p = 0.04). Rates of readmission, surgery, time to surgery, and bowel resection were not significantly different across the three groups. Conclusion It is feasible to implement and utilize an electronic, evidence-based clinical pathway for adhesive SBOs. Use of the electronic and paper pathways was associated with decreased hospital LOS for patients with adhesive SBOs.

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Using an Evidence-Based Approach for Electronic Health Record Downtime Education in Nurse Onboarding

CIN: Computers, Informatics, Nursing ◽

10.1097/cin.0000000000000582 ◽

2020 ◽

Vol 38 (1) ◽

pp. 36-44

Author(s):

Jeffery M. Sano ◽

Susan Alexander

Keyword(s):

Electronic Health Record ◽

Evidence Based ◽

Health Record ◽

Electronic Health

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The Use of Evidence-Based, Problem-Oriented Templates as a Clinical Decision Support in an Inpatient Electronic Health Record System

Applied Clinical Informatics ◽

10.4338/aci-2015-11-ra-0164 ◽

2016 ◽

Vol 07 (03) ◽

pp. 790-802 ◽

Cited By ~ 9

Author(s):

Nila Radhakrishnan ◽

Carrie Warring ◽

Ankur Jain ◽

Jorge Fuentes ◽

Angela Dolganiuc ◽

...

Keyword(s):

Decision Support ◽

Electronic Health Record ◽

Clinical Decision Support ◽

Outcome Measurement ◽

Clinical Decision ◽

Electronic Health Record System ◽

Evidence Based ◽

Health Record ◽

Record System ◽

Electronic Health

SummaryThe integration of clinical decision support (CDS) in documentation practices remains limited due to obstacles in provider workflows and design restrictions in electronic health records (EHRs). The use of electronic problem-oriented templates (POTs) as a CDS has been previously discussed but not widely studied.We evaluated the voluntary use of evidence-based POTs as a CDS on documentation practices.This was a randomized cohort (before and after) study of Hospitalist Attendings in an Academic Medical Center using EPIC EHRs. Primary Outcome measurement was note quality, assessed by the 9-item Physician Documentation Quality Instrument (PDQI-9). Secondary Outcome measurement was physician efficiency, assessed by the total charting time per note.Use of POTs increased the quality of note documentation [score 37.5 vs. 39.0, P = 0.0020]. The benefits of POTs scaled with use; the greatest improvement in note quality was found in notes using three or more POTs [score 40.2, P = 0.0262]. There was no significant difference in total charting time [30 minutes vs. 27 minutes, P = 0.42].Use of evidence-based and problem-oriented templates is associated with improved note quality without significant change in total charting time. It can be used as an effective CDS during note documentation. Citation: Mehta R, Radhakrishnan NS, Warring CD, Jain A, Fuentes J, Dolganiuc A, Lourdes LS, Busigin J, Leverence RR. The use of evidence-based, problemoriented templates as a clinical decision support in an inpatient electronic health record system.

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Lack of Association Between Electronic Health Record Systems and Improvement in Use of Evidence-Based Heart Failure Therapies in Outpatient Cardiology Practices

Clinical Cardiology ◽

10.1002/clc.21971 ◽

2012 ◽

Vol 35 (3) ◽

pp. 187-196 ◽

Cited By ~ 17

Author(s):

Mary Norine Walsh ◽

Nancy M. Albert ◽

Anne B. Curtis ◽

Mihai Gheorghiade ◽

J. Thomas Heywood ◽

...

Keyword(s):

Heart Failure ◽

Electronic Health Record ◽

Evidence Based ◽

Health Record ◽

Electronic Health

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Advice for Decision Makers Based on an Electronic Health Record Evaluation at a Program for All-inclusive Care for Elders Site

Applied Clinical Informatics ◽

10.4338/aci-2010-09-ra-0055 ◽

2011 ◽

Vol 02 (01) ◽

pp. 18-38 ◽

Cited By ~ 6

Author(s):

J.P. Weiner ◽

K.H. Bowles ◽

P. Abbott ◽

H.P. Lehmann ◽

P.S. Sockolow

Keyword(s):

Nursing Home ◽

Mixed Methods ◽

Electronic Health Record ◽

Functional Outcome ◽

Decision Makers ◽

Evidence Based ◽

Health Record ◽

Clinician Satisfaction ◽

Electronic Health ◽

The Impact

Summary Objective: Provide evidence-based advise to “Program of All-inclusive Care for the Elderly” (PACE) decision makers considering implementing an electronic health record (EHR) system, drawing on the results of a mixed methods study to examine: (1) the diffusion of an EHR among clinicians documenting direct patient care in a PACE day care site, (2) the impact of the use of the EHR on the satisfaction levels of clinicians, and (3) the impact of the use of the EHR on patient functional outcomes. Methods: Embedded mixed methods design with a post-test design quantitative experiment and concurrent qualitative component. Quantitative methods included: (1) the EHR audit log used to determine the frequency and timing during the week of clinicians’ usage of the system; (2) a 22-item clinician satisfaction survey; and (3) a 16-item patient functional outcome questionnaire related to locomotion, mobility, personal hygiene, dressing, feeding as well the use of adaptive devices. Qualitative methods included observations and open-ended, semi-structured follow-up interviews. Qualitative data was merged with the quantitative data by comparing the findings along themes. The setting was a PACE utilizing an EHR in Philadelphia: PACE manages the care of nursing-home eligible members to enable them to avoid nursing home admission and reside in their homes. Participants were 39 clinicians on the multi-disciplinary teams caring for the elders and 338 PACE members. Results: Clinicians did not use the system as intended, which may help to explain why the benefits related to clinical processes and patient outcomes as expected for an EHR were not reflected in the results. Clinicians were satisfied with the EHR, although there was a non-significant decline between 11 and 17 months post implementation of the EHR. There was no significant difference in patient functional outcome the two time periods. However, the sample size of 48 was too small to allow any conclusive statements to be made. Interpretation of findings underscores the importance of the interaction of workflow and EHR functionality and usability to impact clinician satisfaction, efficiency, and clinician use of the EHR. Conclusion: This research provides insights into EHR use in the care of the older people in community-based health care settings. This study assessed the adoption of an EHR outside the acute hospital setting and in the community setting to provide evidence-based recommendations to PACE decision makers considering implementing an EHR.

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