Improving Care Transitions Management: Examining the Role of Accountable Care Organization Participation and Expanded Electronic Health Record Functionality

Abstract Background The accumulation of deficits model for frailty has been used to develop an electronic health record (EHR) frailty index (eFI) that has been incorporated into British guidelines for frailty management. However, there have been limited applications of EHR-based approaches in the United States. Methods We constructed an adapted eFI for patients in our Medicare Accountable Care Organization (ACO, N = 12,798) using encounter, diagnosis code, laboratory, medication, and Medicare Annual Wellness Visit (AWV) data from the EHR. We examined the association of the eFI with mortality, health care utilization, and injurious falls. Results The overall cohort was 55.7% female, 85.7% white, with a mean age of 74.9 (SD = 7.3) years. In the prior 2 years, 32.1% had AWV data. The eFI could be calculated for 9,013 (70.4%) ACO patients. Of these, 46.5% were classified as prefrail (0.10 < eFI ≤ 0.21) and 40.1% frail (eFI > 0.21). Accounting for age, comorbidity, and prior health care utilization, the eFI independently predicted all-cause mortality, inpatient hospitalizations, emergency department visits, and injurious falls (all p < .001). Having at least one functional deficit captured from the AWV was independently associated with an increased risk of hospitalizations and injurious falls, controlling for other components of the eFI. Conclusions Construction of an eFI from the EHR, within the context of a managed care population, is feasible and can help to identify vulnerable older adults. Future work is needed to integrate the eFI with claims-based approaches and test whether it can be used to effectively target interventions tailored to the health needs of frail patients.

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Transitioning from one Electronic Health Record (EHR) to Another: A Narrative Literature Review

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/1541931218621112 ◽

2018 ◽

Vol 62 (1) ◽

pp. 489-493 ◽

Cited By ~ 2

Author(s):

Jason J. Saleem ◽

Jennifer Herout

Keyword(s):

Health Care ◽

Literature Review ◽

Electronic Health Record ◽

Health Care Systems ◽

Health Care Organization ◽

Data Migration ◽

Health Record ◽

Care Organization ◽

Healthcare Organizations ◽

Electronic Health

This paper reports the results of a literature review of health care organizations that have transitioned from one electronic health record (EHR) to another. Ten different EHR to EHR transitions are documented in the academic literature. In eight of the 10 transitions, the health care organization transitioned to Epic, a commercial EHR which is dominating the market for large and medium hospitals and health care systems. The focus of the articles reviewed falls into two main categories: (1) data migration from the old to new EHR and (2) implementation of the new EHR as it relates to patient safety, provider satisfaction, and other measures pre-and post-transition. Several conclusions and recommendations are derived from this review of the literature, which may be informative for healthcare organizations preparing to replace an existing EHR. These recommendations are likely broadly relevant to EHR to EHR transitions, regardless of the new EHR vendor.

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The Role of Otolaryngologists in the Accountable Care Organization: Pros and Cons

Otolaryngology ◽

10.1177/0194599814538403a7 ◽

2014 ◽

Vol 151 (1_suppl) ◽

pp. P9-P9

Author(s):

K. J. Lee ◽

Subinoy Das ◽

Jane T. Dillon ◽

David R. Nielsen ◽

Gavin Setzen

Keyword(s):

Accountable Care Organization ◽

Care Organization ◽

Accountable Care ◽

Pros And Cons

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Biometric Secured Electronic Health Record

International Journal of E-Health and Medical Communications ◽

10.4018/ijehmc.2016100101 ◽

2016 ◽

Vol 7 (4) ◽

pp. 1-27

Author(s):

Suresh Sankaranarayanan ◽

Vigneshwaran Udayasuriyan

Keyword(s):

Electronic Health Record ◽

Medical Personnel ◽

Health Record ◽

Care Organization ◽

Biometric Authentication ◽

Biometric System ◽

Record System ◽

Rejection Ratio ◽

Electronic Health ◽

False Rejection

Lot of Hospitals around the world are going through transformation from paper based to Electronic Health record system which can be accessed from anywhere. But with such Electronic health record, security is very much needed towards avoiding hackers and unauthorized personnel to access the medical record pretending as doctor or patient. Lot of research been conducted in regards to an authentication of the biometric system and security on the digital electronic health records of the health care organization. In such biometric system, there has been an increase in the false rejection ratio due to a slight difference in the positioning of the finger on the biometric scanner. The small wounds and scratches on the fingers may also lead to the false rejection of the legitimate user. So accordingly the authors in this research have developed innovative and enhanced technology of the frame based biometric authentication system by segmenting the fingerprint image towards authenticating the medical personnel. This method reduces the False Rejection Ratio (FRR) and False Acceptance Ratio (FAR) compared to neighbouring nodal and data centric method. In addition, with the frame based biometric authentication, the authors have also developed level of strictness for doctor's and patient's based on placement of finger in biometric scanner. Lastly, the authors have also developed an application which integrates Frame based biometric methodology along with RFID and GSM for access of records in a secured way and also to provide a better treatment and medicines for incoming patients.

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Resource-based view on safety culture’s influence on hospital performance: The moderating role of electronic health record implementation

Health Care Management Review ◽

10.1097/hmr.0000000000000217 ◽

2018 ◽

Vol 45 (3) ◽

pp. 207-216

Author(s):

Soumya Upadhyay ◽

Robert Weech-Maldonado ◽

Christy H. Lemak ◽

Amber Stephenson ◽

Tapan Mehta ◽

...

Keyword(s):

Electronic Health Record ◽

Hospital Performance ◽

Health Record ◽

Resource Based View ◽

Electronic Health ◽

Moderating Role

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The role of perceived usefulness and attitude on electronic health record acceptance

2013 IEEE 15th International Conference on e-Health Networking, Applications and Services (Healthcom 2013) ◽

10.1109/healthcom.2013.6720706 ◽

2013 ◽

Keyword(s):

Electronic Health Record ◽

Perceived Usefulness ◽

Health Record ◽

Electronic Health

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Back to the Future: Portable Word Processors and the Electronic Health Record

Prehospital and Disaster Medicine ◽

10.1017/s1049023x19002188 ◽

2019 ◽

Vol 34 (s1) ◽

pp. s104-s105

Author(s):

Alfredo Mori

Keyword(s):

Electronic Health Record ◽

Emergency Departments ◽

Extreme Environments ◽

Health Record ◽

Physician Burnout ◽

Software And Hardware ◽

Electronic Health ◽

Professional Writers ◽

Word Processors

Introduction:The Electronic Health Record (EHR) is now the standard means for recording and maintaining medical notes in most emergency departments. The EHR is an independent cause of physician burnout, and maintenance of the EHR may occupy 30 to 50% of clinical time. There are software solutions available, but they are connected to fixed, expensive, distracting, and bright electronically powered computers. Scribes have been successfully trialed, but are also expensive and attached to computers on wheels. Portable digital word processors in the form of the AlphaSmart Neo is a redundant technology designed primarily for children with typing difficulties. It has recently enjoyed a resurgence in popularity among professional writers, journalists, and field researchers for the ultimate distraction-free writing experience. The Alphasmart Neo is cheap, nearly indestructible, intuitive, and requires almost no recharging. It is compatible with all software across Mac OS, Windows, and Linux. Notes are entered by the clinician or scribe, independently of computers, at the bedside, and uploaded to any software via USB cable.Aim:To describe the introduction and impact of the AlphaSmart Neo on the EHR in emergency departments across Australia.Methods:We will examine the role of the Alphasmart Neo in austere, low power, extreme environments with a demonstration on how to enter, maintain, and transfer an electronic health record independent of any computer or power source.Discussion:We believe the AlphaSmart Neo is an ideal, personalized, cheap, effective, and efficient hardware solution to entering notes independent of other software and hardware. It is distraction free at the patient’s bedside, resulting in better notes that the clinician enjoys writing.

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