scholarly journals Electronic Health Record Phenotypes for Precision Medicine: Perspectives and Caveats From Treatment of Breast Cancer at a Single Institution

2018 ◽  
Vol 11 (1) ◽  
pp. 85-92 ◽  
Author(s):  
Matthew K. Breitenstein ◽  
Hongfang Liu ◽  
Kara N. Maxwell ◽  
Jyotishman Pathak ◽  
Rui Zhang
Keyword(s):  
Breast Cancer ◽  
Electronic Health Record ◽  
Precision Medicine ◽  
Health Record ◽  
Single Institution ◽  
Electronic Health

scholarly journals Electronic Health Record Use among Ophthalmology Residents while on Call

2020 ◽  
Vol 12 (02) ◽  
pp. e143-e150
Author(s):  
Christopher P. Long ◽  
Ming Tai-Seale ◽  
Robert El-Kareh ◽  
Jeffrey E. Lee ◽  
Sally L. Baxter
Keyword(s):  
Internal Medicine ◽  
Electronic Health Record ◽  
Chart Review ◽  
Health Record ◽  
Physician Burnout ◽  
Single Institution ◽  
Clinical Exposure ◽  
Future Studies ◽  
After Hours ◽  
Electronic Health

Abstract Background As electronic health record (EHR) use becomes more widespread, detailed records of how users interact with the EHR, known as EHR audit logs, are being used to characterize the clinical workflows of physicians including residents. After-hours EHR use is of particular interest given its known association with physician burnout. Several studies have analyzed EHR audit logs for residents in other fields, such as internal medicine, but none thus far in ophthalmology. Here, we focused specifically on EHR use during on-call shifts outside of normal clinic hours. Methods In this retrospective study, we analyzed raw EHR audit log data from on-call shifts for 12 ophthalmology residents at a single institution over the course of a calendar year. Data were analyzed to characterize total time spent using the EHR, clinical volume, diagnoses of patients seen on call, and EHR tasks. Results Across all call shifts, the median and interquartile range (IQR) of the time spent logged into the EHR per shift were 88 and 131 minutes, respectively. The median (IQR) unique patient charts accessed per shift was 7 (9) patients. When standardized to per-hour measures, weekday evening shifts were the busiest call shifts with regard to both EHR use time and clinical volume. Total EHR use time and clinical volume were greatest in the summer months (July to September). Chart review comprised a majority (63.4%) of ophthalmology residents' on-call EHR activities. Conclusion In summary, EHR audit logs demonstrate substantial call burden for ophthalmology residents outside of regular clinic hours. These data and future studies can be used to further characterize the clinical exposure and call burden of ophthalmology residents and could potentially have broader implications in the fields of physician burnout and education policy.

Enhancing the electronic health record to promote and measure adherence to breast cancer clinical pathways.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 322-322
Author(s):  
Lauren E. Geisel ◽  
Helen M. Johnson ◽  
Andrew Weil ◽  
Mahvish Muzaffar ◽  
Nasreen A. Vohra ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Family History ◽  
Electronic Health Record ◽  
Clinical Pathways ◽  
Clinical Stage ◽  
Baseline Data ◽  
Clinical Staging ◽  
Health Record ◽  
Electronic Health ◽  
Multidisciplinary Conference

322 Background: Clinical pathways are widely accepted tools for improving the quality of cancer care. We developed and implemented, within the electronic health record (EHR), a standardized multidisciplinary breast cancer conference template comprised of NCCN clinical pathway elements, with triggers to promote adherence and measure compliance. Methods: The records of breast cancer patients diagnosed from January 2016 to December 2017 were reviewed. Baseline data on (1) the documentation of clinical stage prior to prospective presentation at multidisciplinary conference, (2) documentation of family history, and (3) functional breast imaging utilization were recorded. EHR enhancements developed throughout 2018 were implemented in January 2019. Post-implementation data were obtained via an EHR query of records from January 2019 to the present. Results: At baseline, 56.5% of new patients (n = 435) had a clinical stage documented appropriately (goal 100%). After the EHR enhancements went live, this rate increased to 76.9% (n = 78 new diagnoses), ranging from 40% for patients with metastatic disease to 85.7% for non-metastatic. Compared with baseline data, EHR-derived data from 149 multidisciplinary conference notes demonstrated relatively stable rates of compliance with the family history and imaging metrics: 94.3% to 93.9% (goal 100%), and 12.8% to 13.4% (goal ≤20%), respectively. In 2019, there were 128 instances of an EHR trigger prompting physicians to review the multidisciplinary conference recommendations. While 89.1% of users responded that they reviewed the note, only 42.1% of these clicked on the link to view it. Conclusions: The EHR is a powerful tool for incorporating clinical pathways into oncology providers’ daily workflow. Quality improvement data can be extracted rapidly and efficiently, which facilitates continuous QI. We observed a notable improvement in documentation of clinical staging prior to multidisciplinary conference after the implementation of the clinical pathways in the EHR. Our first report identified several areas for improvement, which will be the focus of subsequent PDSA cycles.

scholarly journals Feasibility of Embedding a Scalable, Virtually Enabled Biorepository in the Electronic Health Record for Precision Medicine

2021 ◽  
Vol 4 (2) ◽  
pp. e2037739
Author(s):  
Kimberley M. DeMerle ◽  
Jason N. Kennedy ◽  
Octavia M. Peck Palmer ◽  
Emily Brant ◽  
Chung-Chou H. Chang ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Precision Medicine ◽  
Health Record ◽  
Electronic Health

An Analysis of Electronic Health Record Work to Manage Asynchronous Clinical Messages among Breast Cancer Care Teams

2021 ◽  
Vol 12 (04) ◽  
pp. 877-887
Author(s):  
Bryan D. Steitz ◽  
Kim M. Unertl ◽  
Mia A. Levy
Keyword(s):  
Breast Cancer ◽  
Electronic Health Record ◽  
Cancer Care ◽  
Medical Center ◽  
Asynchronous Communication ◽  
Care Team ◽  
Health Record ◽  
Breast Cancer Care ◽  
Team Members ◽  
Electronic Health

Abstract Objective Asynchronous messaging is an integral aspect of communication in clinical settings, but imposes additional work and potentially leads to inefficiency. The goal of this study was to describe the time spent using the electronic health record (EHR) to manage asynchronous communication to support breast cancer care coordination. Methods We analyzed 3 years of audit logs and secure messaging logs from the EHR for care team members involved in breast cancer care at Vanderbilt University Medical Center. To evaluate trends in EHR use, we combined log data into sequences of events that occurred within 15 minutes of any other event by the same employee about the same patient. Results Our cohort of 9,761 patients were the subject of 430,857 message threads by 7,194 employees over a 3-year period. Breast cancer care team members performed messaging actions in 37.5% of all EHR sessions, averaging 29.8 (standard deviation [SD] = 23.5) messaging sessions per day. Messaging sessions lasted an average of 1.1 (95% confidence interval: 0.99–1.24) minutes longer than nonmessaging sessions. On days when the cancer providers did not otherwise have clinical responsibilities, they still performed messaging actions in an average of 15 (SD = 11.9) sessions per day. Conclusion At our institution, clinical messaging occurred in 35% of all EHR sessions. Clinical messaging, sometimes viewed as a supporting task of clinical work, is important to delivering and coordinating care across roles. Measuring the electronic work of asynchronous communication among care team members affords the opportunity to systematically identify opportunities to improve employee workload.

scholarly journals An Electronic Health Record–based Algorithm to Ascertain the Date of Second Breast Cancer Events

Medical Care ◽  
2017 ◽  
Vol 55 (12) ◽  
pp. e81-e87 ◽  
Author(s):  
Jessica Chubak ◽  
Tracy Onega ◽  
Weiwei Zhu ◽  
Diana S. M. Buist ◽  
Rebecca A. Hubbard
Keyword(s):  
Breast Cancer ◽  
Electronic Health Record ◽  
Health Record ◽  
Electronic Health ◽  
Second Breast Cancer

scholarly journals CADe System Integrated within the Electronic Health Record

2013 ◽  
Vol 2013 ◽  
pp. 1-14
Author(s):  
Noelia Vállez ◽  
Gloria Bueno ◽  
Óscar Déniz ◽  
María del Milagro Fernández ◽  
Carlos Pastor ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Electronic Health Record ◽  
Clinical Information ◽  
Breast Cancer Diagnosis ◽  
Working Environment ◽  
Information Support ◽  
Health Record ◽  
Wide Range ◽  
Electronic Health ◽  
Cade System

The latest technological advances and information support systems for clinics and hospitals produce a wide range of possibilities in the storage and retrieval of an ever-growing amount of clinical information as well as in detection and diagnosis. In this work, an Electronic Health Record (EHR) combined with a Computer Aided Detection (CADe) system for breast cancer diagnosis has been implemented. Our objective is to provide to radiologists a comprehensive working environment that facilitates the integration, the image visualization, and the use of aided tools within the EHR. For this reason, a development methodology based on hardware and software system features in addition to system requirements must be present during the whole development process. This will lead to a complete environment for displaying, editing, and reporting results not only for the patient information but also for their medical images in standardised formats such as DICOM and DICOM-SR. As a result, we obtain a CADe system which helps in detecting breast cancer using mammograms and is completely integrated into an EHR.

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