Impact of the COVID-19 pandemic on remote mental healthcare and prescribing in psychiatry: an electronic health record study

ObjectivesThe recent COVID-19 pandemic has disrupted mental healthcare delivery, with many services shifting from in-person to remote patient contact. We investigated the impact of the pandemic on the use of remote consultation and on the prescribing of psychiatric medications.Design and settingThe Clinical Record Interactive Search tool was used to examine deidentified electronic health records of people receiving mental healthcare from the South London and Maudsley (SLaM) NHS Foundation Trust. Data from the period before and after the onset of the pandemic were analysed using linear regression, and visualised using locally estimated scatterplot smoothing.ParticipantsAll patients receiving care from SLaM between 7 January 2019 and 20 September 2020 (around 37 500 patients per week).Outcome measures(i) The number of clinical contacts (in-person, remote or non-attended) with mental healthcare professionals per week.(ii) Prescribing of antipsychotic and mood stabiliser medications per week.ResultsFollowing the onset of the pandemic, the frequency of in-person contacts was significantly reduced compared with that in the previous year (β coefficient: −5829.6 contacts, 95% CI −6919.5 to −4739.6, p<0.001), while the frequency of remote contacts significantly increased (β coefficient: 3338.5 contacts, 95% CI 3074.4 to 3602.7, p<0.001). Rates of remote consultation were lower in older adults than in working age adults, children and adolescents. Despite this change in the type of patient contact, antipsychotic and mood stabiliser prescribing remained at similar levels.ConclusionsThe COVID-19 pandemic has been associated with a marked increase in remote consultation, particularly among younger patients. However, there was no evidence that this has led to changes in psychiatric prescribing. Nevertheless, further work is needed to ensure that older patients are able to access mental healthcare remotely.

Download Full-text

Impact of the COVID-19 pandemic on remote mental healthcare and prescribing in psychiatry

10.1101/2020.10.26.20219576 ◽

2020 ◽

Author(s):

Rashmi Patel ◽

Jessica Irving ◽

Aimee Brinn ◽

Matthew Broadbent ◽

Hitesh Shetty ◽

...

Keyword(s):

Healthcare Delivery ◽

Mental Healthcare ◽

List Type ◽

Patient Contact ◽

Mood Stabiliser ◽

Remote Consultation ◽

Before And After ◽

Working Age ◽

Remote Patient ◽

The Impact

AbstractObjectivesThe recent COVID-19 pandemic has disrupted mental healthcare delivery, with many services shifting from in- person to remote patient contact. We investigated the impact of the pandemic on the use of remote consultation and on the prescribing of psychiatric medications.Design and settingThe Clinical Record Interactive Search tool (CRIS) was used to examine de-identified electronic health records (EHRs) of people receiving mental healthcare from the South London and Maudsley (SLaM) NHS Foundation Trust. Data from the period before and after the onset of the pandemic were analysed using linear regression, and visualised using locally estimated scatterplot smoothing (LOESS).ParticipantsAll patients receiving care from SLaM between 7th January 2019 and 20th September 2020 (around 37,500 patients per week).Outcome measuresThe number of clinical contacts (in-person, remote or non-attended) with mental healthcare professionals per weekPrescribing of antipsychotic and mood stabiliser medications per weekResultsFollowing the onset of the pandemic, the frequency of in-person contacts was significantly reduced compared to that in the previous year (β coefficient: −5829.6 contacts, 95% CI −6919.5 to −4739.6, p<0.001), while the frequency of remote contacts significantly increased (β coefficient: 3338.5 contacts, 95% CI 3074.4 to 3602.7, p<0.001). Rates of remote consultation were lower in older adults than in working age adults, children and adolescents. Despite this change in the type of patient contact, antipsychotic and mood stabiliser prescribing remained at similar levels.ConclusionsThe COVID-19 pandemic has been associated with a marked increase in remote consultation, particularly among younger patients. However, there was no evidence that this has led to changes in psychiatric prescribing. Nevertheless, further work is needed to ensure that older patients are able to access mental healthcare remotely.

Download Full-text

AIRA, an Artificial Intelligence Realistic Assistant that will save your time, a before-and-after study during Pandemic (Preprint)

10.2196/preprints.29012 ◽

2021 ◽

Author(s):

Kaio Bin ◽

Adler Araújo Ribeiro Melo ◽

José Guilherme Franco Da Rocha ◽

Renata Pivi De Almeida ◽

Vilson Cobello Junior ◽

...

Keyword(s):

Artificial Intelligence ◽

Electronic Health Record ◽

Medical Care ◽

Health Screening ◽

Urgent Care ◽

Health Record ◽

Before And After ◽

Electronic Health ◽

The Impact ◽

Before And After Study

BACKGROUND AIRA is an AI designed to reduce the time that doctors dedicate filling out EHR, winner of the first edition of MIT Hacking Medicine held in Brazil in 2020. As a proof of concept, AIRA was implemented in administrative process before its application in a medical process. OBJECTIVE The aim of the study is to determinate the impact of AIRA by eliminating the Medical Care Registration (MCR) on Electronic Health Record (EHR) by Administrative Officer. METHODS This is a comparative before-and-after study following the guidance “Evaluating digital health products” from Public Health England. An Artificial Intelligence named AIRA was created and implemented at CEAC (Employee Attention Center) from HCFMUSP. A total of 25,507 attendances were evaluated along 2020 for determinate AIRA´s impact. Total of MCR, time of health screening and time between the end of the screening and the beginning of medical care, were compared in the pre and post AIRA periods. RESULTS AIRA eliminated the need for Medical Care Registration by Administrative Officer in 92% (p<0.0001). The nurse´s time of health screening increased 16% (p<0.0001) during the implementation, and 13% (p<0.0001) until three months after the implementation, but reduced in 4% three months after implementation (p<0.0001). The mean and median total time to Medical Care after the nurse’ Screening was decreased in 30% (p<0.0001) and 41% (p<0.0001) respectively. CONCLUSIONS The implementation of AIRA reduced the time to medical care in an urgent care after the nurse´ screening, by eliminating non-value-added activity the Medical Care Registration on Electronic Health Record (EHR) by Administrative Officer.

Download Full-text

Opinions, perceptions and attitudes toward an electronic health record system among practicing nurses

Journal of Nursing Education and Practice ◽

10.5430/jnep.v8n3p12 ◽

2017 ◽

Vol 8 (3) ◽

pp. 12

Author(s):

Ahmad H. Abu Raddaha ◽

Arwa Obeidat ◽

Huda Al Awaisi ◽

Jahara Hayudini

Keyword(s):

Electronic Health Record ◽

Clinical Information System ◽

Research Work ◽

Healthcare Delivery ◽

Future Research ◽

Health Record ◽

Randomized Sampling ◽

Positive Attitudes ◽

Electronic Health ◽

The Impact

Background: Despite worldwide expanding implementation of electronic health record (EHR) systems, healthcare professionals conducted limited number of studies to explore factors that might facilitate or jeopardize using these systems. This study underscores the impact of nurses’ opinions, perceptions, and computer competencies on their attitudes toward using an EHR system.Methods: With randomized sampling, a cross-sectional exploratory design was used. The sample consisted of 169 nurses who worked at a public teaching hospital in Oman. They completed self-administered questionnaire. Several standardized valid and reliable instruments were utilized.Results: Seventy-four percent of our study nurses had high positive attitudes toward the EHR system. The least ranked perception scores (60.4%) were linked to perceiving that suggestions made by nurses about the system would be taken into account. Nurses who reported that the hospital sought for suggestions for customization of the system [OR: 2.54 (95% CI: 1.09, 5.88), p = .03], who found the system as an easy-to-use clinical information system [OR: 6.53 (95% CI: 1.72, 24.75), p = .01], who reported the presence of good relationship with the system’s managing personnel [OR: 3.59 (95% CI: 1.13, 11.36), p = .03] and who reported that the system provided all needed health information [OR: 2.97 (95% CI: 1.16, 7.62), p = .02] were more likely to develop high positive attitudes toward the system.Conclusions: To better develop plans to foster the EHR system’s use facilitators and overcome its usage barriers by nursing professionals, more involvement of nurses in system’s customization endeavors is highly suggested. When the system did not disrupt workflows, it would decrease clinical errors and expand nursing productivity. In order to maximize the utilization of the system in healthcare delivery, future research work to investigate the effect of the system on other healthcare providers and inter-professional communications is pressingly needed.

Download Full-text

The Benefits and Challenges of an Interfaced Electronic Health Record and Laboratory Information System: Effects on Laboratory Processes

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2016-0146-oa ◽

2017 ◽

Vol 141 (3) ◽

pp. 410-417 ◽

Cited By ~ 8

Author(s):

Athena K. Petrides ◽

Ida Bixho ◽

Ellen M. Goonan ◽

David W. Bates ◽

Shimon Shaykevich ◽

...

Keyword(s):

Information System ◽

Electronic Health Record ◽

Government Regulation ◽

Turnaround Time ◽

Health Record ◽

Laboratory Information System ◽

Before And After ◽

Electronic Health ◽

Ordered Data ◽

The Impact

Context.— A recent government regulation incentivizes implementation of an electronic health record (EHR) with computerized order entry and structured results display. Many institutions have also chosen to interface their EHR with their laboratory information system (LIS). Objective.— To determine the impact of an interfaced EHR-LIS on laboratory processes. Design.— We analyzed several different processes before and after implementation of an interfaced EHR-LIS: the turnaround time, the number of stat specimens received, venipunctures per patient per day, preanalytic errors in phlebotomy, the number of add-on tests using a new electronic process, and the number of wrong test codes ordered. Data were gathered through the LIS and/or EHR. Results.— The turnaround time for potassium and hematocrit decreased significantly (P = .047 and P = .004, respectively). The number of stat orders also decreased significantly, from 40% to 7% for potassium and hematocrit, respectively (P < .001 for both). Even though the average number of inpatient venipunctures per day increased from 1.38 to 1.62 (P < .001), the average number of preanalytic errors per month decreased from 2.24 to 0.16 per 1000 specimens (P < .001). Overall there was a 16% increase in add-on tests. The number of wrong test codes ordered was high and it was challenging for providers to correctly order some common tests. Conclusions.— An interfaced EHR-LIS significantly improved within-laboratory turnaround time and decreased stat requests and preanalytic phlebotomy errors. Despite increasing the number of add-on requests, an electronic add-on process increased efficiency and improved provider satisfaction. Laboratories implementing an interfaced EHR-LIS should be cautious of its effects on test ordering and patient venipunctures per day.

Download Full-text

THE IMPACT OF MEETING ACCREDITATION STANDARDS ON THE QUALITY OF THE ELECTRONIC HEALTH RECORDS

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2020.v13i5.37013 ◽

2020 ◽

pp. 114-117

Author(s):

MOHAMED HOSSAM ATTIA ◽

ABDELNASSER IBRAHIM

Keyword(s):

Electronic Health Records ◽

Patient Information ◽

Medical Records ◽

Simple Random Sample ◽

Health Records ◽

Entire Study ◽

Before And After ◽

Electronic Health ◽

The Impact

Objective: Electronic health records (EHRs) are considered a way to make the management of patient information easier, improve efficiency, and decrease costs related to medical information management. Compliance with requirements from accreditation bodies on quality of documentation ensures the complete and accurate patient information in the EHR. The purpose of this study is to measure the effect of quality accreditation on the quality of documentation in the EHR. Methods: A simple random sample of 18% of patient records was manually selected each month during the entire study period from the population of discharged patients. The auditing process included 18 months starting from January 2014 until June 2015. The data collection was performed by a quality management unit using a modified medical record completeness checklist adapted from Joint Commission International (JCI) criteria. Results: The results of the study show the improvement in compliance with complete medical records’ documentation after the JCI accreditation. However, after the accreditation, the compliance suffers a dramatic fall which could be referred to the post-accreditation slump. The compliance then improved again to reach higher levels of compliance. Using paired t-test, the mean of total compliance with complete and accurate medical records in October 2014 was less than in May 2015. Conclusion: This study highlighted the performance of one process before and after the first accreditation of the organization showing the real difference between the performance before and after the accreditation and explaining the drop that happened just after the accreditation.

Download Full-text

VP147 Implementing Electronic Health Record In A Children's Hospital

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462317003919 ◽

2017 ◽

Vol 33 (S1) ◽

pp. 216-217

Author(s):

Martina Andellini ◽

Francesco Faggiano ◽

Francesca Sabusco ◽

Pietro Derrico ◽

Matteo Ritrovato

Keyword(s):

Electronic Health Record ◽

Healthcare Delivery ◽

Legal Aspects ◽

Health Record ◽

Privacy And Security ◽

Children's Hospital ◽

Organizational Outcome ◽

Children’S Hospital ◽

Electronic Health ◽

The Impact

INTRODUCTION:Since the adoption of electronic health record (EHR) systems, which contain large volumes of aggregated longitudinal clinical data, promises a number of substantial benefits including better care, improved safety issues and decreased healthcare costs (1). It is also associated with significant costs and large technical and organizational impacts, therefore it is important to conduct comprehensive evaluations of healthcare delivery outcomes. The purpose of the study is to gather evidence on safety and overall effectiveness of EHR implementation in Bambino Gesù Children's Hospital (OPBG).METHODS:Decision-oriented HTA (DoHTA) method (2) was applied to assess the technology on clinical, technical, organizational, economic, legal, ethical and safety domains. It's a new implementation of the European Network for Health Technology Assessment (EUnetHTA) CoreModel integrated with the Analytic Hierarchy Process. It allows defining an evaluation structure represented by a hierarchical decision tree filled by indicators of technology's performances, each of which was given a weight proportional to the impact that this criterion provides to achieve the purpose of the decision problem; finally, the alternatives’ ranking was defined.RESULTS:The multidisciplinary assessment took into consideration all of the aspects and recommendations about the benefits and disadvantages of EHR (3). The synthesis of scientific evidence integrated with results of the specific context analysis, resulted in the definition of components of the decisional hierarchy structure. In particular, EHR seems to offer many benefits in terms of safety and clinical effectiveness such as improved continuity and quality of care, and increased accessibility of the data. The implementation of EHR resulted in important organizational outcome such as EHR configuration, learning curve and training. For these reasons, the usability was the main technical characteristics of the technology taken into account. Finally, legal aspects on privacy and security of data, covered a key role in the assessment.CONCLUSIONS:A thorough evaluation of the EHR before its implementation has permitted hospital's decision makers to choose knowingly.

Download Full-text

Implementation of Electronic Health Record (EHR) System in the Healthcare Industry

International Journal of Privacy and Health Information Management ◽

10.4018/ijphim.2014070104 ◽

2014 ◽

Vol 2 (2) ◽

pp. 57-71 ◽

Cited By ~ 1

Author(s):

Robert P Schumaker ◽

Kavya P. Reganti

Keyword(s):

Electronic Health Record ◽

Information Exchange ◽

Health Information Exchange ◽

Health Management ◽

Healthcare Delivery ◽

Healthcare Services ◽

Health Record ◽

Healthcare Industry ◽

Electronic Health ◽

The Impact

The purpose of this research is to demonstrate the efficiency of the Electronic Health Record (EHR) software that is adopted in the healthcare industry to provide better patient care. The authors examine the impact of EHRs on the efficient delivery of healthcare services. More specifically, they detail the origin of EHR, its significance in modern healthcare delivery along with the selection and implementation criteria for EHR software. They present a survey on the extent of adoption of EHR by clinicians. They also highlight the challenges and barriers faced by organizations in adopting EHR software such as cost, workflow impact and data security. Finally, the authors contemplate the future of EHR, its role in the implementation of health information exchange and its implementation in the cloud. They conclude that the implementation of EHR in the cloud is an important step towards better health management across the population with the end-goal of better health outcomes.

Download Full-text

Abstract P156: Improvement In Blood Pressure Using Remote Patient Monitoring During COVID19

Hypertension ◽

10.1161/hyp.76.suppl_1.p156 ◽

2020 ◽

Vol 76 (Suppl_1) ◽

Author(s):

Nadia A Liyanage-Don ◽

Joseph E Schwartz ◽

Nathalie Moise ◽

Kelsey B Bryant ◽

Adina Bono ◽

...

Keyword(s):

Blood Pressure ◽

Patient Monitoring ◽

Healthcare Access ◽

Vital Signs ◽

Primary Care Doctor ◽

Remote Patient Monitoring ◽

Nursing Support ◽

Before And After ◽

Remote Patient ◽

The Impact

Introduction: The coronavirus disease 2019 (COVID19) pandemic required strict social distancing to curb transmission. Unfortunately, these measures severely limited healthcare access and chronic disease management. In response, many health organizations rapidly developed or expanded telemedicine to provide care directly to patients at home. Little has been reported about the impact of such interventions on clinical outcomes during COVID19. We examined whether enrollment in a remote patient monitoring (RPM) program for hypertension (HTN) prior to COVID19 was associated with improved blood pressure during the pandemic. Methods: We developed an RPM program that tracked vital signs, medication side effects, and treatment adherence patterns outside of the clinic. Patients were referred by their primary care doctor for uncontrolled HTN or suspected white coat HTN. Patients received a two-way tablet, blood pressure cuff, and virtual nursing support via scheduled video visits. Those referred for uncontrolled HTN who had at least two weeks of data both before and after the onset of COVID19 (defined as the first two weeks of March 2020) were included in the study. A mixed-models analysis that adjusted for serial autocorrelation was used to compare mean systolic blood pressure (SBP) and mean diastolic blood pressure (DBP) in the pre-/post-COVID19 periods. Results: Of 94 patients enrolled in the RPM program to date, 46 had at least two weeks of data both pre-COVID19 and post-COVID19. Mean age was 69.0 ± 10.9 years, 69.6% (32 of 46) were women, 78.3% (36 of 46) were Hispanic, and 63.0% (29 of 46) were Spanish-speaking. Pre-COVID, mean SBP was 132.31 ± 13.99 mmHg, mean DBP was 77.10 ± 9.87 mmHg, and 70% (32 of 46) of patients had uncontrolled BP (>130/80 mmHg per AHA guidelines). Post-COVID, mean SBP was 129.57 ± 13.29 mmHg, mean DBP was 76.00 ± 9.16 mmHg, and 57% (26 of 46) of patients had uncontrolled BP. There was a significant reduction in both mean SBP (β = –2.74, 95% CI –5.21, –0.26, p = 0.03) and mean DBP (β = –1.10, 95% CI –2.22, 0.02, p = 0.05) post-COVID vs. pre-COVID. Discussion: Despite the stress and social isolation associated with COVID19, participation in an RPM program that combines home BP monitoring with virtual nursing support can help maintain and even mildly decrease BP.

Download Full-text

Multimorbidity Clustering of the Emergency Department Patient Flow: Impact Analysis of New Unscheduled Care Clinics

10.21203/rs.3.rs-125764/v1 ◽

2020 ◽

Author(s):

Adrien Wartelle ◽

Farah Mourad-Chehade ◽

Farouk Yalaoui ◽

Hélène Questiaux ◽

Thomas Monneret ◽

...

Keyword(s):

Emergency Department ◽

Emergency Departments ◽

Patient Flow ◽

Temporal Trends ◽

Healthcare Delivery ◽

Period Effect ◽

Care Services ◽

Unscheduled Care ◽

Before And After ◽

The Impact

Abstract Background: In France, the number of admissions to emergency departments doubled between 1996 and 2016, leading to overcrowding. To cope with the resultant overcrowding, redirecting patients to new healthcare services is a viable solution, to spread demand more evenly across available healthcare delivery points, and render care more efficient. The goal of this study was to analyse the impact of opening new unscheduled care services on variations in patient attendance at a large emergency department. Methods: We performed a before-and-after study investigating the use of unscheduled care services in the Aube Department (Eastern France), focusing on emergency department attendance of Troyes Hospital. We applied a hierarchical clustering based on co-occurrence of diagnoses, to divide the population into different multimorbidity profiles and study their temporal trends. A multivariate logistic regression model was constructed to adjust the period effect for appropriate confounders. Results: In total, 120,718 visits to the emergency department were recorded over a 24-month period (2018-2019), and 14 clusters were identified accounting for 94.76% of all visits. The before-and-after analysis showed a decrease of 57.95 visits per week in 7 specific clusters, while the consumption of unscheduled health care services increased by 328.12 visits per week.Conclusions: Using an innovative and reliable methodology to evaluate changes in patient flow through the emergency department, our results could help to inform public health policy regarding the implementation of unscheduled care services, to ease pressure on emergency departments.

Download Full-text

Impact of the 2020 COVID-19 Pandemic on Ambulatory Hepatitis C Testing

Journal of Primary Care & Community Health ◽

10.1177/2150132720969554 ◽

2020 ◽

Vol 11 ◽

pp. 215013272096955

Author(s):

Heather Sperring ◽

Glorimar Ruiz-Mercado ◽

Elissa M. Schechter-Perkins

Keyword(s):

Hepatitis C ◽

Medical Center ◽

Healthcare Delivery ◽

Hcv Rna ◽

Patient Identification ◽

Before And After ◽

Health Initiatives ◽

Hcv Screening ◽

The Impact ◽

Hcv Testing

Introduction: Coronavirus disease 2019 (COVID-19) has led to unprecedented modifications to healthcare delivery in the U.S. To preserve resources in preparation for a COVID-19 surge, Boston Medical Center (BMC) implemented workflows to decrease ambulatory in-person visits effective March 16th, 2020. Telemedicine was incorporated into clinical workflows and much preventive care, including Hepatitis C (HCV) testing, was not routinely performed. Objective: To explore the impact that the COVID-19 rapid restructuring response has had on HCV testing and identification hospital-wide and in ambulatory settings. Methods: BMC utilizes reflex confirmatory testing for HCV. When a sample is HCV Ab positive, it is automatically reflexed for confirmatory RNA and genotype testing. HCV test results for patients were collected daily. We compared unique patient tests for 3.5 month periods before and after March 16th, 2020. Descriptive statistics showed total tests and total new HCV RNA+ before versus after, both hospital-wide and in ambulatory clinics alone. Mean daily tests completed were compared. Results: Hospital-wide, total HCV testing decreased by 49.6%, and new HCV+ patient identification decreased by 42.1%. In ambulatory clinics, testing decreased by 71.9%, and new HCV+ identification decreased by 63.3%. Hospital-wide, mean daily tests decreased by 22.9 tests per day (95% CI: 17.9-28.0, P < .001), and mean daily new HCV+ identification decreased by 0.36 (95% CI: 0.20-0.53, P < .001). In ambulatory clinics, mean daily tests decreased by 22.1 tests per day (95% CI: 17.5-26.7, P < .001) and mean daily HCV+ decreased by 1.40 (95% CI: 1.03-1.76, P < .001). Conclusion: The COVID-19 systematic emergency response led to decreased HCV testing and identification, and in this regard telemedicine acts as a barrier to HCV care. Other public health initiatives must be monitored in the context of telemedicine workflows. Continued monitoring of HCV screening trends is vital, and adaptive approaches to work toward the goal of HCV elimination are needed.

Download Full-text