ED syphilis and gonorrhea/chlamydia cotesting practices before and after the implementation of an electronic health record-based alert

2021 ◽  
pp. emermed-2020-210331
Author(s):  
James S Ford ◽  
Tasleem Chechi ◽  
Michella Otmar ◽  
Melissa Baker ◽  
Sarah Waldman ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Underserved Populations ◽  
Cohort Analysis ◽  
Treponema Pallidum ◽  
Interrupted Time Series ◽  
Health Record ◽  
Interrupted Time Series Analysis ◽  
Syphilis Testing ◽  
Before And After ◽  
Electronic Health

BackgroundThe prevalence of syphilis is increasing in many countries, including the USA. The ED is often used by underserved populations, making it an important setting to test and treat patients who are not evaluated in outpatient clinical settings. We aimed to assess the utility of an ED-based syphilis and gonorrhoea/chlamydia cotesting protocol by comparing testing practices before and after its implementation.MethodsWe implemented an electronic health record (EHR) alert that prompted clinicians to order syphilis testing in patients undergoing gonorrhoea/chlamydia testing. We performed a retrospective cohort analysis that compared outcomes between the preimplementation period (January–November 2018) and the postimplementation period (January–November 2019). Patients were tested for Treponema pallidum antibody (TPA) using a multiplex flow immunoassay (MFI), and positive results were confirmed by rapid plasma reagin (RPR). The primary implementation outcome was the number of syphilis tests/month, and the primary clinical outcome was the number of syphilis diagnoses/month (defined as positive TPA MFI and RPR). We performed an interrupted time-series analysis to evaluate the effect of implementing the alert over time.ResultsFour-hundred and ninety-four and 1106 unique patients were tested for syphilis in the preimplementation and postimplementation periods, respectively. Syphilis testing increased by 55.6 tests/month (95% CI 45.9 to 65.3, p<0.001) following alert implementation. Patients tested in the postimplementation period who were tested using the alert were much younger (difference: 14 years (95% CI 12 to 15)) and were more likely to be female (difference: 15% (95% CI 8 to 21)) and African-American (difference: 11% (95% CI 5 to 17)) than patients tested by clinician-initiated testing. Presumptive syphilis diagnoses increased from 3.4 diagnoses/month to 7.9 diagnoses/month (difference, 4.5 (95% CI 2.2 to 6.9), p<0.001).ConclusionsOur study demonstrates that use of a targeted EHR alert testing protocol can increase syphilis testing and diagnosis and may reduce clinician bias in testing.

scholarly journals Impact of CancelRx on Discontinuation of Controlled Substance Prescriptions

2021 ◽  
Author(s):  
Taylor L. Watterson ◽  
Jamie A Stone ◽  
Aaron Gilson ◽  
Roger Brown ◽  
Ka Z Xiong ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Health System ◽  
Secondary Data ◽  
Interrupted Time Series ◽  
Health Record ◽  
Interrupted Time Series Analysis ◽  
Pharmacy Records ◽  
Controlled Substance ◽  
Electronic Health ◽  
Over Time

ObjectiveTo assess how controlled substance medication discontinuations were communicated over timeData SourcesSecondary data from a midwestern academic health system electronic health record and pharmacy platform were collected 12-months prior to CancelRx implementation and for 12-months post implementation.Study DesignThe study utilized an interrupted time series analysis (ITSA) to capture the proportion of controlled substance medications that were cancelled in the clinic’s electronic health record and also cancelled in the pharmacy’s dispensing software. The ITSA plotted the proportion of successful cancellation messages over time, particularly after the health system’s implementation of CancelRx, a novel technology.Data Collection/ExtractionData were extracted from the EHR and pharmacy records for patients aged 18+ who had a controlled substance discontinued by a health system provider. Information collected included patient demographics, drug information (name, dose), and dates discontinued in the clinic and pharmacy records.Principal FindingsAfter CancelRx implementation there was a significant increase in the proportion of discontinued controlled substance medications that were communicated to the pharmacy.ConclusionsThis study demonstrates the role that technology can play in promoting controlled substance policy and medication safety.

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

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.

Impact of Legislation on Opioid Prescribing following Hysterectomy and Hysteroscopy in Arizona and Florida

2021 ◽  
pp. 1-9
Author(s):  
Aakriti R. Carrubba ◽  
Amy E. Glasgow ◽  
Elizabeth B. Habermann ◽  
Amanda P. Stanton ◽  
Megan N. Wasson ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Cohort Analysis ◽  
Oral Morphine ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Before And After ◽  
Legislative Changes

<b><i>Objectives:</i></b> This study aimed to determine the oral morphine equivalents (OMEs) prescribed and refill rates following hysterectomy and hysteroscopy in the setting of opioid prescribing practice changes in 2 states. <b><i>Design:</i></b> This is a retrospective cohort analysis consisting of 2,916 patients undergoing hysterectomy or hysteroscopy between July 2016 and September 2019 at 2 affiliated academic hospitals in states that underwent legislative changes in opioid prescribing in 2018. <b><i>Methods:</i></b> Participants were identified using the Current Procedural Terminology procedure codes in Arizona and Florida. Hysterectomy was chosen as the most invasive gynecologic procedure, while hysteroscopy was chosen as the least invasive. Medical records were abstracted to find opioid prescriptions from 90 days before surgery to 30 days after discharge. Patients with opioid use between 90 and 7 days before surgery were excluded. Prescriptions were converted to OMEs and were calculated per quarter year. Statistical analysis included Wilcoxon rank sum <i>t</i> tests for OMEs and χ<sup>2</sup> <i>t</i> tests for refill rates. Interrupted time-series analysis was used to determine significant change in OMEs before and after legislative change. Statistical analysis was performed using SAS version 9.4 (SAS Institute, Cary, NC, USA). <b><i>Results:</i></b> In Arizona, 1,067 hysterectomies were performed; 459 (43%) vaginal, 561 (52.6%) laparoscopic/robotic, and 47 (4.4%) abdominal. There were 530 hysteroscopies. Overall median OMEs decreased from 225 prior to July 2018 to 75 after July 2018 (<i>p</i> &#x3c; 0.0001). The opioid refill rate remained unchanged at 7.4% (<i>p</i> = 0.966). In Florida, there were 769 hysterectomies; 241 (31.3%) vaginal, 476 (61.9%) laparoscopic/robotic, and 52 (6.8%) abdominal. There were 549 hysteroscopies. Overall median OMEs decreased from 150 prior to July 2018 to 0 after July 2018 (<i>p</i> &#x3c; 0.0001). The opioid refill rate was similar (7.8% before July 2018 and 7.3% after July 2018; <i>p</i> = 0.739). <b><i>Limitations:</i></b> Limitations include involvement of a single hospital institution with a total of 10 fellowship-trained surgeons and biases inherent to retrospective study design. <b><i>Conclusions:</i></b> Legislative and provider-led changes coincided with decreases in opioid prescribing after 2018 in both states without increasing rates of refills and showed actual data reflected in the medical record. Gynecologists must actively participate in safe prescribing practices to decrease opioid dependence and misuse.

scholarly journals Providing ‘the bigger picture’: benefits and feasibility of integrating remote monitoring from smartphones into the electronic health record

Rheumatology ◽  
2019 ◽  
Vol 59 (2) ◽  
pp. 367-378 ◽  
Author(s):  
Lynn Austin ◽  
Charlotte A Sharp ◽  
Sabine N van der Veer ◽  
Matthew Machin ◽  
John Humphreys ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Remote Monitoring ◽  
Qualitative Evaluation ◽  
Graphical Form ◽  
Health Record ◽  
Structured Interviews ◽  
Before And After ◽  
Electronic Health ◽  
Remote Monitoring Systems ◽  
Time Changes

Abstract Objectives To establish the acceptability and feasibility of collecting daily patient-generated health data (PGHD) using smartphones and integrating PGHD into the electronic health record, using the example of RA. Methods The Remote Monitoring of RA smartphone app was co-designed with patients, clinicians and researchers using qualitative semi-structured interviews and focus groups, including selection of question sets for symptoms and disease impact. PGHD were integrated into the electronic health record of one hospital and available in graphical form during consultations. Acceptability and feasibility were assessed with 20 RA patients and two clinicians over 3 months. A qualitative evaluation included semi-structured interviews with patients and clinicians before and after using the app, and audio-recordings of consultations to explore impact on the consultation. PGHD completeness was summarized descriptively, and qualitative data were analysed thematically. Results Patients submitted data on a median of 91% days over 3 months. Qualitative analysis generated three themes: RA as an invisible disease; providing the bigger picture of RA; and enabling person-centred consultations. The themes demonstrated that the system helped render patients’ RA more visible by providing the ‘bigger picture’, identifying real-time changes in disease activity and capturing symptoms that would otherwise have been missed. Graphical summaries during consultations enabled a more person-centred approach whereby patients felt better able to participate in consultations and treatment plans. Conclusion Remote Monitoring of RA has uniquely integrated daily PGHD from smartphones into the electronic health record. It has delivered proof-of-concept that such integrated remote monitoring systems are feasible and can transform consultations for clinician and patient benefit.

A minimalist electronic health record-based intervention to reduce standing lab utilisation

2020 ◽  
pp. postgradmedj-2019-136992
Author(s):  
Kuo-Kai Chin ◽  
Amrita Krishnamurthy ◽  
Talhah Zubair ◽  
Tara Ramaswamy ◽  
Jason Hom ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Complete Blood Count ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
General Medicine ◽  
Health Record ◽  
Care Hospital ◽  
Before And After ◽  
Electronic Health ◽  
One Year

BackgroundRepetitive laboratory testing in stable patients is low-value care. Electronic health record (EHR)-based interventions are easy to disseminate but can be restrictive.ObjectiveTo evaluate the effect of a minimally restrictive EHR-based intervention on utilisation.SettingOne year before and after intervention at a 600-bed tertiary care hospital. 18 000 patients admitted to General Medicine, General Surgery and the Intensive Care Unit (ICU).InterventionProviders were required to specify the number of times each test should occur instead of being able to order them indefinitely.MeasurementsFor eight tests, utilisation (number of labs performed per patient day) and number of associated orders were measured.ResultsUtilisation decreased for some tests on all services. Notably, complete blood count with differential decreased 9% (p<0.001) on General Medicine and 21% (p<0.001) in the ICU.ConclusionsRequiring providers to specify the number of occurrences of labs changes significantly reduces utilisation in some cases.

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

2017 ◽  
Vol 141 (3) ◽  
pp. 410-417 ◽  
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 &lt; .001 for both). Even though the average number of inpatient venipunctures per day increased from 1.38 to 1.62 (P &lt; .001), the average number of preanalytic errors per month decreased from 2.24 to 0.16 per 1000 specimens (P &lt; .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.

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