Abstract 3429: Implementation of Electronic Medical Record Stroke Templates Increases Compliance with Stroke Performance Measures

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Crismely A Perdomo ◽  
Vepuka E Kauari ◽  
Elizabeth Suarez ◽  
Olajide Williams ◽  
Joshua Stillman ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Performance Measures ◽  
New York State ◽  
Stroke Care ◽  
Performance Measure ◽  
Performance Comparison ◽  
York State Department ◽  
Free Text ◽  
And Performance

Background and Purpose The literature demonstrates how utilizing evidence-based, standardized stroke care can improve patient outcomes; however, the contribution of electronic medical record (EMR) systems may also impact outcomes by ensuring utilization and compliance with established stroke performance measures, facilitating and improving documentation requirements, and standardizing approach to care. In 2008, documentation in patients’ medical records was done in combination of paper and a template free EMR. Originally, the EMR was used for order entry, then transitioned to full electronic documentation in 2009. At that time we implemented our stroke templates and performance measures based on regulatory standards. We hypothesized that the stroke template implementation would help us achieve performance measure criteria above state benchmarks as set out by the New York State Department of Health (NYS DOH). Methods Implementation was phased in [over 18 months], initially using a template that only included neurological assessment and free text fields for stroke measures. By July 2010, existing templates were modified and additional stroke templates were implemented to meet new regulatory requirements and meaningful use criteria. Retrospective data review was conducted for performance comparison between 2008 -- one year prior to EMR/template implementation -- and 2010. In Quarter 1 of 2011 EMR was also implemented in the Emergency Department (ED). Data was reviewed for compliance with stroke measures. Results Documentation compliance substantially improved between 2008 and Quarter 1 2011: Compliance for these measures has been maintained ≥ 85% since November 2010, ≥ 90% Q1 2011 Conclusions The EMR implementation of stroke templates and performance measures can produce substantial improvement in performance measure compliance. Future steps will include automated documentation alerts to retrieve information and real time discovery of missing documentation for concurrent quality review and improvement

Abstract T P260: Utilizing Concurrent Chart Review With Electronic Medical Record to Improve Stroke Core and Quality Measures

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Jenny Fung
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Performance Measures ◽  
Chart Review ◽  
Heart Association ◽  
Quality Measures ◽  
Stroke Care ◽  
Thromboembolism Prophylaxis ◽  
Gradual Improvement ◽  
Stroke Team

Background and Purpose: The purpose of this project was to utilize concurrent chart review with electronic medical record as one method to improve stroke performance measures. In order to standardize and improve stroke care in the acute care setting, stroke performance measures have been set forth by the American Heart Association/American Stroke Association through Get With The Guidelines Registry, and from the Joint Commission. Maintaining stroke measures above goal can present a challenge in the world of paper documentation and chart review after discharge. Electronic medical record (EMR) allows multiple providers, including physicians, nurses, therapists, and stroke coordinator to access the health record concurrently during the patient’s hospital stay. Methods: Guided by a successful program implemented by St Mary’s Health Center in Jefferson City, Missouri, a 2 step concurrent chart review process was initiated for all stroke and transient ischemic attack (TIA) patients admitted to our facility. A stroke coordinator conducted chart review via EMR focusing on 8 of the quality measures (Early Antithrombotics, venous thromboembolism prophylaxis, antithrombotics at discharge, anticoagulation at discharge for atrial fibrillation/atrial flutter, smoking cessation, statin at discharge, dysphagia screen, and stroke education). Chart review was conducted the day after admission and the day of discharge with the goal of correcting potential outliers on the same day of chart review. Monthly performance data was collected over 1 year. Results: Concurrent chart review was conducted on 409 stroke/TIA patients. There was gradual improvement in quality and core stroke measures following implementation with achieving and sustaining 100% in 7 measures by month 6 and acheivement of >90% for dysphagia screen. Conclusions: In conclusion, concurrent chart review with the use of electronic medical record allows the stroke coordinator to focus on core and quality measures, while allowing multiple members of the stroke team (physician, nurse, and therapist) to access the same patient record. This also provides opportunities for collaboration and process improvement within the same stroke team.

scholarly journals Adult Learning Principles and Peer Delivery Improve Satisfaction of Electronic Medical Record Onboarding Education

ACI Open ◽  
2020 ◽  
Vol 04 (02) ◽  
pp. e114-e118
Author(s):  
Joanna Lawrence ◽  
Sharman Tan Tanny ◽  
Victoria Heaton ◽  
Lauren Andrew
Keyword(s):  
Adult Learning ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Junior Doctors ◽  
Free Text ◽  
Organizational Safety ◽  
Adult Learning Principles ◽  
Learning Practices ◽  
Learning Principles ◽  
The Impact

Abstract Objectives Given the importance of onboarding education in ensuring the safety and efficiency of medical users in the electronic medical record (EMR), we re-designed our EMR curriculum to incorporate adult learning principles, informed and delivered by peers. We aimed to evaluate the impact of these changes based on their satisfaction with the training. Methods A single site pre- and post-observational study measured satisfaction scores (four questions) from junior doctors attending EMR onboarding education in 2018 (pre-implementation) compared with 2019 (post-implementation). An additional four questions were asked in the post-implementation survey. All questions employed a Likert scale (1–5) with an opportunity for free-text. Raw data were used to calculate averages, standard deviations and the student t-test was used to compare the two cohorts where applicable. Results There were a total of 98 respondents in 2018 (pre-implementation) and 119 in 2019 (post-implementation). Satisfaction increased from 3.8/5 to 4.5/5 (p < 0.0001) following implementation of a peer-delivered curriculum in line with adult learning practices. The highest-rated factors were being taught by other doctors (4.9/5) and doctors having the appropriate knowledge to deliver training (4.9/5). Ninety-two percent of junior doctors were motivated to engage in further EMR education and 90% felt classroom support was adequate. Conclusion EMR onboarding education for medical users is a critical ingredient to organizational safety and efficiency. An improvement in satisfaction ratings by junior doctors was demonstrated after significant re-design of the curriculum was informed and delivered by peers, in line with adult learning principles.

Consultation of Medical Narratives in the Electronic Medical Record

1999 ◽  
Vol 38 (04/05) ◽  
pp. 289-293 ◽  
Author(s):  
H. J. Tange
Keyword(s):  
Information Retrieval ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Data Entry ◽  
Daily Practice ◽  
Evaluation Study ◽  
System Level ◽  
Free Text ◽  
Patient Case ◽  
Medical Narratives

AbstractThis article presents an overview of a research project concerning the consultation of medical narratives in the electronic medical record (EMR). It describes an analysis of user needs, the design and implementation of a prototype EMR system, and the evaluation of the ease of consultation of medical narratives when using this system. In a questionnaire survey, 85 hospital physicians judged the quality of their paper-based medical record with respect to data entry, information retrieval and some other aspects. Participants were more positive about the paper medical record than the literature suggests. They wished to maintain the flexibility of data entry but indicated the need to improve the retrieval of information. A prototype EMR system was developed to facilitate the consultation of medical narratives. These parts were divided into labeled segments that could be arranged source-oriented and problem-oriented. This system was used to evaluate the ease of information retrieval of 24 internists and 12 residents at a teaching hospital when using free-text medical narratives divided at different levels of detail. They solved, without time pressure, some predefined problems concerning three voluminous, inpatient case records. The participants were randomly allocated to a sequence that was balanced by patient case and learning effect. The division of medical narratives affected speed, but not completeness of information retrieval. Progress notes divided into problem-related segments could be consulted 22% faster than when undivided. Medical history and physical examination divided into segments at organ-system level could be consulted 13% faster than when divided into separate questions and observations. These differences were statistically significant. The fastest divisions were also appreciated as the best combination of easy searching and best insight in the patient case. The results of our evaluation study suggest a trade-off between searching and reading: too much detailed segments will delay the consultation of medical narratives. Validation of the results in daily practice is recommended.

Operational performance measures for startups

2018 ◽  
Vol 22 (1) ◽  
pp. 31-41 ◽  
Author(s):  
Nopadol Rompho
Keyword(s):  
Performance Measures ◽  
Statistical Tests ◽  
Chief Executive ◽  
Performance Measure ◽  
Survey Method ◽  
Analysis Tool ◽  
Content Type ◽  
Perceived Importance ◽  
Large Corporations ◽  
And Performance

PurposeThe purpose of this study is to investigate the uses of performance measures in startup firms, including perceived importance and performance of those measures. Design/methodology/approachThe survey method is used in this study. Data are collected from founders/chief executive officers/managers of 110 startups in Thailand. The correlation analysis and analysis of variance techniques are used as the analysis tool in this study. FindingsThe results show that there is a positive relationship between the perceived importance and the performance of each metric. However, no significant differences are found in the importance and performance of each metric among the various stages of startups. Research limitations/implicationsBecause there are so few startups compared to large corporations, the sample size of this study is relatively small, which is a limitation for some statistical tests. Practical implicationsStartup should measure and monitor the correct metrics in a particular stage, instead of trying to perform well in all areas, which will lead them to lose focus, and possibly even fail. Results obtained from this study will aid startups in properly monitoring and managing their performance. Originality/valueUnlike large corporations, the performance measures used by startups vary, and depend on a startup’s stage and type. Because of the fact that there are much fewer startups than large corporations, there are a limited number of studies in this area. This research is among the first studies that try to investigate the uses of performance measure for this new type of organizations.

Validity of Selection Tests: A Study

1980 ◽  
Vol 5 (4) ◽  
pp. 267-274
Author(s):  
Mirza S. Saiyadain
Keyword(s):  
Performance Evaluation ◽  
Performance Appraisal ◽  
Performance Measures ◽  
Significant Relationship ◽  
Test Scores ◽  
Performance Measure ◽  
First Year ◽  
Subsequent Performance ◽  
Evaluation Scores ◽  
And Performance

Several reasons have been offered for the depressed values of coefficients of correlation between performance evaluation scores and test scores for tests that otherwise seem to have high validity. Most of these studies have concerned themselves with only the first year performance measure. This study was undertaken to broadbase the validity design by including performance measures of three subsequent years. Data on the test and performance scores of a sample of executives were analysed. The results indicate that though test scores may not show significant relationship with the first year performance appraisal score, they show positive and significant relationship with subsequent performance appraisal scores. The results are explained in terms of changed performance evaluation.

Window of Opportunity for New Disease Surveillance: Developing Keyword Lists for Monitoring Mental Health and Injury Through Syndromic Surveillance

2016 ◽  
Vol 11 (2) ◽  
pp. 173-178 ◽  
Author(s):  
Ursula Lauper ◽  
Jian-Hua Chen ◽  
Shao Lin
Keyword(s):  
Public Health ◽  
Mental Health ◽  
New York ◽  
Syndromic Surveillance ◽  
New York State ◽  
Hurricane Sandy ◽  
York State Department ◽  
Free Text ◽  
York State ◽  
The Impact

AbstractStudies have documented the impact that hurricanes have on mental health and injury rates before, during, and after the event. Since timely tracking of these disease patterns is crucial to disaster planning, response, and recovery, syndromic surveillance keyword filters were developed by the New York State Department of Health to study the short- and long-term impacts of Hurricane Sandy. Emergency department syndromic surveillance is recognized as a valuable tool for informing public health activities during and immediately following a disaster. Data typically consist of daily visit reports from hospital emergency departments (EDs) of basic patient data and free-text chief complaints. To develop keyword lists, comparisons were made with existing CDC categories and then integrated with lists from the New York City and New Jersey health departments in a collaborative effort. Two comprehensive lists were developed, each containing multiple subcategories and over 100 keywords for both mental health and injury. The data classifiers using these keywords were used to assess impacts of Sandy on mental health and injuries in New York State. The lists will be validated by comparing the ED chief complaint keyword with the final ICD diagnosis code. (Disaster Med Public Health Preparedness. 2017;11:173–178)

scholarly journals Correction: Combining Free Text and Structured Electronic Medical Record Entries to Detect Acute Respiratory Infections

PLoS ONE ◽  
2011 ◽  
Vol 6 (1) ◽  
Author(s):  
Sylvain DeLisle ◽  
Brett South ◽  
Jill A. Anthony ◽  
Ericka Kalp ◽  
Adi Gundlapalli ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Respiratory Infections ◽  
Free Text ◽  
Acute Respiratory Infections

scholarly journals Electronic Medical Record–Based Radiation Oncology Toxicity Recording Instrument Aids Benchmarking and Quality Improvement in the Clinic

2018 ◽  
Vol 14 (3) ◽  
pp. e186-e193 ◽  
Author(s):  
Kevin Albuquerque ◽  
Kellie Rodgers ◽  
Ann Spangler ◽  
Asal Rahimi ◽  
DuWayne Willett
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Radiation Oncology ◽  
Local Population ◽  
Free Text ◽  
Flow Sheet ◽  
High Grade ◽  
Recording Instrument ◽  
Uniform Sample ◽  
High Level

Purpose: The on-treatment visit (OTV) for radiation oncology is essential for patient management. Radiation toxicities recorded during the OTV may be inconsistent because of the use of free text and the lack of treatment site–specific templates. We developed a radiation oncology toxicity recording instrument (ROTOX) in a health system electronic medical record (EMR). Our aims were to assess improvement in documentation of toxicities and to develop clinic toxicity benchmarks. Methods: A ROTOX that was based on National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.0) with flow-sheet functionality was developed in the EMR. Improvement in documentation was assessed at various time intervals. High-grade toxicities (ie, grade ≥ 3 by CTCAE) by site were audited to develop benchmarks and to track nursing and physician actions taken in response to these. Results: A random sample of OTV notes from each clinic physician before ROTOX implementation was reviewed and assigned a numerical document quality score (DQS) that was based on completeness and comprehensiveness of toxicity grading. The mean DQS improved from an initial level of 41% to 99% (of the maximum possible DQS) when resampled at 6 months post-ROTOX. This high-level DQS was maintained 3 years after ROTOX implementation at 96% of the maximum. For months 7 to 9 after implementation (during a 3-month period), toxicity grading was recorded in 4,443 OTVs for 698 unique patients; 107 episodes of high-grade toxicity were identified during this period, and toxicity-specific intervention was documented in 95%. Conclusion: An EMR-based ROTOX enables consistent recording of treatment toxicity. In a uniform sample of patients, local population toxicity benchmarks can be developed, and clinic response can be tracked.

Manipulation and performance persistence: an examination of Iranian equity mutual fund performance

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Mahsa Hosseini ◽  
Mohammad Khodaei Valahzaghard ◽  
Ali Saeedi
Keyword(s):  
Mutual Funds ◽  
Performance Measures ◽  
Mutual Fund ◽  
Performance Measure ◽  
Performance Persistence ◽  
Content Type ◽  
Lower Tertile ◽  
Time Horizons ◽  
Equity Mutual Funds ◽  
And Performance

Purpose This paper aims to study manipulation and performance persistence in equity mutual funds. To this end, Manipulation-Proof Performance Measure (MPPM) and Doubt Ratio, along with a number of current performance measures are used to evaluate the performance of equity mutual funds in Iran. Design/methodology/approach The authors investigate performance manipulation by 1) comparing the results of the MPPM with the current performance measures, 2) checking the Doubt Ratio to detect suspicious funds. Additionally, the authors investigate performance persistence by forming and evaluating portfolios of the equity mutual funds at several time horizons. Findings The authors conclude that there is no evidence of performance manipulation in the equity mutual funds. Additionally, when comparing the performance of the upper (top) tertile portfolios and the lower tertile portfolios, in all of the studied 1, 3, 6 and 12-month horizons, the authors find performance persistence in the equity mutual funds. Originality/value To the best of the authors’ knowledge, this research is the first study to investigate the performance manipulation in the Iranian equity mutual funds, and also is the first study in Iran that uses the MPPM and the Doubt Ratio in addition to a number of current performance measures to investigate the performance persistence in the equity mutual funds at several time horizons.

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