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.

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

scholarly journals Natural Language Processing Performance for the Identification of Venous Thromboembolism in an Integrated Healthcare System

2021 ◽  
Vol 27 ◽  
pp. 107602962110131
Author(s):  
Bela Woller ◽  
Austin Daw ◽  
Valerie Aston ◽  
Jim Lloyd ◽  
Greg Snow ◽  
...  
Keyword(s):  
Natural Language Processing ◽  
Venous Thromboembolism ◽  
Natural Language ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Ct Angiography ◽  
Language Processing ◽  
Predictive Value ◽  
Chart Review ◽  
Imaging Studies

Real-time identification of venous thromboembolism (VTE), defined as deep vein thrombosis (DVT) and pulmonary embolism (PE), can inform a healthcare organization’s understanding of these events and be used to improve care. In a former publication, we reported the performance of an electronic medical record (EMR) interrogation tool that employs natural language processing (NLP) of imaging studies for the diagnosis of venous thromboembolism. Because we transitioned from the legacy electronic medical record to the Cerner product, iCentra, we now report the operating characteristics of the NLP EMR interrogation tool in the new EMR environment. Two hundred randomly selected patient encounters for which the imaging report assessed by NLP that revealed VTE was present were reviewed. These included one hundred imaging studies for which PE was identified. These included computed tomography pulmonary angiography—CTPA, ventilation perfusion—V/Q scan, and CT angiography of the chest/ abdomen/pelvis. One hundred randomly selected comprehensive ultrasound (CUS) that identified DVT were also obtained. For comparison, one hundred patient encounters in which PE was suspected and imaging was negative for PE (CTPA or V/Q) and 100 cases of suspected DVT with negative CUS as reported by NLP were also selected. Manual chart review of the 400 charts was performed and we report the sensitivity, specificity, positive and negative predictive values of NLP compared with manual chart review. NLP and manual review agreed on the presence of PE in 99 of 100 cases, the presence of DVT in 96 of 100 cases, the absence of PE in 99 of 100 cases and the absence of DVT in all 100 cases. When compared with manual chart review, NLP interrogation of CUS, CTPA, CT angiography of the chest, and V/Q scan yielded a sensitivity = 93.3%, specificity = 99.6%, positive predictive value = 97.1%, and negative predictive value = 99%.

A Novel Electronic Medical Record–Based Workflow to Measure and Report Colonoscopy Quality Measures

2016 ◽  
Vol 14 (3) ◽  
pp. 333-337.e1 ◽  
Author(s):  
David A. Leiman ◽  
David C. Metz ◽  
Gregory G. Ginsberg ◽  
J.T. Howell ◽  
Shivan J. Mehta ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Quality Measures ◽  
Colonoscopy Quality

Correlation of venous thromboembolism prophylaxis and electronic medical record alerts with incidence among surgical patients

Surgery ◽  
2016 ◽  
Vol 160 (5) ◽  
pp. 1202-1210 ◽  
Author(s):  
Rajesh Ramanathan ◽  
Nathaniel Lee ◽  
Therese M. Duane ◽  
Zirui Gu ◽  
Natalie Nguyen ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Surgical Patients ◽  
Thromboembolism Prophylaxis ◽  
Venous Thromboembolism Prophylaxis

scholarly journals Transcranial Doppler Ultrasound Screening in Urban Pediatric Sickle Cell Center - Better Charting Improves Compliance over Published Rates

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4749-4749
Author(s):  
Ariel Gliksberg ◽  
Christopher McCauley ◽  
Lewis L. Hsu
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Sickle Cell ◽  
Research Funding ◽  
Chart Review ◽  
Ultrasound Screening ◽  
Patients Âgés ◽  
Lost To Follow Up

Abstract Background: TranscranialDoppler ultrasound (TCD) screening for stroke risk is one of the major advances in pediatric sickle cell disease, since the landmark STOP study. TCD screening is among the measures for quality of pediatric sickle cell care proposed by expert consensus (Wang 2011, NHLBI guidelines 2014). Reeves et al 2016 shows that TCD screening rates are low but still improving (22% in 2006 -44% in 2010). To improve the quality-of-care provided to pediatric sickle cell patients at University of Illinois Hospital, we conducted chart review in 2014 to establish a baseline report of UI Hospitalsadherence to the expert care standards. At that time TCD screening rates were much lower than immunization rates. We then introduced a reminder table in the electronic medical record. 18 months since this change in EMR we re-evaluated our compliance with TCDs. Objectives: To evaluate the improvement atUIHealthpediatric sickle cell clinic compliance with annual TCD. Methods: A manual chart review of these pediatric sickle cell patients was employed to determine adherence to TCD screening standards. All patients ages 2-16yowith SCD-SS and SCD-S/Beta-0-thalassemia that were seen in pediatric sickle cell clinic and adolescent-adult transition clinics two times over 15 months from 2/1/15-5/1/16 were included in study. TCD compliance was determined if patient had TCD between 5/1/2015 through 5/31/16. 5-15 minutes per patient was spent evaluating EMR for TCD compliance Data from the 2014 previous study was also re-evaluated using the same criteria of 2 visits within 15 months of original study date and TCD within 1 year of study. Results: In this work, the charts of 91 pediatric SCD-SS and SCD-S/Beta0 patients were reviewed (ages 2-16 years; M: 34 F 28, 5 ineligible [2 on chronic transfusion, 1 high hemoglobin, 1 yearly MRI, 1 last visit before 2yo]. Lost to follow-up (Seen in clinic since 2014 but not 2 visits from 2/1/15-5/1/16): 24 The rate of TCD screening among these eligible children was 53 out of 62, or 85.5% in 2016. Comparable figures from the 2014 chart review were 17 out of 27, or 63% in 2014. Fishers exact test indicates that this was a significant improvement, p=0.05. Conclusions: We focused our quality-improvement efforts onTranscranialDoppler screening, adding a reminder table in the Electronic Medical Record then re-assessing 18 months later. The rate of TCD screening significantly improved from 63% to 85%. Although less than 100%, these compare favorably to other published TCD rates (Table). The next step is to improve clinic attendance and tracking, to reduce the rate of patients who are "lost to follow-up." To facilitate future chart reviews we have incorporated the key parameters into our "Screening & Management Table" as a component of the electronic medical record. Table Table. Disclosures Hsu: Purdue Pharma: Research Funding; Mast Therapeutics: Research Funding; Eli Lilly: Research Funding; Sancilio: Research Funding; Centers for Medicare and Medicaid Innovation: Research Funding; Pfizer: Consultancy, Research Funding; EMMI Solutions: Consultancy; Gerson Lehman Group: Consultancy; Astra Zeneca: Consultancy, Research Funding; Hilton Publishing: Consultancy, Research Funding.

scholarly journals Development and validation of a computer-based algorithm to identify foreign-born patients with HIV infection from the electronic medical record

2014 ◽  
Vol 05 (02) ◽  
pp. 557-570 ◽  
Author(s):  
V. Triant ◽  
E. Losina ◽  
K. Keefe ◽  
K. Freedberg ◽  
S. Regan ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Outcomes Research ◽  
Chart Review ◽  
Place Of Birth ◽  
Foreign Born ◽  
Computer Based ◽  
Stage 1 ◽  
Development And Validation

SummaryObjective: To develop and validate an efficient and accurate method to identify foreign-born patients from a large patient data registry in order to facilitate population-based health outcomes research.Methods: We developed a three-stage algorithm for classifying foreign-born status in HIV-infected patients receiving care in a large US healthcare system (January 1, 2001-March 31, 2012) (n = 9,114). In stage 1, we classified those coded as non-English language speaking as foreign-born. In stage 2, we searched free text electronic medical record (EMR) notes of remaining patients for keywords associated with place of birth and language spoken. Patients without keywords were classified as US-born. In stage 3, we retrieved and reviewed a 50-character text window around the keyword (i.e. token) for the remaining patients. To validate the algorithm, we performed a chart review and asked all HIV physicians (n = 37) to classify their patients (n = 957).We calculated algorithm sensitivity and specificity.Results: We excluded 160/957 because physicians indicated the patient was not HIV-infected (n = 54), “not my patient” (n = 103), or had unknown place of birth (n = 3), leaving 797 for analysis. In stage 1, providers agreed that 71/95 foreign language speakers were foreign-born. Most disagreements (23/24) involved patients born in Puerto Rico. In stage 2, 49/50 patients without keywords were classified as US-born by chart review. In stage 3, token review correctly classified 55/60 patients (92%), with 93% (CI: 84.4, 100%) sensitivity and 90% (CI: 74.3, 100%) specificity compared with full chart review. After application of the three-stage algorithm, 2,102/9,114 (23%) patients were classified as foreign-born. When compared against physician response, estimated sensitivity of the algorithm was 94% (CI: 90.9, 97.2%) and specificity 92% (CI: 89.7, 94.1%), with 92% correctly classified.Conclusion: A computer-based algorithm classified foreign-born status in a large HIV-infected cohort efficiently and accurately. This approach can be used to improve EMR-based outcomes research.Citation: Levison J, Triant V, Losina E, Keefe K, Freedberg K, Regan S. Development and validation of a computer-based algorithm to identify foreign-born patients with HIV infection from the electronic medical record. Appl Clin Inf 2014; 5: 557–570 http://dx.doi.org/10.4338/ACI-02-RA-0013

scholarly journals A Retrospective Study Investigating the Incidence and Predisposing Factors of Hospital-Acquired Anemia

Anemia ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Peter C. Kurniali ◽  
Stephanie Curry ◽  
Keith W. Brennan ◽  
Kim Velletri ◽  
Mohammed Shaik ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Retrospective Study ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Chart Review ◽  
Diagnostic Testing ◽  
Hospitalized Patients ◽  
Predisposing Factors ◽  
Significant Morbidity ◽  
Hospital Acquired

Hospitalized patients frequently have considerable volumes of blood removed for diagnostic testing which could lead to the development of hospital-acquired anemia. Low hemoglobin levels during hospitalization may result in significant morbidity for patients with underlying cardiorespiratory and other illnesses. We performed a retrospective study and data was collected using a chart review facilitated through an electronic medical record. A total of 479 patients who were not anemic during admission were included in analysis. In our study, we investigated the incidence of HAA and found that, between admission and discharge, 65% of patients dropped their hemoglobin by 1.0 g/dL or more, and 49% of patients developed anemia. We also found that the decrease in hemoglobin between admission and discharge did not differ significantly with smaller phlebotomy tubes. In multivariate analysis, we found that patients with longer hospitalization and those with lower BMI are at higher risk of developing HAA. In conclusion, our study confirms that hospital-acquired anemia is common. More aggressive strategies such as reducing the frequency of blood draws and expanding the use of smaller volume tubes for other laboratory panels may be helpful in reducing the incidence of HAA during hospitalization.

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