The interaction between high-level electronic medical record adoption and hospitalist staffing levels: A focus on value-based purchasing

2021 ◽  
pp. 095148482110016
Author(s):  
Kate Jiayi Li ◽  
Mona Al-Amin
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Hospital Performance ◽  
Potential Interaction ◽  
Staffing Level ◽  
Value Based Purchasing ◽  
Individual Level ◽  
Staffing Levels ◽  
Emr Adoption ◽  
High Level

Objective This study sought to understand the relationship of hospital performance with high-level electronic medical record (EMR) adoption, hospitalists staffing levels, and their potential interaction. Materials and methods We evaluated 2,699 non-federal, general acute hospitals using 2016 data merged from four data sources. We performed ordinal logistic regression of hospitals’ total performance score (TPS) on their EMR capability and hospitalists staffing level while controlling for other market- and individual-level characteristics. Results Hospitalists staffing level is shown to be positively correlated with TPS. High-level EMR adoption is associated with both short-term and long-term improvement on TPS. Large, urban, non-federal government hospitals, and academic medical centers tend to have lower TPS compared to their respective counterparts. Hospitals belonging to medium- or large-sized healthcare systems have lower TPS. Higher registered nurse (RN) staffing level is associated with higher TPS, while higher percentage of Medicare or Medicaid share of inpatient days is associated with lower TPS. Discussion Although the main effects of hospitalists staffing level and EMR capability are significant, their interaction is not, suggesting that hospitalists and EMR act through separate mechanisms to help hospitals achieve better performance. When hospitals are not able to invest on both simultaneously, given financial constraints, they can still reap the full benefits from each. Conclusion Hospitalists staffing level and EMR capability are both positively correlated with hospitals’ TPS, and they act independently to bolster hospital performance.

Perioperative Nurses’ Perceptions Pre-Implementation of an Electronic Medical Record System

2021 ◽  
Author(s):  
Agnes Njane ◽  
Rebecca Jedwab ◽  
Rafael Calvo ◽  
Naomi Dobroff ◽  
Nicholas Glozier ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Care Delivery ◽  
Theoretical Domains Framework ◽  
Perioperative Nurses ◽  
Medical Record System ◽  
Focus Group Data ◽  
Emr Adoption ◽  
Facilitators And Barriers ◽  
Nurses Perceptions

The use of electronic medical record (EMR) systems is transforming health care delivery in hospitals. Perioperative nurses work in a unique high-risk health setting, hence require specific considerations for EMR implementation. This research explored perioperative nurses’ perceptions of facilitators and barriers to the implementation of an EMR in their workplace to make context-specific recommendations about strategies to optimise EMR adoption. Using a qualitative exploratory descriptive design, focus group data were collected from 27 perioperative nurses across three hospital sites. Thematic analyses revealed three themes: 1) The world is going to change; 2) What does it mean for me? and 3) We can do it, but we have some reservations. Mapping coded data to the Theoretical Domains Framework identified prominent facilitators and barriers, and informed recommended implementation strategies for EMR adoption by perioperative nurses.

36 Developing Burn Specific Documents in the Electronic Medical Record

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S25-S25
Author(s):  
Kari Gabehart ◽  
Sara Tuvell ◽  
Christina L Cook ◽  
David Roggy ◽  
Rajiv Sood
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Fluid Resuscitation ◽  
Wound Care ◽  
Burn Wound ◽  
Monthly Basis ◽  
Team Members ◽  
Handheld Device ◽  
Burn Care ◽  
High Level

Abstract Introduction The challenge with burn documentation needs in electronic medical record systems is recognized and often limited in the foundation of commercial electronic systems. In October 2016, our institution transitioned to a new all-inclusive electronic medical record. The transition to this new Electronic Medical Record (EMR) afforded us the opportunity to develop and build burn specific documentation needs in the new EMR system. In this paper, we share our experiences and the keys to our successful builds to streamline burn patients’ documentation and information. Methods In January 2013, the EMR build team was composed of corporate contractors, dedicated clinical staff from all areas of the hospital that transitioned to the build team, and private contractors experienced in the EMR build process. To our great fortune, our burn team was provided access to four dedicated build team members that worked specifically on meeting our burn team documentation needs. With high level collaboration our team was able to assess foundation abilities of the new system, identify gaps to burn care and collaboratively create and build automated documents to meet our burn needs. In October 2016, the EMR system was implemented with our burn specific documents, flowsheets, and reports. Results Through working with our dedicated build team, we were able to create an electronic Lund-Browder Chart with an avatar that is completed with each admission by our medical team. We developed a fluid resuscitation flowsheet that is documented in real-time; displays fluid resuscitation goals; displays urine output goals. The creation of a standardized wound care note template was necessary as the wound template within the existing EMR system was too cumbersome. Burn wound photo-documentation to include inpatient, outpatient, intra-operative and emergency department needs automatically uploads into the patient’s medical record from an encrypted portable handheld device connected to the EMR. Burn specific reports were developed to meet the specific needs of inquiry whether it is for performance improvement or research. Additionally, the same EMR is used in all phases of care to include the burn clinic which allows for ease and continuity of care. Conclusions An EMR that is all-inclusive has benefitted our team and patient safety by streamlining the review and documentation of information. Having specific and dedicated EMR build specialist allocated to focusing on the needs of the burn unit was invaluable in the build, implementation, and maintenance phases. We continue to work with our EMR specialist to improve processes and documentation practices that impact patient outcomes. Our burn EMR specialist meets with the burn team on a monthly basis to evaluate and assess ongoing needs to further outcomes. Applicability of Research to Practice Within this presentation, we will share our journey, challenges, and successes.

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.

Using the Electronic Medical Record to Engage Staff in Equitable Workload and Justify Staffing Levels

Nurse Leader ◽  
2020 ◽  
Vol 18 (4) ◽  
pp. 376-380
Author(s):  
Cynthia Hummel ◽  
Lea Ann Laabs ◽  
Brenda Tyczkowski ◽  
Bonnie Teuteberg ◽  
Kimberly Franzen ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Staffing Levels

scholarly journals Older Nurses’ Perceptions of an Electronic Medical Record Implementation

2021 ◽  
Author(s):  
Shaluni Tissera ◽  
Rebecca Jedwab ◽  
Rafael Calvo ◽  
Naomi Dobroff ◽  
Nicholas Glozier ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Psychological Factors ◽  
Mixed Methods Design ◽  
Sequential Mixed Methods ◽  
Group Data ◽  
Focus Group Data ◽  
Emr Adoption ◽  
Facilitators And Barriers ◽  
Nurses Perceptions

In Australia, almost 40% of nurses are aged 50 years and older. These nurses may be vulnerable to leaving the workforce due to challenges experienced during electronic medical record (EMR) implementations. This research explored older nurses’ perceptions of factors expected to influence their adoption of an EMR, to inform recommendations to support implementation. The objectives were to: 1) measure psychological factors expected to influence older nurses’ adoption of the EMR; and 2) explore older nurses’ perceptions of facilitators and barriers to EMR adoption. An explanatory sequential mixed methods design was used to collect survey and focus group data from older nurses, prior to introducing an EMR system. These nurses were highly engaged with their work; 79.3% reported high wellbeing scores. However, their motivation appeared to be predominantly governed by external rather than internal influences. Themes reflecting barriers to EMR and resistance to adoption emerged in the qualitative data.

Virtuelle Medizin in der Behandlung von Sucht in den USA, Kanada und darüber hinaus

Suchttherapie ◽  
2020 ◽  
Vol 21 (04) ◽  
pp. 189-193
Author(s):  
R. Michael Krausz ◽  
Farhud Shams ◽  
Maurice Cabanis
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Electronic Medical Record Systems

ZusammenfassungInsbesondere während der aktuellen Corona-Pandemie hat der Gebrauch virtueller Lösungen in der Medizin international stark zugenommen. Es gibt eine zunehmende Akzeptanz gerade auch in dem Bereich der hausärztlichen Versorgung, der Behandlung psychischer Störungen und der Abhängigkeitserkrankungen.Die Entwicklung ist international unterschiedlich, v. a, wenn man die USA und Kanada auf der einen Seite und Europa, insbesondere Deutschland, andererseits vergleicht. In Nordamerika hat bei dem Einsatz von moderner Technologie die Einführung von „Electronic Medical Record Systems“ eine dominierende Rolle gespielt. Diese ist insbesondere auf Abrechnung und Dokumentation zu Versicherungszwecken fokussiert. Daneben gibt es zunehmend Apps, die spezifische therapeutische Ansätze zu implementieren helfen. Die Anwendung virtueller Ansätze im Suchtbereich ist begrenzt, aber in Teilen sehr innovativ und auf deutsche Verhältnisse anwendbar. Wie in Europa gibt es auch in Nordamerika nur sehr begrenzte Forschungskapazitäten und prinzipiell Widerstand bei den medizinischen Berufsgruppen bezüglich der Anwendungsmöglichkeiten und der Rolle im Behandlungsprozess. Mehr Kooperation würde international zu einer Beschleunigung der Entwicklung und der Etablierung gemeinsamer Standards beitragen sowie die Behandlungssysteme bedeutend verbessern.

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