scholarly journals The future of medical scribes documenting in the electronic health record: results of an expert consensus conference

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sky Corby ◽  
Keaton Whittaker ◽  
Joan S. Ash ◽  
Vishnu Mohan ◽  
James Becton ◽  
...  
Keyword(s):  
Care Delivery ◽  
Clinical Care ◽  
Consensus Conference ◽  
Negative Consequences ◽  
Team Members ◽  
Clinical Encounters ◽  
Stakeholder Perspectives ◽  
The Future ◽  
Electronic Health ◽  
Medical Scribes

Abstract Background With the use of electronic health records (EHRs) increasing and causing unintended negative consequences, the medical scribe profession has burgeoned, but it has yet to be regulated. The purpose of this study was to describe scribe workflow as well as identify the threats and opportunities for the future of the scribe industry. Methods The first phase of the study used ethnographic methods consisting of interviews and observations by a multi-disciplinary team of researchers at five United States sites. In April 2019, a two-day conference of experts representing different stakeholder perspectives was held to discuss the results from site visits and to predict the future of medical scribing. An interpretive content analysis approach was used to discover threats and opportunities for the future of medical scribes. Results Threats facing the medical scribe industry were related to changes in the documentation model, EHR usability, different payment structures, the need to acquire disparate data during clinical encounters, and workforce-related changes relevant to the scribing model. Simultaneously, opportunities for medical scribing in the future included extension of their role to include workflow analysis, acting as EHR-related subject-matter-experts, and becoming integrated more effectively into the clinical care delivery team. Experts thought that if EHR usability increases, the need for medical scribes might decrease. Additionally, the scribe role could be expanded to allow scribes to document more or take on more informatics-related tasks. The experts also anticipated an increased use of alternative models of scribing, like tele-scribing. Conclusion Threats and opportunities for medical scribing were identified. Many experts thought that if the scribe role could be expanded to allow scribes to document more or take on more informatics activities, it would be beneficial. With COVID-19 continuing to change workflows, it is critical that medical scribes receive standardized training as tele-scribing continues to grow in popularity and new roles for scribes as medical team members are identified.

scholarly journals 483. OPAT Delivery during COVID-19

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S308-S308
Author(s):  
Michael J Swartwood ◽  
Renae A Boerneke ◽  
Alan C Kinlaw ◽  
Nikolaos Mavrogiorgos ◽  
Ashley Marx ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Care Delivery ◽  
Clinical Care ◽  
Monitoring Program ◽  
Baseline Data ◽  
Readmission Rates ◽  
Team Members ◽  
Comparison Time ◽  
Clinic Visits

Abstract Background In 2020, COVID-19 spurred unprecedented change in the delivery of routine clinical care. The UNC OPAT program staff, previously accustomed to in-person collaboration in the hospital, became geographically distant amid North Carolina’s partial shutdown starting in March 2020. Team members relied on teleworking and many OPAT clinic visits shifted to phone and video telehealth. We assessed how COVID-19 impacted our care of OPAT patients including follow-up visits and readmissions. Methods UNC’s OPAT database contains clinical and demographic information on all patients on OPAT for at least 14 days who received specialized monitoring program led by an infectious diseases (ID) pharmacist, after evaluation by an ID physician. For all OPAT courses that ended between 3/1/20 and 5/20/20 (last available data cut), we assessed the length of OPAT treatment course, readmissions, adverse events, follow-up ID clinic visits, and the method of follow up visit utilized. We compared these measurements to historical baseline data from 3/1/19 to 5/20/19. Results During the 2020 period, 73 patients completed OPAT, with median OPAT enrollment lasting 36 days, which was similar to 2019 data (70 patients; median OPAT enrollment of 35 days). During the 2019 period, 93% of patients attended a follow up visit with an infectious diseases clinician, all of which took place in person. During the 2020 (COVID-19) period, 85% of patients attended an ID follow up visit; contrary to 2019, 42% of these visits took place in person, 45% were by phone and 13% were via a telemedicine video service. Readmission rates were similar across the two time periods (16% during COVID-19 vs 14% during 2019 comparison time period, P=0.72). Conclusion UNC OPAT continued through the emergence of COVID-19 as an essential service for a high patient volume by adapting its care delivery and follow-up visit protocols to include virtual care options. Readmission rates for OPAT patients during COVID-19 were comparable to historical baseline data. Disclosures All Authors: No reported disclosures

scholarly journals The Future of Personal Health Records and Patient Portals

2021 ◽  
Vol 9 (12) ◽  
Author(s):  
Kim Nazi
Keyword(s):  
Care Delivery ◽  
Clinical Care ◽  
Personal Health Record ◽  
Personal Health Records ◽  
Personal Health Information ◽  
Personal Health ◽  
Patient Portals ◽  
Health Records ◽  
The Future ◽  
The Impact

Over the last two decades, the early development of standalone Personal Health Records (PHRs), and later tethered patient portals, have had a transformative effect on engaging patients by providing them with tools to manage their health and unprecedented access to their heath data. However, despite anticipated benefits and continued high consumer demand for online access to personal health information, adoption and sustained use has been less than expected. Moreover, powerful forces are transforming healthcare, necessitating change and adaptation. This aim of this paper is to examine several significant trends that are influencing the intersection of health care and technology and provide an assessment of the impact of these trends on the future of PHRs and patient portals. An aging population with an increased prevalence of chronic disease and mental health conditions, coupled with rising consumerism and more diverse care settings, has significant implications for patient-facing tools such as patient portals. Similarly, the proliferation of data generating consumer health technology and technical advances such as artificial intelligence and emerging data standards calls for the next iteration of tools to support care delivery. Moreover, the acceleration of virtual care driven by national policy changes and the COVID 19 pandemic requires better tools to realize the promising potential of the technology in an increasingly complex and interconnected world. Taken together, these factors may provide the perfect storm that will enable a critical shift to envision a more holistic patient-centric information and resource hub that is characterized by improved architecture, optimized design and content, a robust set of well-designed tools and functions, and enhanced integration with clinical care processes and structures. This personal health portal could provide a long desired single comprehensive longitudinal personal health record with best of breed design and features to empower patients as they navigate their health journey.

scholarly journals A Multidisciplinary Delphi Consensus-Based Checklist to Define Clinical Documentation Tools for Both Routine and Research Purposes

2018 ◽  
Vol 5 ◽  
pp. 233339281775416
Author(s):  
Cecilia Veraar ◽  
Paul Hasler ◽  
Michael Schirmer
Keyword(s):  
Working Group ◽  
Clinical Care ◽  
Quality Data ◽  
Clinical Documentation ◽  
Delphi Consensus ◽  
Strategic Approach ◽  
Group 12 ◽  
The Future ◽  
Electronic Health ◽  
Set Up

Background: To the best of our knowledge, a strategic approach to define the contents of structured clinical documentation tools for both clinical routine patient care and research purposes has not been reported so far, although electronic health record will become more and more structured and detailed in the future. Objective: To achieve an interdisciplinary consensus on a checklist to be considered for the preparation of disease- and situation-specific clinical documentation tools. Methods: A 2-round Delphi consensus-based process was conducted both with 19 physicians of different disciplines and 14 students from Austria, Switzerland, and Germany. Agreement was defined as 80% or more positive votes of the participants. Results: The participants agreed that a working group should be set up for the development of structured disease- or situation-specific documentation tools (97% agreement). The final checklist included 4 recommendations concerning the setup of the working group, 12 content-related recommendations, and 3 general and technical recommendations (mean agreement [standard deviation] = 97.4% [4.0%], ranging from 84.2% to 100.0%). Discussion and Conclusion: In the future, disease- and situation-specific structured documentation tools will provide an important bridge between registries and electronic health records. Clinical documentation tools defined according to this Delphi consensus-based checklist will provide data for registries while serving as high-quality data acquisition tools in routine clinical care.

scholarly journals The Adaptation and Implementation of a Medical–Dental Electronic Health Record in an Academic Dental Center

ACI Open ◽  
2019 ◽  
Vol 03 (01) ◽  
pp. e37-e43
Author(s):  
Maria C. Dolce ◽  
Jessica L. Parker ◽  
Scott Jason ◽  
Catherine R. Ramos ◽  
John D. DaSilva
Keyword(s):  
Electronic Health Record ◽  
Nurse Practitioners ◽  
Medical Information ◽  
Care Delivery ◽  
Case Reports ◽  
Health Care Systems ◽  
Clinical Care ◽  
The United States ◽  
Health Record ◽  
Electronic Health

Background Several large health care systems in the United States have pioneered the integration of dentistry into their medical care delivery models. To date, no studies or case reports on combining medical information into the dental electronic health record within U.S. academic dental centers were found in the extant literature. Objective This report details how we developed and implemented customized primary care elements into axiUm, a popular dental practice management software primarily used in dental schools, to facilitate medical–dental clinical integration. This work was undertaken to provide the infrastructure for nurse practitioners and dentists to deliver a holistic, integrated, person-centered approach to care. Methods A multidisciplinary design team used the Centers for Disease Control and Prevention's Framework for Patient-centered Health Risk Assessments, an evidence-based framework to guide the adaptation of the existing axiUm dental record. The design featured individual data fields to source data, generate reports, and analyze information to improve clinical care and operations. Results To date, medical information on more than 260 dental patients over 600 clinic visits has been documented in the adapted electronic health record. Conclusion The customization capability of axiUm facilitated efficient and effective development and implementation processes. Training and user support were essential for effective implementation and led to further system refinements.

scholarly journals Characterizing communication patterns among members of the clinical care team to deliver breast cancer treatment

2019 ◽  
Vol 27 (2) ◽  
pp. 236-243 ◽  
Author(s):  
Bryan D Steitz ◽  
Kim M Unertl ◽  
Mia A Levy
Keyword(s):  
Breast Cancer ◽  
Electronic Health Record ◽  
Medical Center ◽  
Clinical Care ◽  
Communication Patterns ◽  
Care Team ◽  
Health Record ◽  
Team Members ◽  
The Subject ◽  
Electronic Health

Abstract Objective Research to date focused on quantifying team collaboration has relied on identifying shared patients but does not incorporate the major role of communication patterns. The goal of this study was to describe the patterns and volume of communication among care team members involved in treating breast cancer patients. Materials and Methods We analyzed 4 years of communications data from the electronic health record between care team members at Vanderbilt University Medical Center (VUMC). Our cohort of patients diagnosed with breast cancer was identified using the VUMC tumor registry. We classified each care team member participating in electronic messaging by their institutional role and classified physicians by specialty. To identify collaborative patterns, we modeled the data as a social network. Results Our cohort of 1181 patients was the subject of 322 424 messages sent in 104 210 unique communication threads by 5620 employees. On average, each patient was the subject of 88.2 message threads involving 106.4 employees. Each employee, on average, sent 72.9 messages and was connected to 24.6 collaborators. Nurses and physicians were involved in 98% and 44% of all message threads, respectively. Discussion and Conclusion Our results suggest that many providers in our study may experience a high volume of messaging work. By using data routinely generated through interaction with the electronic health record, we can begin to evaluate how to iteratively implement and assess initiatives to improve the efficiency of care coordination and reduce unnecessary messaging work across all care team roles.

The electronic health record as a clinical trials tool: Opportunities and challenges

2020 ◽  
Vol 17 (3) ◽  
pp. 237-242 ◽  
Author(s):  
Monica M Bertagnolli ◽  
Brian Anderson ◽  
Andre Quina ◽  
Steven Piantadosi
Keyword(s):  
Clinical Trials ◽  
Clinical Research ◽  
Electronic Health Record ◽  
Care Delivery ◽  
Clinical Care ◽  
Health Record ◽  
Electronic Health Record Data ◽  
Treatment Protocols ◽  
Record Data ◽  
Electronic Health

Clinical trials provide evidence essential for progress in health care, and as the complexity of medical care has increased, the demand for such data has dramatically expanded. Conducting clinical trials has also become more complicated, evolving to meet increasing challenges in delivering clinical care and meeting regulatory requirements. Despite this, the general approach to data collection remains the same, requiring that researchers submit clinical data in response to study treatment protocols, using precisely defined data structures made available in study-specific case report forms. Currently, research data management is not integrated within the patient’s clinical care record, creating added burden for clinical staff and opportunities for error. During the past decade, the electronic health record has become standard across the US healthcare system and is increasingly used to collect and analyze data reporting quality metrics for clinical care delivery. Recently, electronic health record data have also been used to address clinical research questions; however, this approach has significant drawbacks due to the unstructured and incomplete nature of current electronic health record data. This report describes steps necessary to use the electronic health record as a tool for conducting high-quality clinical research.

INTERACTION OF THE NATIONAL ECONOMY OF UKRAINE WITH INTERNATIONAL CREDIT AND FINANCIAL ORGANIZATIONS

2017 ◽  
Author(s):  
Serhii Voitko ◽  
◽  
Yuliia Borodinova ◽  
Keyword(s):  
Financial Institutions ◽  
National Economy ◽  
Financial Support ◽  
Global Economy ◽  
Financial Sector ◽  
Negative Consequences ◽  
International Financial Institutions ◽  
The Future ◽  
International Credit

The article examines the interaction of the national economy of Ukraine with international credit and financial organizations, evaluates the positive and negative consequences and identifies possible areas for further cooperation. The role of international credit and financial organizations in the development of the global economy is analyzed. Today, international financial institutions have taken a leading place among institutions that provide financial support and contribute to the implementation of necessary reforms aimed at developing enterprises in various sectors of the economy and strengthening the country's financial sector as a whole. The importance of cooperation between Ukraine and international financial institutions for the development of the country's economy has been determined. The problems and directions of development of cooperation with leading credit and financial organizations in modern conditions are identified. Despite the presence of certain shortcomings, cooperation between Ukraine and international credit and financial organizations will continue in the future.

scholarly journals Understanding decisions about antibiotic prescribing in ICU: an application of the Necessity Concerns Framework

2021 ◽  
pp. bmjqs-2020-012479
Author(s):  
Alyssa M Pandolfo ◽  
Robert Horne ◽  
Yogini Jani ◽  
Tom W Reader ◽  
Natalie Bidad ◽  
...  
Keyword(s):  
Focus Groups ◽  
Antibiotic Prescribing ◽  
Negative Consequences ◽  
Out Of Hours ◽  
Team Members ◽  
Clinical Vignettes ◽  
Molecular Microbiology ◽  
Semistructured Interviews ◽  
Decision Making Processes ◽  
The Individual

BackgroundAntibiotics are extensively prescribed in intensive care units (ICUs), yet little is known about how antibiotic-related decisions are made in this setting. We explored how beliefs, perceptions and contextual factors influenced ICU clinicians’ antibiotic prescribing.MethodsWe conducted 4 focus groups and 34 semistructured interviews with clinicians involved in antibiotic prescribing in four English ICUs. Focus groups explored factors influencing prescribing, whereas interviews examined decision-making processes using two clinical vignettes. Data were analysed using thematic analysis, applying the Necessity Concerns Framework.ResultsClinicians’ antibiotic decisions were influenced by their judgement of the necessity for prescribing/not prescribing, relative to their concerns about potential adverse consequences. Antibiotic necessity perceptions were strongly influenced by beliefs that antibiotics would protect patients from deterioration and themselves from the ethical and legal consequences of undertreatment. Clinicians also reported concerns about prescribing antibiotics. These generally centred on antimicrobial resistance; however, protecting the individual patient was prioritised over these societal concerns. Few participants identified antibiotic toxicity concerns as a key influencer. Clinical uncertainty often complicated balancing antibiotic necessity against concerns. Decisions to start or continue antibiotics often represented ‘erring on the side of caution’ as a protective response in uncertainty. This approach was reinforced by previous experiences of negative consequences (‘being burnt’) which motivated prescribing ‘just in case’ of an infection. Prescribing decisions were also context-dependent, exemplified by a lower perceived threshold to prescribe antibiotics out-of-hours, input from external team members and local prescribing norms.ConclusionEfforts to improve antibiotic stewardship should consider clinicians’ desire to protect with a prescription. Rapid molecular microbiology, with appropriate communication, may diminish clinicians’ fears of not prescribing or of using narrower-spectrum antibiotics.

scholarly journals Consequences of COVID-19 crisis for persons with HIV: the impact of social determinants of health

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kristie C. Waterfield ◽  
Gulzar H. Shah ◽  
Gina D. Etheredge ◽  
Osaremhen Ikhile
Keyword(s):  
Public Health ◽  
Health Care ◽  
Clinical Care ◽  
Hiv Infections ◽  
People Living With Hiv ◽  
Negative Consequences ◽  
Persons Who Inject Drugs ◽  
Persons Living With Hiv ◽  
Living With Hiv ◽  
The Impact

Abstract Background With the indiscriminate spread of COVID-19 globally, many populations are experiencing negative consequences such as job loss, food insecurity, and inability to manage existing medical conditions and maintain preventive measures such as social distancing and personal preventative equipment. Some of the most disadvantaged in the COVID-19 era are people living with HIV/AIDS and other autoimmune diseases. Discussion As the number of new HIV infections decrease globally, many subpopulations remain at high risk of infection due to lack of or limited access to prevention services, as well as clinical care and treatment. For persons living with HIV or at higher risk of contracting HIV, including persons who inject drugs or men that have sex with men, the risk of COVID-19 infection increases if they have certain comorbidities, are older than 60 years of age, and are homeless, orphaned, or vulnerable children. The risk of COVID-19 is also more significant for those that live in Low- and Middle-Income Countries, rural, and/or poverty-stricken areas. An additional concern for those living the HIV is the double stigma that may arise if they also test positive for COVID-19. As public health and health care workers try to tackle the needs of the populations that they serve, they are beginning to realize the need for a change in the infrastructure that will include more efficient partnerships between public health, health care, and HIV programs. Conclusion Persons living with HIV that also have other underlying comorbidities are a great disadvantage from the negative consequences of COVID-19. For those that may test positive for both HIV and COVID-19, the increased psychosocial burdens stemming from stress and isolation, as well as, experiencing additional barriers that inhibit access to care, may cause them to become more disenfranchised. Thus, it becomes very important during the current pandemic for these challenges and barriers to be addressed so that these persons living with HIV can maintain continuity of care, as well as, their social and mental support systems.

Can machine learning be used to forecast the future uncertainty of military teams?

2021 ◽  
pp. 154851292199911
Author(s):  
Ronald H Stevens ◽  
Trysha L Galloway
Keyword(s):  
Machine Learning ◽  
Sensory Information ◽  
Fundamental Property ◽  
Transition Matrices ◽  
Team Members ◽  
Student Teams ◽  
The Future ◽  
Network States ◽  
Uncertainty Models ◽  
Military Teams

Uncertainty is a fundamental property of neural computation that becomes amplified when sensory information does not match a person’s expectations of the world. Uncertainty and hesitation are often early indicators of potential disruption, and the ability to rapidly measure uncertainty would have implications for future educational and training efforts by targeting reflective discussions about past actions, supporting in-progress corrections, and generating forecasts about future disruptions. An approach is described combining neurodynamics and machine learning to provide quantitative measures of uncertainty. Models of neurodynamic information derived from electroencephalogram (EEG) brainwaves have provided detailed neurodynamic histories of US Navy submarine navigation team members. Persistent periods (25–30 s) of neurodynamic information were seen as discrete peaks when establishing the submarine’s position and were identified as periods of uncertainty by an artificial intelligence (AI) system previously trained to recognize the frequency, magnitude, and duration of different patterns of uncertainty in healthcare and student teams. Transition matrices of neural network states closely predicted the future uncertainty of the navigation team during the three minutes prior to a grounding event. These studies suggest that the dynamics of uncertainty may have common characteristics across teams and tasks and that forecasts of their short-term evolution can be estimated.

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