scholarly journals The effect of an electronic medical record intervention on hydroxychloroquine prescribing habits and surveyed providers’ opinions of the 2016 American Academy of Ophthalmology guidelines in the rheumatology and dermatology practices of an academic institutionle

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rebecca S. Overbury ◽  
Gregory J. Stoddard ◽  
Jakrapun Pupaibool ◽  
Christopher B. Hansen ◽  
Dorota Lebiedz-Odrobina
Keyword(s):  
American Academy ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Statistical Significance ◽  
Demographic Data ◽  
Clinical Decision ◽  
Descriptive Statistics ◽  
Controlled Study ◽  
Post Intervention ◽  
Prescribing Habits

Abstract Background Retinal toxicity is a rare adverse event related to the use of hydroxychloroquine (HCQ). To address this, in 2016, the American Academy of Ophthalmology (AAO) issued guidelines recommending that HCQ not exceed 5 mg/kg/day. We analyzed HCQ prescribing habits at our institution, compared to these guidelines, and used surveys to determine the opinions on these guidelines. We then introduced, in a prospective and non-controlled study, a clinical decision support (CDS) tool into the electronic medical record (EMR) to study how this intervention might affect adherence with or opinions on these guidelines. Methods Data were collected pre-intervention (June 2017–January 2019) and post-intervention (March 2019–April 2020). In January 2019 we released our CDS tool. Results were analyzed using descriptive statistics for demographic data and Fisher’s exact tests for comparisons of proportions between groups. Results Pre-intervention, we reviewed 1128 rheumatology charts and 282 dermatology charts. 31.0 and 39.7% respectively (32.8% combined) were prescribed HCQ > 5 .0 mg/kg/day. Post-intervention, we reviewed 1161 rheumatology charts and 110 dermatology charts. 23.0 and 25.5% respectively (23.2% combined) were prescribed HCQ > 5.0 mg/kg/day. Post-intervention, 9.6% fewer patients were prescribed HCQ > 5 mg/kg/day (P < .001). Pre-intervention, we compiled 18 rheumatology surveys and 12 dermatology surveys. Post-intervention, we compiled 16 rheumatology surveys and 12 dermatology surveys. Post-intervention, fewer rheumatologists incorrectly described the AAO weight-based guidelines. Combined, there was an overall reduction but not of statistical significance (P = .47). The majority of providers surveyed believed that the CDS tool was useful (72.2%). Conclusions At our academic institution, there remains unfamiliarity with and hesitation to comply with the 2016 AAO guidelines. Prescribed doses often exceed what is recommended in these guidelines. A CDS tool can improve adherence with these guidelines and might improve providers’ familiarity with these guidelines.

scholarly journals The Effect of an Electronic Medical Record Intervention on Hydroxychloroquine Prescribing Habits and Surveyed Providers’ Opinions of the 2016 American Academy of Ophthalmology Guidelines in the Rheumatology and Dermatology Practices of an Academic Institution

2021 ◽  
Author(s):  
Rebecca Overbury ◽  
Jakrapun Pupaibool ◽  
Christopher Hansen ◽  
Dorota Lebiedz-Odrobina
Keyword(s):  
American Academy ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Statistical Significance ◽  
Demographic Data ◽  
Academic Institution ◽  
Controlled Study ◽  
Post Intervention ◽  
Prescribing Habits ◽  
Improve Compliance

Abstract Background Retinal toxicity is a rare adverse event related to the use of hydroxychloroquine (HCQ). To address this, in 2016, the American Academy of Ophthalmology (AAO) issued guidelines recommending that HCQ not exceed 5 mg/kg/day. We analyzed HCQ prescribing habits at our institution, compared to these guidelines, and used surveys to determine the opinions on these guidelines. We then introduced, in a prospective and non-controlled study, an electronic medical record (EMR) tool to study how this intervention might affect compliance with or opinions on these guidelines. Methods Data were collected pre-intervention (June 2017 - January 2019) and post-intervention (March 2019 - April 2020). In January 2019 we released our EMR tool. Results were analyzed using descriptive statistics for demographic data and Fisher’s exact tests for comparisons of proportions between groups. Results Pre-intervention, we reviewed 1,128 rheumatology charts and 282 dermatology charts. 31.0% and 39.7% respectively (32.8% combined) were prescribed HCQ > 5 .0 mg/kg/day. Post-intervention, we reviewed 1,158 rheumatology charts and 106 dermatology charts. 23.1% and 26.4% respectively (23.3% combined) were prescribed HCQ > 5.0 mg/kg/day. Post-intervention, fewer patients (9.5%) were prescribed HCQ > 5 mg/kg/day (p < 0.00001). Pre-intervention, we compiled 18 rheumatology surveys and 12 dermatology surveys. Post-intervention, we compiled 16 rheumatology surveys and 12 dermatology surveys. Post-intervention, fewer rheumatologists incorrectly described the AAO weight-based guidelines. Combined, there was an overall reduction but not of statistical significance (p = 0.47). Conclusions At our academic institution, there remains unfamiliarity of and hesitation to comply with the 2016 AAO guidelines. Prescribed doses often exceed what is recommended in these guidelines. An EMR tool can improve compliance with these guidelines and might improve providers’ familiarity with these guidelines.

scholarly journals 180. Leveraging the Electronic Medical Record as a Method of Antibiotic Stewardship

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S97-S97
Author(s):  
Christina M Kaul ◽  
Eric Molina ◽  
Donna Armellino ◽  
Mary Ellen Schilling ◽  
Mark Jarrett
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Antibiotic Usage ◽  
P Value ◽  
Inpatient Setting ◽  
Post Intervention ◽  
Paired Samples ◽  
Viable Method

Abstract Background Overutilization of antibiotics remains an issue in the inpatient setting. What is more, many protocols geared toward curbing improper antibiotic use rely heavily on resource- and personnel-intensive interventions. Thus, the potential for using the EMR to facilitate antibiotic stewardship remains largely unexplored. Methods We implemented a novel change for ordering certain antibiotics in our EMR: ceftriaxone, daptomycin, ertapenem, imipenem, meropenem, and piperacillin-tazobactam. When ordering one of these antibiotics, providers had to note a usage indication, which assigned a usage duration as per our Antibiotic Stewardship Committee guidelines. Pre-intervention, manual discontinuation was required if a provider did not enter a duration. The intervention was enacted August 2019 in 13 hospitals. Data was collected from January 2018 to February 2020. Antibiotic usage was reported monthly as rate per 1000-patient days. Monthly pre- and post-intervention rates were averaged, respectively. Paired samples t-tests were used to compare pre- and post-intervention rates per unit type per hospital. A p-value of less than 0.05 was considered significant. Units with minimal usage, as defined by a pre- or post-intervention mean of 0, were excluded from analysis. Example of Ordering an Antibiotic Prior to Intervention Example of Ordering an Antibiotic After Intervention Results Ertapenem was noted to have a statistically significant decrease in utilization in seven units at three hospitals. Piperacillin-tazobactam was found to have a decrease in utilization in 19 units at eight hospitals. Daptomycin was found to have a decrease in utilization in one unit. Significant decreases in the utilization of ceftriaxone, imipenem, and meropenem were not noted. Example of Statistically Significant Decreased Utilization in Piperacillin-Tazobactam on a Medical-Surglcal Unit Conclusion Our study showed a statistically significant decrease in use of ertapenem, piperacillin-tazobactam and daptomycin using a simple built-in EMR prompt that curtails provider error. This should allow for an increased ease of integration, as the protocol does not require a host of resources for maintenance. Of note is decreased utilization of piperacillin-tazobactam and ertapenem across multiple hospitals, most notably on the medical and surgical wards. Thus, usage of the EMR without personnel-intensive protocols is a viable method for augmenting antibiotic stewardship in health systems. Disclosures All Authors: No reported disclosures

Improving the Quality of Our Clinical Work for Coumadin Anticoagulation Therapy with Electronic Medical Record (EMR) Based System Redesign

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4714-4714
Author(s):  
Linda Thomas-Hemak ◽  
Lisa Thomas ◽  
Qi Shi ◽  
Jignesh Sheth ◽  
Etikala Praveen ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Therapeutic Range ◽  
Conflicts Of Interest ◽  
Anticoagulation Therapy ◽  
Clinical Work ◽  
Clinical Decision ◽  
Outpatient Setting ◽  
Flow Sheet ◽  
Total Blood

Abstract Abstract 4714 Introduction: Coumadin anticoagulation therapy is indicated in a variety of thromboembolic conditions. Close INR monitoring is required to maintain therapeutic range in order to decrease complications, emergency room visits, and medical costs associated with Coumadin therapy. To achieve this, tight quality control in primary health care systems is undeniably important. The purpose of this study is to assess the effects of a redesigned system for coumadin anticoagulation therapy in an outpatient setting. Our project includes: (1) Meaningful use of a new electronic medical record (EMR) based INR flow sheet; (2) Improved physician and staff efficiency using new EMR based protocol for INR tracking and clinical decision support, including drug interaction information, dose adjustment, per-procedure anticoagulation bridging, and an education/training program; (3) Improved patient education, including enhanced Coumadin educational materials. Vitamin K prescriptions will be given to the patients in the event of complications with coumadin. Method and Materials: INR data were collected from 55 patients receiving Coumadin therapy from 10/01/2009 to 10/31/2011 at an outpatient setting. Total blood tests for INR were 1679 samples. We summarized results from 55 patients twelve months before and after using our redesigned system. Result: Our data shows the new system helped to: (1) Increased the percentage of INRs (average) in the therapeutic range from 51.35% to 54.05% and the percentage of INRs (average) in extended therapeutic range (+/−0.2) from 63.78% to 70.43%; (2) Decreased the highest value from 15.4 to 10.2; (3)Decreased annual total number of INR checkups for all patients from 881 to 798; and (4)Decreased average number of INR checkups per month from 1.8 to 1.3 (average). Conclusion: Our clinical data shows that Our EMR based system redesign not only helps to increase efficiency and safety of Coumadin anticoagulation therapy, but also decreases the frequency of INR checks, thereby reducing medical expenditures. Disclosures: No relevant conflicts of interest to declare.

Use of electronic medical record queries to support clinical decision quality assurance.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 239-239
Author(s):  
Michelle Nielsen ◽  
Senti Senthelal ◽  
Jidong Lian ◽  
Miller MacPherson ◽  
Gaylene Medlam ◽  
...  
Keyword(s):  
Peer Review ◽  
Real Time ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Radiation Oncology ◽  
Clinical Decision ◽  
Decision Quality ◽  
Clinical Decisions ◽  
Radiation Oncologist ◽  
Medical Systems

239 Background: Clinical Treatment Decisions in radiation oncology direct the patient’s treatment plans. There is a need for Clinical Decisions to be peer reviewed preferably in real time before the patient plan is completed. Traditional peer review of clinical decisions which ensure high quality patient treatments can be challenging in a busy radiation oncology clinic. Leveraging Electronic Medical Records (EMR) to query standard patient staging and demographics data per disease type allows for efficient peer review of the clinical decision. Methods: Through the use of EMR system (Aria, Varian Medical Systems, Palo Alto CA), data is entered into the radiation oncology chart by the primary radiation oncologist during a patient’s work up. Tools within the EMR have been configured to automatically query patient charts and summarize the data. A second Oncologist runs the query, reviews the data and peer reviews clinical decision for radiotherapy including treatment intent, dose and target contours. The radiation oncologist can then discuss modifications with the original oncologist, or indicate to the dosimetrist to continue planning. Those clinical decisions that are uncertain are escalated to review in a traditional peer review setting. Results: The EMR queries have allowed a shift to real time peer review of clinical decisions. The summary of disease specific staging and demographics data has added to efficiency in clinic in both the oncologists’ ability to complete a timely peer review and the lowering the amount of planning rework. Traditional peer review setting is then used to discuss the controversial and complex cases that would receive the most benefit. Conclusions: The ability to leverage electronic medical record data has made the peer review of clinical decisions in our institution more efficient and therefore the majority can be completed in real time.

scholarly journals Can Ease of Use and Usefulness perception be influenced by physicians characteristics in the adoption of technology innovations?

2020 ◽  
Vol 8 (10) ◽  
pp. 87-93
Author(s):  
Cesar Augusto Pascali Rago ◽  
Paola Zucchi
Keyword(s):  
Technology Acceptance ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Clinical Decision ◽  
Ease Of Use ◽  
Adoption Of Technology ◽  
Technology Innovations ◽  
Usefulness Perception ◽  
Acceptance Model ◽  
Technology Tool

Ease of use and Usefulness are the two attributes of Technology Acceptance Model – TAM. These attributes are the basis of this article that comprises the results of a survey with 221 physicians located at Santa Casa de Misericordia de Santos - SCMS, in the state of São Paulo, Brazil regarding the use of an innovation technology tool like Electronic Medical Record. The method was based on a questionnaire specially developed for this study, based on the literature review and the results show that the younger and the newer to the profession, besides those who began to use voluntarily and those who had academic preparation to use this kind of tool showed greater perception of both attributes, what led them to a faster adoption of Electronic Medical Record and its funcionalities like clinical decision support and big data. It was also identified that gender, amount of training and instructors do not influence the perception of attributes leading to adoption, but the familiarity with informatics influence the perception of ease of use as though as professional ties influence the perception of usefullness.

scholarly journals Information needs for the OR and PACU electronic medical record

2014 ◽  
Vol 05 (03) ◽  
pp. 630-641 ◽  
Author(s):  
V. Herasevich ◽  
J.R. Hebl ◽  
M.J. Brown ◽  
B.W. Pickering ◽  
M.A. Ellsworth
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Medical Error ◽  
Information Needs ◽  
Clinical Decision Making ◽  
Information Overload ◽  
Clinical Information ◽  
Clinical Decision ◽  
Anesthesia Providers ◽  
Survey Responses

Summary Objective: The amount of clinical information that anesthesia providers encounter creates an environment for information overload and medical error. In an effort to create more efficient OR and PACU EMR viewer platforms, we aimed to better understand the intraoperative and post-anesthesia clinical information needs among anesthesia providers. Materials and Methods: A web-based survey to evaluate 75 clinical data items was created and distributed to all anesthesia providers at our institution. Participants were asked to rate the importance of each data item in helping them make routine clinical decisions in the OR and PACU settings. Results: There were 107 survey responses with distribution throughout all clinical roles. 84% of the data items fell within the top 2 proportional quarters in the OR setting compared to only 65% in the PACU. Thirty of the 75 items (40%) received an absolutely necessary rating by more than half of the respondents for the OR setting as opposed to only 19 of the 75 items (25%) in the PACU. Only 1 item was rated by more than 20% of respondents as not needed in the OR compared to 20 data items (27%) in the PACU. Conclusion: Anesthesia providers demonstrate a larger need for EMR data to help guide clinical decision making in the OR as compared to the PACU. When creating EMR platforms for these settings it is important to understand and include data items providers deem the most clinically useful. Minimizing the less relevant data items helps prevent information overload and reduces the risk for medical error. Citation: Herasevich V, Ellsworth MA, Hebl JR, Brown MJ, Pickering BW. Information needs for the OR and PACU electronic medical record. Appl Clin Inf 2014; 5: 630–641http://dx.doi.org/10.4338/ACI-2014-02-RA-0015

scholarly journals Impact of an Electronic Medical Record-Based Clinical Decision Support Tool for Dysphagia Screening on Care Quality

Stroke ◽  
2012 ◽  
Vol 43 (12) ◽  
pp. 3399-3401 ◽  
Author(s):  
Kamakshi Lakshminarayan ◽  
Nassir Rostambeigi ◽  
Candace C. Fuller ◽  
James M. Peacock ◽  
Albert W. Tsai
Keyword(s):  
Decision Support ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Clinical Decision Support ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Care Quality ◽  
Support Tool ◽  
Clinical Decision Support Tool
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