Oncologists’ Views Regarding the Role of Electronic Health Records in Care Coordination

2018 ◽  
pp. 1-12 ◽  
Author(s):  
Onur Asan ◽  
Ann B. Nattinger ◽  
Ayse P. Gurses ◽  
Jeanne T. Tyszka ◽  
Tina W.F. Yen
Keyword(s):  
Electronic Health Records ◽  
Care Coordination ◽  
Information Transfer ◽  
Medical Center ◽  
Academic Medical Center ◽  
Unintended Consequences ◽  
Safety Hazards ◽  
Health Records ◽  
Electronic Health ◽  
Oncology Providers

Background Electronic health records (EHRs) play a significant role in complex health care processes, especially in information transfer with patients and care coordination among providers. EHRs may also generate unintended consequences, introducing new patient safety risks. To date, little investigation has been performed in oncology settings, despite the need for quality provider-patient communication and information transfer during oncology visits. In this qualitative study, we focused on oncology providers’ perceptions of EHRs for supporting communication with patients and coordination of care with other providers. Methods We conducted semistructured interviews with oncologists from an urban academic medical center to learn their perceptions of the use of EHRs before, during, and after clinic visits with patients. Our interview guide was developed on the basis of the work system model. We coded transcripts using inductive content analysis. Results Data analysis yielded four main themes regarding oncologists’ practices in using the EHR and perceptions about EHRs: (1) EHR use for care coordination (eg, timeliness of receiving information, SmartSet documentation); (2) EHR use in the clinic visit (eg, educating patients, using as a reinforcement tool); (3) safety hazards in care coordination associated with EHRs (eg, incomplete documentation, error propagating, no filtering mechanism to capture errors); and (4) suggestions for improvements (eg, improved SmartSet functionalities, simplification of user interface). Conclusion Current EHRs do not adequately support teamwork of oncology providers, which could lead to potential hazards in the care of patients with cancer. Redesigning EHR features that are tailored to support oncology care and addressing the concerns regarding information overload, improved organization of flagging abnormal results, and documentation-related workload are needed to minimize potential safety hazards.

scholarly journals Awareness of the Care Team in Electronic Health Records

2011 ◽  
Vol 02 (04) ◽  
pp. 395-405 ◽  
Author(s):  
L.G. Wilcox ◽  
S. Collins ◽  
S. Feiner ◽  
O. Mamykina ◽  
D.M. Stein ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Medical Center ◽  
Academic Medical Center ◽  
Physician Assistants ◽  
Care Team ◽  
Accurate Information ◽  
Care Providers ◽  
Health Records ◽  
Electronic Health ◽  
Attending Physicians

SummaryObjective: To support collaboration and clinician-targeted decision support, electronic health records (EHRs) must contain accurate information about patients’ care providers. The objective of this study was to evaluate two approaches for care provider identification employed within a commercial EHR at a large academic medical center.Methods: We performed a retrospective review of EHR data for 121 patients in two cardiology wards during a four-week period. System audit logs of chart accesses were analyzed to identify the clinicians who were likely participating in the patients’ hospital care. The audit log data were compared with two functions in the EHR for documenting care team membership: 1) a vendor-supplied module called “Care Providers”, and 2) a custom “Designate Provider” order that was created primarily to improve accuracy of the attending physician of record documentation.Results: For patients with a 3–5 day hospital stay, an average of 30.8 clinicians accessed the electronic chart, including 10.2 nurses, 1.4 attending physicians, 2.3 residents, and 5.4 physician assistants. The Care Providers module identified 2.7 clinicians/patient (1.8 attending physicians and 0.9 nurses). The Designate Provider order identified 2.1 clinicians/patient (1.1 attending physicians, 0.2 resident physicians, and 0.8 physician assistants). Information about other members of patients’ care teams (social workers, dietitians, pharmacists, etc.) was absent.Conclusions: The two methods for specifying care team information failed to identify numerous individuals involved in patients’ care, suggesting that commercial EHRs may not provide adequate tools for care team designation. Improvements to EHR tools could foster greater collaboration among care teams and reduce communication-related risks to patient safety.

scholarly journals A Qualitative Study of Physician Perspectives on Adaptation to Electronic Health Records

2019 ◽  
Author(s):  
Cynthia Judine Sieck ◽  
Nicole Pearl ◽  
Tiffani J. Bright ◽  
Po-Yin Yen
Keyword(s):  
Qualitative Study ◽  
Electronic Health Records ◽  
Medical Center ◽  
Academic Medical Center ◽  
Opportunity To Learn ◽  
Structured Interviews ◽  
Health Records ◽  
Physician Perspectives ◽  
Academic Medical ◽  
Electronic Health

Abstract Background Electronic Health Records (EHRs) have the potential to improve many aspects of care and their use has increased in the last decade. Because of this, acceptance and adoption of EHRs is less of a concern than adaptation to use. To understand this issue more deeply, we conducted a qualitative study of physician perspectives on EHR use to identify factors that facilitate adaptation.Methods We conducted semi-structured interviews with 9 physicians across a range of inpatient disciplines at a large Academic Medical Center. Interviews were conducted by phone, lasting approximately 30 minutes, and were transcribed verbatim for analysis. We utilized inductive and deductive methods in our analysis.Results We identified 4 major themes related to EHR adapation: impact of EHR changes on physicians, how physicians managed these changes, factors that facilitated adapation to using the EHR and adapting to using the EHR in the patient encounter. Within these themes, physicians felt that a positive mindset toward change, providing upgrade training that was tailored to their role, and the opportunity to learn from colleagues were important facilitators of adaption.Conclusions As EHR use moves beyond implementation, physicians continue to be required to adapt to the technology and to its frequent changes. Our study provides actionable findings that allow healthcare systems to focus on factors that facilitate the adaptation process for physicians.

scholarly journals A Qualitative Study of Physician Perspectives on Adaptation to Electronic Health Records

2019 ◽  
Author(s):  
Cynthia Judine Sieck ◽  
Nicole Pearl ◽  
Tiffani J. Bright ◽  
Po-Yin Yen
Keyword(s):  
Qualitative Study ◽  
Electronic Health Records ◽  
Medical Center ◽  
Academic Medical Center ◽  
Opportunity To Learn ◽  
Structured Interviews ◽  
Health Records ◽  
Physician Perspectives ◽  
Academic Medical ◽  
Electronic Health

Abstract Background Electronic Health Records (EHRs) have the potential to improve many aspects of care and their use has increased in the last decade. Because of this, acceptance and adoption of EHRs is less of a concern than adaptation to use. To understand this issue more deeply, we conducted a qualitative study of physician perspectives on EHR use to identify factors that facilitate adaptation.Methods We conducted semi-structured interviews with 9 physicians across a range of inpatient disciplines at a large Academic Medical Center. Interviews were conducted by phone, lasting approximately 30 minutes, and were transcribed verbatim for analysis. We utilized inductive and deductive methods in our analysis.Results We identified 4 major themes related to EHR adapation: impact of EHR changes on physicians, how physicians managed these changes, factors that facilitated adapation to using the EHR and adapting to using the EHR in the patient encounter. Within these themes, physicians felt that a positive mindset toward change, providing upgrade training that was tailored to their role, and the opportunity to learn from colleagues were important facilitators of adaption.Conclusions As EHR use moves beyond implementation, physicians continue to be required to adapt to the technology and to its frequent changes. Our study provides actionable findings that allow healthcare systems to focus on factors that facilitate the adaptation process for physicians.

scholarly journals A Qualitative Study of Physician Perspectives on Adaptation to Electronic Health Records

2019 ◽  
Author(s):  
Cynthia Judine Sieck ◽  
Nicole Pearl ◽  
Tiffani J. Bright ◽  
Po-Yin Yen
Keyword(s):  
Qualitative Study ◽  
Electronic Health Records ◽  
Medical Center ◽  
Academic Medical Center ◽  
Opportunity To Learn ◽  
Structured Interviews ◽  
Health Records ◽  
Physician Perspectives ◽  
Academic Medical ◽  
Electronic Health

Abstract Background Electronic Health Records (EHRs) have the potential to improve many aspects of care and their use has increased in the last decade. Because of this, acceptance and adoption of EHRs is less of a concern than adaptation to use. To understand this issue more deeply, we conducted a qualitative study of physician perspectives on EHR use to identify factors that facilitate adaptation.Methods We conducted semi-structured interviews with 9 physicians across a range of inpatient disciplines at a large Academic Medical Center. Interviews were conducted by phone, lasting approximately 30 minutes, and were transcribed verbatim for analysis. We utilized inductive and deductive methods in our analysis.Results We identified 4 major themes related to EHR adapation: impact of EHR changes on physicians, how physicians managed these changes, factors that facilitated adapation to using the EHR and adapting to using the EHR in the patient encounter. Within these themes, physicians felt that a positive mindset toward change, providing upgrade training that was tailored to their role, and the opportunity to learn from colleagues were important facilitators of adaption.Conclusions As EHR use moves beyond implementation, physicians continue to be required to adapt to the technology and to its frequent changes. Our study provides actionable findings that allow healthcare systems to focus on factors that facilitate the adaptation process for physicians.

scholarly journals The Postencounter Form System: Viewpoint on Efficient Data Collection Within Electronic Health Records (Preprint)

2019 ◽  
Author(s):  
Philip Held ◽  
Randy A Boley ◽  
Walter G Faig ◽  
John A O'Toole ◽  
Imran Desai ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Medical Center ◽  
Health Records ◽  
Clinical Notes ◽  
The Road ◽  
Clinical Encounters ◽  
Efficient Data ◽  
Data Points ◽  
Electronic Health ◽  
Using Data

UNSTRUCTURED Electronic health records (EHRs) offer opportunities for research and improvements in patient care. However, challenges exist in using data from EHRs due to the volume of information existing within clinical notes, which can be labor intensive and costly to transform into usable data with existing strategies. This case report details the collaborative development and implementation of the postencounter form (PEF) system into the EHR at the Road Home Program at Rush University Medical Center in Chicago, IL to address these concerns with limited burden to clinical workflows. The PEF system proved to be an effective tool with over 98% of all clinical encounters including a completed PEF within 5 months of implementation. In addition, the system has generated over 325,188 unique, readily-accessible data points in under 4 years of use. The PEF system has since been deployed to other settings demonstrating that the system may have broader clinical utility.

Development and validation of a pancreatic cancer prediction model from electronic health records using machine learning.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 679-679
Author(s):  
Limor Appelbaum ◽  
Jose Pablo Cambronero ◽  
Karla Pollick ◽  
George Silva ◽  
Jennifer P. Stevens ◽  
...  
Keyword(s):  
Machine Learning ◽  
Feature Selection ◽  
Electronic Health Records ◽  
Medical Center ◽  
Characteristic Curve ◽  
External Validation ◽  
Data Driven ◽  
Health Records ◽  
Clinical Correlates ◽  
Electronic Health

679 Background: Pancreatic Adenocarcinoma (PDAC) is often diagnosed at an advanced stage. We sought to develop a model for early PDAC prediction in the general population, using electronic health records (EHRs) and machine learning. Methods: We used three EHR datasets from Beth-Israel Deaconess Medical Center (BIDMC) and Partners Healthcare (PHC): 1. “BIDMC-Development-Data” (BIDMC-DD) for model development, using a feed-forward neural network (NN) and L2-regularized logistic regression,randomly split (80:20) into training and test groups. We tuned hyperparameters using cross-validation in training, and report performance on the test split. 2. “BIDMC-Large-Data” (BIDMC-LD) to re-fit and calibrate models. 3. “PHC-Data” for external validation. We evaluate using Area Under the Receiver Operating Characteristic Curve (AUC) and compute 95% CI using empirical bootstrap over test data. PDAC patients were selected using ICD9/-10 codes and validated with tumor registries. In contrast to prior work, we did not predefine feature sets based on known clinical correlates and instead employed data-driven feature selection, specifically importance-based feature pruning, regularization, and manual validation, to identify diagnostic-based features. Results: BIDMC-DD included demographics, diagnoses, labs and medications for 1018 patients (cases = 509; age-sex paired controls). BIDMC-LD included diagnoses for 547,917 patients (cases = 509), and PHC included diagnoses for 160,593 patients (cases = 408). We compared our approach to adapted and re-fitted published baselines. With a 365-day lead-time, NN obtained a BIDMC-DD test AUC of 0.84 (CI 0.79 - 0.90) versus the previous best baseline AUC of 0.70 (CI 0.62 - 0.78). We also validated using BIDMC-DD’s test cancer patients and BIDMC LD controls. The AUC was 0.71 (CI 0.67 - 0.76) at the 365-day cutoff. NN’s external validation AUC on PHC-Data was 0.71 (CI 0.63 - 0.79), outperforming an existing model’s AUC of 0.61 (CI 0.52 - 0.70) (Baecker et al, 2019). Conclusions: Models based on data-driven feature selection outperform models that use predefined sets of known clinical correlates and can help in early prediction of PDAC development.

scholarly journals Care Coordination and Comprehensive Electronic Health Records are Associated With Increased Transition Planning Activities

2018 ◽  
Vol 18 (1) ◽  
pp. 111-118 ◽  
Author(s):  
Niraj Sharma ◽  
Kitty O'Hare ◽  
Karen G. O'Connor ◽  
Umbereen Nehal ◽  
Megumi J. Okumura
Keyword(s):  
Electronic Health Records ◽  
Care Coordination ◽  
Transition Planning ◽  
Health Records ◽  
Electronic Health

Nursesʼ Use of Positive Deviance When Encountering Electronic Health Records-Related Unintended Consequences

2018 ◽  
Vol 42 (1) ◽  
pp. E1-E11 ◽  
Author(s):  
Alycia A. Bristol ◽  
Christine W. Nibbelink ◽  
Sheila M. Gephart ◽  
Jane M. Carrington
Keyword(s):  
Electronic Health Records ◽  
Unintended Consequences ◽  
Positive Deviance ◽  
Health Records ◽  
Electronic Health

scholarly journals Barriers to comparing the usability of electronic health records

2016 ◽  
Vol 24 (e1) ◽  
pp. e191-e193 ◽  
Author(s):  
Raj M Ratwani ◽  
A Zachary Hettinger ◽  
Rollin J Fairbanks
Keyword(s):  
Information Technology ◽  
Patient Safety ◽  
Electronic Health Records ◽  
Health Technology ◽  
Certification Program ◽  
Safety Hazards ◽  
Health Records ◽  
Technology Program ◽  
Development Processes ◽  
Electronic Health

Despite the widespread adoption of electronic health records (EHRs), usability of many EHRs continues to be suboptimal, with some vendors failing to meet usability standards, resulting in clinician frustration and patient safety hazards. In an effort to increase EHR vendor competition on usability, recommendations have been made and legislation drafted to develop comparison tools that would allow purchasers to better understand the usability of EHR products prior to purchase. Usability comparison can be based on EHR vendor design and development processes, vendor usability testing as part of the Office of the National Coordinator for Health Information Technology certification program, and usability of implemented products. Barriers exist within the current certified health technology program that prevent effective comparison of usability during each of these stages. We describe the importance of providing purchasers with improved information about EHR usability, barriers to making usability comparisons, and solutions to overcome these barriers.

scholarly journals The Postencounter Form System: Viewpoint on Efficient Data Collection Within Electronic Health Records

10.2196/17429 ◽  
2020 ◽  
Vol 4 (4) ◽  
pp. e17429
Author(s):  
Philip Held ◽  
Randy A Boley ◽  
Walter G Faig ◽  
John A O'Toole ◽  
Imran Desai ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Medical Center ◽  
Health Records ◽  
Clinical Notes ◽  
The Road ◽  
Clinical Encounters ◽  
Efficient Data ◽  
Data Points ◽  
Electronic Health ◽  
Using Data

Electronic health records (EHRs) offer opportunities for research and improvements in patient care. However, challenges exist in using data from EHRs due to the volume of information existing within clinical notes, which can be labor intensive and costly to transform into usable data with existing strategies. This case report details the collaborative development and implementation of the postencounter form (PEF) system into the EHR at the Road Home Program at Rush University Medical Center in Chicago, IL to address these concerns with limited burden to clinical workflows. The PEF system proved to be an effective tool with over 98% of all clinical encounters including a completed PEF within 5 months of implementation. In addition, the system has generated over 325,188 unique, readily-accessible data points in under 4 years of use. The PEF system has since been deployed to other settings demonstrating that the system may have broader clinical utility.

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