scholarly journals Clinician Perspectives on Electronic Health Records, Communication, and Patient Safety Across Diverse Medical Oncology Practices

2019 ◽  
Vol 15 (6) ◽  
pp. e529-e536 ◽  
Author(s):  
Minal R. Patel ◽  
Christopher R. Friese ◽  
Kari Mendelsohn-Victor ◽  
Alex J. Fauer ◽  
Bidisha Ghosh ◽  
...  
Keyword(s):  
Patient Safety ◽  
Electronic Health Records ◽  
Safety Culture ◽  
Care Quality ◽  
Clinical Practices ◽  
Seamless Integration ◽  
Health Records ◽  
Clinician Communication ◽  
Electronic Health

PURPOSE: We know little about how increased technological sophistication of clinical practices affects safety of chemotherapy delivery in the outpatient setting. This study investigated to what degree electronic health records (EHRs), satisfaction with technology, and quality of clinician-to-clinician communication enable a safety culture. METHODS: We measured actions consistent with a safety culture, satisfaction with practice technology, and quality of clinician communication using validated instruments among 297 oncology nurses and prescribers in a statewide collaborative. We constructed an index to reflect practice reliance on EHRs (1 = “all paper” to 5 = “all electronic”). Linear regression models (with robust SEs to account for clustering) examined relationships between independent variables of interest and safety. Models were adjusted for clinician age. RESULTS: The survey response rate was 68% (76% for nurses and 59% for prescribers). The mean (standard deviation) safety score was 5.3 (1.1), with a practice-level range of 4.9 to 5.4. Prescribers reported fewer safety actions than nurses. Higher satisfaction with technology and higher-quality clinician communication were significantly associated with increased safety actions, whereas increased reliance on EHRs was significantly associated with lower safety actions. CONCLUSION: Practices vary in their performance of patient safety actions. Supporting clinicians to integrate technology and strengthen communication are promising intervention targets. The inverse relationship between reliance on EHRs and safety suggests that technology may not facilitate clinicians’ ability to attend to patient safety. Efforts to improve cancer care quality should focus on more seamless integration of EHRs into routine care delivery and emphasize increasing the capacity of all care clinicians to communicate effectively and coordinate efforts when administering high-risk treatments in ambulatory settings.

scholarly journals Electronic health records improve clinical note quality

2014 ◽  
Vol 22 (1) ◽  
pp. 199-205 ◽  
Author(s):  
Harry B Burke ◽  
Laura L Sessums ◽  
Albert Hoang ◽  
Dorothy A Becher ◽  
Paul Fontelo ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Primary Care Physicians ◽  
Time Interval ◽  
Clinical Practices ◽  
Health Records ◽  
Clinical Note ◽  
Clinical Notes ◽  
The Usa ◽  
Electronic Health

Abstract Background and objective The clinical note documents the clinician's information collection, problem assessment, clinical management, and its used for administrative purposes. Electronic health records (EHRs) are being implemented in clinical practices throughout the USA yet it is not known whether they improve the quality of clinical notes. The goal in this study was to determine if EHRs improve the quality of outpatient clinical notes. Materials and methods A five and a half year longitudinal retrospective multicenter quantitative study comparing the quality of handwritten and electronic outpatient clinical visit notes for 100 patients with type 2 diabetes at three time points: 6 months prior to the introduction of the EHR (before-EHR), 6 months after the introduction of the EHR (after-EHR), and 5 years after the introduction of the EHR (5-year-EHR). QNOTE, a validated quantitative instrument, was used to assess the quality of outpatient clinical notes. Its scores can range from a low of 0 to a high of 100. Sixteen primary care physicians with active practices used QNOTE to determine the quality of the 300 patient notes. Results The before-EHR, after-EHR, and 5-year-EHR grand mean scores (SD) were 52.0 (18.4), 61.2 (16.3), and 80.4 (8.9), respectively, and the change in scores for before-EHR to after-EHR and before-EHR to 5-year-EHR were 18% (p<0.0001) and 55% (p<0.0001), respectively. All the element and grand mean quality scores significantly improved over the 5-year time interval. Conclusions The EHR significantly improved the overall quality of the outpatient clinical note and the quality of all its elements, including the core and non-core elements. To our knowledge, this is the first study to demonstrate that the EHR significantly improves the quality of clinical notes.

Implementing Health Care Quality Measures in Electronic Health Records: A Conceptual Model

2021 ◽  
Author(s):  
Claire M. Campbell ◽  
Daniel R. Murphy ◽  
George E. Taffet ◽  
Anita B. Major ◽  
Christine S. Ritchie ◽  
...  
Keyword(s):  
Health Care ◽  
Electronic Health Records ◽  
Conceptual Model ◽  
Health Care Quality ◽  
Quality Measures ◽  
Care Quality ◽  
Health Records ◽  
Electronic Health

scholarly journals Electronic Health Records and Patient Safety

2015 ◽  
Vol 06 (01) ◽  
pp. 136-147 ◽  
Author(s):  
D. Gans ◽  
J. White ◽  
R. Nath ◽  
J. Pohl ◽  
C. Tanner
Keyword(s):  
Primary Care ◽  
Patient Safety ◽  
Electronic Health Records ◽  
Medication Management ◽  
Health Records ◽  
Safety Practices ◽  
Care Practices ◽  
Electronic Health ◽  
Primary Care Practices ◽  
Promote Patient Safety

Summary Background: The role of electronic health records (EHR) in enhancing patient safety, while substantiated in many studies, is still debated. Objective: This paper examines early EHR adopters in primary care to understand the extent to which EHR implementation is associated with the workflows, policies and practices that promote patient safety, as compared to practices with paper records. Early adoption is defined as those who were using EHR prior to implementation of the Meaningful Use program. Methods: We utilized the Physician Practice Patient Safety Assessment (PPPSA) to compare primary care practices with fully implemented EHR to those utilizing paper records. The PPPSA measures the extent of adoption of patient safety practices in the domains: medication management, handoffs and transition, personnel qualifications and competencies, practice management and culture, and patient communication. Results: Data from 209 primary care practices responding between 2006–2010 were included in the analysis: 117 practices used paper medical records and 92 used an EHR. Results showed that, within all domains, EHR settings showed significantly higher rates of having workflows, policies and practices that promote patient safety than paper record settings. While these results were expected in the area of medication management, EHR use was also associated with adoption of patient safety practices in areas in which the researchers had no a priori expectations of association. Conclusions: Sociotechnical models of EHR use point to complex interactions between technology and other aspects of the environment related to human resources, workflow, policy, culture, among others. This study identifies that among primary care practices in the national PPPSA database, having an EHR was strongly empirically associated with the workflow, policy, communication and cultural practices recommended for safe patient care in ambulatory settings. Citation: Tanner C, Gans D, White J, Nath R, Pohl J. Electronic health records and patient safety – co-occurrence of early EHR implementation with patient safety practices in primary care settings. Appl Clin Inf 2015; 6: 136–147http://dx.doi.org/10.4338/ACI-2014-11-RA-0099

scholarly journals Putting the “why” in “EHR”: capturing and coding clinical cognition

2019 ◽  
Vol 26 (11) ◽  
pp. 1379-1384 ◽  
Author(s):  
James J Cimino
Keyword(s):  
Electronic Health Records ◽  
Information Overload ◽  
Data Retrieval ◽  
Formal Structure ◽  
Health Records ◽  
Clinical Notes ◽  
Electronic Health ◽  
Physical Findings ◽  
Substantial Effort

Abstract Complaints about electronic health records, including information overload, note bloat, and alert fatigue, are frequent topics of discussion. Despite substantial effort by researchers and industry, complaints continue noting serious adverse effects on patient safety and clinician quality of life. I believe solutions are possible if we can add information to the record that explains the “why” of a patient’s care, such as relationships between symptoms, physical findings, diagnostic results, differential diagnoses, therapeutic plans, and goals. While this information may be present in clinical notes, I propose that we modify electronic health records to support explicit representation of this information using formal structure and controlled vocabularies. Such information could foster development of more situation-aware tools for data retrieval and synthesis. Informatics research is needed to understand what should be represented, how to capture it, and how to benefit those providing the information so that their workload is reduced.

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