The impact of electronic health records on diagnosis

Diagnosis ◽  
2017 ◽  
Vol 4 (4) ◽  
pp. 211-223 ◽  
Author(s):  
Mark L. Graber ◽  
Colene Byrne ◽  
Doug Johnston
Keyword(s):  
Safety Concern ◽  
Diagnostic Error ◽  
The United States ◽  
Unintended Consequences ◽  
Diagnostic Process ◽  
Health It ◽  
Health Care Information ◽  
Health Care Information Technology ◽  
Electronic Health ◽  
The Impact

AbstractDiagnostic error may be the largest unaddressed patient safety concern in the United States, responsible for an estimated 40,000–80,000 deaths annually. With the electronic health record (EHR) now in near universal use, the goal of this narrative review is to synthesize evidence and opinion regarding the impact of the EHR and health care information technology (health IT) on the diagnostic process and its outcomes. We consider the many ways in which the EHR and health IT facilitate diagnosis and improve the diagnostic process, and conversely the major ways in which it is problematic, including the unintended consequences that contribute to diagnostic error and sometimes patient deaths. We conclude with a summary of suggestions for improving the safety and safe use of these resources for diagnosis in the future.

scholarly journals The health and relationship dynamics of late-life couples: a systematic review of the literature

2009 ◽  
Vol 29 (3) ◽  
pp. 455-480 ◽  
Author(s):  
RUTH B. WALKER ◽  
MARY A. LUSZCZ
Keyword(s):  
Systematic Review ◽  
Marital Quality ◽  
Late Life ◽  
The United States ◽  
Health It ◽  
Social Emotional ◽  
Marital Relations ◽  
The Impact ◽  
The Relationship ◽  
Adequate Communication

ABSTRACTLate-life husband and wife relationships are increasingly recognised as an important factor in promoting wellbeing, particularly in terms of the health, social, emotional, financial and practical needs of older people. Knowledge of marital dynamics and how they affect both members of a couple remains scarce. This systematic review aimed to identify and appraise research that has focused explicitly on the dynamics of the relationship, as evinced by data frombothspouses. Implementing rigorous identification strategies, 45 articles were identified and reviewed. These studies were grouped into three broad thematic areas: marital relations and satisfaction; concordance in emotional state or physical health; and the interplay between marital quality and wellbeing. The issues found to affect marital relations and satisfaction in late life included equality of roles, having adequate communication, and transitions to living apart. There is strong evidence for couple concordance in depression, that marital relationships affect ill-health, longevity and recovery from illness, and reciprocally that ill-health impacts on the marriage itself. The research also suggests important gender differences in the impact of marital dynamics on health. It has led to the conclusion that there is a need for more diverse studies of late-life marriages, particularly ones that examine the dynamics of non-traditional elderly couples and that extend beyond a predominant focus on the Caucasian population of the United States.

scholarly journals The Development and Piloting of the Ambulatory Electronic Health Record Evaluation Tool: Lessons Learned

2021 ◽  
Vol 12 (01) ◽  
pp. 153-163
Author(s):  
Zoe Co ◽  
A. Jay Holmgren ◽  
David C. Classen ◽  
Lisa P. Newmark ◽  
Diane L. Seger ◽  
...  
Keyword(s):  
Decision Support ◽  
Electronic Health Record ◽  
Medication Safety ◽  
Medication Reconciliation ◽  
The United States ◽  
Health Record ◽  
Evaluation Tool ◽  
Safety Test ◽  
Electronic Health ◽  
The Impact

Abstract Background Substantial research has been performed about the impact of computerized physician order entry on medication safety in the inpatient setting; however, relatively little has been done in ambulatory care, where most medications are prescribed. Objective To outline the development and piloting process of the Ambulatory Electronic Health Record (EHR) Evaluation Tool and to report the quantitative and qualitative results from the pilot. Methods The Ambulatory EHR Evaluation Tool closely mirrors the inpatient version of the tool, which is administered by The Leapfrog Group. The tool was piloted with seven clinics in the United States, each using a different EHR. The tool consists of a medication safety test and a medication reconciliation module. For the medication test, clinics entered test patients and associated test orders into their EHR and recorded any decision support they received. An overall percentage score of unsafe orders detected, and order category scores were provided to clinics. For the medication reconciliation module, clinics demonstrated how their EHR electronically detected discrepancies between two medication lists. Results For the medication safety test, the clinics correctly alerted on 54.6% of unsafe medication orders. Clinics scored highest in the drug allergy (100%) and drug–drug interaction (89.3%) categories. Lower scoring categories included drug age (39.3%) and therapeutic duplication (39.3%). None of the clinics alerted for the drug laboratory or drug monitoring orders. In the medication reconciliation module, three (42.8%) clinics had an EHR-based medication reconciliation function; however, only one of those clinics could demonstrate it during the pilot. Conclusion Clinics struggled in areas of advanced decision support such as drug age, drug laboratory, and drub monitoring. Most clinics did not have an EHR-based medication reconciliation function and this process was dependent on accessing patients' medication lists. Wider use of this tool could improve outpatient medication safety and can inform vendors about areas of improvement.

scholarly journals A Survey of the Literature on Unintended Consequences Associated with Health Information Technology: 2014–2015

2016 ◽  
Vol 25 (01) ◽  
pp. 13-29 ◽  
Author(s):  
J. Abraham ◽  
L. L. Novak ◽  
T. L. Reynolds ◽  
A. Gettinger ◽  
K. Zheng
Keyword(s):  
Information Technology ◽  
Time Series ◽  
Health Information Technology ◽  
Health Information ◽  
Unintended Consequences ◽  
Adverse Outcomes ◽  
Future Research ◽  
Health It ◽  
Recorded Data ◽  
The Impact

SummaryObjective: To summarize recent research on unintended consequences associated with implementation and use of health information technology (health IT). Included in the review are original empirical investigations published in English between 2014 and 2015 that reported unintended effects introduced by adoption of digital interventions. Our analysis focuses on the trends of this steam of research, areas in which unintended consequences have continued to be reported, and common themes that emerge from the findings of these studies.Method: Most of the papers reviewed were retrieved by searching three literature databases: MEDLINE, Embase, and CINAHL. Two rounds of searches were performed: the first round used more restrictive search terms specific to unintended consequences; the second round lifted the restrictions to include more generic health IT evaluation studies. Each paper was independently screened by at least two authors; differences were resolved through consensus development.Results: The literature search identified 1,538 papers that were potentially relevant; 34 were deemed meeting our inclusion criteria after screening. Studies described in these 34 papers took place in a wide variety of care areas from emergency departments to ophthalmology clinics. Some papers reflected several previously unreported unintended consequences, such as staff attrition and patients’ withholding of information due to privacy and security concerns. A majority of these studies (71%) were quantitative investigations based on analysis of objectively recorded data. Several of them employed longitudinal or time series designs to distinguish between unintended consequences that had only transient impact, versus those that had persisting impact. Most of these unintended consequences resulted in adverse outcomes, even though instances of beneficial impact were also noted. While care areas covered were heterogeneous, over half of the studies were conducted at academic medical centers or teaching hospitals. Conclusion: Recent studies published in the past two years represent significant advancement of unintended consequences research by seeking to include more types of health IT applications and to quantify the impact using objectively recorded data and longitudinal or time series designs. However, more mixed-methods studies are needed to develop deeper insights into the observed unintended adverse outcomes, including their root causes and remedies. We also encourage future research to go beyond the paradigm of simply describing unintended consequences, and to develop and test solutions that can prevent or minimize their impact.

Analysis of the U.S. Student Visa System

2008 ◽  
Vol 13 (1) ◽  
pp. 72-109 ◽  
Author(s):  
David Urias ◽  
Carol Camp Yeakey
Keyword(s):  
International Student ◽  
The United States ◽  
Unintended Consequences ◽  
Entry And Exit ◽  
Muslim Students ◽  
Social Events ◽  
Research Questions ◽  
Political Economic ◽  
The Impact ◽  
Comprehensive Compilation

Given the political, economic, and social events surrounding 9/11, the major issue addressed concerns the impact of federal legislation on international students/scholars. The study explored several research questions that can be summarized as, What are the relevant laws affecting international student study in the United States, and What are the consequences of having those laws? To date, there has not been a comprehensive compilation identifying such regulations nor an analysis and charting of the broader public policy at various levels of implementation. This article attempts to do this. Sifting through the miasma of regulations, certain themes emerge from the analysis: philosophical changes, entry and exit registration, intended and unintended consequences, impact on Arab and Muslim students, effects on U.S. citizens, and emergent problems.

Improving diagnosis by improving education: a policy brief on education in healthcare professions

Diagnosis ◽  
2018 ◽  
Vol 5 (3) ◽  
pp. 107-118 ◽  
Author(s):  
Mark L. Graber ◽  
Joseph Rencic ◽  
Diana Rusz ◽  
Frank Papa ◽  
Pat Croskerry ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Reasoning ◽  
Health Care Professionals ◽  
Interprofessional Education ◽  
Safety Concern ◽  
Diagnostic Error ◽  
Education And Training ◽  
Diagnostic Process ◽  
Specific Content ◽  
And Training

Abstract Diagnostic error is increasingly recognized as a major patient safety concern. Efforts to improve diagnosis have largely focused on safety and quality improvement initiatives that patients, providers, and health care organizations can take to improve the diagnostic process and its outcomes. This educational policy brief presents an alternative strategy for improving diagnosis, centered on future healthcare providers, to improve the education and training of clinicians in every health care profession. The hypothesis is that we can improve diagnosis by improving education. A literature search was first conducted to understand the relationship of education and training to diagnosis and diagnostic error in different health care professions. Based on the findings from this search we present the justification for focusing on education and training, recommendations for specific content that should be incorporated to improve diagnosis, and recommendations on educational approaches that should be used. Using an iterative, consensus-based process, we then developed a driver diagram that categorizes the key content into five areas. Learners should: 1) Acquire and effectively use a relevant knowledge base, 2) Optimize clinical reasoning to reduce cognitive error, 3) Understand system-related aspects of care, 4) Effectively engage patients and the diagnostic team, and 5) Acquire appropriate perspectives and attitudes about diagnosis. These domains echo recommendations in the National Academy of Medicine’s report Improving Diagnosis in Health Care. The National Academy report suggests that true interprofessional education and training, incorporating recent advances in understanding diagnostic error, and improving clinical reasoning and other aspects of education, can ultimately improve diagnosis by improving the knowledge, skills, and attitudes of all health care professionals.

scholarly journals The performance of the Indian stock market during COVID-19

2020 ◽  
Vol 17 (3) ◽  
pp. 133-147
Author(s):  
Rashmi Chaudhary ◽  
Priti Bakhshi ◽  
Hemendra Gupta
Keyword(s):  
Standard Deviation ◽  
Stock Market ◽  
Stock Exchange ◽  
Health Care Information ◽  
Crisis Period ◽  
Daily Data ◽  
Composite Indices ◽  
Health Care Information Technology ◽  
Indian Stock Market ◽  
The Impact

The current empirical study attempts to analyze the impact of COVID-19 on the performance of the Indian stock market concerning two composite indices (BSE 500 and BSE Sensex) and eight sectoral indices of Bombay Stock Exchange (BSE) (Auto, Bankex, Consumer Durables, Capital Goods, Fast Moving Consumer Goods, Health Care, Information Technology, and Realty) of India, and compare the composite indices of India with three global indexes S&P 500, Nikkei 225, and FTSE 100. The daily data from January 2019 to May 2020 have been considered in this study. GLS regression has been applied to assess the impact of COVID-19 on the multiple measures of volatility, namely standard deviation, skewness, and kurtosis of all indices. All indices’ key findings show lower mean daily return than specific, negative returns in the crisis period compared to the pre-crisis period. The standard deviation of all the indices has gone up, the skewness has become negative, and the kurtosis values are exceptionally large. The relation between indices has increased during the crisis period. The Indian stock market depicts roughly the same standard deviation as the global markets but has higher negative skewness and higher positive kurtosis of returns, making the market seem more volatile.

scholarly journals Accountability and the pressures to exclude: A cautionary tale from England.

2005 ◽  
Vol 13 ◽  
pp. 26 ◽  
Author(s):  
E. Rustique-Forrester
Keyword(s):  
School Choice ◽  
Student Performance ◽  
Teacher Collaboration ◽  
The United States ◽  
International Perspective ◽  
Unintended Consequences ◽  
High Stakes ◽  
Ranking Systems ◽  
Improve Student Performance ◽  
The Impact

Recent studies have produced conflicting findings about whether test-based rewards and sanctions create incentives that improve student performance, or hurdles that increase dropout and pushout rates from schools. This article reports the findings from a study that examined the impact of England's accountability reforms and investigated whether the confluent pressures associated with increased testing, school ranking systems, and other sanctions contributed to higher levels of student exclusion (expulsion and suspension). The study found that England's high-stakes approach to accountability, combined with the dynamics of school choice and other curriculum and testing pressures led to a narrowing of the curriculum, the marginalization of low-performing students, and a climate perceived by teachers to be less tolerant of students with academic and behavioral difficulties. A comparison of higher- and lower-excluding schools, however, found that these effects were more pronounced in the higher-excluding schools, which lacked strong systems and internal structures for supporting staff communication, teacher collaboration, and students' individual needs. The study offers an international perspective on recent trends toward greater accountability in education, pointing to a complex inter-relationship between the pressures of national policies and the unintended consequences on schools' organizational and teachers' instructional capacities. The study's findings raise particular implications for the United States and show that in the design of accountability systems, attention must be paid to how the pressures from accountability will affect the capacity of schools and teachers to respond to students who are low-performing and struggling academically.

scholarly journals Impact of Oxycodone HCl Extended-release Formulary Restrictions on Extended-release Opioid Market Share, Healthcare Resource Utilization and Costs in Commercial and Medicare Plans

10.36469/9800 ◽  
2017 ◽  
Vol 5 (1) ◽  
pp. 75-88
Author(s):  
Rolin L. Wade ◽  
Chi-Chang Chen ◽  
Ajita P. De ◽  
Jaren C. Howard
Keyword(s):  
Resource Utilization ◽  
Market Share ◽  
Extended Release ◽  
Healthcare Resource ◽  
Office Visit ◽  
The United States ◽  
Healthcare Resource Utilization ◽  
Unintended Consequences ◽  
Health Plans ◽  
The Impact

Background: Previous research demonstrated that utilization management (UM) such as prior authorization (PA) or non-formulary (NF) restrictions may reduce pharmacy costs when designed and applied appropriately to certain drug classes. However, such access barriers may also have unintended consequences. Few studies systemically analyzed the impact of major UM strategies to extended-release (ER) opioids on different types of health plans. Objective: This study evaluated, from payer perspective, the impact of formulary restrictions (PA, NF, or step therapy [ST]) for branded oxycodone HCl extended release (OER) on market share, and healthcare resource utilization/costs in ER opioids patients for multiple types of health plans in the United States. Methods: This retrospective, longitudinal case-control study analyzed prescription and outpatient medical claims data (2012 to 2015) for adult ER opioid patients from US plans (commercial,/Medicare, national/regional) that instituted OER PA, NF, or ST. Patients from each restricted plan (cases) were matched to patients in an unrestricted plan (controls) on key patient characteristics. ER opioid market share and healthcare resource utilization/costs for both cases and controls were evaluated for the 6-month period before and after the formulary restriction dates. A difference-in-differences (DiD) approach was utilized to evaluate change in the total per patient per month (PPPM) healthcare utilization and costs. Results: The study comprised 1622 (national commercial PA), 2020 (regional commercial PA), 34 703 (national commercial ST), and 4372 (national Medicare NF) cases and equivalent number of controls. OER market share decreased after the formulary restrictions, with the national Medicare NF plan showing the greatest decrease (9.2%). DiD analyses indicated that PPPM office visit change in the PA and NF plans were non-significant (decreased by 0.1 and 0.2, P>0.05), but significant in the ST plan (increased by 0.1, P=0.0001). For most plans, no significant total monthly cost change was observed; PPPM costs decreased by $48.74 and $59.87 in ST and regional PA plans and increased by $37.90 in national NF plans (all P>0.05). Conclusions: This study observed that despite reducing the market share of OER, OER formulary restrictions had negligible impact on overall ER opioid utilization, and did not result in substantial pharmacy/medical cost savings.

scholarly journals Prison Gangs

2017 ◽  
Author(s):  
Danilo Freire
Keyword(s):  
United States ◽  
Property Rights ◽  
The United States ◽  
Unintended Consequences ◽  
The State ◽  
Correctional Facilities ◽  
Street Level ◽  
Illicit Markets ◽  
Prison Gangs ◽  
The Impact

Although widely seen as unruly and predatory, prison gangs operate as quasi-governments in many American correctional facilities. Inmate groups enforce property rights, regulate illicit markets, and promote cooperation when the state is unable or unwilling to act. Prison gangs are relatively new to the United States, and are best understood as unintended consequences of recent shifts in inmate demographics and the gradual erosion of the convict code. The impact of prison gangs on street-level criminal activities and directions for further research are also discussed.

Beyond One-Off Integrations: A Commercial, Substitutable, Reusable, Standards-Based, Electronic Health Record–Connected App (Preprint)

2018 ◽  
Author(s):  
Kenneth D Mandl ◽  
Daniel Gottlieb ◽  
Alyssa Ellis
Keyword(s):  
Electronic Health Record ◽  
Diffusion Of Innovation ◽  
Market Competition ◽  
Application Programming Interface ◽  
The United States ◽  
Health Record ◽  
Health It ◽  
Medical Apps ◽  
Open Api ◽  
Electronic Health

UNSTRUCTURED The Substitutable Medical Apps and Reusable Technology (SMART) Health IT project launched in 2010 to facilitate the development of medical apps that are scalable and substitutable. SMART defines an open application programming interface (API) specification that enables apps to connect to electronic health record systems and data warehouses without custom integration efforts. The SMART-enabled version of the Meducation app, developed by Polyglot, has been implemented at scores of hospitals and clinics in the United States, nation-wide. After expanding their product’s reach by relying on a universal, open API for integrations, the team estimates that one project manager can handle up to 20 simultaneous implementations. The app is made available through the SMART App Gallery, an open app store that supports discovery of apps and, because the apps are substitutable, market competition. This case illustrates how a universal open API for patient and clinician-facing health IT systems supported and accelerated commercial success for a start-up company. Giving end users a wide and ever-growing choice of apps that leverage data generated by the health care system and patients at home through a universal, open API is a promising and generalizable approach for rapid diffusion of innovation across health systems.

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