Pediatric hypertension: diagnostic patterns derived from electronic health records

Diagnosis ◽  
2018 ◽  
Vol 5 (3) ◽  
pp. 157-160 ◽  
Author(s):  
Goutham Rao ◽  
Sara Naureckas ◽  
Avisek Datta ◽  
Nivedita Mohanty ◽  
Victoria Bauer ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Target Organ Damage ◽  
Correct Diagnosis ◽  
Primary Care Providers ◽  
Care Providers ◽  
Pediatric Hypertension ◽  
Health Records ◽  
Factors Associated ◽  
Increased Risk ◽  
Electronic Health

Abstract Background Pediatric hypertension is a serious problem associated with target organ damage in children and an increased risk for adult hypertension. African-American and Latino children are disproportionately affected. Unfortunately, due to a variety of factors, including the complexity of blood pressure (BP) standards, pediatric hypertension is undiagnosed in the majority of cases. We sought to identify factors associated with correct diagnosis and to better understand diagnosis of hypertension by studying the diagnostic paths of a small number of children. Methods Data were extracted from electronic health records (EHRs) of children who met criteria for hypertension. Logistic regression was used to identify factors associated with correct diagnosis. Diagnostic paths for 20 diagnosed children were extracted through chart review and analyzed. Results Among 1478 hypertensive children, only 85 were diagnosed (6.1%). Age ≥12 compared to age ≤6 was associated with correct diagnosis [odds ratio (OR) of 1.96, 95% confidence interval (CI) (1.16, 3.32)]. Diagnostic paths revealed that primary care providers (PCPs) make the diagnosis based on multiple readings over time and order laboratory tests appropriately. Conclusions Hypertension is missed in a large proportion of all children. Effective, systematic approaches to diagnosis are necessary.

scholarly journals Association between Electronic Health Records and Health Care Utilization

2015 ◽  
Vol 06 (01) ◽  
pp. 42-55 ◽  
Author(s):  
A. Edwards ◽  
L.M. Kern ◽  
R. Kaushal ◽  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Electronic Health Records ◽  
Health Care Utilization ◽  
Primary Care Providers ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Care Providers ◽  
Health Records ◽  
Electronic Health

SummaryBackground: The federal government is investing approximately $20 billion in electronic health records (EHRs), in part to address escalating health care costs. However, empirical evidence that provider use of EHRs decreases health care costs is limited.Objective: To determine any association between EHRs and health care utilization.Methods: We conducted a cohort study (2008–2009) in the Hudson Valley, a multi-payer, multi-provider community in New York State. We included 328 primary care physicians in predominantly small practices (median practice size four primary care physicians), who were caring for 223,772 patients. Data from an independent practice association was used to determine adoption of EHRs. Claims data aggregated across five commercial health plans was used to characterize seven types of health care utilization: primary care visits, specialist visits, radiology tests, laboratory tests, emergency department visits, hospital admissions, and readmissions. We used negative binomial regression to determine associations between EHR adoption and each utilization outcome, adjusting for ten physician characteristics.Results: Approximately half (48%) of the physicians were using paper records and half (52%) were using EHRs. For every 100 patients seen by physicians using EHRs, there were 14 fewer specialist visits (adjusted p < 0.01) and 9 fewer radiology tests (adjusted p = 0.01). There were no significant differences in rates of primary care visits, laboratory tests, emergency department visits, hospitalizations or readmissions.Conclusions: Patients of primary care providers who used EHRs were less likely to have specialist visits and radiology tests than patients of primary care providers who did not use EHRs.Citation: Kaushal R, Edwards A, Kern LM, with the HITEC Investigators. Association between electronic health records and health care utilization. Appl Clin Inf 2015; 6: 42–55http://dx.doi.org/10.4338/ACI-2014-10-RA-0089

scholarly journals Title: Playing Telephone: Understanding the state of medication decision making in growing healthcare teams in the time of electronic health records (Preprint)

2018 ◽  
Author(s):  
Kathryn Mercer ◽  
Catherine Burns ◽  
Lisa Guirguis ◽  
Jessie Chin ◽  
Maman Joyce Dogba ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Decision Making ◽  
Electronic Health Records ◽  
Shared Decision Making ◽  
Primary Care Providers ◽  
Shared Decision ◽  
Care Providers ◽  
Health Records ◽  
Electronic Health

BACKGROUND Primary care needs to be patient-centred, integrated and interprofessional to help patients with complex needs manage the burden of medication-related problems. Considering the growing problem of polypharmacy, there is increasing attention on how and when medication-related decisions should be coordinated across multi-disciplinary care teams. Improved knowledge on how integrated EHRs can support interprofessional shared decision-making for medication therapy management is necessary to continue to improve patient care. OBJECTIVE This objective of this study was to examine how physicians and pharmacists understand and communicate patient-focused medication information with each other and how this knowledge can influence the design of electronic health records. METHODS This study is part of a broader cross-Canada study between patients and health care providers around how health-related decisions are made and communicated. We visited community pharmacies, team-based primary care clinics, and independent-practice family physician clinics throughout Ontario, Nova Scotia, Alberta, and Quebec. Semi-structured interviews were conducted with physician and pharmacists. A modified version of the Multidisciplinary Framework Method was used to analyze the data. RESULTS Data was collected at 19 pharmacies and 9 medical clinics and we identified six main themes from 34 health care professionals. Interprofessional Shared Decision Making was not occurring and clinicians made decisions based on their understanding of the patient. Physicians and pharmacists reported indirect Communication, incomplete Information specifically missing insight into indication and adherence, and misaligned Processes of Care further compounded by electronic health records not designed to facilitate collaboration. Scope of Practice examined professional and workplace boundaries for pharmacists and physicians that were internally and externally imposed. Physicians decided on the degree of the Physician/Pharmacist Relationship which was often predicated by co-location. CONCLUSIONS When managing medications, there was limited communication and collaboration between primary care providers and pharmacists. Pharmacists were missing key information around reason for use, and physicians required accurate information around adherence. EHRs are a potential tool to help clinicians communicate information to resolve this issue. EHRs need to be designed to facilitate interprofessional medication management, so that pharmacists and physicians move beyond task-based work toward a collaborative approach CLINICALTRIAL n/a

scholarly journals Patients’ moral attitudes toward electronic health records: Survey study with vignettes and statements

2021 ◽  
Vol 27 (1) ◽  
pp. 146045822098003
Author(s):  
Tania Moerenhout ◽  
Ignaas Devisch ◽  
Laetitia Cooreman ◽  
Jodie Bernaerdt ◽  
An De Sutter ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
De Novo ◽  
Information Access ◽  
Survey Study ◽  
Sensitive Information ◽  
Patient Portal ◽  
Care Providers ◽  
Health Records ◽  
Electronic Health ◽  
Moral Attitudes

Patient access to electronic health records gives rise to ethical questions related to the patient-doctor-computer relationship. Our study aims to examine patients’ moral attitudes toward a shared EHR, with a focus on autonomy, information access, and responsibility. A de novo self-administered questionnaire containing three vignettes and 15 statements was distributed among patients in four different settings. A total of 1688 valid questionnaires were collected. Patients’ mean age was 51 years, 61% was female, 50% had a higher degree (college or university), and almost 50% suffered from a chronic illness. Respondents were hesitant to hide sensitive information electronically from their care providers. They also strongly believed hiding information could negatively affect the quality of care provided. Participants preferred to be informed about negative test results in a face-to-face conversation, or would have every patient decide individually how they want to receive results. Patients generally had little experience using patient portal systems and expressed a need for more information on EHRs in this survey. They tended to be hesitant to take up control over their medical data in the EHR and deemed patients share a responsibility for the accuracy of information in their record.

Impact of simulation training on self-efficacy of outpatient health care providers to use electronic health records

2015 ◽  
Vol 84 (6) ◽  
pp. 423-429 ◽  
Author(s):  
Jasna Vuk ◽  
Michael E. Anders ◽  
Cynthia C. Mercado ◽  
Robert L. Kennedy ◽  
Jessie Casella ◽  
...  
Keyword(s):  
Health Care ◽  
Electronic Health Records ◽  
Health Care Providers ◽  
Self Efficacy ◽  
Simulation Training ◽  
Care Providers ◽  
Health Records ◽  
Electronic Health

scholarly journals Exploring Perceptions of Health Care Providers' Use of Electronic Advance Directive Forms in Electronic Health Records

2019 ◽  
Vol 45 (1) ◽  
pp. 17-21
Author(s):  
Bunmi Folarinde ◽  
Gregory Lynn Alexander ◽  
Colleen Galambos ◽  
Bonnie J. Wakefield ◽  
Amy Vogelsmeier ◽  
...  
Keyword(s):  
Health Care ◽  
Electronic Health Records ◽  
Health Care Providers ◽  
Advance Directive ◽  
Care Providers ◽  
Health Records ◽  
Electronic Health

scholarly journals Patient Use and Experience With Online Access to Electronic Health Records in Norway: Results From an Online Survey (Preprint)

2019 ◽  
Author(s):  
Paolo Zanaboni ◽  
Per Egil Kummervold ◽  
Tove Sørensen ◽  
Monika Alise Johansen
Keyword(s):  
Health Care ◽  
Electronic Health Records ◽  
Health Care Providers ◽  
National Health ◽  
Chronic Conditions ◽  
Online Survey ◽  
Health Condition ◽  
Care Providers ◽  
Health Records ◽  
Electronic Health

BACKGROUND The electronic health record (EHR) has been fully established in all Norwegian hospitals. Patient-accessible electronic health records (PAEHRs) are available to citizens aged 16 years and older through the national health portal Helsenorge. OBJECTIVE This study aimed at understanding how patients use PAEHRs. Three research questions were addressed in order to explore (1) characteristics of users, (2) patients’ use of the service, and (3) patient experience with the service. METHODS We conducted an online survey of users who had accessed their EHR online at least once through the national health portal. Patients from two of the four health regions in Norway were invited to participate. Quantitative data were supplemented by qualitative information. RESULTS A total of 1037 respondents participated in the survey, most of whom used the PAEHR regularly (305/1037, 29.4%) or when necessary (303/1037, 29.2%). Service utilization was associated with self-reported health, age, gender, education, and health care professional background. Patients found the service useful to look up health information (687/778, 88.3%), keep track of their treatment (684/778, 87.9%), prepare for a hospital appointment (498/778, 64.0%), and share documents with their general practitioner (292/778, 37.5%) or family (194/778, 24.9%). Most users found it easy to access their EHR online (965/1037, 93.1%) and did not encounter technical challenges. The vast majority of respondents (643/755, 85.2%) understood the content, despite over half of them acknowledging some difficulties with medical terms or phrases. The overall satisfaction with the service was very high (700/755, 92.7%). Clinical advantages to the patients included enhanced knowledge of their health condition (565/691, 81.8%), easier control over their health status (685/740, 92.6%), better self-care (571/653, 87.4%), greater empowerment (493/674, 73.1%), easier communication with health care providers (493/618, 79.8%), and increased security (655/730, 89.7%). Patients with complex, long-term or chronic conditions seemed to benefit the most. PAEHRs were described as useful, informative, effective, helpful, easy, practical, and safe. CONCLUSIONS PAEHRs in Norway are becoming a mature service and are perceived as useful by patients. Future studies should include experimental designs focused on specific populations or chronic conditions that are more likely to achieve clinically meaningful benefits. Continuous evaluation programs should be conducted to assess implementation and changes of wide-scale routine services over time.

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