A clinically useful diabetes electronic medical record: Lessons from the past; pointers toward the future

1996 ◽  
Vol 134 (1) ◽  
pp. 31-42 ◽  
Author(s):  
Colum Gorman ◽  
James Looker ◽  
Tom Fisk ◽  
William Oelke ◽  
David Erickson ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Data Entry ◽  
Clinical Encounter ◽  
Free Text ◽  
Diabetes Clinic ◽  
The Past ◽  
The Future ◽  
Patients With Diabetes ◽  
On Line

Gorman C, Looker J, Fisk T, Oelke W, Erickson D, Smith S, Zimmerman B. A clinically useful diabetes electronic medical record. Lessons from the past; pointers toward the future. Eur J Endocrinol 1996;134:31–42. ISSN 0804–4643 We have analysed the deficiencies of paper medical records in facilitating the care of patients with diabetes and have developed an electronic medical record that corrects some of them. The diabetes electronic medical record (DEMR) is designed to facilitate the work of a busy diabetes clinic. Design principles include heavy reliance on graphic displays of laboratory and clinical data, consistent color coding and aggregation of data needed to facilitate the different types of clinical encounter (initial consultation, continuing care visit, insulin adjustment visit, dietitian encounter, nurse educator encounter, obstetric patient, transplant patient, visits for problems unrelated to diabetes). Data input is by autoflow from the institutional laboratories, by desk attendants or on-line by all users. Careful attention has been paid to making data entry a point and click process wherever possible. Opportunity for free text comment is provided on every screen. On completion of the encounter a narrative text summary of the visit is generated by the computer and is annotated by the care giver. Currently there are about 7800 patients in the system. Remaining challenges include the adaptation of the system to accommodate the occasional user, development of portable laptop derivatives that remain compatible with the parent system and improvements in the screen structure and graphic display formats. Colum Gorman, Division of Endocrinology and Metabolism, Mayo Clinic, Rochester. MN. USA

Consultation of Medical Narratives in the Electronic Medical Record

1999 ◽  
Vol 38 (04/05) ◽  
pp. 289-293 ◽  
Author(s):  
H. J. Tange
Keyword(s):  
Information Retrieval ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Data Entry ◽  
Daily Practice ◽  
Evaluation Study ◽  
System Level ◽  
Free Text ◽  
Patient Case ◽  
Medical Narratives

AbstractThis article presents an overview of a research project concerning the consultation of medical narratives in the electronic medical record (EMR). It describes an analysis of user needs, the design and implementation of a prototype EMR system, and the evaluation of the ease of consultation of medical narratives when using this system. In a questionnaire survey, 85 hospital physicians judged the quality of their paper-based medical record with respect to data entry, information retrieval and some other aspects. Participants were more positive about the paper medical record than the literature suggests. They wished to maintain the flexibility of data entry but indicated the need to improve the retrieval of information. A prototype EMR system was developed to facilitate the consultation of medical narratives. These parts were divided into labeled segments that could be arranged source-oriented and problem-oriented. This system was used to evaluate the ease of information retrieval of 24 internists and 12 residents at a teaching hospital when using free-text medical narratives divided at different levels of detail. They solved, without time pressure, some predefined problems concerning three voluminous, inpatient case records. The participants were randomly allocated to a sequence that was balanced by patient case and learning effect. The division of medical narratives affected speed, but not completeness of information retrieval. Progress notes divided into problem-related segments could be consulted 22% faster than when undivided. Medical history and physical examination divided into segments at organ-system level could be consulted 13% faster than when divided into separate questions and observations. These differences were statistically significant. The fastest divisions were also appreciated as the best combination of easy searching and best insight in the patient case. The results of our evaluation study suggest a trade-off between searching and reading: too much detailed segments will delay the consultation of medical narratives. Validation of the results in daily practice is recommended.

scholarly journals Using a Scripted Data Entry Process to Transfer Legacy Immunization Data While Transitioning Between Electronic Medical Record Systems

2014 ◽  
Vol 05 (01) ◽  
pp. 284-298 ◽  
Author(s):  
A. Hsiao ◽  
A. Fenick ◽  
J. Michel
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Data Transfer ◽  
Clinical Care ◽  
Data Entry ◽  
Data Migration ◽  
Legacy Systems ◽  
The Future ◽  
Electronic Medical Record Systems ◽  
Manual Data Entry

SummaryBackground: Transitioning between Electronic Medical Records (EMR) can result in patient data being stranded in legacy systems with subsequent failure to provide appropriate patient care. Manual chart abstraction is labor intensive, error-prone, and difficult to institute for immunizations on a systems level in a timely fashion.Objectives: We sought to transfer immunization data from two of our health system’s soon to be replaced EMRs to the future EMR using a single process instead of separate interfaces for each facility.Methods: We used scripted data entry, a process where a computer automates manual data entry, to insert data into the future EMR. Using the Center for Disease Control’s CVX immunization codes we developed a bridge between immunization identifiers within our system’s EMRs. We performed a two-step process evaluation of the data transfer using automated data comparison and manual chart review.Results: We completed the data migration from two facilities in 16.8 hours with no data loss or corruption. We successfully populated the future EMR with 99.16% of our legacy immunization data – 500,906 records – just prior to our EMR transition date. A subset of immunizations, first recognized during clinical care, had not originally been extracted from the legacy systems. Once identified, this data – 1,695 records – was migrated using the same process with minimal additional effort.Conclusions: Scripted data entry for immunizations is more accurate than published estimates for manual data entry and we completed our data transfer in 1.2% of the total time we predicted for manual data entry. Performing this process before EMR conversion helped identify obstacles to data migration. Drawing upon this work, we will reuse this process for other healthcare facilities in our health system as they transition to the future EMR.Citation: Michel J, Hsiao A, Fenick A. Using a scripted data entry process to transfer legacy immunization data while transitioning between electronic medical record systems. Appl Clin Inf 2014; 5: 284–298 http://dx.doi.org/10.4338/ACI-2013-11-RA-0096

scholarly journals Adult Learning Principles and Peer Delivery Improve Satisfaction of Electronic Medical Record Onboarding Education

ACI Open ◽  
2020 ◽  
Vol 04 (02) ◽  
pp. e114-e118
Author(s):  
Joanna Lawrence ◽  
Sharman Tan Tanny ◽  
Victoria Heaton ◽  
Lauren Andrew
Keyword(s):  
Adult Learning ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Junior Doctors ◽  
Free Text ◽  
Organizational Safety ◽  
Adult Learning Principles ◽  
Learning Practices ◽  
Learning Principles ◽  
The Impact

Abstract Objectives Given the importance of onboarding education in ensuring the safety and efficiency of medical users in the electronic medical record (EMR), we re-designed our EMR curriculum to incorporate adult learning principles, informed and delivered by peers. We aimed to evaluate the impact of these changes based on their satisfaction with the training. Methods A single site pre- and post-observational study measured satisfaction scores (four questions) from junior doctors attending EMR onboarding education in 2018 (pre-implementation) compared with 2019 (post-implementation). An additional four questions were asked in the post-implementation survey. All questions employed a Likert scale (1–5) with an opportunity for free-text. Raw data were used to calculate averages, standard deviations and the student t-test was used to compare the two cohorts where applicable. Results There were a total of 98 respondents in 2018 (pre-implementation) and 119 in 2019 (post-implementation). Satisfaction increased from 3.8/5 to 4.5/5 (p < 0.0001) following implementation of a peer-delivered curriculum in line with adult learning practices. The highest-rated factors were being taught by other doctors (4.9/5) and doctors having the appropriate knowledge to deliver training (4.9/5). Ninety-two percent of junior doctors were motivated to engage in further EMR education and 90% felt classroom support was adequate. Conclusion EMR onboarding education for medical users is a critical ingredient to organizational safety and efficiency. An improvement in satisfaction ratings by junior doctors was demonstrated after significant re-design of the curriculum was informed and delivered by peers, in line with adult learning principles.

Abstract 3429: Implementation of Electronic Medical Record Stroke Templates Increases Compliance with Stroke Performance Measures

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Crismely A Perdomo ◽  
Vepuka E Kauari ◽  
Elizabeth Suarez ◽  
Olajide Williams ◽  
Joshua Stillman ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Performance Measures ◽  
New York State ◽  
Stroke Care ◽  
Performance Measure ◽  
Performance Comparison ◽  
York State Department ◽  
Free Text ◽  
And Performance

Background and Purpose The literature demonstrates how utilizing evidence-based, standardized stroke care can improve patient outcomes; however, the contribution of electronic medical record (EMR) systems may also impact outcomes by ensuring utilization and compliance with established stroke performance measures, facilitating and improving documentation requirements, and standardizing approach to care. In 2008, documentation in patients’ medical records was done in combination of paper and a template free EMR. Originally, the EMR was used for order entry, then transitioned to full electronic documentation in 2009. At that time we implemented our stroke templates and performance measures based on regulatory standards. We hypothesized that the stroke template implementation would help us achieve performance measure criteria above state benchmarks as set out by the New York State Department of Health (NYS DOH). Methods Implementation was phased in [over 18 months], initially using a template that only included neurological assessment and free text fields for stroke measures. By July 2010, existing templates were modified and additional stroke templates were implemented to meet new regulatory requirements and meaningful use criteria. Retrospective data review was conducted for performance comparison between 2008 -- one year prior to EMR/template implementation -- and 2010. In Quarter 1 of 2011 EMR was also implemented in the Emergency Department (ED). Data was reviewed for compliance with stroke measures. Results Documentation compliance substantially improved between 2008 and Quarter 1 2011: Compliance for these measures has been maintained ≥ 85% since November 2010, ≥ 90% Q1 2011 Conclusions The EMR implementation of stroke templates and performance measures can produce substantial improvement in performance measure compliance. Future steps will include automated documentation alerts to retrieve information and real time discovery of missing documentation for concurrent quality review and improvement

The Meaningful Use of Information Therapy (Ix®)

2013 ◽  
Vol 3 (2) ◽  
pp. 1-8
Author(s):  
Donald W. Kemper ◽  
Molly Mettler
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Meaningful Use ◽  
Patient Centered Care ◽  
Patient Centered ◽  
Patient Response ◽  
The Past ◽  
Health Decision ◽  
Centered Care ◽  
The Right

Information Therapy (Ix), getting the right information to the right person at the right time in order to help the person make an informed health decision, is a field that is constantly evolving. Over the past decade, several changes –particularly technological and policy-based developments -- have helped to advance the model. This paper traces the evolution of Information Therapy from a good idea to one that has been widely adopted by clinicians. This paper emphasizes the use of the electronic medical record (EMR) in delivering information therapy prescriptions directly to patients. Patient Response (Px) is proposed as the next phase in the evolution of Information Therapy and patient-centered care.

scholarly journals Lessons from the past: A window on the future

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Alan Katz ◽  
Marni Brownell ◽  
Mark Smith
Keyword(s):  
Data Sharing ◽  
Linked Data ◽  
Ethical Issues ◽  
Interdisciplinary Collaboration ◽  
Critical Role ◽  
Relationship Building ◽  
Administrative Databases ◽  
Free Text ◽  
The Past ◽  
The Future

IntroductionThe Manitoba Centre for Health Policy has provided international leadership in organizing and accessing administrative databases, linking and analyzing data and translating the findings of research into policy for three decades. During this period, MCHP has addressed numerous challenges in each of these areas. Objectives and ApproachLinked data research is expanding rapidly in terms of access to new data sources, different types of data, sharing of data across jurisdictions, and advances in data analytics. Technical advances such as computing power and artificial intelligence support these developments while governance structures and ethical issues challenge them. This presentation will describe some of the challenges MCHP has met with a view to gaining insight into how solutions evolved and how experience can guide the future of linked data research. ResultsThe scaling up of linked data research will need to address specific challenges including de-identification of free text, accessing and linking data from private enterprise such as wearables, and interdisciplinary collaboration to incorporate new techniques developed by computer scientists. Cross-jurisdictional data analysis presents challenges in addressing differences in data architecture. Inter-jurisdictional and international data sharing create ethical and governance challenges. Experience has demonstrated the critical role that relationship building plays in addressing each of these. These relationships are different depending on the partners. They are all based on the development of common use of language, understanding the motivation and concerns of each party, clearly articulating the benefits of the relationship and data use and attention to the cultural and political environment. Conclusion/ImplicationsLessons from the past can guide us in addressing challenges posed by the exciting opportunities available to us all. While many of these challenges will be solved with technical solutions, we should not overlook the importance of human relationships in building a culture of trust and collaboration as we move

Sign in / Sign up

Export Citation Format

Share Document