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.

Business: The Electronic Health Record: Front Line Experience

2011 ◽  
Vol 21 (1) ◽  
pp. 18-22
Author(s):  
Rosemary Griffin
Keyword(s):  
Health Care ◽  
Information Technology ◽  
Electronic Health Record ◽  
Financial Incentives ◽  
Best Practice ◽  
Health Care Systems ◽  
The United States ◽  
Health Record ◽  
Health Trends ◽  
Electronic Health

National legislation is in place to facilitate reform of the United States health care industry. The Health Care Information Technology and Clinical Health Act (HITECH) offers financial incentives to hospitals, physicians, and individual providers to establish an electronic health record that ultimately will link with the health information technology of other health care systems and providers. The information collected will facilitate patient safety, promote best practice, and track health trends such as smoking and childhood obesity.

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 Clinical decision support alert malfunctions: analysis and empirically derived taxonomy

2017 ◽  
Vol 25 (5) ◽  
pp. 496-506 ◽  
Author(s):  
Adam Wright ◽  
Angela Ai ◽  
Joan Ash ◽  
Jane F Wiesen ◽  
Thu-Trang T Hickman ◽  
...  
Keyword(s):  
Decision Support ◽  
Electronic Health Record ◽  
Medical Informatics ◽  
Clinical Decision Support ◽  
Quantitative Methods ◽  
Clinical Decision ◽  
The United States ◽  
Health Record ◽  
Qualitative And Quantitative Methods ◽  
Electronic Health

Abstract Objective To develop an empirically derived taxonomy of clinical decision support (CDS) alert malfunctions. Materials and Methods We identified CDS alert malfunctions using a mix of qualitative and quantitative methods: (1) site visits with interviews of chief medical informatics officers, CDS developers, clinical leaders, and CDS end users; (2) surveys of chief medical informatics officers; (3) analysis of CDS firing rates; and (4) analysis of CDS overrides. We used a multi-round, manual, iterative card sort to develop a multi-axial, empirically derived taxonomy of CDS malfunctions. Results We analyzed 68 CDS alert malfunction cases from 14 sites across the United States with diverse electronic health record systems. Four primary axes emerged: the cause of the malfunction, its mode of discovery, when it began, and how it affected rule firing. Build errors, conceptualization errors, and the introduction of new concepts or terms were the most frequent causes. User reports were the predominant mode of discovery. Many malfunctions within our database caused rules to fire for patients for whom they should not have (false positives), but the reverse (false negatives) was also common. Discussion Across organizations and electronic health record systems, similar malfunction patterns recurred. Challenges included updates to code sets and values, software issues at the time of system upgrades, difficulties with migration of CDS content between computing environments, and the challenge of correctly conceptualizing and building CDS. Conclusion CDS alert malfunctions are frequent. The empirically derived taxonomy formalizes the common recurring issues that cause these malfunctions, helping CDS developers anticipate and prevent CDS malfunctions before they occur or detect and resolve them expediently.

scholarly journals Assessing the National Prevalence of HIV Screening in the United States using Electronic Health Record Data

Cureus ◽  
2019 ◽  
Author(s):  
Joshua D Niforatos ◽  
Jonathon W Wanta ◽  
Emily Durbak ◽  
Jacqueline Cavendish ◽  
Justin A Yax
Keyword(s):  
United States ◽  
Electronic Health Record ◽  
The United States ◽  
Health Record ◽  
Hiv Screening ◽  
Electronic Health Record Data ◽  
Record Data ◽  
Electronic Health ◽  
National Prevalence

scholarly journals 517. Treatment Patterns of Hospitalized Adults with Infections Due to Carbapenem Non-Susceptible Gram-Negative Organisms in a Large Electronic Health Record Database in the United States

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S249-S249
Author(s):  
Tanya Burton ◽  
Amy Anderson ◽  
Jerry Seare ◽  
Ryan J Dillon ◽  
Eilish McCann
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Electronic Health Record ◽  
Infection Type ◽  
Treatment Options ◽  
Complicated Urinary Tract Infection ◽  
The United States ◽  
Treatment Patterns ◽  
Health Record ◽  
Gram Negative ◽  
Electronic Health

Abstract Background Infections caused by carbapenem non-susceptible (C-NS) Gram-negative (GN) organisms pose a major threat, due in part to limited treatment options. The aim of this study was to assess treatment patterns for these infections in a large US electronic health record database. Methods A retrospective cohort study of hospitalized adults with complicated intra-abdominal infection (cIAI), complicated urinary tract infection (cUTI), bacterial pneumonia (BP), or bacteremia (BAC) due to C-NS (resistant/intermediate susceptibility to carbapenem) GN organisms from January 2013 to March 2018. Patients with inherently C-NS organisms (e.g., Pseudomonas aeruginosa to ertapenem) were only included if resistance to another carbapenem was identified. The index date was the date of first C-NS culture in a qualifying hospitalization (±3 days from admission/discharge). Clinical characteristics and administered treatments were assessed from admission to discharge with variables summarized descriptively and stratified by infection type. Results 7,702 patients met inclusion criteria: 31% cUTI ± BAC, 24% BP ± BAC, 21% cUTI + BP ± BAC, 17% cIAI ± BAC, cUTI, or BP, 7% BAC only. The median age was 66 years, ranging from 60 (BAC) to 69 (cUTI) years; male, 57%. The most common pathogens were Pseudomonas aeruginosa (64%) and Klebsiella pneumoniae (15%). Antibiotics were administered to the majority of patients (87%); of which, 79% received combination therapy (median classes: 3, maximum: 7), the remainder received monotherapy. For antibiotic-treated patients, 93% initiated an antibiotic before the non-susceptibility status of the underlying organism was known. The most common classes given during the index hospitalization were: penicillin (49%), fluoroquinolone (44%), carbapenem (40%), cephalosporin (39%), aminoglycoside (28%) (by infection type, Figure 1). Eleven percent of patients received colistin/polymyxin B. Conclusion Varied antibiotic use was observed in this cohort, with carbapenems frequently detected despite the C-NS nature of the underlying GN organisms. The use of antibiotics to which organisms are non-susceptible could lead to poor health outcomes, supporting the need for new targeted therapies to treat C-NS infections. Disclosures All authors: No reported disclosures.

scholarly journals An Analysis of Patient Safety Incident Reports Associated with Electronic Health Record Interoperability

2017 ◽  
Vol 08 (02) ◽  
pp. 593-602 ◽  
Author(s):  
Katharine Adams ◽  
Jessica Howe ◽  
Allan Fong ◽  
Joseph Puthumana ◽  
Kathryn Kellogg ◽  
...  
Keyword(s):  
Patient Safety ◽  
Electronic Health Record ◽  
Health Record ◽  
Health It ◽  
Specific Patient ◽  
It Systems ◽  
Safety Incident ◽  
Patient Safety Incident ◽  
Incident Reports ◽  
Electronic Health

SummaryBackground: With the widespread use of electronic health records (EHRs) for many clinical tasks, interoperability with other health information technology (health IT) is critical for the effective delivery of care. While it is generally recognized that poor interoperability negatively impacts patient care, little is known about the specific patient safety implications. Understanding the patient safety implications will help prioritize interoperability efforts around architectures and standards.Objectives: Our objectives were to (1) identify patient safety incident reports that reflect EHR interoperability challenges with other health IT, and (2) perform a detailed analysis of these reports to understand the health IT systems involved, the clinical care processes impacted, whether the incident occurred within or between provider organizations, and the reported severity of the patient safety events.Methods: From a database of 1.735 million patient safety event (PSE) reports spanning multiple provider organizations, 2625 reports that were indicated as being health IT related by the event reporter were reviewed to identify EHR interoperability related reports. Through a rigorous coding process 209 EHR interoperability related events were identified and coded.Results: The majority of EHR interoperability PSE reports involved interfacing with pharmacy systems (i.e. medication related), followed by laboratory, and radiology. Most of the interoperability challenges in these clinical areas were associated with the EHR receiving information from other health IT systems as opposed to the EHR sending information to other systems. The majority of EHR interoperability challenges were within a provider organization and while many of the safety events reached the patient, only a few resulted in patient harm.Conclusions: Interoperability efforts should prioritize systems in pharmacy, laboratory, and radiology. Providers should recognize the need to improve EHRs interfacing with other health IT systems within their own organization.Citation: Adams KT, Howe JL, Fong A, Puthumana JS, Kellogg KM, Gaunt M, Ratwani RM. An analysis of patient safety incident reports associated with electronic health record interoperability. Appl Clin Inform 2017; 8: 593–602 https://doi.org/10.4338/ACI-2017-01-RA-0014

scholarly journals The Use of Electronic Health Record Systems During COVID-19 at a Local Community Hospital on the West Coast

2021 ◽  
pp. 53-58
Author(s):  
Malini Krishnamurthi, Ph.D.
Keyword(s):  
Health Care ◽  
Electronic Health Record ◽  
Patient Care ◽  
Data Privacy ◽  
Local Community ◽  
Quality Care ◽  
The United States ◽  
Health Record ◽  
Privacy And Security ◽  
Electronic Health

The United States Federal government looks toward information technology to curtail health care costs while increasing the quality of patient care through the adoption of electronic health record (EHR)systems. This paper examined the experience of a hospital with its EHR system in the context of the pandemic. Results showed that the hospital maintains a state-of-the-art health care system to provide quality care to its community and was responsive to the recent crisis. The results were consistent with other comparable hospitals examined in this study. The hospitals were successful in adopting EHR systems. They were able to identify gaps that could be filled with technology add-ons from different software vendors to improve their functionality and thereby provide better & timely patient care. Managing large volumes of data generated in the normal process of EHR operation and ensuring data privacy and security were the significant challenges faced and are likely to continue in the future.

scholarly journals Implementation and adoption of a health insurance support tool in the electronic health record: A mixed methods analysis within a randomized trial

2020 ◽  
Author(s):  
Brigit Hatch ◽  
Carrie Tillotson ◽  
Nathalie Huguet ◽  
Miguel Marino ◽  
Andrea Baron ◽  
...  
Keyword(s):  
Health Insurance ◽  
Electronic Health Record ◽  
Health Center ◽  
The United States ◽  
Audit And Feedback ◽  
Research Network ◽  
Relative Advantage ◽  
Health Record ◽  
Clinic Staff ◽  
Electronic Health

Abstract Background: In addition to delivering vital health care to millions of patients in the United States, community health centers (CHCs) provide needed health insurance outreach and enrollment support to their communities. We developed a health insurance enrollment tracking tool integrated within the electronic health record (EHR) and conducted a hybrid implementation-effectiveness trial in a CHC-based research network to assess tool adoption using two implementation strategies. Methods: CHCs were recruited from the OCHIN practice-based research network. Seven health center systems (23 CHC clinic sites) were recruited and randomized to receive basic educational materials alone (Arm 1), or these materials plus facilitation (Arm 2) during the 18-month study period, September 2016-April 2018. Facilitation consisted of monthly contacts with clinic staff and utilized audit and feedback and guided improvement cycles. We measured total and monthly tool utilization from the EHR. We conducted structured interviews of CHC staff to assess factors associated with tool utilization. Qualitative data were analyzed using an immersion-crystallization approach with barriers and facilitators identified using the Consolidated Framework for Implementation Research. Results: The majority of CHCs in both study arms adopted the enrollment tool. The rate of tool utilization was, on average, higher in Arm 2 compared to Arm 1 (20.0% versus 4.7%, p <0.01). However, by the end of the study period, the rate of tool utilization was similar in both arms; and observed between-arm differences in tool utilization were largely driven by a single, large health center in Arm 2. Perceived relative advantage of the tool was the key factor identified by clinic staff as driving tool utilization. Implementation climate and leadership engagement were also associated with tool utilization. Conclusions: Using basic education materials and low-intensity facilitation, CHCs quickly adopted an EHR-based tool to support critical outreach and enrollment activities aimed at improving access to health insurance in their communities. Though facilitation carried some benefit, a CHC’s perceived relative advantage of the tool was the primary driver of decisions to implement the tool. Trial Registration: ClinicalTrials.gov: NCT02355262, Posted February 4, 2015

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