Investigating Electronic Health Record Downtimes: A Scoping Review of Literature and News Media (Preprint)

2019 ◽  
Author(s):  
Ethan Larsen ◽  
Arjun Rao ◽  
Farzan Sasangohar
Keyword(s):  
Electronic Health Record ◽  
Patient Care ◽  
Scoping Review ◽  
News Media ◽  
Normal Operation ◽  
Health Record ◽  
Cyber Attack ◽  
Top Down ◽  
Bottom Up ◽  
Electronic Health

BACKGROUND Electronic Health Record Systems have become ubiquitous in the delivery of patient care. While the implementation has brought safety and efficiency boosts to the industry, it has also exposed patients and their data to new risks in the form of downtime. Downtimes are any period where the computer systems are unavailable and these periods occur for updates or upgrades, but can also be triggered by deliberate cyber-attack. During an unexpected downtime, healthcare workers are forced to fall back to rarely practiced paper-based methods for healthcare delivery, while at the same time, patient data is potentially exposed to parties seeking to profit from its sale. OBJECTIVE We sought to provide a foundational perspective of the current state of downtime readiness in light of the growing cyber-attack threat on healthcare data and hospital networks. METHODS A search of technical news media related to healthcare informatics and a scoping review of research literature were conducted. Following the ENTEREQ framework, 1,651 records were retrieved, of which 16 were included in the final review. RESULTS 164 US-based hospitals experienced a total of 670 days of downtime in 41 events between 2012 and 2018. Almost half (48.8%) of the published downtime events involved some form of cyber-attack. 1,651 studies matching downtime search strings were found, 16 of which were found to meet inclusion criteria. Few research studies have a downtime emphasis; those that do are predominantly focused on a top-down approach. They were found to have a range of focus from the theoretical exploration of downtime to direct empirical comparison of downtime versus normal operation. CONCLUSIONS Downtime contingency planning is still predominantly considered in abstract or top-down organizational focus. It is proposed that a bottom-up approach to comprehending and addressing downtime will be beneficial due to the complicated nature of patient care and computer downtime events. A bottom-up approach would involve the front-line clinical staff responsible for executing the downtime procedure and directly caring for the patients. EHR downtime events will continue to be a complication to hospital and healthcare operations. Significant new research support for the development of contingency plans will be needed as the cyber-attack threat continues to grow.

scholarly journals Continuing Patient Care during Electronic Health Record Downtime

2019 ◽  
Vol 10 (03) ◽  
pp. 495-504
Author(s):  
Ethan Larsen ◽  
Daniel Hoffman ◽  
Carlos Rivera ◽  
Brian M. Kleiner ◽  
Christian Wernz ◽  
...  
Keyword(s):  
Quantitative Analysis ◽  
Electronic Health Record ◽  
Clinical Laboratory ◽  
Normal Operation ◽  
Contingency Planning ◽  
Health Record ◽  
Safety Assurance ◽  
Hospital Operations ◽  
Recorded Data ◽  
Electronic Health

Introduction Electronic health record (EHR) downtime is any period during which the EHR system is fully or partially unavailable. These periods are operationally disruptive and pose risks to patients. EHR downtime has not sufficiently been studied in the literature, and most hospitals are not adequately prepared. Objective The objective of this study was to assess the operational implications of downtime with a focus on the clinical laboratory, and to derive recommendations for improved downtime contingency planning. Methods A hybrid qualitative–quantitative study based on historic performance data and semistructured interviews was performed at two mid-Atlantic hospitals. In the quantitative analysis, paper records from downtime events were analyzed and compared with normal operations. To enrich this quantitative analysis, interviews were conducted with 17 hospital employees, who had experienced several downtime events, including a hospital-wide EHR shutdown. Results During downtime, laboratory testing results were delayed by an average of 62% compared with normal operation. However, the archival data were incomplete due to inconsistencies in the downtime paper records. The qualitative interview data confirmed that delays in laboratory result reporting are significant, and further uncovered that the delays are often due to improper procedural execution, and incomplete or incorrect documentation. Interviewees provided a variety of perspectives on the operational implications of downtime, and how to best address them. Based on these insights, recommendations for improved downtime contingency planning were derived, which provide a foundation to enhance Safety Assurance Factors for EHR Resilience guides. Conclusion This study documents the extent to which downtime events are disruptive to hospital operations. It further highlights the challenge of quantitatively assessing the implication of downtimes events, due to a lack of otherwise EHR-recorded data. Organizations that seek to improve and evaluate their downtime contingency plans need to find more effective methods to collect data during these times.

scholarly journals I-THS-1908 A Big Data Electronic Health Record for Patient Care Management and Analytics

2019 ◽  
Author(s):  
Ahmad Hidayat ◽  
Arief Hasani
Keyword(s):  
Big Data ◽  
Electronic Health Record ◽  
Patient Care ◽  
Care Management ◽  
Patient Care Management ◽  
Health Conditions ◽  
Health Record ◽  
Complex Variety ◽  
Electronic Health ◽  
Further Development

The I-THS-1908, a big data electronic health record platform, is capable of establishing its capability as an electronic health record to tackle the large volume of data with high velocity and complex variety of patient data by providing the value to the patient care management and analytics. The further development of I-THS-1908 opens the opportunity to use the electronic health record for patient care management and analytics for all type of health conditions.

scholarly journals Electronic Health Record Adoption – Maybe It’s not about the Money

2011 ◽  
Vol 02 (04) ◽  
pp. 460-471 ◽  
Author(s):  
A. Skinner ◽  
J. Windle ◽  
L. Grabenbauer
Keyword(s):  
Electronic Health Record ◽  
Patient Care ◽  
Resistance To Change ◽  
Medical Center ◽  
Academic Medical Center ◽  
Care Physician ◽  
Health Record ◽  
Record System ◽  
Intuitive Interfaces ◽  
Electronic Health

SummaryObjective: The slow adoption of electronic health record (EHR) systems has been linked to physician resistance to change and the expense of EHR adoption. This qualitative study was conducted to evaluate benefits, and clarify limitations of two mature, robust, comprehensive EHR Systems by tech-savvy physicians where resistance and expense are not at issue.Methods: Two EHR systems were examined – the paperless VistA / Computerized Patient Record System used at the Veterans‘ Administration, and the General Electric Centricity Enterprise system used at an academic medical center. A series of interviews was conducted with 20 EHR-savvy multi-institutional internal medicine (IM) faculty and house staff. Grounded theory was used to analyze the transcribed data and build themes. The relevance and importance of themes were constructed by examining their frequency, convergence, and intensity.Results: Despite eliminating resistance to both adoption and technology as drivers of acceptance, these two robust EHR’s are still viewed as having an adverse impact on two aspects of patient care, physician workflow and team communication. Both EHR’s had perceived strengths but also significant limitations and neither were able to satisfactorily address all of the physicians’ needs.Conclusion: Difficulties related to physician acceptance reflect real concerns about EHR impact on patient care. Physicians are optimistic about the future benefits of EHR systems, but are frustrated with the non-intuitive interfaces and cumbersome data searches of existing EHRs.

scholarly journals Measuring Electronic Health Record Use in Primary Care: A Scoping Review

2018 ◽  
Vol 09 (01) ◽  
pp. 015-033 ◽  
Author(s):  
Michael Huang ◽  
Candace Gibson ◽  
Amanda Terry
Keyword(s):  
Primary Care ◽  
Electronic Health Record ◽  
Scoping Review ◽  
Web Sites ◽  
Health Record ◽  
Current State ◽  
Level Of Use ◽  
Ehr Adoption ◽  
Electronic Health ◽  
Citation Databases

Background Simple measures of electronic health record (EHR) adoption may be inadequate to evaluate EHR use; and positive outcomes associated with EHRs may be better gauged when varying degrees of EHR use are taken into account. In this article, we aim to assess the current state of the literature regarding measuring EHR use. Objective This article conducts a scoping review of the literature to identify and classify measures of primary care EHR use with a focus on the Canadian context. Methods We conducted a scoping review. Multiple citation databases were searched, as well as gray literature from relevant Web sites. Resulting abstracts were screened for inclusion. Included full texts were reviewed by two authors. Data from the articles were extracted; we synthesized the findings. Subsequently, we reviewed these results with seven EHR stakeholders in Canada. Results Thirty-seven articles were included. Eighteen measured EHR function use individually, while 19 incorporated an overall level of use. Eight frameworks for characterizing overall EHR use were identified. Conclusion There is a need to create standardized frameworks for assessing EHR use.

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 Explainable artificial intelligence models using real-world electronic health record data: a systematic scoping review

2020 ◽  
Vol 27 (7) ◽  
pp. 1173-1185 ◽  
Author(s):  
Seyedeh Neelufar Payrovnaziri ◽  
Zhaoyi Chen ◽  
Pablo Rengifo-Moreno ◽  
Tim Miller ◽  
Jiang Bian ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Electronic Health Record ◽  
Scoping Review ◽  
Real World ◽  
Research Trend ◽  
Health Record ◽  
Electronic Health Record Data ◽  
Explainable Artificial Intelligence ◽  
Record Data ◽  
Electronic Health

Abstract Objective To conduct a systematic scoping review of explainable artificial intelligence (XAI) models that use real-world electronic health record data, categorize these techniques according to different biomedical applications, identify gaps of current studies, and suggest future research directions. Materials and Methods We searched MEDLINE, IEEE Xplore, and the Association for Computing Machinery (ACM) Digital Library to identify relevant papers published between January 1, 2009 and May 1, 2019. We summarized these studies based on the year of publication, prediction tasks, machine learning algorithm, dataset(s) used to build the models, the scope, category, and evaluation of the XAI methods. We further assessed the reproducibility of the studies in terms of the availability of data and code and discussed open issues and challenges. Results Forty-two articles were included in this review. We reported the research trend and most-studied diseases. We grouped XAI methods into 5 categories: knowledge distillation and rule extraction (N = 13), intrinsically interpretable models (N = 9), data dimensionality reduction (N = 8), attention mechanism (N = 7), and feature interaction and importance (N = 5). Discussion XAI evaluation is an open issue that requires a deeper focus in the case of medical applications. We also discuss the importance of reproducibility of research work in this field, as well as the challenges and opportunities of XAI from 2 medical professionals’ point of view. Conclusion Based on our review, we found that XAI evaluation in medicine has not been adequately and formally practiced. Reproducibility remains a critical concern. Ample opportunities exist to advance XAI research in medicine.

Novel Nonproprietary Measures of Ambulatory Electronic Health Record Use Associated with Physician Work Exhaustion

2021 ◽  
Vol 12 (03) ◽  
pp. 637-646
Author(s):  
Amrita Sinha ◽  
Tait D. Shanafelt ◽  
Mickey Trockel ◽  
Hanhan Wang ◽  
Christopher Sharp
Keyword(s):  
Electronic Health Record ◽  
Patient Care ◽  
Dominant Factor ◽  
Health Record ◽  
Occupational Burnout ◽  
Electronic Health ◽  
Perception Of Time ◽  
Professional Fulfillment ◽  
The Impact ◽  
Physician Work

Abstract Background Accumulating evidence indicates an association between physician electronic health record (EHR) use after work hours and occupational distress including burnout. These studies are based on either physician perception of time spent in EHR through surveys which may be prone to bias or by utilizing vendor-defined EHR use measures which often rely on proprietary algorithms that may not take into account variation in physician's schedules which may underestimate time spent on the EHR outside of scheduled clinic time. The Stanford team developed and refined a nonproprietary EHR use algorithm to track the number of hours a physician spends logged into the EHR and calculates the Clinician Logged-in Outside Clinic (CLOC) time, the number of hours spent by a physician on the EHR outside of allocated time for patient care. Objective The objective of our study was to measure the association between CLOC metrics and validated measures of physician burnout and professional fulfillment. Methods Physicians from adult outpatient Internal Medicine, Neurology, Dermatology, Hematology, Oncology, Rheumatology, and Endocrinology departments who logged more than 8 hours of scheduled clinic time per week and answered the annual wellness survey administered in Spring 2019 were included in the analysis. Results We observed a statistically significant positive correlation between CLOC ratio (defined as the ratio of CLOC time to allocated time for patient care) and work exhaustion (Pearson's r = 0.14; p = 0.04), but not interpersonal disengagement, burnout, or professional fulfillment. Conclusion The CLOC metrics are potential objective EHR activity-based markers associated with physician work exhaustion. Our results suggest that the impact of time spent on EHR, while associated with exhaustion, does not appear to be a dominant factor driving the high rates of occupational burnout in physicians.

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