AIRA, an Artificial Intelligence Realistic Assistant that will save your time, a before-and-after study during Pandemic (Preprint)

2021 ◽  
Author(s):  
Kaio Bin ◽  
Adler Araújo Ribeiro Melo ◽  
José Guilherme Franco Da Rocha ◽  
Renata Pivi De Almeida ◽  
Vilson Cobello Junior ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Electronic Health Record ◽  
Medical Care ◽  
Health Screening ◽  
Urgent Care ◽  
Health Record ◽  
Before And After ◽  
Electronic Health ◽  
The Impact ◽  
Before And After Study

BACKGROUND AIRA is an AI designed to reduce the time that doctors dedicate filling out EHR, winner of the first edition of MIT Hacking Medicine held in Brazil in 2020. As a proof of concept, AIRA was implemented in administrative process before its application in a medical process. OBJECTIVE The aim of the study is to determinate the impact of AIRA by eliminating the Medical Care Registration (MCR) on Electronic Health Record (EHR) by Administrative Officer. METHODS This is a comparative before-and-after study following the guidance “Evaluating digital health products” from Public Health England. An Artificial Intelligence named AIRA was created and implemented at CEAC (Employee Attention Center) from HCFMUSP. A total of 25,507 attendances were evaluated along 2020 for determinate AIRA´s impact. Total of MCR, time of health screening and time between the end of the screening and the beginning of medical care, were compared in the pre and post AIRA periods. RESULTS AIRA eliminated the need for Medical Care Registration by Administrative Officer in 92% (p<0.0001). The nurse´s time of health screening increased 16% (p<0.0001) during the implementation, and 13% (p<0.0001) until three months after the implementation, but reduced in 4% three months after implementation (p<0.0001). The mean and median total time to Medical Care after the nurse’ Screening was decreased in 30% (p<0.0001) and 41% (p<0.0001) respectively. CONCLUSIONS The implementation of AIRA reduced the time to medical care in an urgent care after the nurse´ screening, by eliminating non-value-added activity the Medical Care Registration on Electronic Health Record (EHR) by Administrative Officer.

scholarly journals The Benefits and Challenges of an Interfaced Electronic Health Record and Laboratory Information System: Effects on Laboratory Processes

2017 ◽  
Vol 141 (3) ◽  
pp. 410-417 ◽  
Author(s):  
Athena K. Petrides ◽  
Ida Bixho ◽  
Ellen M. Goonan ◽  
David W. Bates ◽  
Shimon Shaykevich ◽  
...  
Keyword(s):  
Information System ◽  
Electronic Health Record ◽  
Government Regulation ◽  
Turnaround Time ◽  
Health Record ◽  
Laboratory Information System ◽  
Before And After ◽  
Electronic Health ◽  
Ordered Data ◽  
The Impact

Context.— A recent government regulation incentivizes implementation of an electronic health record (EHR) with computerized order entry and structured results display. Many institutions have also chosen to interface their EHR with their laboratory information system (LIS). Objective.— To determine the impact of an interfaced EHR-LIS on laboratory processes. Design.— We analyzed several different processes before and after implementation of an interfaced EHR-LIS: the turnaround time, the number of stat specimens received, venipunctures per patient per day, preanalytic errors in phlebotomy, the number of add-on tests using a new electronic process, and the number of wrong test codes ordered. Data were gathered through the LIS and/or EHR. Results.— The turnaround time for potassium and hematocrit decreased significantly (P = .047 and P = .004, respectively). The number of stat orders also decreased significantly, from 40% to 7% for potassium and hematocrit, respectively (P &lt; .001 for both). Even though the average number of inpatient venipunctures per day increased from 1.38 to 1.62 (P &lt; .001), the average number of preanalytic errors per month decreased from 2.24 to 0.16 per 1000 specimens (P &lt; .001). Overall there was a 16% increase in add-on tests. The number of wrong test codes ordered was high and it was challenging for providers to correctly order some common tests. Conclusions.— An interfaced EHR-LIS significantly improved within-laboratory turnaround time and decreased stat requests and preanalytic phlebotomy errors. Despite increasing the number of add-on requests, an electronic add-on process increased efficiency and improved provider satisfaction. Laboratories implementing an interfaced EHR-LIS should be cautious of its effects on test ordering and patient venipunctures per day.

scholarly journals Impact of Homecare Electronic Health Record on Timeliness of Clinical Documentation, Reimbursement, and Patient Outcomes

2014 ◽  
Vol 05 (02) ◽  
pp. 445-462 ◽  
Author(s):  
K. H. Bowles ◽  
M. C. Adelsberger ◽  
J. L. Chittams ◽  
C. Liao ◽  
P. S. Sockolow
Keyword(s):  
Electronic Health Record ◽  
Patient Outcomes ◽  
Point Of Care ◽  
The United States ◽  
Health Record ◽  
Clinical Documentation ◽  
Billing Data ◽  
Before And After ◽  
Electronic Health ◽  
The Impact

SummaryBackground: Homecare is an important and effective way of managing chronic illnesses using skilled nursing care in the home. Unlike hospitals and ambulatory settings, clinicians visit patients at home at different times, independent of each other. Twenty-nine percent of 10,000 homecare agencies in the United States have adopted point-of-care EHRs. Yet, relatively little is known about the growing use of homecare EHRs.Objective: Researchers compared workflow, financial billing, and patient outcomes before and after implementation to evaluate the impact of a homecare point-of-care EHR.Methods: The design was a pre/post observational study embedded in a mixed methods study. The setting was a Philadelphia-based homecare agency with 137 clinicians. Data sources included: (1) clinician EHR documentation completion; (2) EHR usage data; (3) Medicare billing data; (4) an EHR Nurse Satisfaction survey; (5) clinician observations; (6) clinician interviews; and (7) patient outcomes.Results: Clinicians were satisfied with documentation timeliness and team communication. Following EHR implementation, 90% of notes were completed within the 1-day compliance interval (n = 56,702) compared with 30% of notes completed within the 7-day compliance interval in the pre-implementation period (n = 14,563; OR 19, p < .001). Productivity in the number of clinical notes documented post-implementation increased almost 10-fold compared to pre-implementation. Days to Medicare claims fell from 100 days pre-implementation to 30 days post-implementation, while the census rose. EHR implementation impact on patient outcomes was limited to some behavioral outcomes.Discussion: Findings from this homecare EHR study indicated clinician EHR use enabled a sustained increase in productivity of note completion, as well as timeliness of documentation and billing for reimbursement with limited impact on improving patient outcomes. As EHR adoption increases to better meet the needs of the growing population of older people with chronic health conditions, these results can inform homecare EHR development and implementation.Citation: Sockolow PS, Bowles KH, Adelsberger MC, Chittams JL, Liao C. Impact of homecare electronic health record on timeliness of clinical documentation, reimbursement, and patient outcomes. Appl Clin Inf 2014; 5: 445–462 http://dx.doi.org/10.4338/ACI-2013-12-RA-0106

scholarly journals Management of a parenteral opioid shortage using ASHP guidelines

2021 ◽  
Vol 78 (5) ◽  
pp. 426-435
Author(s):  
Peter Vo ◽  
Daniel A Sylvia ◽  
Loay Milibari ◽  
John Ryan Stackhouse ◽  
Paul Szumita ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Drug Product ◽  
Health Record ◽  
Large Hospital ◽  
Hospital Administrators ◽  
Utilization Data ◽  
Electronic Health ◽  
Opioid Medications ◽  
American Society ◽  
The Impact

Abstract Purpose Management of an acute shortage of parenteral opioid products at a large hospital through prescribing interventions and other guideline-recommended actions is described. Summary In early 2018, many hospitals were faced with a shortage of parenteral opioids that was predicted to last an entire year. The American Society of Health-System Pharmacists (ASHP) has published guidelines on managing drug product shortages. This article describes the application of these guidelines to manage the parenteral opioid shortage and the impact on opioid dispensing that occurred in 2018. Our approach paralleled that recommended in the ASHP guidelines. Daily dispensing reports generated from automated dispensing cabinets and from the electronic health record were used to capture dispenses of opioid medications. Opioid prescribing and utilization data were converted to morphine milligram equivalents (MME) to allow clinical leaders and hospital administrators to quickly evaluate opioid inventories and consumption. Action steps included utilization of substitute opioid therapies and conversion of opioid patient-controlled analgesia (PCA) and opioid infusions to intravenous bolus dose administration. Parenteral opioid supplies were successfully rationed so that surgical and elective procedures were not canceled or delayed. During the shortage, opioid dispensing decreased in the inpatient care areas from approximately 2.0 million MME to 1.4 million MME and in the operating rooms from 0.56 MME to 0.29 million MME. The combination of electronic health record alerts, increased utilization of intravenous acetaminophen and liposomal bupivacaine, and pharmacist interventions resulted in a 67% decline in PCA use and a 65% decline in opioid infusions. Conclusion A multidisciplinary response is necessary for effective management of drug shortages through implementation of strategies and practices for notifying clinicians of shortages and identifying optimal alternative therapies.

scholarly journals Estimating the Impact of Diabetes Mellitus on Worker Productivity Using Self-Report, Electronic Health Record and Human Resource Data

2018 ◽  
Vol 60 (11) ◽  
pp. e569-e574 ◽  
Author(s):  
David C. Tabano ◽  
Melissa L. Anderson ◽  
Debra P. Ritzwoller ◽  
Arne Beck ◽  
Nikki Carroll ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Electronic Health Record ◽  
Human Resource ◽  
Self Report ◽  
Health Record ◽  
Worker Productivity ◽  
Electronic Health ◽  
Resource Data ◽  
The Impact

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 Opinions, perceptions and attitudes toward an electronic health record system among practicing nurses

2017 ◽  
Vol 8 (3) ◽  
pp. 12
Author(s):  
Ahmad H. Abu Raddaha ◽  
Arwa Obeidat ◽  
Huda Al Awaisi ◽  
Jahara Hayudini
Keyword(s):  
Electronic Health Record ◽  
Clinical Information System ◽  
Research Work ◽  
Healthcare Delivery ◽  
Future Research ◽  
Health Record ◽  
Randomized Sampling ◽  
Positive Attitudes ◽  
Electronic Health ◽  
The Impact

Background: Despite worldwide expanding implementation of electronic health record (EHR) systems, healthcare professionals conducted limited number of studies to explore factors that might facilitate or jeopardize using these systems. This study underscores the impact of nurses’ opinions, perceptions, and computer competencies on their attitudes toward using an EHR system.Methods: With randomized sampling, a cross-sectional exploratory design was used. The sample consisted of 169 nurses who worked at a public teaching hospital in Oman. They completed self-administered questionnaire. Several standardized valid and reliable instruments were utilized.Results: Seventy-four percent of our study nurses had high positive attitudes toward the EHR system. The least ranked perception scores (60.4%) were linked to perceiving that suggestions made by nurses about the system would be taken into account. Nurses who reported that the hospital sought for suggestions for customization of the system [OR: 2.54 (95% CI: 1.09, 5.88), p = .03], who found the system as an easy-to-use clinical information system [OR: 6.53 (95% CI: 1.72, 24.75), p = .01], who reported the presence of good relationship with the system’s managing personnel [OR: 3.59 (95% CI: 1.13, 11.36), p = .03] and who reported that the system provided all needed health information [OR: 2.97 (95% CI: 1.16, 7.62), p = .02] were more likely to develop high positive attitudes toward the system.Conclusions: To better develop plans to foster the EHR system’s use facilitators and overcome its usage barriers by nursing professionals, more involvement of nurses in system’s customization endeavors is highly suggested. When the system did not disrupt workflows, it would decrease clinical errors and expand nursing productivity. In order to maximize the utilization of the system in healthcare delivery, future research work to investigate the effect of the system on other healthcare providers and inter-professional communications is pressingly needed.

scholarly journals Beyond Getting Rid of Stupid Stuff in the Electronic Health Record (Beyond-GROSS): Protocol for a User-Centered, Mixed-Method Intervention to Improve the Electronic Health Record System

10.2196/25148 ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. e25148
Author(s):  
Ahmed Umar Otokiti ◽  
Catherine K Craven ◽  
Avniel Shetreat-Klein ◽  
Stacey Cohen ◽  
Bruce Darrow
Keyword(s):  
Health Care ◽  
Data Analysis ◽  
Electronic Health Record ◽  
Health Record ◽  
User Centered Design ◽  
Pilot Phase ◽  
Direct Input ◽  
Electronic Health ◽  
The Impact ◽  
User Centered

Background Up to 60% of health care providers experience one or more symptoms of burnout. Perceived clinician burden resulting in burnout arises from factors such as electronic health record (EHR) usability or lack thereof, perceived loss of autonomy, and documentation burden leading to less clinical time with patients. Burnout can have detrimental effects on health care quality and contributes to increased medical errors, decreased patient satisfaction, substance use, workforce attrition, and suicide. Objective This project aims to improve the user-centered design of the EHR by obtaining direct input from clinicians about deficiencies. Fixing identified deficiencies via user-centered design has the potential to improve usability, thereby increasing satisfaction by reducing EHR-induced burnout. Methods Quantitative and qualitative data will be obtained from clinician EHR users. The input will be received through a form built in a REDCap database via a link embedded in the home page of the EHR. The REDCap data will be analyzed in 2 main dimensions, based on nature of the input, what section of the EHR is affected, and what is required to fix the issue(s). Identified issues will be escalated to relevant stakeholders responsible for rectifying the problems identified. Data analysis, project evaluation, and lessons learned from the evaluation will be incorporated in a Plan-Do-Study-Act (PDSA) manner every 4-6 weeks. Results The pilot phase of the study began in October 2020 in the Gastroenterology Division at Mount Sinai Hospital, New York City, NY, which includes 39 physicians and 15 nurses. The pilot is expected to run over a 4-6–month period. The results of the REDCap data analysis will be reported within 1 month of completing the pilot phase. We will analyze the nature of requests received and the impact of rectified issues on the clinician EHR user. We expect that the results will reveal which sections of the EHR have the highest deficiencies while also highlighting issues about workflow difficulties. Perceived impact of the project on provider engagement, patient safety, and workflow efficiency will also be captured by evaluation survey and other qualitative methods where possible. Conclusions The project aims to improve user-centered design of the EHR by soliciting direct input from clinician EHR users. The ultimate goal is to improve efficiency, reduce EHR inefficiencies with the possibility of improving staff engagement, and lessen EHR-induced clinician burnout. Our project implementation includes using informatics expertise to achieve the desired state of a learning health system as recommended by the National Academy of Medicine as we facilitate feedback loops and rapid cycles of improvement. International Registered Report Identifier (IRRID) PRR1-10.2196/25148

ED syphilis and gonorrhea/chlamydia cotesting practices before and after the implementation of an electronic health record-based alert

2021 ◽  
pp. emermed-2020-210331
Author(s):  
James S Ford ◽  
Tasleem Chechi ◽  
Michella Otmar ◽  
Melissa Baker ◽  
Sarah Waldman ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Underserved Populations ◽  
Cohort Analysis ◽  
Treponema Pallidum ◽  
Interrupted Time Series ◽  
Health Record ◽  
Interrupted Time Series Analysis ◽  
Syphilis Testing ◽  
Before And After ◽  
Electronic Health

BackgroundThe prevalence of syphilis is increasing in many countries, including the USA. The ED is often used by underserved populations, making it an important setting to test and treat patients who are not evaluated in outpatient clinical settings. We aimed to assess the utility of an ED-based syphilis and gonorrhoea/chlamydia cotesting protocol by comparing testing practices before and after its implementation.MethodsWe implemented an electronic health record (EHR) alert that prompted clinicians to order syphilis testing in patients undergoing gonorrhoea/chlamydia testing. We performed a retrospective cohort analysis that compared outcomes between the preimplementation period (January–November 2018) and the postimplementation period (January–November 2019). Patients were tested for Treponema pallidum antibody (TPA) using a multiplex flow immunoassay (MFI), and positive results were confirmed by rapid plasma reagin (RPR). The primary implementation outcome was the number of syphilis tests/month, and the primary clinical outcome was the number of syphilis diagnoses/month (defined as positive TPA MFI and RPR). We performed an interrupted time-series analysis to evaluate the effect of implementing the alert over time.ResultsFour-hundred and ninety-four and 1106 unique patients were tested for syphilis in the preimplementation and postimplementation periods, respectively. Syphilis testing increased by 55.6 tests/month (95% CI 45.9 to 65.3, p<0.001) following alert implementation. Patients tested in the postimplementation period who were tested using the alert were much younger (difference: 14 years (95% CI 12 to 15)) and were more likely to be female (difference: 15% (95% CI 8 to 21)) and African-American (difference: 11% (95% CI 5 to 17)) than patients tested by clinician-initiated testing. Presumptive syphilis diagnoses increased from 3.4 diagnoses/month to 7.9 diagnoses/month (difference, 4.5 (95% CI 2.2 to 6.9), p<0.001).ConclusionsOur study demonstrates that use of a targeted EHR alert testing protocol can increase syphilis testing and diagnosis and may reduce clinician bias in testing.

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