scholarly journals PS1-26: Use of an Electronic Health Record to Facilitate the Enrollment of Patients in Prospective Randomized Clinical Trials: Lessons Learned from STABILITY Trial

2010 ◽  
Vol 8 (3-4) ◽  
pp. 185-186
Author(s):  
Y. M. Henry ◽  
K. W. Evans ◽  
V. Harkins ◽  
Y. Mahmud ◽  
P. Berger
Keyword(s):  
Clinical Trials ◽  
Electronic Health Record ◽  
Randomized Clinical Trials ◽  
Lessons Learned ◽  
Health Record ◽  
Electronic Health

scholarly journals Diabetes and Hypertension Quality Measurement in Four Safety-Net Sites

2014 ◽  
Vol 05 (03) ◽  
pp. 757-772 ◽  
Author(s):  
R. Benkert ◽  
P. Dennehy ◽  
J. White ◽  
A. Hamilton ◽  
C. Tanner ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Quality Measurement ◽  
Safety Net ◽  
Lessons Learned ◽  
Health Record ◽  
Partnership Model ◽  
Safety Net Clinics ◽  
Electronic Health ◽  
Query Algorithms

SummaryBackground: In this new era after the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, the literature on lessons learned with electronic health record (EHR) implementation needs to be revisited.Objectives: Our objective was to describe what implementation of a commercially available EHR with built-in quality query algorithms showed us about our care for diabetes and hypertension populations in four safety net clinics, specifically feasibility of data retrieval, measurements over time, quality of data, and how our teams used this data.Methods: A cross-sectional study was conducted from October 2008 to October 2012 in four safety-net clinics located in the Midwest and Western United States. A data warehouse that stores data from across the U.S was utilized for data extraction from patients with diabetes or hypertension diagnoses and at least two office visits per year. Standard quality measures were collected over a period of two to four years. All sites were engaged in a partnership model with the IT staff and a shared learning process to enhance the use of the quality metrics.Results: While use of the algorithms was feasible across sites, challenges occurred when attempting to use the query results for research purposes. There was wide variation of both process and outcome results by individual centers. Composite calculations balanced out the differences seen in the individual measures. Despite using consistent quality definitions, the differences across centers had an impact on numerators and denominators. All sites agreed to a partnership model of EHR implementation, and each center utilized the available resources of the partnership for Center-specific quality initiatives.Conclusions: Utilizing a shared EHR, a Regional Extension Center-like partnership model, and similar quality query algorithms allowed safety-net clinics to benchmark and improve the quality of care across differing patient populations and health care delivery models.Citation: Benkert R, Dennehy P, White J, Hamilton A, Tanner C, Pohl JM. Diabetes and hypertension quality measurement in four safety-net sites: Lessons learned after implementation of the same commercial electronic health record. Appl Clin Inf 2014; 5: 757–772http://dx.doi.org/10.4338/ACI-2014-03-RA-0019

scholarly journals Phenotyping issues for exploring electronic health records to design clinical trials

2020 ◽  
Vol 17 (4) ◽  
pp. 402-404
Author(s):  
Jill Schnall ◽  
LingJiao Zhang ◽  
Jinbo Chen
Keyword(s):  
Clinical Trials ◽  
Electronic Health Records ◽  
Electronic Health Record ◽  
Statistical Methods ◽  
Gold Standard ◽  
The Other ◽  
Health Record ◽  
Health Records ◽  
Electronic Health ◽  
Downstream Analysis

For utilizing electronic health records to help design and conduct clinical trials, an essential first step is to select eligible patients from electronic health records, that is, electronic health record phenotyping. We present two novel statistical methods that can be used in the context of electronic health record phenotyping. One mitigates the requirement for gold-standard control patients in developing phenotyping algorithms, and the other effectively corrects for bias in downstream analysis introduced by study samples contaminated by ineligible subjects.

scholarly journals Transition to a new electronic health record and pediatric medication safety: lessons learned in pediatrics within a large academic health system

2018 ◽  
Vol 25 (7) ◽  
pp. 848-854 ◽  
Author(s):  
Kimberly Whalen ◽  
Emily Lynch ◽  
Iman Moawad ◽  
Tanya John ◽  
Denise Lozowski ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Medication Safety ◽  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Lessons Learned ◽  
Future Research ◽  
Health Record ◽  
Electronic Health ◽  
Roll Out

Abstract Objective While the electronic health record (EHR) has become a standard of care, pediatric patients pose a unique set of risks in adult-oriented systems. We describe medication safety and implementation challenges and solutions in the pediatric population of a large academic center transitioning its EHR to Epic. Methods Examination of the roll-out of a new EHR in a mixed neonatal, pediatric and adult tertiary care center with staggered implementation. We followed the voluntarily reported medication error rate for the neonatal and pediatric subsets and specifically monitored the first 3 months after the roll-out of the new EHR. Data was reviewed and compiled by theme. Results After implementation, there was a 5-fold increase in the overall number of medication safety reports; by the third month the rate of reported medication errors had returned to baseline. The majority of reports were near misses. Three major safety themes arose: (1) enterprise logic in rounding of doses and dosing volumes; (2) ordering clinician seeing a concentration and product when ordering medications; and (3) the need for standardized dosing units through age contexts created issues with continuous infusions and pump library safeguards. Conclusions Future research and work need to be focused on standards and guidelines on implementing an EHR that encompasses all age contexts.

scholarly journals Overcoming barriers to implementing patient-reported outcomes in an electronic health record: a case report

2015 ◽  
Vol 23 (1) ◽  
pp. 74-79 ◽  
Author(s):  
Christopher A Harle ◽  
Alyson Listhaus ◽  
Constanza M Covarrubias ◽  
Siegfried OF Schmidt ◽  
Sean Mackey ◽  
...  
Keyword(s):  
Case Report ◽  
Electronic Health Record ◽  
Patient Reported Outcomes ◽  
System Development ◽  
Lessons Learned ◽  
Health Record ◽  
Patient Reported ◽  
Electronic Health ◽  
Clinical Tools ◽  
The Right

Abstract In this case report, the authors describe the implementation of a system for collecting patient-reported outcomes and integrating results in an electronic health record. The objective was to identify lessons learned in overcoming barriers to collecting and integrating patient-reported outcomes in an electronic health record. The authors analyzed qualitative data in 42 documents collected from system development meetings, written feedback from users, and clinical observations with practice staff, providers, and patients. Guided by the Unified Theory on the Adoption and Use of Information Technology, 5 emergent themes were identified. Two barriers emerged: (i) uncertain clinical benefit and (ii) time, work flow, and effort constraints. Three facilitators emerged: (iii) process automation, (iv) usable system interfaces, and (v) collecting patient-reported outcomes for the right patient at the right time. For electronic health record-integrated patient-reported outcomes to succeed as useful clinical tools, system designers must ensure the clinical relevance of the information being collected while minimizing provider, staff, and patient burden.

scholarly journals Establishing an electronic health record–supported approach for outreach to and recruitment of persons at high risk of type 2 diabetes in clinical trials: The vitamin D and type 2 diabetes (D2d) study experience

2019 ◽  
Vol 16 (3) ◽  
pp. 306-315 ◽  
Author(s):  
Vanita R Aroda ◽  
Patricia R Sheehan ◽  
Ellen M Vickery ◽  
Myrlene A Staten ◽  
Erin S LeBlanc ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Vitamin D ◽  
Clinical Trials ◽  
Electronic Health Record ◽  
System Level ◽  
Health Record ◽  
Recruitment Methods ◽  
Clinical Environments ◽  
Electronic Health

Aims To establish recruitment approaches that leverage electronic health records in multicenter prediabetes/diabetes clinical trials and compare recruitment outcomes between electronic health record–supported and conventional recruitment methods. Methods Observational analysis of recruitment approaches in the vitamin D and type 2 diabetes (D2d) study, a multicenter trial in participants with prediabetes. Outcomes were adoption of electronic health record–supported recruitment approaches by sites, number of participants screened, recruitment performance (proportion screened who were randomized), and characteristics of participants from electronic health record–supported versus non–electronic health record methods. Results In total, 2423 participants were randomized: 1920 from electronic health record (mean age of 60 years, 41% women, 68% White) and 503 from non–electronic health record sources (mean age of 56.9 years, 58% women, 61% White). Electronic health record–supported recruitment was adopted by 21 of 22 sites. Electronic health record–supported recruitment was associated with more participants screened versus non–electronic health record methods (4969 vs 2166 participants screened), higher performance (38.6% vs 22.7%), and more randomizations (1918 vs 505). Participants recruited via electronic health record were older, included fewer women and minorities, and reported higher use of dietary supplements. Electronic health record–supported recruitment was incorporated in diverse clinical environments, engaging clinicians either at the individual or the healthcare system level. Conclusion Establishing electronic health record–supported recruitment approaches across a multicenter prediabetes/diabetes trial is feasible and can be adopted by diverse clinical environments.

Electronic health record technology designed for the clinical encounter: MS neuroSHARE

2020 ◽  
pp. 10.1212/CPJ.0000000000000986
Author(s):  
Riley Bove ◽  
Christa A. Bruce ◽  
Chelsea K. Lunders ◽  
Jennifer R. Pearce ◽  
Jacqueline Liu ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Web Application ◽  
Care Delivery ◽  
Digital Health ◽  
Lessons Learned ◽  
Advisory Group ◽  
Health Record ◽  
Design Development ◽  
Design And Implementation ◽  
Electronic Health

ABSTRACTObjectives:Advances in medical discoveries have bolstered expectations of precise and complete care, but delivering on such a promise for complex, chronic neurological care delivery requires solving last-mile challenges. We describe the iterative human-centered design and pilot process for MS neuroSHARE, a digital health solution that brings practical information to the point-of-care so clinicians and patients with multiple sclerosis (MS) can view, discuss and make informed decisions together.Methods:We initiated a comprehensive human-centered process to iteratively design, develop and implement a digital health solution for managing MS in the routine outpatient setting of the nonprofit Sutter Health system in Northern California. The human-centered co-design process included three phases: Discovery and Design, Development, and Implementation and Pilot. Stakeholders included Sutter Health’s Research Development and Dissemination team, academic domain experts, neurologists, patients with MS, and an Advisory Group.Results:MS neuroSHARE went live in November 2018. It included a patient- and clinician-facing web application that launches from the electronic health record, visually displays a patient’s data relevant to MS, and prompts the clinician to comprehensively evaluate and treat the patient. Both patients and clinicians valued the ability to jointly view patient-generated and other data. Preliminary results suggest that MS neuroSHARE promotes patient-clinician communication and more active patient participation in decision-making.Conclusions:Lessons learned in the design and implementation of MS NeuroSHARE are broadly applicable to the design and implementation of digital tools aiming to improve the experience of delivering and receiving high-quality care for complex, neurological conditions across large health systems.

Sign in / Sign up

Export Citation Format

Share Document