scholarly journals Genomic Information for Clinicians in the Electronic Health Record: Lessons Learned from ClinGen and eMERGE

2019 ◽  
Author(s):  
Marc S Williams ◽  
Casey Overby Taylor ◽  
Nephi A Walton ◽  
Scott R Goehringer ◽  
Samuel Aronson ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Clinical Decision Making ◽  
Clinical Care ◽  
Genomic Medicine ◽  
Clinical Decision ◽  
Lessons Learned ◽  
Health Record ◽  
Sustainable Solutions ◽  
Electronic Health ◽  
Credible Information

Genomic knowledge is being translated into clinical care. To fully realize the value, it is critical to place credible information in the hands of clinicians in time to support clinical decision-making. The electronic health record is an essential component of clinician workflow. Utilizing the electronic health record to present information to support the use of genomic medicine in clinical care to improve outcomes represents a tremendous opportunity. However, there are numerous barriers that prevent the effective use of the electronic health record for this purpose. The electronic health record working groups of the electronic MEdical Records and GEnomics network (eMERGE) and the Clinical Genome Resource (ClinGen) project, along with other groups, have been defining these barriers, to allow the development of solutions that can be tested using implementation pilots. In this paper, we present ‘lessons learned’ from these efforts to inform future efforts leading to the development of effective and sustainable solutions that will support the realization of genomic medicine.

scholarly journals The development and electronic delivery of case-based learning using a fast healthcare interoperability resource system

JAMIA Open ◽  
2019 ◽  
Vol 2 (4) ◽  
pp. 440-446
Author(s):  
Mark L Braunstein ◽  
Iulia Oancea ◽  
Benjamin K Barry ◽  
Sharon Darlington ◽  
Jim Steel ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Clinical Decision Making ◽  
Application Programming Interface ◽  
Clinical Decision ◽  
Health Record ◽  
Record System ◽  
Case Based Learning ◽  
Electronic Health ◽  
Electronic Delivery ◽  
Case Based

Abstract HL7 International’s Fast Healthcare Interoperability Resources (FHIR) standard provides a common format for sharing health data (eg, FHIR resources) and a RESTful Application Programming Interface (eg, FHIR API) for accessing those resources via a FHIR server connected to an electronic health record system or any other system storing clinical data. Substitutable Medical Applications and Reusable Technologies (SMART) leverages FHIR to create an electronic health record (EHR) agnostic app platform. It utilizes the OAuth standard to provide for authorization and authentication. This paper describes the development and informal evaluation of Case Based Learning on FHIR (CBL on FHIR), a prototype EHR-connected FHIR/SMART platform to provide interactive digital cases for use in medical education. The project goals were to provide a more interactive form of CBL than is possible on paper to more realistically simulate clinical decision making and to expose medical students to modern informatics systems and tools for use in patient care.

scholarly journals Electronic health record: integrating evidence-based information at the point of clinical decision making

2014 ◽  
Vol 102 (1) ◽  
pp. 52-55 ◽  
Author(s):  
Susan A. Fowler ◽  
Lauren H. Yaeger ◽  
Feliciano Yu ◽  
Dwight Doerhoff ◽  
Paul Schoening ◽  
...  
Keyword(s):  
Decision Making ◽  
Electronic Health Record ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Based ◽  
Health Record ◽  
Electronic Health

scholarly journals Integrating pharmacogenomics into the electronic health record by implementing genomic indicators

2019 ◽  
Vol 27 (1) ◽  
pp. 154-158 ◽  
Author(s):  
Pedro J Caraballo ◽  
Joseph A Sutton ◽  
Jyothsna Giri ◽  
Jessica A Wright ◽  
Wayne T Nicholson ◽  
...  
Keyword(s):  
Decision Support ◽  
Electronic Health Record ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Automatic Generation ◽  
Lessons Learned ◽  
Health Record ◽  
Laboratory Report ◽  
Individualized Care ◽  
Electronic Health

Abstract Pharmacogenomics (PGx) clinical decision support integrated into the electronic health record (EHR) has the potential to provide relevant knowledge to clinicians to enable individualized care. However, past experience implementing PGx clinical decision support into multiple EHR platforms has identified important clinical, procedural, and technical challenges. Commercial EHRs have been widely criticized for the lack of readiness to implement precision medicine. Herein, we share our experiences and lessons learned implementing new EHR functionality charting PGx phenotypes in a unique repository, genomic indicators, instead of using the problem or allergy list. The Gen-Ind has additional features including a brief description of the clinical impact, a hyperlink to the original laboratory report, and links to additional educational resources. The automatic generation of genomic indicators from interfaced PGx test results facilitates implementation and long-term maintenance of PGx data in the EHR and can be used as criteria for synchronous and asynchronous CDS.

scholarly journals Implementation of the Randomized Embedded Multifactorial Adaptive Platform for COVID-19 (REMAP-COVID) trial in a US health system—lessons learned and recommendations

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Keyword(s):  
Electronic Health Record ◽  
Health System ◽  
Clinical Care ◽  
Regulatory Compliance ◽  
Lessons Learned ◽  
Health Record ◽  
Trial Management ◽  
Learning Health System ◽  
Management Procedures ◽  
Electronic Health

Abstract Background The Randomized Embedded Multifactorial Adaptive Platform for COVID-19 (REMAP-COVID) trial is a global adaptive platform trial of hospitalized patients with COVID-19. We describe implementation at the first US site, the UPMC health system, and offer recommendations for implementation at other sites. Methods To implement REMAP-COVID, we focused on six major areas: engaging leadership, trial embedment, remote consent and enrollment, regulatory compliance, modification of traditional trial management procedures, and alignment with other COVID-19 studies. Results We recommend aligning institutional and trial goals and sharing a vision of REMAP-COVID implementation as groundwork for learning health system development. Embedment of trial procedures into routine care processes, existing institutional structures, and the electronic health record promotes efficiency and integration of clinical care and clinical research. Remote consent and enrollment can be facilitated by engaging bedside providers and leveraging institutional videoconferencing tools. Coordination with the central institutional review board will expedite the approval process. Protocol adherence, adverse event monitoring, and data collection and export can be facilitated by building electronic health record processes, though implementation can start using traditional clinical trial tools. Lastly, establishment of a centralized institutional process optimizes coordination of COVID-19 studies. Conclusions Implementation of the REMAP-COVID trial within a large US healthcare system is feasible and facilitated by multidisciplinary collaboration. This investment establishes important groundwork for future learning health system endeavors. Trial registration NCT02735707. Registered on 13 April 2016.

scholarly journals Establishing a multidisciplinary initiative for interoperable electronic health record innovations at an academic medical center

JAMIA Open ◽  
2021 ◽  
Vol 4 (3) ◽  
Author(s):  
Kensaku Kawamoto ◽  
Polina V Kukhareva ◽  
Charlene Weir ◽  
Michael C Flynn ◽  
Claude J Nanjo ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
User Satisfaction ◽  
Clinical Care ◽  
Academic Medical Center ◽  
Critical Role ◽  
Lessons Learned ◽  
Evaluation Framework ◽  
Health Record ◽  
Digital Innovation ◽  
Electronic Health

Abstract Objective To establish an enterprise initiative for improving health and health care through interoperable electronic health record (EHR) innovations. Materials and Methods We developed a unifying mission and vision, established multidisciplinary governance, and formulated a strategic plan. Key elements of our strategy include establishing a world-class team; creating shared infrastructure to support individual innovations; developing and implementing innovations with high anticipated impact and a clear path to adoption; incorporating best practices such as the use of Fast Healthcare Interoperability Resources (FHIR) and related interoperability standards; and maximizing synergies across research and operations and with partner organizations. Results University of Utah Health launched the ReImagine EHR initiative in 2016. Supportive infrastructure developed by the initiative include various FHIR-related tooling and a systematic evaluation framework. More than 10 EHR-integrated digital innovations have been implemented to support preventive care, shared decision-making, chronic disease management, and acute clinical care. Initial evaluations of these innovations have demonstrated positive impact on user satisfaction, provider efficiency, and compliance with evidence-based guidelines. Return on investment has included improvements in care; over $35 million in external grant funding; commercial opportunities; and increased ability to adapt to a changing healthcare landscape. Discussion Key lessons learned include the value of investing in digital innovation initiatives leveraging FHIR; the importance of supportive infrastructure for accelerating innovation; and the critical role of user-centered design, implementation science, and evaluation. Conclusion EHR-integrated digital innovation initiatives can be key assets for enhancing the EHR user experience, improving patient care, and reducing provider burnout.

scholarly journals Dissemination of child abuse clinical decision support: Moving beyond a single electronic health record

2021 ◽  
Vol 147 ◽  
pp. 104349
Author(s):  
Thomas McGinn ◽  
David A. Feldstein ◽  
Isabel Barata ◽  
Emily Heineman ◽  
Joshua Ross ◽  
...  
Keyword(s):  
Child Abuse ◽  
Decision Support ◽  
Electronic Health Record ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Health Record ◽  
Electronic Health
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