The Impact of the Transition to an Electronic Medical Record on Patient Perceptions in a Pediatric Ophthalmology Practice

Abstract Objectives Given the importance of onboarding education in ensuring the safety and efficiency of medical users in the electronic medical record (EMR), we re-designed our EMR curriculum to incorporate adult learning principles, informed and delivered by peers. We aimed to evaluate the impact of these changes based on their satisfaction with the training. Methods A single site pre- and post-observational study measured satisfaction scores (four questions) from junior doctors attending EMR onboarding education in 2018 (pre-implementation) compared with 2019 (post-implementation). An additional four questions were asked in the post-implementation survey. All questions employed a Likert scale (1–5) with an opportunity for free-text. Raw data were used to calculate averages, standard deviations and the student t-test was used to compare the two cohorts where applicable. Results There were a total of 98 respondents in 2018 (pre-implementation) and 119 in 2019 (post-implementation). Satisfaction increased from 3.8/5 to 4.5/5 (p < 0.0001) following implementation of a peer-delivered curriculum in line with adult learning practices. The highest-rated factors were being taught by other doctors (4.9/5) and doctors having the appropriate knowledge to deliver training (4.9/5). Ninety-two percent of junior doctors were motivated to engage in further EMR education and 90% felt classroom support was adequate. Conclusion EMR onboarding education for medical users is a critical ingredient to organizational safety and efficiency. An improvement in satisfaction ratings by junior doctors was demonstrated after significant re-design of the curriculum was informed and delivered by peers, in line with adult learning principles.

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The Impact of Implementation of Electronic Medical Record on the Practice

10.1055/s-0041-1730674 ◽

2018 ◽

Author(s):

Khalid Othman ◽

Omar Bashir ◽

Mohammed Arabi

Keyword(s):

Medical Record ◽

Electronic Medical Record ◽

The Impact

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United Kingdom Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group: report 4, real-world data on the impact of deprivation on the presentation of diabetic eye disease at hospital services

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-312568 ◽

2018 ◽

Vol 103 (6) ◽

pp. 837-843 ◽

Cited By ~ 8

Author(s):

Alastair K Denniston ◽

Aaron Y Lee ◽

Cecilia S Lee ◽

David P Crabb ◽

Clare Bailey ◽

...

Keyword(s):

Visual Acuity ◽

Diabetic Retinopathy ◽

Medical Record ◽

Electronic Medical Record ◽

Real World ◽

Eye Disease ◽

Inclusion Criteria ◽

Data Set ◽

Diabetic Eye Disease ◽

The Impact

AimTo assess the impact of deprivation on diabetic retinopathy presentation and related treatment interventions, as observed within the UK hospital eye service.MethodsThis is a multicentre, national diabetic retinopathy database study with anonymised data extraction across 22 centres from an electronic medical record system. The following were the inclusion criteria: all patients with diabetes and a recorded, structured diabetic retinopathy grade. The minimum data set included, for baseline, age and Index of Multiple Deprivation, based on residential postcode; and for all time points, visual acuity, ETDRS grading of retinopathy and maculopathy, and interventions (laser, intravitreal therapies and surgery). The main outcome measures were (1) visual acuity and binocular visual state, and (2) presence of sight-threatening complications and need for early treatment.Results79 775 patients met the inclusion criteria. Deprivation was associated with later presentation in patients with diabetic eye disease: the OR of being sight-impaired at entry into the hospital eye service (defined as 6/18 to better than 3/60 in the better seeing eye) was 1.29 (95% CI 1.20 to 1.39) for the most deprived decile vs 0.77 (95% CI 0.70 to 0.86) for the least deprived decile; the OR for being severely sight-impaired (3/60 or worse in the better seeing eye) was 1.17 (95% CI 0.90 to 1.55) for the most deprived decile vs 0.88 (95% CI 0.61 to 1.27) for the least deprived decile (reference=fifth decile in all cases). There is also variation in sight-threatening complications at presentation and treatment undertaken: the least deprived deciles had lower chance of having a tractional retinal detachment (OR=0.48 and 0.58 for deciles 9 and 10, 95% CI 0.24 to 0.90 and 0.29 to 1.09, respectively); in terms of accessing treatment, the rate of having a vitrectomy was lowest in the most deprived cohort (OR=0.34, 95% CI 0.19 to 0.58).ConclusionsThis large real-world study suggests that first presentation at a hospital eye clinic with visual loss or sight-threatening diabetic eye disease is associated with deprivation. These initial hospital visits represent the first opportunities to receive treatment and to formally engage with support services. Such patients are more likely to be sight-impaired or severely sight-impaired at presentation, and may need additional resources to engage with the hospital eye services over complex treatment schedules.

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An Objective Study of the Impact of the Electronic Medical Record on Outcomes in Trauma Patients

The American Surgeon ◽

10.1177/000313481207801134 ◽

2012 ◽

Vol 78 (11) ◽

pp. 1249-1254 ◽

Cited By ~ 4

Author(s):

Paul J. Schenarts ◽

Claudia E. Goettler ◽

Michael A. White ◽

Brett H. Waibel

Keyword(s):

Length Of Stay ◽

Medical Record ◽

Electronic Medical Record ◽

Injury Severity ◽

Unit Length ◽

Traumatic Injury ◽

Hospital Length Of Stay ◽

Trauma Patients ◽

Delay In Diagnosis ◽

The Impact

It is commonly believed that the electronic medical record (EMR) will improve patient outcomes. However, there is scant published literature to support this claim and no studies in any surgical population. Our hypothesis was that the EMR would not improve objective outcome measures in patients with traumatic injury. Prospectively collected data from our university-based Level I trauma center was retrospectively reviewed. Demographic, injury severity as well as outcomes and complications data were compared for all patients admitted over a 20-month period before introduction of the EMR and a 20-month period after full, hospital-wide use of the EMR. Implementation of the EMR was associated with a decreased hospital length of stay, P = 0.02; intensive care unit length of stay, P = 0.001; ventilator days, P = 0.002; acute respiratory distress syndrome, P = 0.006, pneumonia, P = 0.008; myocardial infarction, P = 0.001; line infection, P = 0.03; septicemia, P = 0.000; renal failure, P = 0.000; drug complication, P = 0.001; and delay in diagnosis, P = 0.04. There was no difference in mortality, unexpected cardiac arrest, missed injury, pulmonary embolism/deep vein thrombosis, or late urinary tract infection. This is the first study to investigate the impact of the EMR in surgical patients. Although there was an improvement in some complications, the overall impact was inconsistent.

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Dietetics in the digital age: The impact of an electronic medical record on a tertiary hospital dietetic department

Nutrition & Dietetics ◽

10.1111/1747-0080.12552 ◽

2019 ◽

Vol 76 (4) ◽

pp. 480-485 ◽

Cited By ~ 4

Author(s):

Jordan McCamley ◽

Angela Vivanti ◽

Sisira Edirippulige

Keyword(s):

Medical Record ◽

Electronic Medical Record ◽

Digital Age ◽

Tertiary Hospital ◽

The Impact

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Impact of interoperability of smart infusion pumps and an electronic medical record in critical care

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxaa164 ◽

2020 ◽

Vol 77 (15) ◽

pp. 1231-1236

Author(s):

Roy Joseph ◽

Sang Weon Lee ◽

Scott V Anderson ◽

Matthew J Morrisette

Keyword(s):

Medical Record ◽

Electronic Medical Record ◽

Infusion Pump ◽

Medication Administration ◽

Absolute Difference ◽

Infusion Pumps ◽

Adult Intensive Care Unit ◽

Incremental Value ◽

The Impact ◽

Smart Pump

Abstract Purpose To describe the benefits of smart infusion pump interoperability with an electronic medical record (EMR) system in an adult intensive care unit (ICU) setting. Summary In order to assess the impact of smart infusion pump and EMR interoperability, we observed whether there were changes in the frequency of electronic medication administration record (eMAR) documentation of dose titrations in epinephrine and norepinephrine infusions in the ICU setting. As a secondary endpoint, we examined whether smart pump/EMR interoperability had any impact on the rate of alerts triggered by the dose-error reduction software. Pharmacist satisfaction was measured to determine the impact of smart pump/EMR interoperability on pharmacist workflow. In the preimplementation phase, there were a total of 2,503 administrations of epinephrine and norepinephrine; 13,299 rate changes were documented, for an average of 5.31 documented rate changes per administration. With smart pump interoperability, a total of 13,024 rate changes were documented in association with 1,401 administrations, for an average of 9.29 documented rate changes per administration (a 74.9% increase). A total of 1,526 dose alerts were triggered in association with 76,145 infusions in the preimplementation phase; there were 820 dose alerts associated with 48,758 autoprogammed infusions in the postimplementation phase (absolute difference, –0.32%). ICU pharmacists largely agreed (75% of survey respondents) that the technology provided incremental value in providing patient care. Conclusion Interoperability between the smart pump and EMR systems proved beneficial in the administration and monitoring of continuous infusions in the ICU setting. Additionally, ICU pharmacists may be positively impacted by improved clinical data accuracy and operational efficiency.

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How an Electronic Medical Record System Facilitates and Demonstrates Effective Psychosocial Screening in Pediatric Primary Care

Clinical Pediatrics ◽

10.1177/0009922819892038 ◽

2019 ◽

Vol 59 (2) ◽

pp. 154-162

Author(s):

Alexy Arauz-Boudreau ◽

Alexa Riobueno-Naylor ◽

Haregnesh Haile ◽

Juliana M. Holcomb ◽

Cara M. Lucke ◽

...

Keyword(s):

Medical Record ◽

Electronic Medical Record ◽

Electronic System ◽

Electronic Medical Record System ◽

Administrative Claims ◽

Record System ◽

Psychosocial Screening ◽

Medical Record System ◽

The Impact

Using questionnaires, administrative claims, and chart review data, the current study explored the impact of using an electronic medical record system to administer, score, and store the Pediatric Symptom Checklist (PSC-17) during annual pediatric well-child visits. Within a sample of 1773 Medicaid-insured outpatients, the electronic system demonstrated that 90.5% of cases completed a PSC-17 screen electronically, billing codes indicating a screen was administered agreed with the existence of a questionnaire in the chart in 98.8% of cases, the classification of risk based on PSC-17 scores agreed with the classification of risk based on the Current Procedural Terminology code modifiers in 72.9% of cases, and 90.0% of clinicians’ progress notes mentioned PSC-17 score in treatment planning. Using an electronic approach to psychosocial screening in pediatrics facilitated the use of screening information gathered during the clinical visit and allowed for enhanced tracking of outcomes and quality monitoring.

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Assessing the impact of a targeted electronic medical record intervention on growth factor usage in cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.30_suppl.262 ◽

2014 ◽

Vol 32 (30_suppl) ◽

pp. 262-262

Author(s):

Jordan Bernens ◽

Kara Hartman ◽

Brendan F. Curley ◽

Sijin Wen ◽

Jame Abraham ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Febrile Neutropenia ◽

Cancer Patients ◽

Medical Record ◽

Electronic Medical Record ◽

Low Risk ◽

Individual Risk ◽

Individual Risk Factors ◽

The Impact

262 Background: Patients receiving chemotherapy are at risk for febrile neutropenia following treatment. The American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) recommend screening patients for risk of febrile neutropenia and risk stratification based on likelihood of febrile neutropenia events. Prophylactic growth factors (G-CSF) should be in patients receiving high-risk regimens or intermediate-risk regimens with individual risk factors. The impact of electronic medical record system (EMR) implementation on compliance with G-CSF support guidelines has not been studied. Methods: At West Virginia University/Mary Babb Randolph Cancer Center we conducted an IRB approved retrospective chart review of cancer patients receiving chemotherapy from January 1, 2007 to August 1, 2008 (pre-EMR) and January 1, 2011 to December 31, 2011 (post-EMR). We reviewed the chemotherapy regimens and patient risk factors for developing febrile neutropenia, and determined if the G-CSF usage was consistent with guideline recommendations. Results: Compliance with prophylactic G-CSF guidelines was 75.6% in the post-EMR arm, compared to 67.5% in the pre-EMR arm (p=0.041, ch-square). The post EMR data of 1,042 new chemotherapy initiations showed: (see Table). The appropriateness of usage in high and low risk patients were the most compliant, as G-CSF orders were built into chemotherapy plans of high risk regimens and omitted from low risk regimens. Conclusions: Appropriate prophylactic G-CSF usage can be improved when orders are integrated into standard chemotherapy order sets in an EMR. An area of further improvement would include automatic identification of individual risk factors by the EMR. [Table: see text]

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