Examining Heterogeneous Patterns of Electronic Health Records Use

2012 ◽  
Vol 7 (2) ◽  
pp. 1-16 ◽  
Author(s):  
David D. Dobrzykowski
Keyword(s):  
Electronic Health Records ◽  
Healthcare Delivery ◽  
Teaching Hospitals ◽  
Structural Constraints ◽  
Health Records ◽  
Information Technology Managers ◽  
Hospital Executives ◽  
Major Teaching ◽  
Electronic Health ◽  
Technology Managers

The basic use of Electronic Health Records (EHR) and the progression toward advanced EHR applications are key concerns facing leaders interested in integrating the healthcare delivery supply chain. Currently, substantial heterogeneity exists among hospitals in terms of EHR use and the progression toward advanced EHR applications. Understanding this heterogeneity is important as hospitals face pressure to adopt and achieve meaningful use of the technology. Contingency theory is tested herein to suggest that a hospital’s structural constraints may explain the heterogeneity among hospitals in terms of their EHR use. Data collected from 297 acute care hospitals in 47 states reveals that critical access hospitals may be slow to use EHR, even in basic applications. Conversely, major teaching hospitals appear to be early adopters, achieving advanced EHR use. These findings are important for hospital executives, Health Information Technology managers, and policymakers concerned with directing resources with an aim toward EHR integration.

scholarly journals Recordkeeping Metadata Standardization for Electronic Health Records System Integration: a Preliminary Study

2018 ◽  
Vol 7 (3.7) ◽  
pp. 266
Author(s):  
Seri Intan Idayu Binti Shahrul Asari ◽  
Nurussobah Binti Hussin ◽  
Ahmad Zam Hariro Bin Samsudin ◽  
Mohd Nizam Bin Yunus
Keyword(s):  
Electronic Health Records ◽  
System Integration ◽  
Health Records ◽  
Metadata Standard ◽  
Information Technology Managers ◽  
Record Keeping ◽  
Recordkeeping System ◽  
Face To Face ◽  
Electronic Health ◽  
Technology Managers

Electronic Health Records (EHRs) are beneficial in improving patient care, promoting safe practice, as well as enhancing patients and multiple providers’ communication and risk error reduction. However, it seems that the adoption of EHR system is happening very slowly to become fully integrated in both primary care and within hospital settings. In Malaysia, the implemented system still has limited integration and interoperability for supporting clinical operations among other Ministry of Health Malaysia (MOHM) hospitals, health centres, and clinics. Therefore, the objective of this paper is to discuss about this scenario and strain the need for solution through the consideration towards metadata standard establishment in health records system integration. Method used in this study is literature review analysis and face-to-face interview. The paper begins with discussions from various literatures highlighting the need of metadata standard for recordkeeping system integration. Subsequently, the face-to-face interview is done to explore the real situation in Malaysia to encounter the scenario discuss in the literatures. The finding of this study reveals that there is significant need for further research on record keeping metadata standard development for realization of electronic health records system integration. This study is significant for records managers, information technology managers, system developers and record keeping audit.   

Handoff Communication and Electronic Health Records

2014 ◽  
Vol 3 (1) ◽  
pp. 162-169 ◽  
Author(s):  
Julie Apker ◽  
Christopher Beach ◽  
Kevin O’Leary ◽  
Jennifer Ptacek ◽  
Dickson Cheung ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Patient Care ◽  
Healthcare Delivery ◽  
Communication Style ◽  
Health Records ◽  
Practical Applications ◽  
Sensemaking Theory ◽  
Making Sense ◽  
Study Results ◽  
Electronic Health

When transferring patient care responsibilities across the healthcare continuum, clinicians strive to communicate safely and effectively, but communication failures exist that threaten patient safety. Although researchers are making great strides in understanding and solving intraservice handoff problems, inter-service transition communication remains underexplored. Further, electronic health records (EHRs) figure prominently in healthcare delivery, but less is known about how EHRs contribute to inter-service handoffs. This descriptive, qualitative study uses Sensemaking Theory to explore EHR-facilitated, inter-service handoffs occurring between emergency medicine and internal/hospitalist medicine physicians. The researchers conducted six focus groups with 16 attending physicians and medical residents at a major Midwestern academic hospital. Findings suggest clinicians hold varied expectations for information content and relational communication/style. Their expectations contribute to making sense of uncertain handoff situations and communication best practices. Participants generally perceive EHRs as tools that, when used appropriately, can enhance handoffs and patient care continuity. Ideas for practical applications are offered based on study results.

scholarly journals Use of Diagnosis Codes to Find Blood Transfusion Adverse Events in Electronic Health Records

2021 ◽  
Author(s):  
Roselie A. Bright ◽  
Susan J. Bright-Ponte ◽  
Lee Anne Palmer ◽  
Summer K. Rankin ◽  
Sergey Blok
Keyword(s):  
Adverse Events ◽  
Electronic Health Records ◽  
Study Data ◽  
Medical Product ◽  
Health Records ◽  
Packed Red Blood Cells ◽  
Diagnosis Codes ◽  
Major Teaching Hospital ◽  
Major Teaching ◽  
Electronic Health

ABSTRACTBackgroundElectronic health records (EHRs) and big data tools offer the opportunity for surveillance of adverse events (patient harm associated with medical care). We chose the case of transfusion adverse events (TAEs) and potential TAEs (PTAEs) because 1.) real dates were obscured in the study data, and 2.) there was emerging recognition of new types during the study data period.ObjectiveWe aimed to use the structured data in electronic health records (EHRs) to find TAEs and PTAEs among adults.MethodsWe used 49,331 adult admissions involving critical care at a major teaching hospital, 2001-2012, in the MIMIC-III EHRs database. We formed a T (defined as packed red blood cells, platelets, or plasma) group of 21,443 admissions vs. 25,468 comparison (C) admissions. The ICD-9-CM diagnosis codes were compared for T vs. C, described, and tested with statistical tools.ResultsTAEs such as transfusion associated circulatory overload (TACO; 12 T cases; rate ratio (RR) 15.61; 95% CI 2.49 to 98) were found. There were also PTAEs similar to TAEs, such as fluid overload disorder (361 T admissions; RR 2.24; 95% CI 1.88 to 2.65), similar to TACO. Some diagnoses could have been sequelae of TAEs, including nontraumatic compartment syndrome of abdomen (52 T cases; RR 6.76; 95% CI 3.40 to 14.9) possibly being a consequence of TACO.ConclusionsSurveillance for diagnosis codes that could be TAE sequelae or unrecognized TAE might be useful supplements to existing medical product adverse event programs.

scholarly journals Electronic health records and clinician burnout: A story of three eras

2020 ◽  
Author(s):  
Kevin B Johnson ◽  
Michael J Neuss ◽  
Don Eugene Detmer
Keyword(s):  
Electronic Health Records ◽  
Technology Policy ◽  
Healthcare Delivery ◽  
Medical Documentation ◽  
Health Records ◽  
Behavioral Determinants ◽  
System A ◽  
History Of ◽  
Electronic Health ◽  
Time Required

Abstract Objective The study sought to provide physicians, informaticians, and institutional policymakers with an introductory tutorial about the history of medical documentation, sources of clinician burnout, and opportunities to improve electronic health records (EHRs). We now have unprecedented opportunities in health care, with the promise of new cures, improved equity, greater sensitivity to social and behavioral determinants of health, and data-driven precision medicine all on the horizon. EHRs have succeeded in making many aspects of care safer and more reliable. Unfortunately, current limitations in EHR usability and problems with clinician burnout distract from these successes. A complex interplay of technology, policy, and healthcare delivery has contributed to our current frustrations with EHRs. Fortunately, there are opportunities to improve the EHR and health system. A stronger emphasis on improving the clinician’s experience through close collaboration by informaticians, clinicians, and vendors can combine with specific policy changes to address the causes of burnout. Target audience This tutorial is intended for clinicians, informaticians, policymakers, and regulators, who are essential participants in discussions focused on improving clinician burnout. Learners in biomedicine, regardless of clinical discipline, also may benefit from this primer and review. Scope We include (1) an overview of medical documentation from a historical perspective; (2) a summary of the forces converging over the past 20 years to develop and disseminate the modern EHR; and (3) future opportunities to improve EHR structure, function, user base, and time required to collect and extract information.

scholarly journals Electronic health records, communication, and data sharing: challenges and opportunities for improving the diagnostic process

Diagnosis ◽  
2019 ◽  
Vol 6 (3) ◽  
pp. 241-248 ◽  
Author(s):  
Martha Quinn ◽  
Jane Forman ◽  
Molly Harrod ◽  
Suzanne Winter ◽  
Karen E. Fowler ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Health Information ◽  
Data Sharing ◽  
Ethnographic Study ◽  
Teaching Hospitals ◽  
Diagnostic Process ◽  
Health Records ◽  
Challenges And Opportunities ◽  
Electronic Health ◽  
The Way

Abstract Background Diagnosis requires that clinicians communicate and share patient information in an efficient manner. Advances in electronic health records (EHRs) and health information technologies have created both challenges and opportunities for such communication. Methods We conducted a multi-method, focused ethnographic study of physicians on general medicine inpatient units in two teaching hospitals. Physician teams were observed during and after morning rounds to understand workflow, data sharing and communication during diagnosis. To validate findings, interviews and focus groups were conducted with physicians. Field notes and interview/focus group transcripts were reviewed and themes identified using content analysis. Results Existing communication technologies and EHR-based data sharing processes were perceived as barriers to diagnosis. In particular, reliance on paging systems and lack of face-to-face communication among clinicians created obstacles to sustained thinking and discussion of diagnostic decision-making. Further, the EHR created data overload and data fragmentation, making integration for diagnosis difficult. To improve diagnosis, physicians recommended replacing pagers with two-way communication devices, restructuring the EHR to facilitate access to key information and improving training on EHR systems. Conclusions As advances in health information technology evolve, challenges in the way clinicians share information during the diagnostic process will rise. To improve diagnosis, changes to both the technology and the way in which we use it may be necessary.

scholarly journals Attitudes towards using electronic health records of patients with psoriasis and dermatologists: a cross-sectional study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Toni Maria Klein ◽  
Matthias Augustin ◽  
Natalia Kirsten ◽  
Marina Otten
Keyword(s):  
Electronic Health Records ◽  
Healthcare Delivery ◽  
Cross Sectional Study ◽  
Electronic Version ◽  
Full Potential ◽  
Cross Sectional ◽  
Health Records ◽  
Potential Benefits ◽  
Electronic Health ◽  
Almost All

Abstract Background Electronic health records (EHRs) offer various advantages for healthcare delivery, especially for chronic and complex diseases such as psoriasis. However, both patients’ and physicians’ acceptability is required for EHRs to unfold their full potential. Therefore, this study compares patients’ and physicians’ attitudes towards using EHRs in routine psoriasis care. Methods For the purpose of this study, a questionnaire was developed based on literature research and analyses of previously conducted focus groups. Participants completed either a paper-based or an electronic version of the questionnaire. Patient recruitment took place at an dermatological outpatient clinic and via several online pathways (patient associations, and social media). Physicians were recruited via a mailing list of a dermatological association and at a dermatological conference. Patients’ and physicians’ responses were compared using χ2 tests and Fisher’s exact tests. Results The study consisted of 187 patients and 44 dermatologists. Patients compared to physicians rated almost all potential EHR uses as significantly more important and expected significantly more potential benefits from EHRs. Conclusions Patients showed positive expectations towards using EHRs, whereas there was more scepticism in the physician sample. This aligns with previous findings. These differences illustrate the necessity to involve all stakeholders, especially patients and physicians, into the process of developing and implementing EHRs.

scholarly journals Population-based identification and temporal trend of children with primary nephrotic syndrome: The Kaiser Permanente nephrotic syndrome study

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0257674
Author(s):  
Rishi V. Parikh ◽  
Thida C. Tan ◽  
Dongjie Fan ◽  
David Law ◽  
Anne S. Salyer ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Electronic Health Records ◽  
Healthcare Delivery ◽  
Population Based ◽  
Healthcare Delivery System ◽  
Kaiser Permanente ◽  
Health Records ◽  
Primary Nephrotic Syndrome ◽  
Electronic Health ◽  
Asian Pacific

Introduction Limited population-based data exist about children with primary nephrotic syndrome (NS). Methods We identified a cohort of children with primary NS receiving care in Kaiser Permanente Northern California, an integrated healthcare delivery system caring for >750,000 children. We identified all children <18 years between 1996 and 2012 who had nephrotic range proteinuria (urine ACR>3500 mg/g, urine PCR>3.5 mg/mg, 24-hour urine protein>3500 mg or urine dipstick>300 mg/dL) in laboratory databases or a diagnosis of NS in electronic health records. Nephrologists reviewed health records for clinical presentation and laboratory and biopsy results to confirm primary NS. Results Among 365 cases of confirmed NS, 179 had confirmed primary NS attributed to presumed minimal change disease (MCD) (72%), focal segmental glomerulosclerosis (FSGS) (23%) or membranous nephropathy (MN) (5%). The overall incidence of primary NS was 1.47 (95% Confidence Interval:1.27–1.70) per 100,000 person-years. Biopsy data were available in 40% of cases. Median age for patients with primary NS was 6.9 (interquartile range:3.7 to 12.9) years, 43% were female and 26% were white, 13% black, 17% Asian/Pacific Islander, and 32% Hispanic. Conclusion This population-based identification of children with primary NS leveraging electronic health records can provide a unique approach and platform for describing the natural history of NS and identifying determinants of outcomes in children with primary NS.

scholarly journals Constructing data-derived family histories using electronic health records from a single healthcare delivery system

2019 ◽  
Vol 30 (2) ◽  
pp. 212-218
Author(s):  
Maya Leventer-Roberts ◽  
Ilan Gofer ◽  
Yuval Barak Corren ◽  
Ben Y Reis ◽  
Ran Balicer
Keyword(s):  
Family History ◽  
Electronic Health Records ◽  
Clinical Decision Making ◽  
Healthcare Delivery ◽  
Clinical Value ◽  
Healthcare Delivery System ◽  
Family History Information ◽  
Health Records ◽  
History Information ◽  
Electronic Health

Abstract Background In order to examine the potential clinical value of integrating family history information directly from the electronic health records of patients’ family members, the electronic health records of individuals in Clalit Health Services, the largest payer/provider in Israel, were linked with the records of their parents. Methods We describe the results of a novel approach for creating data-derived family history information for 2 599 575 individuals, focusing on three chronic diseases: asthma, cardiovascular disease (CVD) and diabetes. Results In our cohort, there were 256 598 patients with asthma, 55 309 patients with CVD and 66 324 patients with diabetes. Of the people with asthma, CVD or diabetes, the percentage that also had a family history of the same disease was 22.0%, 70.8% and 70.5%, respectively. Conclusions Linking individuals’ health records with their data-derived family history has untapped potential for supporting diagnostic and clinical decision-making.

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