Physician beliefs about the impact of meaningful use of the EHR

SummaryBackground: As adoption and use of electronic health records (EHRs) grows in the United States, there is a growing need in the field of applied clinical informatics to evaluate physician perceptions and beliefs about the impact of EHRs. The meaningful use of EHR incentive program provides a suitable context to examine physician beliefs about the impact of EHRs.Objective: Contribute to the sparse literature on physician beliefs about the impact of EHRs in areas such as quality of care, effectiveness of care, and delivery of care.Methods: A cross-sectional online survey of physicians at two academic medical centers (AMCs) in the northeast who were preparing to qualify for the meaningful use of EHR incentive program.Results: Of the 1,797 physicians at both AMCs who were preparing to qualify for the incentive program, 967 completed the survey for an overall response rate of 54%. Only 23% and 27% of physicians agreed or strongly agreed that meaningful use of the EHR will help them improve the care they personally deliver and improve quality of care respectively. Physician specialty was significantly associated with beliefs; e.g., 35% of primary care physicians agreed or strongly agreed that meaningful use will improve quality of care compared to 26% of medical specialists and 21% of surgical specialists (p=0.009). Satisfaction with outpatient EHR was also significantly related to all belief items.Conclusions: Only about a quarter of physicians in our study responded positively that meaningful use of the EHR will improve quality of care and the care they personally provide. These findings are similar to and extend findings from qualitative studies about negative perceptions that physicians hold about the impact of EHRs. Factors outside of the regulatory context, such as physician beliefs, need to be considered in the implementation of the meaningful use of the EHR incentive program.Citation: Emani S, Ting DY, Healey M, Lipsitz SR, Karson AS, Einbinder JS, Leinen L, Suric V, Bates DW. Physician beliefs about the impact of meaningful use of the EHR: A cross-sectional study. Appl Clin Inf 2014; 5: 789–801http://dx.doi.org/10.4338/ACI-2014-05-RA-0050

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Physician Beliefs about the Meaningful Use of the Electronic Health Record: A Follow-Up Study

Applied Clinical Informatics ◽

10.4338/aci-2017-05-ra-0079 ◽

2017 ◽

Vol 08 (04) ◽

pp. 1044-1053 ◽

Cited By ~ 8

Author(s):

Srinivas Emani ◽

David Ting ◽

Michael Healey ◽

Stuart Lipsitz ◽

Andrew Karson ◽

...

Keyword(s):

Meaningful Use ◽

Health Record ◽

Improve Quality ◽

Follow Up Study ◽

Incentive Program ◽

Negative Beliefs ◽

Physician Beliefs ◽

Stage 1

Background There is continuing interest in how physicians are responding to the meaningful use of the electronic health record (EHR) incentive program. However, little research has been done on physician beliefs about the meaningful use of the EHR. Objective This study aims to conduct a follow-up study of physician beliefs about the meaningful use of the EHR. Methods Online survey of physicians at two academic medical centers (AMCs) in the northeast who were participating in the meaningful use of the EHR incentive program and were using an internally developed EHR was conducted. Results Of the 2,033 physicians surveyed, 1,075 completed the survey for an overall response rate of 52.9%. Only one-fifth (20.5%) of the physicians agreed or strongly agreed that meaningful use of the EHR would help them improve quality of care, and only a quarter (25.2%) agreed or strongly agreed that the meaningful use of the EHR would improve the care that their organization delivers. Physician satisfaction with the outpatient EHR was the strongest predictor of self-efficacy with achieving stage 2 of the meaningful use of the EHR incentive program (odds ratio: 2.10, 95% confidence interval: 1.61, 2.75, p < 0.001). Physicians reported more negative beliefs in stage 2 than stage 1 across all belief items. For example, 28.1% agreed or strongly agreed that the meaningful use of the EHR would decrease medical errors in stage 2 as compared with 35.9% in stage 1 (p < 0.001). Conclusion Only one-fifth of the physicians in our study believed that the meaningful use of the EHR would improve quality of care, patient-centeredness of care, or the care they personally provide. Primary care physicians expressed more negative beliefs about the meaningful use of the EHR in stage 2 than in stage 1. These findings show that physicians continue to express negative beliefs about the meaningful use of the EHR. These ongoing negative beliefs are concerning for both implementation and policy.

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Understanding the Link between Family Caregiver Quality of Life and the Care Provided to Older People With Dementia

Innovation in Aging ◽

10.1093/geroni/igaa057.500 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 153-154

Author(s):

Afeez Hazzan

Keyword(s):

Quality Of Life ◽

Quality Of Care ◽

Older People ◽

Family Caregivers ◽

Family Caregiver ◽

Well Being ◽

The United States ◽

People With Dementia ◽

The Impact

Abstract Dementia is one of the most rapidly growing diseases in the United States. In 2018, the direct costs to American society of caring for older people with dementia was approximately $277 billion. Primary informal caregivers are mainly responsible for the care of older people with dementia including Alzheimer’s disease. Caregivers perform a myriad of duties ranging from shopping for their loved ones’ groceries, helping with medications, and managing finances. The caregiving role becomes more demanding as the disease progresses over time, and studies have shown that the quality-of-life (QoL) experienced by caregivers of older adults who have dementia is lower than the QoL of caregivers for older people who do not have dementia. To the best of our knowledge, there has been no research conducted to investigate whether lower caregiver QoL affects the level or quality of care that caregivers provide to persons with dementia. In the current study, we interviewed family caregivers living in Rochester, New York to inquire about their quality of life and the care provided to older people living with dementia. Further, caregivers completed the 36-item Short Form Health Survey (SF-36) as well as a draft questionnaire for measuring the quality of care provided to older people living with dementia. Both quantitative and qualitative findings from this study reveals important relationships between family caregiver QoL and the care provided, including the impact of social support and financial well-being. The study findings could have significant impact, particularly for the provision of much needed support for family caregivers.

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Understanding contributors to quality of care in long-term care and changes under COVID-19

Innovation in Aging ◽

10.1093/geroni/igaa057.3509 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 960-960

Author(s):

Sara Luck ◽

Katie Aubrecht

Keyword(s):

Quality Of Care ◽

Long Term Care ◽

The United States ◽

Control Measures ◽

Qualitative Description ◽

Care Staff ◽

Term Care ◽

The Impact

Abstract Nursing home facilities are responsible for providing care for some of the most vulnerable groups in society, including the elderly and those with chronic medical conditions. In times of crisis, such as COVID-19 or other pandemics, the delivery of ‘regular’ care can be significantly impacted. In relation to COVID-19, there is an insufficient supply of personal protective equipment (PPE) to care for residents, as PPE not only protects care staff but also residents. Nursing homes across the United States and Canada have also taken protective measures to maximize the safety of residents by banning visitors, stopping all group activities, and increasing infection control measures. This presentation shares a research protocol and early findings from a study investigating the impact of COVID-19 on quality of care in residential long-term care (LTC) in the Canadian province of New Brunswick. This study used a qualitative description design to explore what contributes to quality of care for residents living in long-term care, and how this could change in times of crisis from the perspective of long-term care staff. Interviews were conducted with a broad range of staff at one LTC home. A semi-structured interview guide and approach to thematic analysis was framed by a social ecological perspective, making it possible to include the individual and proximal social influences as well as community, organizations, and policy influencers. Insights gained will improve the understanding of quality of care, as well as potential barriers and facilitators to care during times of crisis.

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Physician Perceptions and Beliefs about Generating and Providing a Clinical Summary of the Office Visit

Applied Clinical Informatics ◽

10.4338/aci-2015-04-ra-0043 ◽

2015 ◽

Vol 06 (03) ◽

pp. 577-590 ◽

Cited By ~ 5

Author(s):

D.Y. Ting ◽

M. Healey ◽

S.R. Lipsitz ◽

H. Ramelson ◽

V. Suric ◽

...

Keyword(s):

Patient Outcomes ◽

Primary Care Physicians ◽

Online Survey ◽

Office Visit ◽

Meaningful Use ◽

Cross Sectional ◽

Physician Perceptions ◽

Incentive Program ◽

Negative Beliefs ◽

Negative Effect

Summary Background: A core measure of the meaningful use of EHR incentive program is the generation and provision of the clinical summary of the office visit, or the after visit summary (AVS), to patients. However, little research has been conducted on physician perceptions and beliefs about the AVS. Objective: Evaluate physician perceptions and beliefs about the AVS and the effect of the AVS on workload, patient outcomes, and the care the physician delivers. Methods: A cross-sectional online survey of physicians at two academic medical centers (AMCs) in the northeast who are participating in the meaningful use EHR incentive program. Results: Of the 1 795 physicians at both AMCs participating in the incentive program, 853 completed the survey for a response rate of 47.5%. Eighty percent of the respondents reported that the AVS was easy (very easy or quite easy or somewhat easy) to generate and provide to patients. Nonetheless, more than three-fourths of the respondents reported a negative effect of generating and providing the AVS on workload of office staff (78%) and workload of physicians (76%).Primary care physicians had more positive beliefs about the effect of the AVS on patient outcomes than specialists (p<0.001) and also had more positive beliefs about the effect of the AVS on the care they delivered than specialists (p<0.001). Conclusions: Achieving the core meaningful use measure of generating and providing the AVS was easy for physicians but it did not necessarily translate into positive beliefs about the effect of the AVS on patient outcomes or the care the physician delivered. Physicians also had negative beliefs about the effect of the AVS on workload. To promote positive beliefs among physicians around the AVS, organizations should obtain physician input into the design and implementation of the AVS and develop strategies to mitigate its negative impacts on workload. Citation: Emani S, , Ting DY, Healey M, Lipsitz SR, Ramelson H, Suric V, Bates DW. Physician perceptions and beliefs about generating and providing a clinical summary of the office visit. Appl Clin Inform 2015; 6: 577–590http://dx.doi.org/10.4338/ACI-2015-04-RA-0043

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Impacts of common staff on indicators of sanitary evacuation: experience of the gynecology service of Treichville Teaching Hospital

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20181321 ◽

2018 ◽

Vol 7 (4) ◽

pp. 1303

Author(s):

Simplice Anongba ◽

Jean-Marc Dia ◽

Ignace Yao ◽

Edouard N’guessan ◽

Eric Bohoussou ◽

...

Keyword(s):

Quality Of Care ◽

Good Practice ◽

Cross Sectional Study ◽

Fetal Mortality ◽

Cross Sectional ◽

Balance Sheets ◽

Gynecology And Obstetrics ◽

The Common ◽

The Impact

Background: In order to improve the quality of care for patients discharged in our department, since 1996 we have initiated monthly meetings called "common staffs", with the heads of the peripheral maternities who evacuate patients, during which we analyse reference indicators and the SONUs. The objective of this study was to describe the impact of the common staff on the indicators of the reference.Methods: We carried out a retrospective cross-sectional study on the balance sheets of the common staff over the 20 years of practice.Results: In 20 years, 132 meetings were organized, during which 24,337 files were analyzed. In 1996 the indicators of evacuations were at alarming levels: the time taken between the diagnosis and the decision to evacuate was long (more than 1 hour in 83.4%), 73% of the evacuation records were poorly informed, the majority evacuations were by non-medical vehicle (54.8%), pre-discharge management was incorrect in several patients (47%), and maternal and fetal lethality were high (5% and 10%, respectively). Over time, these indicators have improved and have had a favourable impact on maternal and fetal mortality rates, which have gradually decreased. At the same time, the results of the last three years of the evacuees coming from the maternities who do not participate in our staffs, shows that the indicators are still alarming, at levels where we were at the beginning of common staffs.Conclusions: The joint staff proved to be a good practice to promote in the Gynecology and Obstetrics Departments. It helped to improve the quality of care for referred patients.

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Four Needles in a Haystack: A Systematic Review Assessing Quality of Health Care in Specialty Practice by Practice Type

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/0046958018787041 ◽

2018 ◽

Vol 55 ◽

pp. 004695801878704

Author(s):

Shellie D. Ellis ◽

Saleema A. Karim ◽

Rachel R. Vukas ◽

Daniel Marx ◽

Jalal Uddin

Keyword(s):

Quality Of Care ◽

Organizational Factors ◽

The United States ◽

Group Practice ◽

Inclusion Criteria ◽

Group Practices ◽

Specialty Practice ◽

Multidisciplinary Group ◽

The Impact

Specialists, who represent 60% of physicians in the United States, are consolidating into large group practices, but the degree to which group practice type facilitates the delivery of high quality of care in specialty settings is unknown. We conducted a systematic literature review to identify the impact of group practice type on the quality of care among specialty providers. The search resulted in 913 articles, of which only 4 met inclusion criteria. Studies were of moderate methodological quality. From the limited evidence available, we hypothesize that solo specialists deliver care that is inferior to their peers in group practice, whether measured by patient satisfaction ratings or adherence to guideline-based care. However, solo specialists and multidisciplinary group specialists may be more likely to provide some specialized services compared with their single-specialty group peers. Insufficient research compares quality of care among different practice types in specialty care. Substantial opportunity exists to test the degree to which organizational factors, whether size of practice or the mix of providers within the practice, influence quality of care in specialty settings.

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Proposed Agenda for the Measurement of Quality-of-Care Outcomes in Oncology Practice

Journal of Clinical Oncology ◽

10.1200/jco.1999.17.8.2614 ◽

1999 ◽

Vol 17 (8) ◽

pp. 2614-2614 ◽

Cited By ~ 36

Author(s):

Jeanne S. Mandelblatt ◽

Patricia A. Ganz ◽

Katherine L. Kahn

Keyword(s):

Breast Cancer ◽

Quality Of Care ◽

Outcome Measures ◽

Cancer Care ◽

The United States ◽

Leadership Role ◽

Institute Of Medicine ◽

Oncology Practice ◽

The Impact

ABSTRACT: Cancer is an important disease, and health care services have the potential to improve the quality and quantity of life for cancer patients. The delivery of these services also has recently been well codified. Given this framework, cancer care presents a unique opportunity for clinicians to develop and test outcome measures across diverse practice settings. Recently, the Institute of Medicine released a report reviewing the quality of cancer care in the United States and called for further development and monitoring of quality indicators. Thus, as we move into the 21st century, professional and regulatory agencies will be seeking to expand process measures and develop and validate outcomes-oriented measures for cancer and other diseases. For such measures to be clinically relevant and feasible, it is key that the oncology community take an active leadership role in this process. To set the stage for such activities, this article first reviews broad methodologic concerns involved in selecting measures of the quality of care, using breast cancer to exemplify key issues. We then use the case of breast cancer to review the different phases of cancer care and provide examples of phase-specific measures that, after careful operationalization, testing, and validation, could be used as the basis of an agenda for measuring the quality of breast cancer care in oncology practice. The diffusion of process and outcome measures into practice; the practicality, reliability, and validity of these measures; and the impact that these indicators have on practice patterns and the health of populations will be key to evaluating the success of such quality-of-care paradigms. Ultimately, improved quality of care should translate into morbidity and mortality reductions.

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