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Quality of the electronic medical record

José Colleti Junior, Alice Barone de Andrade, Werther Brunow de Carvalho
OBJECTIVE: To examine the prevalence of the use of electronic medical record systems in Brazilian intensive care units and the perceptions of intensive care physicians regarding the contribution of electronic medical record systems toward improving safety and quality in clinical practice. METHODS: Using an online questionnaire, physicians working in Brazilian intensive care units answered questions about the use of electronic medical record systems in the hospitals in which they worked...
July 2018: Revista Brasileira de Terapia Intensiva
Charlotta Lindvall, Elizabeth J Lilley, Sophia N Zupanc, Isabel Chien, Brooks V Udelsman, Anne Walling, Zara Cooper, James A Tulsky
BACKGROUND: Palliative surgical procedures are frequently performed to reduce symptoms in patients with advanced cancer, but quality is difficult to measure. OBJECTIVE: To determine whether natural language processing (NLP) of the electronic health record (EHR) can be used to (1) identify a population of cancer patients receiving palliative gastrostomy and (2) assess documentation of end-of-life process measures in the EHR. DESIGN/SETTING: Retrospective cohort study of 302 adult cancer patients who received a gastrostomy tube at a single tertiary medical center...
October 17, 2018: Journal of Palliative Medicine
Marlon P Mundt, Larissa I Zakletskaia
OBJECTIVES: This study seeks to determine how changes in electronic health record (EHR) communication patterns in primary care teams relate to quality of care and costs for patients with diabetes. STUDY DESIGN: EHR-extracted longitudinal observational study. METHODS: A total of 83 health professionals in 19 care teams at 4 primary care clinics associated with a large Midwestern university participated in the study. Counts of messages routed between any 2 team members in the EHR in the past 18 months were extracted...
October 2018: American Journal of Managed Care
Megan Song McHenry, Carole Ian McAteer, Eren Oyungu, Andrew Roland Deathe, Rachel Christine Vreeman
Children born to HIV-infected mothers have worse developmental outcomes compared to HIV-unexposed children. However, little is known about interventions to improve developmental outcomes in this population. This study systematically reviews the literature on interventions to improve development in children born to HIV-infected mothers. We systematically searched the following electronic bibliographic databases: Ovid MEDLINE, Embase, PsycINFO, Education Resources Information Center, and the Cochrane Database of Systematic Reviews...
October 16, 2018: AIDS Care
Harini Bejjanki, Lazarus K Mramba, Stacy G Beal, Nila Radhakrishnan, Rohit Bishnoi, Chintan Shah, Nikhil Agrawal, Neil Harris, Robert Leverence, Kenneth Rand
Background: The recommendations of the American Board of Internal Medicine Foundation's "Choosing Wisely® " initiative recognize the importance of improving the appropriateness of testing behavior and reducing the number of duplicate laboratory tests. Objective: To assess the effectiveness of an electronic medical record Best Practice Alert (BPA or "pop up") intervention aimed at reducing duplicate laboratory tests and hospital costs. Design: Comparison of the number of duplicated laboratory tests performed on inpatients before and after the intervention...
2018: ClinicoEconomics and Outcomes Research: CEOR
Lauren Krowl, Aashrai Gudlavalleti, Arpan Patel, Lauren Panebianco, Michael Kosters, Amit S Dhamoon
With increased oversight of residency work hours, there has been an increase in shift handoffs, which are prone to medical errors. To date, there are no evidence-based recommendations on essential elements of shift handoffs. We implemented a standardized shift-handoff rubric at an academic medicine residency program. Compliance, resident/faculty perceptions, and surrogate markers of patient safety were measured.Shift-handoff documents were collected January-February 2016 (control) April-June 2016 (intervention)...
October 2018: Medicine (Baltimore)
Gordon T Briscoe, Amy Heerschap, Catherine F Kane, Beth D Quatrara
Hospital readmissions are responsible for considerable health care costs. About 35% of patients with end stage renal disease (ESRD) who are hospitalized are readmitted within 30 days of discharge (United States Renal Data System, 2017). Studies point to the considerable percentage of readmissions that are preventable through effective discharge planning and patient follow-up after discharge (Mistiaen & Poot, 2006). Telephone follow up is a high-quality, low-cost method of providing discharge follow up. This project examined the effectiveness of an evidence-based quality improvement process in providing post-discharge telephone follow up to adult patients on hemodialysis by experienced nephrology nurses through standardized unit workflow and leveraging of the electronic medical record (EMR)...
May 2018: Nephrology Nursing Journal: Journal of the American Nephrology Nurses' Association
Mai-Khanh Bui-Duy, Shirley Wong, Rosemary Lam, Leah S Karliner
Hypertension is a common problem and a major risk factor for cardiovascular disease. It is unclear whether efforts to control blood pressure (BP) known to be effective in integrated healthcare systems can be successfully implemented in an academic setting. We describe our experience implementing a multistep quality improvement program within an academic general medicine practice aimed at improving BP among patients with uncontrolled hypertension. Ensuring medical assistants were correctly measuring BP provided the basis for accurate data entry into the electronic medical record (EMR); our EMR-based registry data allowed us to feedback primary care provider (PCP) level data on BP control for panel management, which resulted in improvements in BP for a substantial proportion of patients, particularly for those with more practice visits...
October 8, 2018: Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality
John B Zamjahn, Raquel Baroni de Carvalho, Megan H Bronson, Deborah D Garbee, John T Paige
Objective: The Objective Structured Assessment of Debriefing (OSAD) is an evidence-based, 8-item tool that uses a behaviorally anchored rating scale in paper-based form to evaluate the quality of debriefing in medical education. The objective of this project was twofold: 1) to create an easy-to-use electronic format of the OSAD (eOSAD) in order to streamline data entry; and 2) to pilot its use on videoed debriefings. Materials and Methods: The eOSAD was developed in collaboration with the LSU Health New Orleans Epidemiology Data Center using SurveyGizmo (Widgix Software, LLC, Boulder, CO, USA) software...
October 1, 2018: Journal of the American Medical Informatics Association: JAMIA
Ian B Stanaway, Taryn O Hall, Elisabeth A Rosenthal, Melody Palmer, Vivek Naranbhai, Rachel Knevel, Bahram Namjou-Khales, Robert J Carroll, Krzysztof Kiryluk, Adam S Gordon, Jodell Linder, Kayla Marie Howell, Brandy M Mapes, Frederick T J Lin, Yoonjung Yoonie Joo, M Geoffrey Hayes, Ali G Gharavi, Sarah A Pendergrass, Marylyn D Ritchie, Mariza de Andrade, Damien C Croteau-Chonka, Soumya Raychaudhuri, Scott T Weiss, Matt Lebo, Sami S Amr, David Carrell, Eric B Larson, Christopher G Chute, Laura Jarmila Rasmussen-Torvik, Megan J Roy-Puckelwartz, Patrick Sleiman, Hakon Hakonarson, Rongling Li, Elizabeth W Karlson, Josh F Peterson, Iftikhar J Kullo, Rex Chisholm, Joshua Charles Denny, Gail P Jarvik, David R Crosslin
The Electronic Medical Records and Genomics (eMERGE) network is a network of medical centers with electronic medical records linked to existing biorepository samples for genomic discovery and genomic medicine research. The network sought to unify the genetic results from 78 Illumina and Affymetrix genotype array batches from 12 contributing medical centers for joint association analysis of 83,717 human participants. In this report, we describe the imputation of eMERGE results and methods to create the unified imputed merged set of genome-wide variant genotype data...
October 8, 2018: Genetic Epidemiology
Patrick A Eder, Birgit Reime, Thomas Wurmb, Uwe Kippnich, Layal Shammas, Asarnusch Rashid
BACKGROUND:  Trauma is a global burden. Emergency medical services (EMS) provide care for individuals who have serious injuries or suffered a major trauma. OBJECTIVE:  This paper provides a comprehensive overview of telemedicine applications in prehospital trauma care. METHODS:  We conducted a systematic review according to PRISMA guidelines. We identified articles by electronic database search (PubMed, EMBASE, the Cochrane Library, CINAHL, SpringerLink, LIVIVO, DARE, IEEE Xplore, Google Scholar and ScienceDirect) using keywords related to prehospital settings, ambulance, telemedicine and trauma...
October 8, 2018: Methods of Information in Medicine
Anthony D Cretara, Christopher N Otis
In previous editorials, Chapman and Otis in 2011 and Layfield in 2014 have summarized much of the work responsible for establishing the concept of critical diagnoses in surgical pathology and cytopathology. Both editorials end with a list of 8 key policy points needed for an effective strategy of handling and communicating critical diagnoses. We have developed and distributed a Web-based survey to elicit clinicians' attitudes regarding many of those key policy points, such as how, when, and to whom critical diagnoses should be reported; we have allowed some level of collaboration with the clinical staff when developing our communication policies as the Association of Directors of Anatomic and Surgical Pathology (ADASP) consensus statement recommends...
October 6, 2018: Cancer Cytopathology
Kathryn A Birnie, Melanie Noel, Christine T Chambers, Lindsay S Uman, Jennifer A Parker
BACKGROUND: This is the second update of a Cochrane Review (Issue 4, 2006). Pain and distress from needle-related procedures are common during childhood and can be reduced through use of psychological interventions (cognitive or behavioral strategies, or both). Our first review update (Issue 10, 2013) showed efficacy of distraction and hypnosis for needle-related pain and distress in children and adolescents. OBJECTIVES: To assess the efficacy of psychological interventions for needle-related procedural pain and distress in children and adolescents...
October 4, 2018: Cochrane Database of Systematic Reviews
Dunia Alarkawi, M Sanni Ali, Dana Bliuc, Jacqueline R Center, Daniel Prieto-Alhambra
Pharmacoepidemiology is used extensively in osteoporosis research and involves the study of the use and effects of drugs in large numbers of people. Randomized controlled trials are considered the gold standard in assessing treatment efficacy and safety. However, their results can have limited external validity when applied to day-to-day patients. Pharmacoepidemiological studies aim to assess the effect/s of treatments in actual practice conditions, but they are limited by the quality, completeness, and inherent bias due to confounding...
July 2018: JBMR Plus
Joan Henderson, Stephen Barnett, Abhijeet Ghosh, Allan J Pollack, Adam Hodgkins, Khin Than Win, Graeme C Miller, Andrew Bonney
BACKGROUND: Electronic medical records are increasingly used for research with limited external validation of their data. OBJECTIVE: This study investigates the validity of electronic medical data (EMD) for estimating diabetes prevalence in general practitioner (GP) patients by comparing EMD with national Bettering the Evaluation and Care of Health (BEACH) data. METHOD: A "decision tree" was created using inclusion/exclusion of pre-agreed variables to determine the probability of diabetes in absence of diagnostic label, including diagnoses (coded/free-text diabetes, polycystic ovarian syndrome, impaired glucose tolerance, impaired fasting glucose), diabetic annual cycle of care (DACC), hemoglobin (HbA1c) > 6...
October 3, 2018: Health Information Management: Journal of the Health Information Management Association of Australia
Timothy Ad Graham, Mark Ballermann, Eddy Lang, Michael J Bullard, Denise Parsons, Gabriella Mercuur, Pat San Agustin, Samina Ali
BACKGROUND: The adoption and use of an electronic health record (EHR) can facilitate real-time access to key health information and support improved outcomes. Many Canadian provinces use interoperable EHRs (iEHRs) to facilitate health information exchange, but the clinical use and utility of iEHRs has not been well described. OBJECTIVE: The aim of this study was to describe the use of a provincial iEHR known as the Alberta Netcare Portal (ANP) in 4 urban Alberta emergency departments...
September 25, 2018: JMIR Medical Informatics
Clemens Scott Kruse, Anna Stein, Heather Thomas, Harmander Kaur
Electronic health records (EHRs) have emerged among health information technology as "meaningful use" to improve the quality and efficiency of healthcare, and health disparities in population health. In other instances, they have also shown lack of interoperability, functionality and many medical errors. With proper implementation and training, are electronic health records a viable source in managing population health? The primary objective of this systematic review is to assess the relationship of electronic health records' use on population health through the identification and analysis of facilitators and barriers to its adoption for this purpose...
September 29, 2018: Journal of Medical Systems
Sina Joneidy, Maria Burke
OBJECTIVE: The purpose of this study was to identify and analyse the US Health Sector concept of the 'Meaningful Use' of electronic health records (EHR's) based on the wide diversity of discourses in the published literature. Meaningful Use is defined as 'use of digital medical and health records to improve quality, safety and efficiency of patient health information'. METHODS: Herman Dooyeweerd's philosophical suite of aspects was the chosen research tool used to analyse seminal papers concerning the Meaningful Use of EHRs...
September 28, 2018: Health Information and Libraries Journal
Christopher P Centonze, Matthew S Davenport, Audrey H Wu, Ella A Kazerooni
PURPOSE: To determine whether routine postprocedure chest radiography is indicated to exclude pneumothorax after outpatient right heart catheterization with or without endomyocardial biopsy. METHODS: This HIPAA-compliant retrospective quality improvement cohort study was approved by the institutional review board. All outpatients from January 1, 2010, to July 1, 2017, who underwent routine postprocedure chest radiography after right heart catheterization with or without endomyocardial biopsy formed the study population (n = 6,036)...
September 25, 2018: Journal of the American College of Radiology: JACR
Michael Leibowitz, Heather Wolfe, Andrea Flynn, Angela Waanders, Caroline Burlingame, Brenna Aumaier, David Friedman, Michele P Lambert
BACKGROUND: Oncology patients are frequent recipients of prophylactic platelet transfusions. Recent studies have demonstrated that lower prophylactic doses of platelets were not associated with a higher incidence of bleeding. At our institution, we found wide variation in platelet dosing due to lack of guidance and support for standardized dosing. STUDY DESIGN AND METHODS: A collaborative process improvement project between oncology, hematology, intensivists, and the transfusion service established guidelines for dosing of prophylactic platelet transfusions in nonbleeding oncology patients: 10 mL/kg or less of apheresis platelets for patients weighing up to 20 kg and 1 unit of apheresis platelets patients weighing 20 kg or more, with our stated goal of standardizing transfusion practice...
September 27, 2018: Transfusion
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