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Steven R Lane, Holly Miller, Elizabeth Ames, Lawrence Garber, David C Kibbe, Joseph H Schneider, Christoph U Lehmann
BACKGROUND: Secure clinical messaging and document exchange utilizing the Direct Protocol (Direct interoperability) has been widely implemented in health information technology (HIT) applications including electronic health records (EHRs) and by health care providers and organizations in the United States. While Direct interoperability has allowed clinicians and institutions to satisfy regulatory requirements and has facilitated communication and electronic data exchange as patients transition across care environments, feature and function enhancements to HIT implementations of the Direct Protocol are required to optimize the use of this technology...
January 2018: Applied Clinical Informatics
Anne G Pereira, Michael Kim, Marcus Seywerd, Brooke Nesbitt, Michael B Pitt
BACKGROUND: Use of the electronic health record (EHR) is widespread in academic medical centers, and hands-on EHR experience in medical school is essential for new residents to be able to meaningfully contribute to patient care. As system-specific EHR training is not portable across institutions-even when the same EHR platform is used-students rotating across health systems are often required to spend time away from clinical training to complete each system's, often duplicative, EHR training regardless of their competency within the EHR...
January 2018: Applied Clinical Informatics
Claudio Vitari, Roxana Ologeanu-Taddei
BACKGROUND: Like other sectors, the healthcare sector has to deal with the issue of users' acceptance of IT. In healthcare, different factors affecting healthcare professionals' acceptance of software applications have been investigated. Unfortunately, inconsistent results have been found, maybe because the different studies focused on different IT and occupational groups. Consequently, more studies are needed to investigate these implications for recent technology, such as Electronic Health Records (EHR)...
March 21, 2018: BMC Health Services Research
Adam Wright, Pamela M Neri, Skye Aaron, Thu-Trang T Hickman, Francine L Maloney, Daniel A Solomon, Dustin McEvoy, Angela Ai, Kevin Kron, Gianna Zuccotti
Background: Microbiology laboratory results are complex and cumbersome to review. We sought to develop a new review tool to improve the ease and accuracy of microbiology results review. Methods: We observed and informally interviewed clinicians to determine areas in which existing microbiology review tools were lacking. We developed a new tool that reorganizes microbiology results by time and organism. We conducted a scenario-based usability evaluation to compare the new tool to existing legacy tools, using a balanced block design...
March 17, 2018: Journal of the American Medical Informatics Association: JAMIA
Li-Tzy Wu, Udi E Ghitza, He Zhu, Susan Spratt, Marvin Swartz, Paolo Mannelli
BACKGROUND: The majority of the U.S. healthcare resources are utilized by a small population characterized as high-risk, high-need persons with complex care needs (e.g., adults with multiple chronic conditions). Substance use disorders (SUDs) and mental health disorders (MHDs) are a driver of poor health and additional healthcare costs, but they are understudied among high-need patients. OBJECTIVE: We examine the prevalence and correlates of SUDs and MHDs among adults with high-risk diabetes, who are patients at the top 10% risk score for developing poor outcomes (hospital admission or death)...
March 3, 2018: Drug and Alcohol Dependence
Nikhil Satchidanand, Timothy J Servoss, Ranjit Singh, Angela M Bosinski, Penny Tirpak, Linda L Horton, Bruce J Naughton
BACKGROUND: Early, data-driven discussion surrounding palliative care can improve care delivery and patient experience. OBJECTIVE: To develop a 30-day mortality prediction tool for older patients in intensive care unit (ICU) with pneumonia that will initiate palliative care earlier in hospital course. DESIGN: Retrospective Electronic Health Record (EHR) review. SETTING: Four urban and suburban hospitals in a Western New York hospital system...
January 1, 2018: American Journal of Hospice & Palliative Care
Brooke N Wolford, Cristen J Willer, Ida Surakka
The combination of Electronic Health Records (EHRs) with genetic data has ushered in the next wave of complex disease genetics. Population-based biobanks and other large cohorts provide sufficient sample sizes to identify novel genetic associations across the hundreds to thousands of phenotypes gleaned from EHRs. In this review we summarize the current state of these EHR-linked biobanks, explore ongoing methods development in the field, and highlight recent discoveries of genetic associations. We enumerate the many existing biobanks with EHRs linked to genetic data, many of which are available to researchers via application and contain sample sizes > 50,000...
March 14, 2018: Human Molecular Genetics
Bonnie L Westra, Steven G Johnson, Samira Ali, Karen M Bavuso, Christopher A Cruz, Sarah Collins, Meg Furukawa, Mary L Hook, Anne LaFlamme, Kay Lytle, Lisiane Pruinelli, Tari Rajchel, Theresa Tess Settergren, Kathryn F Westman, Luann Whittenburg
BACKGROUND:  Secondary use of electronic health record (EHR) data can reduce costs of research and quality reporting. However, EHR data must be consistent within and across organizations. Flowsheet data provide a rich source of interprofessional data and represents a high volume of documentation; however, content is not standardized. Health care organizations design and implement customized content for different care areas creating duplicative data that is noncomparable. In a prior study, 10 information models (IMs) were derived from an EHR that included 2...
January 2018: Applied Clinical Informatics
Katrina E Donahue, Alfred Reid, Elizabeth G Baxley, Charles Carter, Peter J Carek, Mark Robinson, Warren P Newton
BACKGROUND AND OBJECTIVES: The I3 POP Collaborative sought to improve health of patients attending North Carolina, South Carolina, and Virginia primary care teaching practices using the triple aim framework of better quality, appropriate utilization, and enhanced patient experience. We examined change in triple aim measures over 3 years, and identified correlates of improvement. METHODS: Twenty-nine teaching practices representing 23 residency programs participated...
March 2018: Family Medicine
Mark L Graber, Colene Byrne, Doug Johnston
Diagnostic error may be the largest unaddressed patient safety concern in the United States, responsible for an estimated 40,000-80,000 deaths annually. With the electronic health record (EHR) now in near universal use, the goal of this narrative review is to synthesize evidence and opinion regarding the impact of the EHR and health care information technology (health IT) on the diagnostic process and its outcomes. We consider the many ways in which the EHR and health IT facilitate diagnosis and improve the diagnostic process, and conversely the major ways in which it is problematic, including the unintended consequences that contribute to diagnostic error and sometimes patient deaths...
November 27, 2017: Diagnosis
Anuj K Dalal, Adam Schaffer, Esteban F Gershanik, Ranganath Papanna, Katyuska Eibensteiner, Nyryan V Nolido, Cathy S Yoon, Deborah Williams, Stuart R Lipsitz, Christopher L Roy, Jeffrey L Schnipper
BACKGROUND: Follow-up of tests pending at discharge (TPADs) is poor. We previously demonstrated a twofold increase in awareness of any TPAD by attendings and primary care physicians (PCPs) using an automated email intervention OBJECTIVE: To determine whether automated notification improves documented follow-up for actionable TPADs DESIGN: Cluster-randomized controlled trial SUBJECTS: Attendings and PCPs caring for adult patients discharged from general medicine and cardiology services with at least one actionable TPAD between June 2011 and May 2012 INTERVENTION: An automated system that notifies discharging attendings and network PCPs of finalized TPADs by email MAIN MEASURES: The primary outcome was the proportion of actionable TPADs with documented action determined by independent physician review of the electronic health record (EHR)...
March 12, 2018: Journal of General Internal Medicine
Zsolt J Nagykaldi, Huibert Tange, Jan De Maeseneer
Electronic health records (EHRs) have been in place for decades; however, most existing systems were designed in the prevailing disease- and payment-focused care paradigm that often loses sight of the goals, needs, and values of patients and clinicians. The goal-directed health care model was proposed more than 20 years ago, but no design principles have been developed for corresponding electronic record systems. Newly designed EHRs are needed to facilitate health care that is anchored by patient life and health goals...
March 2018: Annals of Family Medicine
Jejo D Koola, Sharon E Davis, Omar Al-Nimri, Sharidan K Parr, Daniel Fabbri, Bradley A Malin, Samuel B Ho, Michael E Matheny
OBJECTIVE: Hepatorenal Syndrome (HRS) is a devastating form of acute kidney injury (AKI) in advanced liver disease patients with high morbidity and mortality, but phenotyping algorithms have not yet been developed using large electronic health record (EHR) databases. We evaluated and compared multiple phenotyping methods to achieve an accurate algorithm for HRS identification. MATERIALS AND METHODS: A national retrospective cohort of patients with cirrhosis and AKI admitted to 124 Veterans Affairs hospitals was assembled from electronic health record data collected from 2005 to 2013...
March 9, 2018: Journal of Biomedical Informatics
Simon J Craddock Lee, Stephen J Inrig, Bijal A Balasubramanian, Celette Sugg Skinner, Robin T Higashi, Katharine McCallister, Wendy Pechero Bishop, Noel O Santini, Jasmin A Tiro
The colorectal cancer (CRC) screening process involves multiple interfaces (communication exchanges and transfers of responsibility for specific actions) among primary care and gastroenterology providers, laboratory, and administrative staff. After a retrospective electronic health record (EHR) analysis discovered substantial clinic variation and low CRC screening prevalence overall in an urban, integrated safety-net system, we launched a qualitative analysis to identify potential quality improvement targets to enhance fecal immunochemical test (FIT) completion, the system's preferred screening modality...
March 2018: Preventive Medicine Reports
Neil Bodagh, R Andrew Archbold, Roshan Weerackody, Meredith K D Hawking, Michael R Barnes, Aaron M Lee, Surjeet Janjuha, Charles Gutteridge, John Robson, Adam Timmis
OBJECTIVES: The electronic health record (EHR) is underused in the hospital setting. The aim of this service evaluation study was to respond to National Health Service (NHS) Digital's ambition for a paperless NHS by capturing routinely collected cardiac outpatient data in the EHR to populate summary patient reports and provide a resource for audit and research. DESIGN: A PowerForm template was developed within the Cerner EHR, for real-time entry of routine clinical data by clinicians attending a cardiac outpatient clinic...
March 8, 2018: BMJ Open
Jonathan S Wald, Saira N Haque, Stephanie Rizk, Jennifer R Webb, Stephen Brown, Shellery Ebron, Christoph U Lehmann, Mark Frisse, Vanessa A Shorte, Edwin A Lomotan, Barbara A Dailey, Kevin B Johnson
Electronic health record (EHR) use throughout the United States has advanced considerably, but functionality to support the optimal care of children has been slower to develop and deploy. A previous team of experts systematically identified gaps in EHR functionality during collaborative work from 2010 to 2013 that produced the Children's EHR Format (Format), funded under the Children's Health Insurance Program Reauthorization Act of 2009, Public Law 111-3. After that, a team of practitioners, software developers, health policy leaders, and other stakeholders examined the Format's exhaustive list of 547 EHR functional requirements in 26 topic areas and found them to be valuable but in need of further refinement and prioritization...
March 8, 2018: Pediatrics
Christopher Kim, Rohini K Hernandez, Lori Cyprien, Alexander Liede, Paul C Cheng
PURPOSE: Current guidelines recommend that intravenous bisphosphonates be initiated in all patients with multiple myeloma for management of bone disease. The objective of this study was to describe real-world bisphosphonate treatment patterns. METHODS: This was a retrospective observational study using oncology electronic health record (EHR) data contained in Amgen's Oncology Services Comprehensive Electronic Records (OSCER) database, generated by Flatiron Health (New York, NY), representing over 1...
March 7, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Molly R Altman, Karen Colorafi, Kenn B Daratha
BACKGROUND:  Hospital electronic health record (EHR) data are increasingly being called upon for research purposes, yet only recently has it been tested to examine its reliability. Studies that have examined reliability of EHR data for research purposes have varied widely in methods used and field of inquiry, with little reporting of the reliability of perinatal and obstetric variables in the current literature. OBJECTIVE:  To assess the reliability of data extracted from a commercially available inpatient EHR as compared with manually abstracted data for common attributes used in obstetrical research...
January 2018: Applied Clinical Informatics
Peter M McEvoy, Matthew P Hyett, Thomas Ehring, Sheri L Johnson, Suraj Samtani, Rebecca Anderson, Michelle L Moulds
BACKGROUND: Repetitive negative thinking (RNT) is a cognitive process that is repetitive, passive, relatively uncontrollable, and focused on negative content, and is elevated in emotional disorders including depression and anxiety disorders. Repetitive positive thinking is associated with bipolar disorder symptoms. The unique contributions of positive versus negative repetitive thinking to emotional symptoms are unknown. The first aim of this study was to use confirmatory factor analyses to evaluate the psychometrics of two transdiagnostic measures of RNT, the Repetitive Thinking Questionnaire (RTQ-10) and Perseverative Thinking Questionnaire (PTQ), and a measure of repetitive positive thinking, the Responses to Positive Affect (RPA) Questionnaire...
February 26, 2018: Journal of Affective Disorders
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