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Ehr implementation

Zachary M Grinspan, Yuhua Bao, Alison Edwards, Phyllis Johnson, Rainu Kaushal, Lisa M Kern
This was a retrospective cohort study of ambulatory care quality by physicians who received payment for Medicaid Stage 1 Meaningful Use (MU) in 2012 using New York State Medicaid Claims (2010-2013). Eight quality measures were used to compare performance of physicians who received payments to Adopt, Implement, or Use (AIU) an electronic health record in 2011 but not for MU in 2012 (AIU-only group) and physicians who cared for Medicaid patients but received no payments (no-incentive group), using propensity score-weighted difference-in-difference logistic regression analyses, clustering by physician...
October 13, 2016: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
Joshua R Ehrlich, Monica Michelotti, Taylor S Blachley, Kai Zheng, Mick P Couper, Grant M Greenberg, Sharon Kileny, Greta L Branford, David A Hanauer, Jennifer S Weizer
OBJECTIVES: To understand the attitudes and perceptions of ophthalmologists toward an electronic health record (EHR) system, before and after its clinical implementation. METHODS: Ophthalmologists at a single large academic ophthalmology department were surveyed longitudinally before and after implementation of a new EHR system. The survey measured ophthalmologists' attitudes toward implementation of a new EHR. Questions focused on satisfaction, efficiency, and documentation...
October 12, 2016: Applied Clinical Informatics
Clemens Scott Kruse, Caitlin Kristof, Beau Jones, Erica Mitchell, Angelica Martinez
Federal efforts and local initiatives to increase adoption and use of electronic health records (EHRs) continue, particularly since the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act. Roughly one in four hospitals not adopted even a basic EHR system. A review of the barriers may help in understanding the factors deterring certain healthcare organizations from implementation. We wanted to assemble an updated and comprehensive list of adoption barriers of EHR systems in the United States...
December 2016: Journal of Medical Systems
Michael G Kahn, Tiffany J Callahan, Juliana Barnard, Alan E Bauck, Jeff Brown, Bruce N Davidson, Hossein Estiri, Carsten Goerg, Erin Holve, Steven G Johnson, Siaw-Teng Liaw, Marianne Hamilton-Lopez, Daniella Meeker, Toan C Ong, Patrick Ryan, Ning Shang, Nicole G Weiskopf, Chunhua Weng, Meredith N Zozus, Lisa Schilling
OBJECTIVE: Harmonized data quality (DQ) assessment terms, methods, and reporting practices can establish a common understanding of the strengths and limitations of electronic health record (EHR) data for operational analytics, quality improvement, and research. Existing published DQ terms were harmonized to a comprehensive unified terminology with definitions and examples and organized into a conceptual framework to support a common approach to defining whether EHR data is 'fit' for specific uses...
2016: EGEMS
Courtney Rees Lyles, Jill Y Allen, Dolly Poole, Lina Tieu, Michael H Kanter, Terhilda Garrido
BACKGROUND: Despite the widespread implementation of electronic health records (EHRs), there is growing evidence that racial/ethnic minority patients do not use portals as frequently as non-Hispanic whites to access their EHR information online. This differential portal use could be problematic for health care disparities since early evidence links portal use to better outcomes. OBJECTIVE: We sought to understand specific barriers to portal use among African American and Latino patients at Kaiser Permanente, which has had a portal in place for over a decade, and broad uptake among the patient population at large...
October 3, 2016: Journal of Medical Internet Research
Bente Olesen, Jacob Anhøj, Kenneth Palle Rasmussen, Kåre Mølbak, Marianne Voldstedlund
BACKGROUND: Although the timely isolation of patients is an essential intervention to limit spread of drug-resistant bacteria, information about the colonization status is often unavailable or lost when patients are readmitted or transferred between hospitals. Therefore, carriers of drug resistant bacteria are not recognized sufficiently early, and proper and timely isolation precautions are not taken. Consequently, resistant bacteria of public health concerns including vancomycin resistant enterococci (VRE) and methicillin resistant Staphylococcus aureus (MRSA) can spread epidemically...
November 2016: International Journal of Medical Informatics
Dana M Zive, Jennifer Cook, Charissa Yang, David Sibell, Susan W Tolle, Michael Lieberman
In April 2015, Oregon Health & Science University (OHSU) deployed a web-based, electronic medical record-embedded application created by third party vendor Vynca Inc. to allow real-time education, and completion of Physician Orders for Life Sustaining Treatment (POLST). Forms are automatically linked to the Epic Systems™ electronic health record (EHR) patient header and submitted to a state Registry, improving efficiency, accuracy, and rapid access to and retrieval of these important medical orders. POLST Forms, implemented in Oregon in 1992, are standardized portable medical orders used to document patient treatment goals for end-of-life care...
November 2016: Journal of Medical Systems
Marie-Pierre Gagnon, Julie Payne-Gagnon, Erik Breton, Jean-Paul Fortin, Lara Khoury, Lisa Dolovich, David Price, David Wiljer, Gillian Bartlett, Norman Archer
BACKGROUND: Healthcare stakeholders have a great interest in the adoption and use of electronic personal health records (ePHRs) because of the potential benefits associated with them. Little is known, however, about the level of adoption of ePHRs in Canada and there is limited evidence concerning their benefits and implications for the healthcare system. This study aimed to describe the current situation of ePHRs in Canada and explore stakeholder perceptions regarding barriers and facilitators to their adoption...
April 6, 2016: International Journal of Health Policy and Management
Rachel D Le, Stacy E F Melanson, Athena K Petrides, Ellen M Goonan, Ida Bixho, Adam B Landman, Anne Marie Brogan, David W Bates, Milenko J Tanasijevic
OBJECTIVES: Most preanalytical errors at our institution occur during nonphlebotomy blood draws. We implemented an electronic health record (EHR), interfaced the EHR to the laboratory information system, and designed a new specimen collection module. We studied the effects of the new system on nonphlebotomy preanalytical errors. METHODS: We used an electronic database of preanalytical errors and calculated the number and type of the most common errors in the emergency department (ED) and inpatient nursing for 3-month periods before (August-October 2014) and after (August-October 2015) implementation...
October 2016: American Journal of Clinical Pathology
Karmen S Williams, Gulzar H Shah
BACKGROUND: Electronic health records (EHRs) are evolving the scope of operations, practices, and outcomes of population health in the United States. Local health departments (LHDs) need adequate health informatics capacities to handle the quantity and quality of population health data. PURPOSE: The purpose of this study was to gain an updated view using the most recent data to identify the primary storage of clinical data, status of data for meaningful use, and characteristics associated with the implementation of EHRs in LHDs...
November 2016: Journal of Public Health Management and Practice: JPHMP
J Mac McCullough, Kate Goodin
CONTEXT: Numerous software and data storage systems are employed by local health departments (LHDs) to manage clinical and nonclinical data needs. Leveraging electronic systems may yield improvements in public health practice. However, information is lacking regarding current usage patterns among LHDs. OBJECTIVE: To analyze clinical and nonclinical data storage and software types by LHDs. DESIGN: Data came from the 2015 Informatics Capacity and Needs Assessment Survey, conducted by Georgia Southern University in collaboration with the National Association of County and City Health Officials...
November 2016: Journal of Public Health Management and Practice: JPHMP
Barbara Sorondo, Amy Allen, Janet Bayleran, Stacy Doore, Samreen Fathima, Iyad Sabbagh, Lori Newcomb
INTRODUCTION: This project implemented an integrated patient self-reported screening tool in a patient portal and assessed clinical workflow and user experience in primary care practices. METHODS: An electronic health risk assessment based on the CMS Annual Wellness Visit (AWV) was developed to integrate self-reported health information into the patient's electronic health record (EHR). Patients enrolled in care coordination tested the implementation. The evaluation plan included quantitative and qualitative measures of patient adoption, provider adoption, workflow impact, financial impact, and technology impact...
2016: EGEMS
Mark E Patterson, Derick Miranda, Greg Schuman, Christopher Eaton, Andrew Smith, Brad Silver
BACKGROUND: Leveraging "big data" as a means of informing cost-effective care holds potential in triaging high-risk heart failure (HF) patients for interventions within hospitals seeking to reduce 30-day readmissions. OBJECTIVE: Explore provider's beliefs and perceptions about using an electronic health record (EHR)-based tool that uses unstructured clinical notes to risk-stratify high-risk heart failure patients. METHODS: Six providers from an inpatient HF clinic within an urban safety net hospital were recruited to participate in a semistructured focus group...
2016: EGEMS
Majed Al Dogether, Yahya Al Muallem, Mowafa Househ, Basema Saddik, Mohamed Khalifa
In recent decades, healthcare organizations have undergone a significant transformation with the integration of Information and Communication Technologies within healthcare operations to improve healthcare services. Various technologies such as Hospital Information Systems (HIS), Electronic Health Records (EHR) and Laboratory Information Systems (LIS) have been incorporated into healthcare services. The aim of this study is to evaluate the completeness of outpatients' laboratory paper based request forms in comparison with a electronic laboratory request system...
September 23, 2016: Journal of Infection and Public Health
Luke V Rasmussen, Casey L Overby, John Connolly, Christopher G Chute, Joshua C Denny, Robert Freimuth, Andrea L Hartzler, Ingrid A Holm, Shannon Manzi, Jyotishman Pathak, Peggy L Peissig, Maureen Smith, Marc S Williams, Brian H Shirts, Elena M Stoffel, Peter Tarczy-Hornoch, Carolyn R Rohrer Vitek, Wendy A Wolf, Justin Starren
OBJECTIVES: To understand opinions and perceptions on the state of information resources specifically targeted to genomics, and approaches to delivery in clinical practice. METHODS: We conducted a survey of genomic content use and its clinical delivery from representatives across eight institutions in the electronic Medical Records and Genomics (eMERGE) network and two institutions in the Clinical Sequencing Exploratory Research (CSER) consortium in 2014. RESULTS: Eleven responses representing distinct projects across ten sites showed heterogeneity in how content is being delivered, with provider-facing content primarily delivered via the electronic health record (EHR) (n=10), and paper/pamphlets as the leading mode for patient-facing content (n=9)...
2016: Applied Clinical Informatics
Michael Cecchini, Kim Framski, Patricia Lazette, Teresita Vega, Michael Strait, Kerin Adelson
PURPOSE: Cancer staging is critical for prognostication, treatment planning, and determining clinical trial eligibility. Electronic health records (EHRs) have structured staging modules, but physician use is inconsistent. Typically, stage is entered as unstructured free text in clinical notes and cannot easily be used for reporting. METHODS: We created an Epic Best Practice Advisory (BPA) decision support tool that requires physicians to enter cancer stage in a structured module...
September 20, 2016: Journal of Oncology Practice
Juan D Chaparro, David C Classen, Melissa Danforth, David C Stockwell, Christopher A Longhurst
OBJECTIVE: To evaluate the safety of computerized physician order entry (CPOE) and associated clinical decision support (CDS) systems in electronic health record (EHR) systems at pediatric inpatient facilities in the US using the Leapfrog Group's pediatric CPOE evaluation tool. METHODS: The Leapfrog pediatric CPOE evaluation tool, a previously validated tool to assess the ability of a CPOE system to identify orders that could potentially lead to patient harm, was used to evaluate 41 pediatric hospitals over a 2-year period...
September 16, 2016: Journal of the American Medical Informatics Association: JAMIA
Gregory E Simon, Arne Beck, Rebecca Rossom, Julie Richards, Beth Kirlin, Deborah King, Lisa Shulman, Evette J Ludman, Robert Penfold, Susan M Shortreed, Ursula Whiteside
BACKGROUND: Suicide remains the 10th-ranked most frequent cause of death in the United States, accounting for over 40,000 deaths per year. Nonfatal suicide attempts lead to over 200,000 hospitalizations and 600,000 emergency department visits annually. Recent evidence indicates that responses to the commonly used Patient Health Questionnaire (PHQ9) can identify outpatients who are at risk of suicide attempt and suicide death and that specific psychotherapy or Care Management programs can prevent suicide attempts in high-risk patients...
2016: Trials
William R Hogan, Werner Ceusters
BACKGROUND: Disease and diagnosis have been the subject of much ontological inquiry. However, the insights gained therein have not yet been well enough applied to the study, management, and improvement of data quality in electronic health records (EHR) and administrative systems. Data in these systems suffer from workarounds clinicians are forced to apply due to limitations in the current state-of-the art in system design which ignore the various types of entities that diagnoses as information content entities can be and are about...
2016: Journal of Biomedical Semantics
Marsha Gold, Catherine McLAUGHLIN
POLICY POINTS: The expansive goals of the Health Information Technology for Economic and Clinical Health (HITECH) Act required the simultaneous development of a complex and interdependent infrastructure and a wide range of relationships, generating points of vulnerability. While federal legislation can be a powerful stimulus for change, its effectiveness also depends on its ability to accommodate state and local policies and private health care markets. Ambitious goals require support over a long time horizon, which can be challenging to maintain...
September 2016: Milbank Quarterly
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