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https://www.readbyqxmd.com/read/28210363/using-the-electronic-medical-record-to-reduce-unnecessary-ordering-of-coagulation-studies-for-patients-with-chest-pain
#1
Jeremiah S Hinson, Binoy Mistry, Yu-Hsiang Hsieh, Nicholas Risko, David Scordino, Karolina Paziana, Susan Peterson, Rodney Omron
INTRODUCTION: Our goal was to reduce ordering of coagulation studies in the emergency department (ED) that have no added value for patients presenting with chest pain. We hypothesized this could be achieved via implementation of a stopgap measure in the electronic medical record (EMR). METHODS: We used a pre and post quasi-experimental study design to evaluate the impact of an EMR-based intervention on coagulation study ordering for patients with chest pain. A simple interactive prompt was incorporated into the EMR of our ED that required clinicians to indicate whether patients were on anticoagulation therapy prior to completion of orders for coagulation studies...
February 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28210351/cross-continuum-tool-is-associated-with-reduced-utilization-and-cost-for-frequent-high-need-users
#2
Lauran Hardin, Adam Kilian, Leslie Muller, Kevin Callison, Michael Olgren
INTRODUCTION: High-need, high-cost (HNHC) patients can over-use acute care services, a pattern of behavior associated with many poor outcomes that disproportionately contributes to increased U.S. healthcare cost. Our objective was to reduce healthcare cost and improve outcomes by optimizing the system of care. We targeted HNHC patients and identified root causes of frequent healthcare utilization. We developed a cross-continuum intervention process and a succinct tool called a Complex Care Map (CCM)© that addresses fragmentation in the system and links providers to a comprehensive individualized analysis of the patient story and causes for frequent access to health services...
February 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28192551/effectiveness-of-computer-automation-for-the-diagnosis-and-management-of-childhood-type-2-diabetes-a-randomized-clinical-trial
#3
Tamara S Hannon, Tamara M Dugan, Chandan K Saha, Steven J McKee, Stephen M Downs, Aaron E Carroll
Importance: Type 2 diabetes (T2D) is increasingly common in young individuals. Primary prevention and screening among children and adolescents who are at substantial risk for T2D are recommended, but implementation of T2D screening practices in the pediatric primary care setting is uncommon. Objective: To determine the feasibility and effectiveness of a computerized clinical decision support system to identify pediatric patients at high risk for T2D and to coordinate screening for and diagnosis of prediabetes and T2D...
February 13, 2017: JAMA Pediatrics
https://www.readbyqxmd.com/read/28187729/use-of-electronic-medical-records-and-quality-of-patient-data-different-reaction-patterns-of-doctors-and-nurses-to-the-hospital-organization
#4
Mattijs S Lambooij, Hanneke W Drewes, Ferry Koster
BACKGROUND: As the implementation of Electronic Medical Records (EMRs) in hospitals may be challenged by different responses of different user groups, this paper examines the differences between doctors and nurses in their response to the implementation and use of EMRs in their hospital and how this affects the perceived quality of the data in EMRs. METHODS: Questionnaire data of 402 doctors and 512 nurses who had experience with the implementation and the use of EMRs in hospitals was analysed with Multi group Structural equation modelling (SEM)...
February 10, 2017: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/28186056/a-conceptual-model-for-increasing-use-of-electronic-medical-records-by-primary-care-physicians-through-end-user-support
#5
Gurprit K Randhawa
A conceptual model for exploring the relationship between end-user support (EUS) and electronic medical record (EMR) use by primary care physicians is presented. The model was developed following a review of conceptual and theoretical frameworks related to technology adoption/use and EUS. The model includes (a) one core construct (facilitating conditions), (b) four antecedents and one postcedent of facilitating conditions, and (c) four moderators. EMR use behaviour is the key outcome of the model. The proposed conceptual model should be tested...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28186031/the-use-of-case-studies-in-systems-implementations-within-health-care-settings-a-scoping-review
#6
Rav Gill, Elizabeth M Borycki
There is little evidence available in the research literature as to how to undertake an implementation process that ensures electronic medical record (EMR)/electronic health record (EHR) implementation success (i.e. high levels of clinician adoption). The research literature has documented the presence of a direct relationship between how systems are implemented and their level of adoption by clinicians after implementation. In order to develop recommendations for systems implementation to enhance the level of clinician adoption and to ensure EHR/EMR success, researchers need to analyze implementation failures (i...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28186029/the-cost-of-quality-in-diabetes
#7
Ahmad Ghany, Karim Keshavjee
The adoption and use of Electronic Medical Records (EMRs) and Electronic Health Records (EHRs) is continuing to rise in North America. These systems contain data of varying degrees of quality, including poor quality or "dirty" data. Data entered into EMRs need to be clean or of high quality for them to be useful for a variety of reasons, including quality improvement, clinical decision support, population management, research and system management. There are two potential solutions to obtaining clean data from EMRs: data discipline and data cleansing...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28156482/implementing-an-emergency-department-emr-trigger-tool-for-palliative-medicine-consultation-and-its-effect-on-length-of-stay-and-health-care-costs-a-retrospective-study
#8
Felix Rivera, Wendy Edwards
: 167 Background: Several studies have shown that palliative medicine consultation can improve multiple patient-centered outcomes, especially when provided early. Our goal is to show that our electronic health record (EHR) trigger tool is a cost-effective way for hospitals to identify patients who may benefit from early consultation, improving outcomes such as hospital length of stay and facilitating appropriate disposition for patients with metastatic cancer. METHODS: Retrospective chart review of 721 patients at an urban community hospital who were identified by a trigger system integrated into the Emergency Department (ED) EHR...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152973/multidisciplinary-process-improvement-to-optimize-oral-chemotherapy-safety
#9
Kerin B Adelson, Monica Fradkin, Renee Havriliak, Michelle Renee Harrison, Osama Abdelghany, Stephanie Kregling, Jessica Wright, Bret Morrow, Roberta Sterling, Mandeep Smith, Frank Esposito, Martha Stutsky, LeeAnn Miller, Rogerio Lilenbaum, Catherine A Lyons, Anne C Chiang, Howard Cohen
: 134 Background: The rapid development of oral chemotherapy agents brings unique challenges. These drugs must be treated with the same vigilance as parenteral chemotherapy. The oral chemotherapy system is not optimized or integrated across our hospital. A quality assessment survey identified the need for a better means to monitor and improve oral chemotherapy patient outcomes. METHODS: Patient and staff satisfaction with the current process was measured. A chartered multidisciplinary task force reviewed existing practice and developed a program to identify patients, ensure drug access, standardize prescription and consent, ensure on-going clinical support including patient education, regimen specific adherence monitoring, toxicity assessment and address patient concerns...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152921/integrating-a-simple-screening-tool-in-the-electronic-medical-record-to-standardize-patient-needs-identification-process
#10
Audrey Caspar-Clark, Neal Niznan, Rebecca Cammy
: 156 Background: Unidentified psychosocial and nutrition needs can impede a patient's quality of life during cancer treatment. Nutritional, social, and logistical patient needs may be overlooked without a standardized identification process. With the increasing use of the electronic medical record (EMR), simple screening tools to identify psychosocial needs and nutritional concerns can be implemented. METHODS: The University of Pennsylvania's Department of Radiation Oncology integrated a simple six-question "yes" or "no" response screen directly into the nursing assessment in the EMR to quickly and easily trigger high-risk patient referrals to social work and nutrition services...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152907/developing-and-implementing-emr-functionality-to-improve-oral-chemotherapy-outcomes
#11
Bruce Brockstein, George W Carro, Ashton Marie Hullett, Brad Hughes, Wayne Spath, Sharon Huginnie
: 159 Background: Approval of new oral anticancer agents (OAA) continues to rise, accounting for 75% of new oncology drugs approved so far in 2015. OAA prescriptions generated at our institution demonstrate similar growth, as the prescription volume for OAA is approximately 200% greater than it was 8 years ago. Challenges of OAA, including safe prescribing, monitoring toxicities, and assessing adherence, continue to be an obstacle to providing quality care. In recognition of these challenges, our institution employed the electronic medical record (EMR) to develop tools to enhance safe prescribing, monitoring, and follow up for patients receiving OAA...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152903/refining-the-use-of-an-electronic-medical-record-emr-to-define-and-implement-psychosocial-distress-screening-and-treatment
#12
(no author information available yet)
: 144 Background: All cancer patients experience some level of distress associated with cancer and its treatment at all stages of the disease. Psychological and social problems created or exacerbated by cancer cause additional suffering, weaken adherence to prescribed treatments and threaten patients' return to health." Health care providers often tend to under estimate psychological distress. Screening and early identification of distress promote improved management of symptoms, which facilitates medical care...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152900/hardwiring-advance-directives-into-an-electronic-medical-record
#13
Tyler Buckley, Andrew Badke, Amy Horyna, Julie Howell, Lisa Gren, Anna Catherine Beck
: 146 Background: Patient preference at the end of life has been extensively researched and documented. Advance Directives (AD) have been shown to make a difference for patients in the areas of quality, cost, and patient satisfaction. Organizations struggle with meeting federal laws and accreditation expectations due to our complex systems. Literature supports "hardwiring" AD documentation into the EMR and providing "one click" accessibility to AD's. Changing EMR vendors provides a unique opportunity to optimize access to AD's, both through patient education /endorsement, review of providers' role, and engagement of IT...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152894/engaging-managing-physicians-in-clinical-staging-prior-to-the-initiation-of-cancer-treatment
#14
Carol Huibregtse, Marija Bjegovich-Weidman, James L Weese
: 143 Background: Managing physicians (medical oncologist, radiation oncologist, surgeons) have a responsibility to clinically stage patients prior to the initiation of cancer treatment. Clinical staging not only directs the treatment plan, but identifies appropriate clinical trials and estimates prognosis. We sought to determine whether engagement of managing physicians would result in increased clinical staging for various types of cancer. METHODS: Baseline data on clinical staging for breast, colorectal (colon, rectal, anal, rectosigmoid junction)*, thoracic (lung esophageal)†, genitourinary (prostate, penis, testes)‡, and pancreatic primary cancers were obtained...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152855/cervical-screening-reminder-calls-pilot-utilizing-emrs-to-improve-cancer-screening
#15
Aaron Randall
: 163 Background: Cancer screening detects pre-cancerous changes, or cancer at an early stage when there is a better chance of treating it successfully. Research shows that that physician encouragement improves the odds of patients getting screened. Furthermore, systematic reviews demonstrate that efforts to encourage screening can be more effective through telephone reminders when compared to other methods of outreach. Electronic Medical Records (EMRs) are a powerful tool for the coordination, recording, monitoring and reporting of patient care in primary care...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152756/making-steps-to-decrease-emergency-room-visits-in-patients-with-cancer-our-experience-after-participating-in-the-asco-quality-training-program
#16
Alvaro Jose Alencar, Aurelio Bartolome Castrellon, Luis E Raez, Vedner Guerrier
: 51 Background: Overutilization of emergency room services by oncology patients is a known problem associated with increased admission rates and health care expenditure. A review of our oncology patients' emergency room (ER) visits from January to May 2015 demonstrated that 48% of ER visits happened during office hours. Consequently a rapid cycle quality improvement project was developed with an aim to decrease ER visits by 30% by September 2015. METHODS: A multidisciplinary team completed an action plan, starting with a project charter and definition of aim statement...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152725/implementing-psychosocial-distress-screening-across-a-health-system-herding-cats-or-herding-cats
#17
(no author information available yet)
: 113 Background: With the American College of Surgeons Commission on Cancer 2015 Standards in hand, Penn Medicine embarked on a project to formulate an entity-wide plan for the provision of psychosocial distress screening. Identifying psychosocial distress and providing resources to meet those needs is an essential component of quality cancer care. Penn Medicine and the Abramson Cancer Center provided more than 91,000 chemotherapy treatments, 121,000 radiation treatments, and 14,000 proton therapy treatments in FY 15 in urban, suburban and rural settings with wide variations in resources...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152714/data-collection-for-care-pathways-in-the-cleveland-clinic-health-system
#18
Chad W Cummings, Marc A Shapiro, Dennis Urbanek, Brian James Bolwell
: 115 Background: Care pathways are established methods of reducing healthcare costs and disparities in oncology care. To demonstrate their impact, health systems must measure and report data on care pathway adherence and outcomes in near real-time. Automating data abstraction across a health system for oncology is difficult due to the amount and detail of data required. Manual abstraction of data is considered slow and costly. Many consider Electronic Medical Record (EMR) integration of care pathways essential in order to successfully implement and assess...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28150097/implementation-successes-and-challenges-in-participating-in-a-pragmatic-study-to-improve-colon-cancer-screening-perspectives-of-health-center-leaders
#19
Gloria D Coronado, Jennifer L Schneider, Amanda Petrik, Jennifer Rivelli, Stephen Taplin, Beverly B Green
Little is known about the challenges faced by community clinics who must address clinical priorities first when participating in pragmatic studies. We report on implementation challenges faced by the eight community health centers that participated in Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC), a large comparative effectiveness cluster-randomized trial to evaluate a direct-mail program to increase the rate of colorectal cancer (CRC) screening. We conducted interviews, at the onset of implementation and 1 year later, with center leaders to identify challenges with implementing and sustaining an electronic medical record (EMR)-driven mailed program to increase CRC screening rates...
February 1, 2017: Translational Behavioral Medicine
https://www.readbyqxmd.com/read/28118919/what-is-the-impact-of-an-electronic-test-result-acknowledgement-system-on-emergency-department-physicians-work-processes-a-mixed-method-pre-post-observational-study
#20
Andrew Georgiou, Euan J McCaughey, Amina Tariq, Scott R Walter, Julie Li, Joanne Callen, Richard Paoloni, William B Runciman, Johanna I Westbrook
OBJECTIVE: To examine the impact of an electronic Results Acknowledgement (eRA) system on emergency physicians' test result management work processes and the time taken to acknowledge microbiology and radiology test results for patients discharged from an Emergency Department (ED). METHODS: The impact of the eRA system was assessed in an Australian ED using: a) semi-structured interviews with senior emergency physicians; and b) a time and motion direct observational study of senior emergency physicians completing test acknowledgment pre and post the implementation of the eRA system...
March 2017: International Journal of Medical Informatics
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