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https://www.readbyqxmd.com/read/27777671/developing-teaching-strategies-in-the-ehr-era-a-survey-of-gme-experts
#1
Amber R Atwater, Mariah Rudd, Audrey Brown, John S Wiener, Robert Benjamin, W Robert Lee, Jullia A Rosdahl
BACKGROUND : There is limited information on the impact of widespread adoption of the electronic health record (EHR) on graduate medical education (GME). OBJECTIVE : To identify areas of consensus by education experts, where the use of EHR impacts GME, with the goal of developing strategies and tools to enhance GME teaching and learning in the EHR environment. METHODS : Information was solicited from experienced US physician educators who use EPIC EHR following 3 steps: 2 rounds of online surveys using the Delphi technique, followed by telephone interviews...
October 2016: Journal of Graduate Medical Education
https://www.readbyqxmd.com/read/27771002/effectiveness-and-safety-of-an-independently-run-nurse-practitioner-outpatient-cardioversion-program-2009-to-2014
#2
Linda Norton, Angela Tsiperfal, Kelly Cook, Ani Bagdasarian, John Varady, Manali Shah, Paul Wang
Sustained growth in the arrhythmia population at Stanford Health Care led to an independent nurse practitioner-run outpatient direct current cardioversion (DCCV) program in 2012. DCCVs performed by a medical doctor, a nurse practitioner under supervision, or nurse practitioners from 2009 to 2014 were compared for safety and efficacy. A retrospective review of the electronic medical records system (Epic) was performed on biodemographic data, cardiovascular risk factors, medication history, procedural data, and DCCV outcomes...
September 15, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27758162/rationale-and-design-of-the-registry-for-stones-of-the-kidney-and-ureter-resku-a-prospective-observational-registry-to-study-the-natural-history-of-urolithiasis-patients
#3
Helena C Chang, David T Tzou, Manint Usawachintachit, Brian D Duty, Ryan S Hsi, Jonathan D Harper, Mathew D Sorensen, Marshall L Stoller, Roger L Sur, Thomas Chi
OBJECTIVES: Registry-based clinical research in nephrolithiasis is critical to advancing quality in urinary stone disease management and ultimately reducing stone recurrence. A need exists to develop Health Insurance Portability and Accountability Act (HIPAA)-compliant registries that comprise integrated electronic health record (EHR) data using prospectively defined variables. An EHR-based standardized patient database-the Registry for Stones of the Kidney and Ureter (ReSKU™)-was developed, and herein we describe our implementation outcomes...
December 2016: Journal of Endourology
https://www.readbyqxmd.com/read/27696173/implementation-of-a-novel-electronic-health-record-embedded-physician-orders-for-life-sustaining-treatment-system
#4
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
https://www.readbyqxmd.com/read/27683664/using-machine-learning-and-natural-language-processing-algorithms-to-automate-the-evaluation-of-clinical-decision-support-in-electronic-medical-record-systems
#5
Donald A Szlosek, Jonathan Ferrett
INTRODUCTION: As the number of clinical decision support systems (CDSSs) incorporated into electronic medical records (EMRs) increases, so does the need to evaluate their effectiveness. The use of medical record review and similar manual methods for evaluating decision rules is laborious and inefficient. The authors use machine learning and Natural Language Processing (NLP) algorithms to accurately evaluate a clinical decision support rule through an EMR system, and they compare it against manual evaluation...
2016: EGEMS
https://www.readbyqxmd.com/read/27650837/electronic-intervention-to-improve-structured-cancer-stage-data-capture
#6
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
https://www.readbyqxmd.com/read/27623949/introduction-of-a-new-electronic-medical-record-system-has-mixed-effects-on-first-surgical-case-efficiency-metrics
#7
Albert Wu, Bhavani S Kodali, Hugh L Flanagan, Richard D Urman
To evaluate the effect of deploying a new electronic medical record (EMR) system on first case starts in the operating room. Data on first case start times were collected after implementation of a new EMR (Epic) from June 2015 to May 2016, which replaced a legacy system of both paper and electronic records. These were compared to data from the same months in the three proceeding years. First patient in room (FPIR) on time was true if the patient was in operating room before 7:35 AM (or 9:35 AM on Wednesdays) and first case on time start (FCOTS) was true if completion of anesthetic induction was less than 20 min after the patient entered the operating room (or 35 min for cardiac and neurosurgery)...
September 13, 2016: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/27613792/patterns-of-electronic-portal-use-among-vulnerable-patients-in-a-nationwide-practice-based-research-network-from-the-ochin-practice-based-research-network-pbrn
#8
Lorraine S Wallace, Heather Angier, Nathalie Huguet, James A Gaudino, Alex Krist, Marla Dearing, Marie Killerby, Miguel Marino, Jennifer E DeVoe
BACKGROUND: Underserved patient populations experience barriers to accessing and engaging within the complex health care system. Electronic patient portals have been proposed as a potential new way to improve access and engagement. We studied patient portal use for 12 consecutive months (365 days) among a large, nationally distributed, underserved patient population within the OCHIN (originally created as the Oregon Community Health Information Network and renamed OCHIN as other states joined) practice-based research network (PBRN)...
September 2016: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/27573921/evaluation-of-electronic-health-record-implementation-on-pharmacist-interventions-related-to-oral-chemotherapy-management
#9
Anastasia Finn, Carolyn Bondarenka, Kathy Edwards, Rebekah Hartwell, Cathy Letton, Andy Perez
BACKGROUND: With the ever growing arsenal of oral chemotherapy agents now available, cancer treatment is being increasingly managed in the outpatient setting. However, oral chemotherapy use is often associated with several potential obstacles and complications. In order to provide optimal patient safety and oral chemotherapy monitoring, our institution implemented an oral chemotherapy program managed by clinical pharmacists electronically through Epic Beacon. OBJECTIVE: To describe implementation of a novel pharmacist-managed oral chemotherapy program and evaluate pharmacist interventions before and after implementation of an oral chemotherapy program...
August 29, 2016: Journal of Oncology Pharmacy Practice
https://www.readbyqxmd.com/read/27530268/the-use-of-evidence-based-problem-oriented-templates-as-a-clinical-decision-support-in-an-inpatient-electronic-health-record-system
#10
Raj Mehta, Nila S Radhakrishnan, Carrie D Warring, Ankur Jain, Jorge Fuentes, Angela Dolganiuc, Laura S Lourdes, John Busigin, Robert R Leverence
BACKGROUND: The integration of clinical decision support (CDS) in documentation practices remains limited due to obstacles in provider workflows and design restrictions in electronic health records (EHRs). The use of electronic problem-oriented templates (POTs) as a CDS has been previously discussed but not widely studied. OBJECTIVE: We evaluated the voluntary use of evidence-based POTs as a CDS on documentation practices. METHODS: This was a randomized cohort (before and after) study of Hospitalist Attendings in an Academic Medical Center using EPIC EHRs...
August 17, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27521368/health-information-exchange-associated-with-improved-emergency-department-care-through-faster-accessing-of-patient-information-from-outside-organizations
#11
Jordan Everson, Keith E Kocher, Julia Adler-Milstein
OBJECTIVE: To assess whether electronic health information exchange (HIE) is associated with improved emergency department (ED) care processes and utilization through more timely clinician viewing of information from outside organizations. MATERIALS AND METHODS: Our data included 2163 patients seen in the ED of a large academic medical center for whom clinicians requested and viewed outside information from February 14, 2014, to February 13, 2015. Outside information requests w...
August 12, 2016: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/27437059/clinical-decision-support-for-a-multicenter-trial-of-pediatric-head-trauma-development-implementation-and-lessons-learned
#12
Eric Tham, Marguerite Swietlik, Sara Deakyne, Jeffrey M Hoffman, Robert W Grundmeier, Marilyn D Paterno, Beatriz H Rocha, Molly H Schaeffer, Deepika Pabbathi, Evaline Alessandrini, Dustin Ballard, Howard S Goldberg, Nathan Kuppermann, Peter S Dayan
INTRODUCTION: For children who present to emergency departments (EDs) due to blunt head trauma, ED clinicians must decide who requires computed tomography (CT) scanning to evaluate for traumatic brain injury (TBI). The Pediatric Emergency Care Applied Research Network (PECARN) derived and validated two age-based prediction rules to identify children at very low risk of clinically-important traumatic brain injuries (ciTBIs) who do not typically require CT scans. In this case report, we describe the strategy used to implement the PECARN TBI prediction rules via electronic health record (EHR) clinical decision support (CDS) as the intervention in a multicenter clinical trial...
2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27429992/using-a-data-quality-framework-to-clean-data-extracted-from-the-electronic-health-record-a-case-study
#13
Oliwier Dziadkowiec, Tiffany Callahan, Mustafa Ozkaynak, Blaine Reeder, John Welton
OBJECTIVES: We examine the following: (1) the appropriateness of using a data quality (DQ) framework developed for relational databases as a data-cleaning tool for a data set extracted from two EPIC databases, and (2) the differences in statistical parameter estimates on a data set cleaned with the DQ framework and data set not cleaned with the DQ framework. BACKGROUND: The use of data contained within electronic health records (EHRs) has the potential to open doors for a new wave of innovative research...
2016: EGEMS
https://www.readbyqxmd.com/read/27404288/the-nature-and-variability-of-automated-practice-alerts-derived-from-electronic-health-records-in-a-u-s-nationwide-critical-care-research-network
#14
Cody Benthin, Sonal Pannu, Akram Khan, Michelle Gong
RATIONALE: The nature, variability and extent of early warning clinical practice alerts derived from automated query of electronic health records (e-alerts) currently employed in acute care settings for clinical care or research is unknown. OBJECTIVES: To describe e-alerts in current use in acute care settings at medical centers participating in a nationwide critical care research network. METHODS: We surveyed investigators at 38 institutions involved in the NIH-funded Clinical Trials Network for the Prevention and Early Treatment of Acute Lung Injury (PETAL) for quantitative and qualitative analysis...
July 12, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27259503/enhanced-cosyntropin-stimulation-test-performance-enabled-by-electronic-medical-record
#15
Anat Ben-Shlomo, Joseph Guzman, James Mirocha
PURPOSE: To improve performance of the cosyntropin stimulation test (CST) used for diagnosis of adrenal-cortisol insufficiency by implementing an electronic medical record (EMR) system protocol. METHODS: We implemented a SmartForm protocol of the validated CST in our EMR system (CS-Link™, EPIC) system and compared medical staff test performance before and after protocol implementation. RESULTS: Correct performance of the CST improved significantly after EMR implementation...
October 2016: Pituitary
https://www.readbyqxmd.com/read/27195633/a-systematic-approach-to-creation-of-a-perioperative-data-warehouse
#16
Ira S Hofer, Eilon Gabel, Michael Pfeffer, Mohammed Mahbouba, Aman Mahajan
Extraction of data from the electronic medical record is becoming increasingly important for quality improvement initiatives such as the American Society of Anesthesiologists Perioperative Surgical Home. To meet this need, the authors have built a robust and scalable data mart based on their implementation of EPIC containing data from across the perioperative period. The data mart is structured in such a way so as to first simplify the overall EPIC reporting structure into a series of Base Tables and then create several Reporting Schemas each around a specific concept (operating room cases, obstetrics, hospital admission, etc...
June 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27130217/quality-of-ehr-data-extractions-for-studies-of-preterm-birth-in-a-tertiary-care-center-guidelines-for-obtaining-reliable-data
#17
Lindsey A Knake, Monika Ahuja, Erin L McDonald, Kelli K Ryckman, Nancy Weathers, Todd Burstain, John M Dagle, Jeffrey C Murray, Prakash Nadkarni
BACKGROUND: The use of Electronic Health Records (EHR) has increased significantly in the past 15 years. This study compares electronic vs. manual data abstractions from an EHR for accuracy. While the dataset is limited to preterm birth data, our work is generally applicable. We enumerate challenges to reliable extraction, and state guidelines to maximize reliability. METHODS: An Epic™ EHR data extraction of structured data values from 1,772 neonatal records born between the years 2001-2011 was performed...
2016: BMC Pediatrics
https://www.readbyqxmd.com/read/27069149/clinical-outcomes-in-patients-with-recurrent-or-metastatic-human-papilloma-virus-positive-head-and-neck-cancer
#18
Rajan P Dang, Valerie H LE, Brett A Miles, Marita S Teng, Eric M Genden, Richard L Bakst, Vishal Gupta, David Y Zhang, Elizabeth G Demicco, Marshall R Posner, Krzysztof J Misiukiewicz
BACKGROUND: There are few data regarding the role of human papilloma virus (HPV) in recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HNSCC). PATIENTS AND METHODS: A retrospective chart review was carried out using our electronic medical record (EPIC) for all patients diagnosed with HPV-positive R/M HNSCC between 2010 and 2014 with minimum of 6 months of follow-up in order to assess progression-free survival (PFS) and overall survival (OS). RESULTS: We assessed 11 patients who underwent a variety of treatments...
April 2016: Anticancer Research
https://www.readbyqxmd.com/read/27051360/effect-of-introduction-of-a-new-electronic-anesthesia-record-epic-system-on-the-safety-and-efficiency-of-patient-care-in-a-gastrointestinal-endoscopy-suite-comparison-with-historical-cohort
#19
B Goudra, P M Singh, A Borle, G Gouda
BACKGROUND: Use of electronic medical record systems has increased in the recent years. Epic is one such system gaining popularity in the USA. Epic is a private company, which invented the electronic documentation system adopted in our hospital. In spite of many presumed advantages, its use is not critically analyzed. Some of the perceived advantages are increased efficiency and protection against litigation as a result of accurate documentation. MATERIALS AND METHODS: In this study, retrospective data of 305 patients who underwent endoscopic retrograde cholangiopancreatography (wherein electronic charting was used - "Epic group") were compared with 288 patients who underwent the same procedure with documentation saved on a paper chart ("paper group")...
April 2016: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/27046413/using-computerized-physician-order-entry-to-ensure-appropriate-vaccination-of-patients-with-inflammatory-bowel-disease
#20
Jacob R Karr, Jonathan J Lu, Robert B Smith, Austin C Thomas
BACKGROUND: Inflammatory bowel disease (IBD) is a disorder in which an aberrant immune response in a genetically susceptible host, with influences from environmental factors, leads to intestinal inflammation. Vaccines against influenza and pneumococcal pneumonia are indicated for all patients with IBD, while vaccines such as hepatitis A and B, human papillomavirus, and meningococcal meningitis are only indicated for patients with specific risk factor profiles. Some vaccines are contraindicated for patients receiving immunosuppressive medications; typically, these are live or live attenuated vaccines such as measles-mumps-rubella, varicella zoster, and herpes zoster...
2016: Ochsner Journal
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