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https://www.readbyqxmd.com/read/28431419/creation-and-validation-of-an-automated-algorithm-to-determine-postoperative-ventilator-requirements-after-cardiac-surgery
#1
Eilon Gabel, Ira S Hofer, Nancy Satou, Tristan Grogan, Richard Shemin, Aman Mahajan, Maxime Cannesson
BACKGROUND: In medical practice today, clinical data registries have become a powerful tool for measuring and driving quality improvement, especially among multicenter projects. Registries face the known problem of trying to create dependable and clear metrics from electronic medical records data, which are typically scattered and often based on unreliable data sources. The Society for Thoracic Surgery (STS) is one such example, and it supports manually collected data by trained clinical staff in an effort to obtain the highest-fidelity data possible...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28423156/creation-of-an-internal-teledermatology-store-and-forward-system-in-an-existing-electronic-health-record-a-pilot-study-in-a-safety-net-public-health-and-hospital-system
#2
Zachary A Carter, Shauna Goldman, Kristen Anderson, Xiaxiao Li, Linda S Hynan, Benjamin F Chong, Arturo R Dominguez
Importance: External store-and-forward (SAF) teledermatology systems operate separately from the primary health record and have many limitations, including care fragmentation, inadequate communication among clinicians, and privacy and security concerns, among others. Development of internal SAF workflows within existing electronic health records (EHRs) should be the standard for large health care organizations for delivering high-quality dermatologic care, improving access, and capturing other telemedicine benchmark data...
April 19, 2017: JAMA Dermatology
https://www.readbyqxmd.com/read/28395051/implementation-of-epic-beaker-clinical-pathology-at-stanford-university-medical-center
#3
Brent T Tan, Jennifer Fralick, William Flores, Cary Schrandt, Vicki Davis, Tom Bruynell, Lisa Wilson, John Christopher, Shirley Weber, Neil Shah
Objectives: To provide an account of implementation of the Epic Beaker 2014 clinical pathology module at Stanford University Medical Center and highlight strengths and weaknesses of the system. Methods: Based on a formal selection process, Stanford selected Epic Beaker to replace Sunquest as the clinical laboratory information system (LIS). The rationale included integration between the LIS and already installed Epic electronic medical record (EMR), reduction in the number of systems and interfaces, and positive patient identification (PPID)...
March 1, 2017: American Journal of Clinical Pathology
https://www.readbyqxmd.com/read/28390396/validity-of-type-2-diabetes-diagnosis-in-a-population-based-electronic-health-record-database
#4
Conchi Moreno-Iribas, Carmen Sayon-Orea, Josu Delfrade, Eva Ardanaz, Javier Gorricho, Rosana Burgui, Marian Nuin, Marcela Guevara
BACKGROUND: The increasing burden of type 2 diabetes mellitus makes the continuous surveillance of its prevalence and incidence advisable. Electronic health records (EHRs) have great potential for research and surveillance purposes; however the quality of their data must first be evaluated for fitness for use. The aim of this study was to assess the validity of type 2 diabetes diagnosis in a primary care EHR database covering more than half a million inhabitants, 97% of the population in Navarra, Spain...
April 8, 2017: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/28360503/the-role-of-copy-and-paste-function-in-orthopedic-trauma-progress-notes
#5
Wesley Winn, Irshad A Shakir, Heidi Israel, Lisa K Cannada
INTRODUCTION: The electronic medical record (EMR) is standard in institutions. While there is not concern for legibility of notes and access to charts, there is an ease of copy and paste for daily notes. This may not lead to accurate portrayal of patient's status. Our purpose was to evaluate the use of copy and paste functions in daily notes of patients with injuries at high risk for complications. METHODS: IRB approval was obtained for a retrospective review. Inclusion criteria included patients aged 18 and older treated at our Level 1 Trauma Center after implementation of Epic Systems Corporation, Verona, WI, USA...
January 2017: Journal of Clinical Orthopaedics and Trauma
https://www.readbyqxmd.com/read/28324321/structured-data-entry-in-the-electronic-medical-record-perspectives-of-pediatric-specialty-physicians-and-surgeons
#6
Ruth A Bush, Cynthia Kuelbs, Julie Ryu, Wen Jiang, George Chiang
The Epic electronic health record (EHR) platform supports structured data entry systems (SDES), which allow developers, with input from users, to create highly customized patient-record templates in order to maximize data completeness and to standardize structure. There are many potential advantages of using discrete data fields in the EHR to capture data for secondary analysis and epidemiological research, but direct data acquisition from clinicians remains one of the largest obstacles to leveraging the EHR for secondary use...
May 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/28323114/physician-activity-during-outpatient-visits-and-subjective-workload
#7
Alan Calvitti, Harry Hochheiser, Shazia Ashfaq, Kristin Bell, Yunan Chen, Robert El Kareh, Mark T Gabuzda, Lin Liu, Sara Mortensen, Braj Pandey, Steven Rick, Richard L Street, Nadir Weibel, Charlene Weir, Zia Agha
We describe methods for capturing and analyzing EHR use and clinical workflow of physicians during outpatient encounters and relating activity to physicians' self-reported workload. We collected temporally-resolved activity data including audio, video, EHR activity, and eye-gaze along with post-visit assessments of workload. These data are then analyzed through a combination of manual content analysis and computational techniques to temporally align streams, providing a range of process measures of EHR usage, clinical workflow, and physician-patient communication...
March 17, 2017: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/28194729/design-and-implementation-of-decision-support-for-tobacco-dependence-treatment-in-an-inpatient-electronic-medical-record-a-randomized-trial
#8
Steven L Bernstein, June Rosner, Michelle DeWitt, Jeanette Tetrault, Allen L Hsiao, James Dziura, Scott Sussman, Patrick O'Connor, Benjamin Toll
Tobacco dependence treatment for hospitalized smokers results in long-term cessation if treatment continues at least 30 days post-discharge. Health information technology may facilitate ongoing tobacco dependence treatment after hospital discharge. To describe the use and impact of a new decision support tool and order set for inpatient physicians, addressing tobacco dependence treatment for hospitalized smokers, embedded in an electronic health record (EHR). In a cluster-randomized trial, 254 physicians were randomized (1:1) to either receive or not receive the decision support tool and order set, which were embedded in the Epic (Madison, WI) EHR used at 2 hospitals in a single city...
February 13, 2017: Translational Behavioral Medicine
https://www.readbyqxmd.com/read/28152915/a-pragmatic-approach-for-measuring-and-monitoring-hospitalizations-in-patients-receiving-chemotherapy-for-pancreatic-cancer
#9
Carole Kathleen Dalby, Saira Chaudary, Joseph O Jacobson
278 Background: Hospitalizations in patients receiving chemotherapy are common and costly. In order to test interventions to reduce hospitalizations in chemotherapy patients, efficient approaches are needed for monitoring the incidence of hospitalization. METHODS: We evaluated the monthly frequency of hospitalization in patients receiving active chemotherapy for pancreas cancer. Two definitions were used to identify patients under "active" chemotherapy treatment in a given month; both definitions required that patients were alive on the first day of the evaluation month...
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
#10
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/28152859/faster-ways-of-pursuing-quality-control-using-ehr-electronic-health-record
#11
Samip R Master, Glenn Morris Mills, Richard P Mansour
169 Background: In this era of electronic health records (EHR), quality monitoring can be a fast repetitive process. Having access to the relational database of the EHR permits rapid case identification and quality indicator determination. We hereby describe evaluation of hepatitis B testing prior to rituximab administration, a quality measure as per ASCO guidelines. METHODS: We connected SQL Query Manager with EPIC Clarity database. Using the object model for medication orders, location and department, we used SQL language to build a temporary dataset of all patients who have a completed order for a Rituximab infusion at a specific department location within the past 6 months...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152839/development-of-a-radiation-oncology-specific-prospective-data-registry-for-clinical-research-and-quality-improvement-a-clinical-workflow-based-solution
#12
Pin-Chieh Wang, Darlene Verittupong, Weber Shao, Susan Ann McCloskey, Vincent Basehart, Michael L Steinberg, Patrick Kupelian
197 Background: The computerized 'paperless' medical recording system has transformed the modern health information system and serves as an idea platform for cancer registry development, particularly in a specialty like radiation oncology, where technological advances generate unprecedented amounts of data. METHODS: From May 2011 to May 2015, physicians prospectively inputted data on patients seen during consultation in the Department of Radiation Oncology at UCLA. Using a customized interface established between an in-house registry and a commercially-available, hospital-based electronic medical record system (Epic Systems, Inc...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28130725/effect-of-the-implementation-of-a-new-electronic-health-record-system-on-surgical-case-turnover-time
#13
Joseph McDowell, Albert Wu, Jesse M Ehrenfeld, Richard D Urman
Many health care providers, hospitals, and hospital systems have adopted new electronic health records (EHR) to streamline patient care and comply with government mandates. Commercial EHR vendors advertise improved efficiency, but few studies have been performed to validate these claims. Therefore, this study was performed to evaluate the effect of deploying a new EHR system on operating room efficiency and surgical case turnover time (TOT) at our institution. Data on TOT were collected after implementation of a new EHR (Epic) from June 2015 to May 2016, which replaced a legacy system of both paper and electronic records...
March 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/28118917/opening-the-duke-electronic-health-record-to-apps-implementing-smart-on-fhir
#14
Richard A Bloomfield, Felipe Polo-Wood, Joshua C Mandel, Kenneth D Mandl
OBJECTIVE: Recognizing a need for our EHR to be highly interoperable, our team at Duke Health enabled our Epic-based electronic health record to be compatible with the Boston Children's project called Substitutable Medical Apps and Reusable Technologies (SMART), which employed Health Level Seven International's (HL7) Fast Healthcare Interoperability Resources (FHIR), commonly known as SMART on FHIR. METHODS: We created a custom SMART on FHIR-compatible server infrastructure written in Node...
March 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/28000116/communication-patterns-in-the-perioperative-environment-during-epic-electronic-health-record-system-implementation
#15
Tynan H Friend, Samantha J Jennings, Wilton C Levine
In April 2016, Massachusetts General Hospital (MGH) went live with the Epic electronic health records (EHR) system, replacing a variety of EHRs that previously existed in different departments throughout the hospital. At the time of implementation, the Vocera® Badge Communication System, a wireless hands-free communication device distributed to perioperative team members, had increased perioperative communication flow and efficiency. As a quality improvement effort to better understand communication patterns during an EHR go-live, we monitored our Vocera call volume and user volume before, during and after our go-live...
February 2017: Journal of Medical Systems
https://www.readbyqxmd.com/read/27777671/developing-teaching-strategies-in-the-ehr-era-a-survey-of-gme-experts
#16
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
#17
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
#18
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
#19
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
#20
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
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