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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
#1
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
#2
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
#3
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
#4
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
#5
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...
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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