scholarly journals P050: Electronic health record perceptions and utilization by physicians in urban emergency departments

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S95-S95
Author(s):  
T.A. Graham ◽  
M. Ballermann ◽  
E. Lang ◽  
M. Bullard ◽  
D. Parsons ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Patient Care ◽  
Emergency Departments ◽  
Mixed Methods Research ◽  
Health Record ◽  
University Of Alberta ◽  
Information Tools ◽  
Field Notes ◽  
Electronic Health ◽  
Grey Nuns

Introduction: In 2006, Alberta implemented an Electronic Health Record called the Alberta Netcare Portal (ANP). The ANP provides provincial read-only access to lab tests, diagnostic imaging, medication information and numerous text reports. There is no computerized order entry, and care is coordinated using a hybrid of paper charting and various electronic systems. Here, we quantify observed ANP use by physician participants providing care in four urban Emergency Departments (EDs) in Alberta. The results form part of a larger mixed methods research project aimed at detecting broader implications of ANP use for patient care. Methods: Between October 2014 and July 2015, ED physicians at four EDs (University of Alberta Hospital [UAH], Grey Nuns Community Hospital [GNCH], Foothills Medical Centre [FMC], Peter Lougheed Centre [PLC]) participated in structured clinical observations. Observations were purposively sampled during the first hours of shifts, when physicians orient themselves to the patients they will see during the rest of their shift, including reviewing available historic patient information. Observers used a tablet based tool to generate a time-stamped record of the information tools used alongside patient care. Information tools included permanent paper records, paper excluding permanent documentation, the ANP, clinical and other applications accessed via desktop computers, and mobile devices. Observers also recorded contextual data, including participant commentary, on paper field notes. Results: Across the 4 sites, 142 physicians participated in 376 sessions for a total of 566 observed physician-hours. Participants accessed information in different computerized applications and on paper (i.e., a ‘hybrid’ care environment). The highest proportion of observed physician time interacting with ANP was observed at the UAH (7.0%-8.1%, all values 95% Confidence Intervals). Physicians spent less time using ANP at GNCH (4.1%-4.8%), which was similar to the Calgary EDs (FMC: 4.4-5.3% and PLC: 5.2%-5.9%). Thematic analysis of field notes showed that ANP acceptance was very high. Patient safety concerns were recorded related to care provided alongside ‘hybrid’ patient records. Conclusion: We found high physician acceptance of ANP based on documented comments and observed usage. We posit a high potential for EHRs such as ANP to support improved care coordination which remains partly realized.

scholarly journals I-THS-1908 A Big Data Electronic Health Record for Patient Care Management and Analytics

2019 ◽  
Author(s):  
Ahmad Hidayat ◽  
Arief Hasani
Keyword(s):  
Big Data ◽  
Electronic Health Record ◽  
Patient Care ◽  
Care Management ◽  
Patient Care Management ◽  
Health Conditions ◽  
Health Record ◽  
Complex Variety ◽  
Electronic Health ◽  
Further Development

The I-THS-1908, a big data electronic health record platform, is capable of establishing its capability as an electronic health record to tackle the large volume of data with high velocity and complex variety of patient data by providing the value to the patient care management and analytics. The further development of I-THS-1908 opens the opportunity to use the electronic health record for patient care management and analytics for all type of health conditions.

scholarly journals Electronic Health Record Adoption – Maybe It’s not about the Money

2011 ◽  
Vol 02 (04) ◽  
pp. 460-471 ◽  
Author(s):  
A. Skinner ◽  
J. Windle ◽  
L. Grabenbauer
Keyword(s):  
Electronic Health Record ◽  
Patient Care ◽  
Resistance To Change ◽  
Medical Center ◽  
Academic Medical Center ◽  
Care Physician ◽  
Health Record ◽  
Record System ◽  
Intuitive Interfaces ◽  
Electronic Health

SummaryObjective: The slow adoption of electronic health record (EHR) systems has been linked to physician resistance to change and the expense of EHR adoption. This qualitative study was conducted to evaluate benefits, and clarify limitations of two mature, robust, comprehensive EHR Systems by tech-savvy physicians where resistance and expense are not at issue.Methods: Two EHR systems were examined – the paperless VistA / Computerized Patient Record System used at the Veterans‘ Administration, and the General Electric Centricity Enterprise system used at an academic medical center. A series of interviews was conducted with 20 EHR-savvy multi-institutional internal medicine (IM) faculty and house staff. Grounded theory was used to analyze the transcribed data and build themes. The relevance and importance of themes were constructed by examining their frequency, convergence, and intensity.Results: Despite eliminating resistance to both adoption and technology as drivers of acceptance, these two robust EHR’s are still viewed as having an adverse impact on two aspects of patient care, physician workflow and team communication. Both EHR’s had perceived strengths but also significant limitations and neither were able to satisfactorily address all of the physicians’ needs.Conclusion: Difficulties related to physician acceptance reflect real concerns about EHR impact on patient care. Physicians are optimistic about the future benefits of EHR systems, but are frustrated with the non-intuitive interfaces and cumbersome data searches of existing EHRs.

scholarly journals Back to the Future: Portable Word Processors and the Electronic Health Record

2019 ◽  
Vol 34 (s1) ◽  
pp. s104-s105
Author(s):  
Alfredo Mori
Keyword(s):  
Electronic Health Record ◽  
Emergency Departments ◽  
Extreme Environments ◽  
Health Record ◽  
Physician Burnout ◽  
Software And Hardware ◽  
Electronic Health ◽  
Professional Writers ◽  
Word Processors

Introduction:The Electronic Health Record (EHR) is now the standard means for recording and maintaining medical notes in most emergency departments. The EHR is an independent cause of physician burnout, and maintenance of the EHR may occupy 30 to 50% of clinical time. There are software solutions available, but they are connected to fixed, expensive, distracting, and bright electronically powered computers. Scribes have been successfully trialed, but are also expensive and attached to computers on wheels. Portable digital word processors in the form of the AlphaSmart Neo is a redundant technology designed primarily for children with typing difficulties. It has recently enjoyed a resurgence in popularity among professional writers, journalists, and field researchers for the ultimate distraction-free writing experience. The Alphasmart Neo is cheap, nearly indestructible, intuitive, and requires almost no recharging. It is compatible with all software across Mac OS, Windows, and Linux. Notes are entered by the clinician or scribe, independently of computers, at the bedside, and uploaded to any software via USB cable.Aim:To describe the introduction and impact of the AlphaSmart Neo on the EHR in emergency departments across Australia.Methods:We will examine the role of the Alphasmart Neo in austere, low power, extreme environments with a demonstration on how to enter, maintain, and transfer an electronic health record independent of any computer or power source.Discussion:We believe the AlphaSmart Neo is an ideal, personalized, cheap, effective, and efficient hardware solution to entering notes independent of other software and hardware. It is distraction free at the patient’s bedside, resulting in better notes that the clinician enjoys writing.

scholarly journals The Use of Electronic Health Record Systems During COVID-19 at a Local Community Hospital on the West Coast

2021 ◽  
pp. 53-58
Author(s):  
Malini Krishnamurthi, Ph.D.
Keyword(s):  
Health Care ◽  
Electronic Health Record ◽  
Patient Care ◽  
Data Privacy ◽  
Local Community ◽  
Quality Care ◽  
The United States ◽  
Health Record ◽  
Privacy And Security ◽  
Electronic Health

The United States Federal government looks toward information technology to curtail health care costs while increasing the quality of patient care through the adoption of electronic health record (EHR)systems. This paper examined the experience of a hospital with its EHR system in the context of the pandemic. Results showed that the hospital maintains a state-of-the-art health care system to provide quality care to its community and was responsive to the recent crisis. The results were consistent with other comparable hospitals examined in this study. The hospitals were successful in adopting EHR systems. They were able to identify gaps that could be filled with technology add-ons from different software vendors to improve their functionality and thereby provide better & timely patient care. Managing large volumes of data generated in the normal process of EHR operation and ensuring data privacy and security were the significant challenges faced and are likely to continue in the future.

Novel Nonproprietary Measures of Ambulatory Electronic Health Record Use Associated with Physician Work Exhaustion

2021 ◽  
Vol 12 (03) ◽  
pp. 637-646
Author(s):  
Amrita Sinha ◽  
Tait D. Shanafelt ◽  
Mickey Trockel ◽  
Hanhan Wang ◽  
Christopher Sharp
Keyword(s):  
Electronic Health Record ◽  
Patient Care ◽  
Dominant Factor ◽  
Health Record ◽  
Occupational Burnout ◽  
Electronic Health ◽  
Perception Of Time ◽  
Professional Fulfillment ◽  
The Impact ◽  
Physician Work

Abstract Background Accumulating evidence indicates an association between physician electronic health record (EHR) use after work hours and occupational distress including burnout. These studies are based on either physician perception of time spent in EHR through surveys which may be prone to bias or by utilizing vendor-defined EHR use measures which often rely on proprietary algorithms that may not take into account variation in physician's schedules which may underestimate time spent on the EHR outside of scheduled clinic time. The Stanford team developed and refined a nonproprietary EHR use algorithm to track the number of hours a physician spends logged into the EHR and calculates the Clinician Logged-in Outside Clinic (CLOC) time, the number of hours spent by a physician on the EHR outside of allocated time for patient care. Objective The objective of our study was to measure the association between CLOC metrics and validated measures of physician burnout and professional fulfillment. Methods Physicians from adult outpatient Internal Medicine, Neurology, Dermatology, Hematology, Oncology, Rheumatology, and Endocrinology departments who logged more than 8 hours of scheduled clinic time per week and answered the annual wellness survey administered in Spring 2019 were included in the analysis. Results We observed a statistically significant positive correlation between CLOC ratio (defined as the ratio of CLOC time to allocated time for patient care) and work exhaustion (Pearson's r = 0.14; p = 0.04), but not interpersonal disengagement, burnout, or professional fulfillment. Conclusion The CLOC metrics are potential objective EHR activity-based markers associated with physician work exhaustion. Our results suggest that the impact of time spent on EHR, while associated with exhaustion, does not appear to be a dominant factor driving the high rates of occupational burnout in physicians.

scholarly journals Time Spent on Dedicated Patient Care and Documentation Tasks Before and After the Introduction of a Structured and Standardized Electronic Health Record

2018 ◽  
Vol 09 (01) ◽  
pp. 046-053 ◽  
Author(s):  
Erik Joukes ◽  
Ameen Abu-Hanna ◽  
Ronald Cornet ◽  
Nicolette de Keizer
Keyword(s):  
Electronic Health Record ◽  
Patient Care ◽  
Time Distribution ◽  
Health Record ◽  
University Hospitals ◽  
Peer Communication ◽  
Significant Difference ◽  
Before And After ◽  
Electronic Health ◽  
Multilevel Linear Regression

Background Physicians spend around 35% of their time documenting patient data. They are concerned that adopting a structured and standardized electronic health record (EHR) will lead to more time documenting and less time for patient care, especially during consultations. Objective This study measures the effect of the introduction of a structured and standardized EHR on documentation time and time for dedicated patient care during outpatient consultations. Methods We measured physicians' time spent on four task categories during outpatient consultations: documentation, patient care, peer communication, and other activities. Physicians covered various specialties from two university hospitals that jointly implemented a structured and standardized EHR. Preimplementation, one hospital used a legacy-EHR, and one primarily paper-based records. The same physicians were observed 2 to 6 months before and 6 to 8 months after implementation.We analyzed consultation duration, and percentage of time spent on each task category. Differences in time distribution before and after implementation were tested using multilevel linear regression. Results We observed 24 physicians (162 hours, 439 consultations). We found no significant difference in consultation duration or number of consultations per hour. In the legacy-EHR center, we found the implementation associated with a significant decrease in time spent on dedicated patient care (−8.5%). In contrast, in the previously paper-based center, we found a significant increase in dedicated time spent on documentation (8.3%) and decrease in time on combined patient care and documentation (−4.6%). The effect on dedicated documentation time significantly differed between centers. Conclusion Implementation of a structured and standardized EHR was associated with 8.5% decrease in time for dedicated patient care during consultations in one center and 8.3% increase in dedicated documentation time in another center. These results are in line with physicians' concerns that the introduction of a structured and standardized EHR might lead to more documentation burden and less time for dedicated patient care.

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