scholarly journals Electronic health records and clinician burnout: A story of three eras

2020 ◽  
Author(s):  
Kevin B Johnson ◽  
Michael J Neuss ◽  
Don Eugene Detmer
Keyword(s):  
Electronic Health Records ◽  
Technology Policy ◽  
Healthcare Delivery ◽  
Medical Documentation ◽  
Health Records ◽  
Behavioral Determinants ◽  
System A ◽  
History Of ◽  
Electronic Health ◽  
Time Required

Abstract Objective The study sought to provide physicians, informaticians, and institutional policymakers with an introductory tutorial about the history of medical documentation, sources of clinician burnout, and opportunities to improve electronic health records (EHRs). We now have unprecedented opportunities in health care, with the promise of new cures, improved equity, greater sensitivity to social and behavioral determinants of health, and data-driven precision medicine all on the horizon. EHRs have succeeded in making many aspects of care safer and more reliable. Unfortunately, current limitations in EHR usability and problems with clinician burnout distract from these successes. A complex interplay of technology, policy, and healthcare delivery has contributed to our current frustrations with EHRs. Fortunately, there are opportunities to improve the EHR and health system. A stronger emphasis on improving the clinician’s experience through close collaboration by informaticians, clinicians, and vendors can combine with specific policy changes to address the causes of burnout. Target audience This tutorial is intended for clinicians, informaticians, policymakers, and regulators, who are essential participants in discussions focused on improving clinician burnout. Learners in biomedicine, regardless of clinical discipline, also may benefit from this primer and review. Scope We include (1) an overview of medical documentation from a historical perspective; (2) a summary of the forces converging over the past 20 years to develop and disseminate the modern EHR; and (3) future opportunities to improve EHR structure, function, user base, and time required to collect and extract information.

scholarly journals Documentation of social determinants in electronic health records with and without standardized terminologies: A comparative study

2018 ◽  
Vol 28 (1) ◽  
pp. 39-47 ◽  
Author(s):  
Karen A Monsen ◽  
Joyce M Rudenick ◽  
Nicole Kapinos ◽  
Kathryn Warmbold ◽  
Siobhan K McMahon ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Free Text ◽  
Snomed Ct ◽  
Health Records ◽  
Behavioral Determinants ◽  
Omaha System ◽  
Standardized Terminology ◽  
Electronic Health ◽  
Data Elements ◽  
Improve Health

Background: Electronic health records (EHRs) are a promising new source of population health data that may improve health outcomes. However, little is known about the extent to which social and behavioral determinants of health (SBDH) are currently documented in EHRs, including how SBDH are documented, and by whom. Standardized nursing terminologies have been developed to assess and document SBDH. Objective: We examined the documentation of SBDH in EHRs with and without standardized nursing terminologies. Methods: We carried out a review of the literature for SBDH phrases organized by topic, which were used for analyses. Key informant interviews were conducted regarding SBDH phrases. Results: In nine EHRs (six acute care, three community care) 107 SBDH phrases were documented using free text, structured text, and standardized terminologies in diverse screens and by multiple clinicians, admitting personnel, and other staff. SBDH phrases were documented using one of three standardized terminologies ( N = average number of phrases per terminology per EHR): ICD-9/10 ( N = 1); SNOMED CT ( N = 1); Omaha System ( N = 79). Most often, standardized terminology data were documented by nurses or other clinical staff versus receptionists or other non-clinical personnel. Documentation ‘unknown’ differed significantly between EHRs with and without the Omaha System (mean = 26.0 (standard deviation (SD) = 8.7) versus mean = 74.5 (SD = 16.5)) ( p = .005). SBDH documentation in EHRs differed based on the presence of a nursing terminology. Conclusions: The Omaha System enabled a more comprehensive, holistic assessment and documentation of interoperable SBDH data. Further research is needed to determine SBDH data elements that are needed across settings, the uses of SBDH data in practice, and to examine patient perspectives related to SBDH assessments.

Handoff Communication and Electronic Health Records

2014 ◽  
Vol 3 (1) ◽  
pp. 162-169 ◽  
Author(s):  
Julie Apker ◽  
Christopher Beach ◽  
Kevin O’Leary ◽  
Jennifer Ptacek ◽  
Dickson Cheung ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Patient Care ◽  
Healthcare Delivery ◽  
Communication Style ◽  
Health Records ◽  
Practical Applications ◽  
Sensemaking Theory ◽  
Making Sense ◽  
Study Results ◽  
Electronic Health

When transferring patient care responsibilities across the healthcare continuum, clinicians strive to communicate safely and effectively, but communication failures exist that threaten patient safety. Although researchers are making great strides in understanding and solving intraservice handoff problems, inter-service transition communication remains underexplored. Further, electronic health records (EHRs) figure prominently in healthcare delivery, but less is known about how EHRs contribute to inter-service handoffs. This descriptive, qualitative study uses Sensemaking Theory to explore EHR-facilitated, inter-service handoffs occurring between emergency medicine and internal/hospitalist medicine physicians. The researchers conducted six focus groups with 16 attending physicians and medical residents at a major Midwestern academic hospital. Findings suggest clinicians hold varied expectations for information content and relational communication/style. Their expectations contribute to making sense of uncertain handoff situations and communication best practices. Participants generally perceive EHRs as tools that, when used appropriately, can enhance handoffs and patient care continuity. Ideas for practical applications are offered based on study results.

Resident Notes in an Electronic Health Record

2016 ◽  
Vol 56 (3) ◽  
pp. 257-262 ◽  
Author(s):  
Megan Aylor ◽  
Emily M. Campbell ◽  
Christiane Winter ◽  
Carrie A. Phillipi
Keyword(s):  
Focus Group ◽  
Electronic Health Records ◽  
Electronic Health Record ◽  
Medical Documentation ◽  
Health Record ◽  
Health Records ◽  
Resident Perceptions ◽  
Progress Notes ◽  
Electronic Health

Adoption of electronic health records (EHRs) has forced a transition in medical documentation, yet little is known about clinician documentation in the EHR. This study compares electronic inpatient progress notes written by residents pre- and post introduction of standardized note templates and investigates resident perceptions of EHR documentation. A total of 454 resident progress notes pre– and 610 notes post–template introduction were identified. Note length was 263 characters shorter ( P = .004) and mean end time was 73 minutes later ( P < .0001) with new template implementation. In subanalysis of 100 notes, the assessment and plan section was 46 words shorter with the new template ( P < .01). Among survey respondents, 89% liked the new note templates, 78% stated the new templates facilitated note completion. The resident focus group revealed ambivalence toward the EHR’s contribution to note writing. Note templates resulted in shorter notes. Residents appreciate electronic note templates but are unsure if the EHR supports note writing overall.

ANALYZING THE SCOPE OF INTEGRATING ELECTRONIC MEDICAL RECORDS (EMR) AND ELECTRONIC HEALTH RECORDS (EHR) WITH MULTIMODAL HUMAN COMPUTER INTERACTION (MMHCI)

2016 ◽  
Vol 78 (6) ◽  
Author(s):  
Vairamuthu S. ◽  
Margret Anouncia
Keyword(s):  
Electronic Health Records ◽  
Human Computer Interaction ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Complex Data ◽  
Medical Systems ◽  
Health Records ◽  
History Of ◽  
Electronic Health ◽  
Computer Interaction

Developing applications using Multi Modal Human Computer Interaction (MMHCI) remains a great challenge due to the advancement of technologies. Enhanced interaction applications and tools employed in medical records will help to improve the quality of patients’ healthcare and it opens a variety of research challenges. Replacing a difficult system to store complex data related to medical history of patients through Electronic Medical Records (EMR)/Electronic Health Records (EHR) would offer several advantages that include confidentiality and patient details reliability along with the mechanisms for quick and flexible retrieval of data/information. The task of designing MMHCI applications for real time environment for EMR/EHR is thus complex. As the inputs to medical systems are heterogeneous, the associated issues grow up with the need for new system since the existing frameworks have many gaps and drawbacks. This paper attempts to discuss the possible guidelines, standards, tools and techniques involved in integrating MMHCI with EMR/EHR.

scholarly journals M128. THE ASSOCIATION BETWEEN CHILDHOOD SEXUAL ABUSE AND OUTCOMES IN PATIENTS WITH SEVERE MENTAL ILLNESS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S184-S184
Author(s):  
Nomi Werbeloff ◽  
Johan Hilge Thygesen ◽  
Joseph Hayes ◽  
Essi Viding ◽  
David Osborn
Keyword(s):  
Mental Illness ◽  
Sexual Abuse ◽  
Substance Use ◽  
Electronic Health Records ◽  
Childhood Trauma ◽  
Antipsychotic Medication ◽  
Health Records ◽  
History Of ◽  
Self Harm ◽  
Electronic Health

Abstract Background Consistent evidence suggests that there is an association between childhood trauma and psychotic disorders. Exposure to childhood trauma among people with severe mental illness (SMI) is associated with a range of negative outcomes, including exacerbation of symptoms, higher rates of readmission and relapse, poorer levels of social and vocational functioning, substance use and self-harm (Grubaugh et al., 2011). We aimed to identify people with SMI and a history of CSA as recorded in electronic health records in a large mental healthcare provider in the UK, describe the clinical and functional characteristics these patients and compare their clinical outcomes (admissions, medication) to those of patients with no recorded history of CSA. Methods Data for this study were obtained from Camden & Islington NHS Foundation Trust using the Clinical Record Interactive Search (CRIS) tool. CRIS is an application developed to enable routinely collected electronic health records to be used in research. C&I NHS FT is a large mental health provider serving a geographic catchment area of two inner-city London boroughs, and approximately 470,000 residents. For purposes of this study we identified patients with an ICD-10 diagnosis of F20-F29 or F30-31 with at least one year of follow-up. We searched text records (clinical notes and documents) for keywords associated with CSA, using an iterative process of inclusion and exclusion rules. We then tested the positive predictive value of this search. We compared the demographic, clinical and functional characteristics of patients with and without a history of CSA using chi square tests. Next, we used logistic regression models to examine the outcomes of inpatient admission and receipt of antipsychotic medication among the study population. Results We identified 7,000 patients with SMI, of which 619 (8.8%) hade a recorded history of CSA. Patients with a recorded history of CSA were more likely to be female (63.8% vs. 43.3%), single (76.9% vs. 66.5%), of white ethnic origin (66.4% vs. 54.3%) than their counterparts without CSA. There was no difference in the distribution of social deprivation between the groups. Major depressive disorder, posttraumatic stress disorder and personality disorders were all more prevalent in patients with CSA (13.4% vs. 7.6%, 4.7% vs. 1.4%, and 22.0% vs. 5.8%, respectively). Higher rates of moderate-severe psychotic symptoms, depressed mood, self-harm, substance use and aggression were also evident in this group, as were problems with relationships and accommodation. There was a 2-fold increase in the odds of inpatient admissions in patients with a history of CSA than in those without (adjusted OR=1.95, 95% CI: 1.64–2.33), and they were more likely to have spent at least 10 days a year as inpatients (adjusted OR=1.32, 95% CI: 1.07–1.62). Similarly, patients with a history of CSA were more likely to be prescribed antipsychotic medication (adjusted OR=2.48, 95% CI: 1.69–3.66), and more likely to be given over 75% of the maximum recommended dose (adjusted OR=1.72, 95% CI: 1.44–2.04). Discussion The current study used routinely recorded data from electronic health records to identify a history of childhood sexual abuse in patients with SMI. Consistent with previous findings, the study demonstrated that exposure to childhood trauma is associated with negative clinical and functional outcomes in these patients. Clinicians working with patients with SMI should be trained and skilled at assessing childhood adversity, and addressing such adversity in the clinical setting.

Optimizing Electronic Health Records Through Readability

2021 ◽  
Vol 10 (1) ◽  
pp. 65-70
Author(s):  
Rachel V. Ball ◽  
Dave B. Miller ◽  
Shaun Wallace ◽  
Kathlyn Camargo Macias ◽  
Mahmoud Ibrahim ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Medical Information ◽  
Medical Training ◽  
Reading Speed ◽  
Medical Professionals ◽  
Health Records ◽  
History Of ◽  
Text Reading ◽  
Electronic Health ◽  
Amount Of Reading

Medical professionals engage in an enormous and ever-increasing amount of reading in Electronic Health Records (EHRs), which may have adverse impacts on patient care. Personalized readability formats (PRFs) may help to accelerate reading these records, without training, and without adversely affecting comprehension in this critical task. Using History of Present Illness (HPI) reports written by physicians, we investigated how personalized fonts impacted medical text reading speed and comprehension. Crowd-workers without medical training read a set of eighth-grade level passages in six common fonts to determine their fastest and slowest fonts, which were then used to display a set of HPI reports and accompanying comprehension questions. Results showed that PRFs accelerated reading of medical passages by 15% while maintaining comprehension. This finding suggests that individualized information design like PRFs, and specifically font optimization, may be a straightforward way to optimize EHRs through readability. We see a future in which PRFs may help physicians in reading medical information, and look toward future studies investigating PRF impacts on medical professionals’ EHR reading.

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