scholarly journals Transition to a new electronic health record and pediatric medication safety: lessons learned in pediatrics within a large academic health system

2018 ◽  
Vol 25 (7) ◽  
pp. 848-854 ◽  
Author(s):  
Kimberly Whalen ◽  
Emily Lynch ◽  
Iman Moawad ◽  
Tanya John ◽  
Denise Lozowski ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Medication Safety ◽  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Lessons Learned ◽  
Future Research ◽  
Health Record ◽  
Electronic Health ◽  
Roll Out

Abstract Objective While the electronic health record (EHR) has become a standard of care, pediatric patients pose a unique set of risks in adult-oriented systems. We describe medication safety and implementation challenges and solutions in the pediatric population of a large academic center transitioning its EHR to Epic. Methods Examination of the roll-out of a new EHR in a mixed neonatal, pediatric and adult tertiary care center with staggered implementation. We followed the voluntarily reported medication error rate for the neonatal and pediatric subsets and specifically monitored the first 3 months after the roll-out of the new EHR. Data was reviewed and compiled by theme. Results After implementation, there was a 5-fold increase in the overall number of medication safety reports; by the third month the rate of reported medication errors had returned to baseline. The majority of reports were near misses. Three major safety themes arose: (1) enterprise logic in rounding of doses and dosing volumes; (2) ordering clinician seeing a concentration and product when ordering medications; and (3) the need for standardized dosing units through age contexts created issues with continuous infusions and pump library safeguards. Conclusions Future research and work need to be focused on standards and guidelines on implementing an EHR that encompasses all age contexts.

scholarly journals Electronic Health Record Acceptance by Physicians: A Single Hospital Experience in Daily Practice

2021 ◽  
Vol 1 (1) ◽  
pp. 6-17
Author(s):  
Andrija Pavlovic ◽  
Nina Rajovic ◽  
Jasmina Pavlovic Stojanovic ◽  
Debora Akinyombo ◽  
Milica Ugljesic ◽  
...  
Keyword(s):  
Health Care ◽  
Logistic Regression ◽  
Electronic Health Record ◽  
Technology Acceptance ◽  
Daily Practice ◽  
Ease Of Use ◽  
Future Research ◽  
Health Record ◽  
Cross Sectional ◽  
Electronic Health

Introduction: Potential benefits of implementing an electronic health record (EHR) to increase the efficiency of health services and improve the quality of health care are often obstructed by the unwillingness of the users themselves to accept and use the available systems. Aim: The aim of this study was to identify factors that influence the acceptance of the use of an EHR by physicians in the daily practice of hospital health care. Material and Methods: The cross-sectional study was conducted among physicians in the General Hospital Pancevo, Serbia. An anonymous questionnaire, developed according to the technology acceptance model (TAM), was used for the assessment of EHR acceptance. The response rate was 91%. Internal consistency was assessed by Cronbach’s alpha coefficient. A logistic regression analysis was used to identify the factors influencing the acceptance of the use of EHR. Results: The study population included 156 physicians. The mean age was 46.4 ± 10.4 years, 58.8% participants were female. Half of the respondents (50.1%) supported the use of EHR in comparison to paper patient records. In multivariate logistic regression modeling of social and technical factors, ease of use, usefulness, and attitudes towards use of EHR as determinants of the EHR acceptance, the following predictors were identified: use of a computer outside of the office for reading daily newspapers (p = 0.005), EHR providing a greater amount of valuable information (p = 0.007), improvement in the productivity by EHR use (p < 0.001), and a statement that using EHR is a good idea (p = 0.014). Overall the percentage of correct classifications in the model was 83.9%. Conclusion: In this research, determinants of the EHR acceptance were assessed in accordance with the TAM, providing an overall good model fit. Future research should attempt to add other constructs to the TAM in order to fully identify all determinants of physician acceptance of EHR in the complex environment of different health systems.

scholarly journals The Development and Piloting of the Ambulatory Electronic Health Record Evaluation Tool: Lessons Learned

2021 ◽  
Vol 12 (01) ◽  
pp. 153-163
Author(s):  
Zoe Co ◽  
A. Jay Holmgren ◽  
David C. Classen ◽  
Lisa P. Newmark ◽  
Diane L. Seger ◽  
...  
Keyword(s):  
Decision Support ◽  
Electronic Health Record ◽  
Medication Safety ◽  
Medication Reconciliation ◽  
The United States ◽  
Health Record ◽  
Evaluation Tool ◽  
Safety Test ◽  
Electronic Health ◽  
The Impact

Abstract Background Substantial research has been performed about the impact of computerized physician order entry on medication safety in the inpatient setting; however, relatively little has been done in ambulatory care, where most medications are prescribed. Objective To outline the development and piloting process of the Ambulatory Electronic Health Record (EHR) Evaluation Tool and to report the quantitative and qualitative results from the pilot. Methods The Ambulatory EHR Evaluation Tool closely mirrors the inpatient version of the tool, which is administered by The Leapfrog Group. The tool was piloted with seven clinics in the United States, each using a different EHR. The tool consists of a medication safety test and a medication reconciliation module. For the medication test, clinics entered test patients and associated test orders into their EHR and recorded any decision support they received. An overall percentage score of unsafe orders detected, and order category scores were provided to clinics. For the medication reconciliation module, clinics demonstrated how their EHR electronically detected discrepancies between two medication lists. Results For the medication safety test, the clinics correctly alerted on 54.6% of unsafe medication orders. Clinics scored highest in the drug allergy (100%) and drug–drug interaction (89.3%) categories. Lower scoring categories included drug age (39.3%) and therapeutic duplication (39.3%). None of the clinics alerted for the drug laboratory or drug monitoring orders. In the medication reconciliation module, three (42.8%) clinics had an EHR-based medication reconciliation function; however, only one of those clinics could demonstrate it during the pilot. Conclusion Clinics struggled in areas of advanced decision support such as drug age, drug laboratory, and drub monitoring. Most clinics did not have an EHR-based medication reconciliation function and this process was dependent on accessing patients' medication lists. Wider use of this tool could improve outpatient medication safety and can inform vendors about areas of improvement.

scholarly journals Opinions, perceptions and attitudes toward an electronic health record system among practicing nurses

2017 ◽  
Vol 8 (3) ◽  
pp. 12
Author(s):  
Ahmad H. Abu Raddaha ◽  
Arwa Obeidat ◽  
Huda Al Awaisi ◽  
Jahara Hayudini
Keyword(s):  
Electronic Health Record ◽  
Clinical Information System ◽  
Research Work ◽  
Healthcare Delivery ◽  
Future Research ◽  
Health Record ◽  
Randomized Sampling ◽  
Positive Attitudes ◽  
Electronic Health ◽  
The Impact

Background: Despite worldwide expanding implementation of electronic health record (EHR) systems, healthcare professionals conducted limited number of studies to explore factors that might facilitate or jeopardize using these systems. This study underscores the impact of nurses’ opinions, perceptions, and computer competencies on their attitudes toward using an EHR system.Methods: With randomized sampling, a cross-sectional exploratory design was used. The sample consisted of 169 nurses who worked at a public teaching hospital in Oman. They completed self-administered questionnaire. Several standardized valid and reliable instruments were utilized.Results: Seventy-four percent of our study nurses had high positive attitudes toward the EHR system. The least ranked perception scores (60.4%) were linked to perceiving that suggestions made by nurses about the system would be taken into account. Nurses who reported that the hospital sought for suggestions for customization of the system [OR: 2.54 (95% CI: 1.09, 5.88), p = .03], who found the system as an easy-to-use clinical information system [OR: 6.53 (95% CI: 1.72, 24.75), p = .01], who reported the presence of good relationship with the system’s managing personnel [OR: 3.59 (95% CI: 1.13, 11.36), p = .03] and who reported that the system provided all needed health information [OR: 2.97 (95% CI: 1.16, 7.62), p = .02] were more likely to develop high positive attitudes toward the system.Conclusions: To better develop plans to foster the EHR system’s use facilitators and overcome its usage barriers by nursing professionals, more involvement of nurses in system’s customization endeavors is highly suggested. When the system did not disrupt workflows, it would decrease clinical errors and expand nursing productivity. In order to maximize the utilization of the system in healthcare delivery, future research work to investigate the effect of the system on other healthcare providers and inter-professional communications is pressingly needed.

scholarly journals Diabetes and Hypertension Quality Measurement in Four Safety-Net Sites

2014 ◽  
Vol 05 (03) ◽  
pp. 757-772 ◽  
Author(s):  
R. Benkert ◽  
P. Dennehy ◽  
J. White ◽  
A. Hamilton ◽  
C. Tanner ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Quality Measurement ◽  
Safety Net ◽  
Lessons Learned ◽  
Health Record ◽  
Partnership Model ◽  
Safety Net Clinics ◽  
Electronic Health ◽  
Query Algorithms

SummaryBackground: In this new era after the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, the literature on lessons learned with electronic health record (EHR) implementation needs to be revisited.Objectives: Our objective was to describe what implementation of a commercially available EHR with built-in quality query algorithms showed us about our care for diabetes and hypertension populations in four safety net clinics, specifically feasibility of data retrieval, measurements over time, quality of data, and how our teams used this data.Methods: A cross-sectional study was conducted from October 2008 to October 2012 in four safety-net clinics located in the Midwest and Western United States. A data warehouse that stores data from across the U.S was utilized for data extraction from patients with diabetes or hypertension diagnoses and at least two office visits per year. Standard quality measures were collected over a period of two to four years. All sites were engaged in a partnership model with the IT staff and a shared learning process to enhance the use of the quality metrics.Results: While use of the algorithms was feasible across sites, challenges occurred when attempting to use the query results for research purposes. There was wide variation of both process and outcome results by individual centers. Composite calculations balanced out the differences seen in the individual measures. Despite using consistent quality definitions, the differences across centers had an impact on numerators and denominators. All sites agreed to a partnership model of EHR implementation, and each center utilized the available resources of the partnership for Center-specific quality initiatives.Conclusions: Utilizing a shared EHR, a Regional Extension Center-like partnership model, and similar quality query algorithms allowed safety-net clinics to benchmark and improve the quality of care across differing patient populations and health care delivery models.Citation: Benkert R, Dennehy P, White J, Hamilton A, Tanner C, Pohl JM. Diabetes and hypertension quality measurement in four safety-net sites: Lessons learned after implementation of the same commercial electronic health record. Appl Clin Inf 2014; 5: 757–772http://dx.doi.org/10.4338/ACI-2014-03-RA-0019

The Electronic Health Record to Support Women's Health

2009 ◽  
pp. 65-76 ◽  
Author(s):  
Emma Parry
Keyword(s):  
Electronic Health Record ◽  
Women’S Health ◽  
Women's Health ◽  
Health Informatics ◽  
Clinical Information System ◽  
Future Research ◽  
Health Record ◽  
Data Accessibility ◽  
Middleware Technology ◽  
Electronic Health

The seamless electronic health record is often hailed as the holy grail of health informatics. What is an electronic health record? This question is answered and consideration is given to the advantages and disadvantages of an electronic health record. The place of the electronic health record at the centre of a clinical information system is discussed. In expanding on the advantages several areas are covered including: analysis of data, accessibility and availability, and access control. Middleware technology and its place are discussed. Requirements for implementing a system and some of the issues that can arise in the field of women’s health are elucidated. Finally, in this exciting and fast moving field, future research is discussed.

scholarly journals Electronic health record-based clinical decision support alert for severe sepsis: a randomised evaluation

2019 ◽  
Vol 28 (9) ◽  
pp. 762-768 ◽  
Author(s):  
Norman Lance Downing ◽  
Joshua Rolnick ◽  
Sarah F Poole ◽  
Evan Hall ◽  
Alexander J Wessels ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Decision Support ◽  
Electronic Health Record ◽  
Clinical Decision Support ◽  
Tertiary Care ◽  
Clinical Decision ◽  
Health Record ◽  
Hospitalised Patients ◽  
Significant Difference ◽  
Electronic Health

BackgroundSepsis remains the top cause of morbidity and mortality of hospitalised patients despite concerted efforts. Clinical decision support for sepsis has shown mixed results reflecting heterogeneous populations, methodologies and interventions.ObjectivesTo determine whether the addition of a real-time electronic health record (EHR)-based clinical decision support alert improves adherence to treatment guidelines and clinical outcomes in hospitalised patients with suspected severe sepsis.DesignPatient-level randomisation, single blinded.SettingMedical and surgical inpatient units of an academic, tertiary care medical centre.Patients1123 adults over the age of 18 admitted to inpatient wards (intensive care units (ICU) excluded) at an academic teaching hospital between November 2014 and March 2015.InterventionsPatients were randomised to either usual care or the addition of an EHR-generated alert in response to a set of modified severe sepsis criteria that included vital signs, laboratory values and physician orders.Measurements and main resultsThere was no significant difference between the intervention and control groups in primary outcome of the percentage of patients with new antibiotic orders at 3 hours after the alert (35% vs 37%, p=0.53). There was no difference in secondary outcomes of in-hospital mortality at 30 days, length of stay greater than 72 hours, rate of transfer to ICU within 48 hours of alert, or proportion of patients receiving at least 30 mL/kg of intravenous fluids.ConclusionsAn EHR-based severe sepsis alert did not result in a statistically significant improvement in several sepsis treatment performance measures.

A minimalist electronic health record-based intervention to reduce standing lab utilisation

2020 ◽  
pp. postgradmedj-2019-136992
Author(s):  
Kuo-Kai Chin ◽  
Amrita Krishnamurthy ◽  
Talhah Zubair ◽  
Tara Ramaswamy ◽  
Jason Hom ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Complete Blood Count ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
General Medicine ◽  
Health Record ◽  
Care Hospital ◽  
Before And After ◽  
Electronic Health ◽  
One Year

BackgroundRepetitive laboratory testing in stable patients is low-value care. Electronic health record (EHR)-based interventions are easy to disseminate but can be restrictive.ObjectiveTo evaluate the effect of a minimally restrictive EHR-based intervention on utilisation.SettingOne year before and after intervention at a 600-bed tertiary care hospital. 18 000 patients admitted to General Medicine, General Surgery and the Intensive Care Unit (ICU).InterventionProviders were required to specify the number of times each test should occur instead of being able to order them indefinitely.MeasurementsFor eight tests, utilisation (number of labs performed per patient day) and number of associated orders were measured.ResultsUtilisation decreased for some tests on all services. Notably, complete blood count with differential decreased 9% (p<0.001) on General Medicine and 21% (p<0.001) in the ICU.ConclusionsRequiring providers to specify the number of occurrences of labs changes significantly reduces utilisation in some cases.

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