Case Study: The Transformation of the Health Record; The Impact of Electronic Medical Records in a Military Treatment Facility

2006 ◽  
Author(s):  
Daren A. Verhulst
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Health Record ◽  
Treatment Facility ◽  
Military Treatment Facility ◽  
The Impact

scholarly journals Digital transformation of the emergency department-inpatient interface (EDii): integration for future innovation

2020 ◽  
Vol 44 (5) ◽  
pp. 666
Author(s):  
Andrew Staib ◽  
Clair Sullivan ◽  
Cara Joyce Cabilan ◽  
Rohan Cattell ◽  
Rob Eley
Keyword(s):  
Electronic Medical Records ◽  
Patient Outcomes ◽  
Medical Records ◽  
Emergency Admission ◽  
Tertiary Hospital ◽  
Digital Transformation ◽  
Relative Reduction ◽  
Process Measures ◽  
The Impact

As the focus of clinicians and government shifts from speciality-based care to system-based key performance indicators such as the National Emergency Access Target (NEAT) or the 4-h rule, integration between emergency department (ED) and inpatient clinical workflows and information systems is becoming increasingly necessary. Such system measures drive the implementation of integrated electronic medical records (ieMR) to digitally integrate these workflows. The objective of this case study was to describe the impact of digital transformation of the ED–in-patient interface (EDii) of a large tertiary hospital on process measures and clinical outcomes for patients requiring emergency admission to hospital. Data were collected from routine clinical and administrative information systems to measure process and clinical outcome measures, including ED length of stay, compliance with the 4-h rule and in-patient mortality between 28 November 2014 and 28 February 2017. The 4-h rule compliance for all patients, as well as for the EDii group (admitted to hospital excluding short stay ward), declined after digitisation. There were 55 fewer deaths in the postintervention group (15% relative reduction; P = 0.02) and a 10% relative reduction in adjusted mortality as measured by the Hospital Standardised Mortality Ratio for emergency patients (eHSMR), which did not reach statistical significance. Digital deceleration in ED performance did occur with an ieMR rollout, but worsening of key patient outcomes was not observed. What is known about this topic? Much has been written about the introduction of electronic medical records (EMRs) in emergency departments. This work sits alongside a substantial body of evidence outlining the relationship between process measures of ED performance and important patient outcomes. However, much less is known about the impact of digital transformation on the complex adaptive system that is the EDii and the impact of digitisation on the vulnerable group of patients who require emergency admission to hospital. What does this paper add? The objective of this case study was to describe the effect of a rapid rollout of an integrated EMR. This EMR simultaneously transformed care delivery both in the ED and the inpatient space and impacted on the politically and clinically sensitive performance and outcome measures of the EDii in a large tertiary hospital. The present study is the first that specifically examined the effect of digitisation at the EDii. What are the implications for practitioners? The understanding that digital deceleration will occur, but that with good patient outcome monitoring worsening of key patient outcomes is not likely to occur, now holds a key place in digital transformation planning. The measures of the EDii examined in this case study provide a foundation for this montoring.

scholarly journals A case study evaluating the portability of an executable computable phenotype algorithm across multiple institutions and electronic health record environments

2018 ◽  
Vol 25 (11) ◽  
pp. 1540-1546 ◽  
Author(s):  
Jennifer A Pacheco ◽  
Luke V Rasmussen ◽  
Richard C Kiefer ◽  
Thomas R Campion ◽  
Peter Speltz ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Chart Review ◽  
Free Text ◽  
Health Record ◽  
Local Data ◽  
Electronic Health ◽  
Potential Use

Abstract Electronic health record (EHR) algorithms for defining patient cohorts are commonly shared as free-text descriptions that require human intervention both to interpret and implement. We developed the Phenotype Execution and Modeling Architecture (PhEMA, http://projectphema.org) to author and execute standardized computable phenotype algorithms. With PhEMA, we converted an algorithm for benign prostatic hyperplasia, developed for the electronic Medical Records and Genomics network (eMERGE), into a standards-based computable format. Eight sites (7 within eMERGE) received the computable algorithm, and 6 successfully executed it against local data warehouses and/or i2b2 instances. Blinded random chart review of cases selected by the computable algorithm shows PPV ≥90%, and 3 out of 5 sites had >90% overlap of selected cases when comparing the computable algorithm to their original eMERGE implementation. This case study demonstrates potential use of PhEMA computable representations to automate phenotyping across different EHR systems, but also highlights some ongoing challenges.

scholarly journals Facilitating Genetics Aware Clinical Decision Support: Putting the eMERGE Infrastructure into Practice

ACI Open ◽  
2021 ◽  
Vol 05 (02) ◽  
pp. e54-e58
Author(s):  
Casey Overby Taylor ◽  
Luke V. Rasmussen ◽  
Laura J. Rasmussen-Torvik ◽  
Cynthia A. Prows ◽  
David A. Dorr ◽  
...  
Keyword(s):  
Decision Support ◽  
Electronic Medical Records ◽  
Clinical Decision Support ◽  
Medical Records ◽  
Case Reports ◽  
Clinical Decision ◽  
Phase Iii ◽  
Health Record ◽  
It Infrastructure ◽  
Emerge Network

AbstractThis editorial provides context for a series of published case reports in ACI Open by summarizing activities and outputs of joint electronic health record integration and pharmacogenomics workgroups in the NIH-funded electronic Medical Records and Genomics (eMERGE) Network. A case report is a useful tool to describe the range of capabilities that an IT infrastructure or a particular technology must support. The activities we describe have informed infrastructure requirements used during eMERGE phase III, provided a venue to share experiences and ask questions among other eMERGE sites, summarized potential hazards that might be encountered for specific clinical decision support (CDS) implementation scenarios, and provided a simple framework that captured progress toward implementing CDS at eMERGE sites in a consistent format.

Electronic Medical Records and Public Perceptions

2013 ◽  
Vol 8 (3) ◽  
pp. 38-57
Author(s):  
Tarik Abdel-Monem ◽  
Mitchel N. Herian ◽  
Nancy Shank
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Online Survey ◽  
Public Attitudes ◽  
Public Perceptions ◽  
Deliberative Discussion ◽  
The Impact ◽  
Opinion Polls

Public attitudes about electronic medical records (EMRs) have been primarily gauged by one-time opinion polls. The authors investigated the impact of an interactive deliberative polling process on general attitudes towards EMRs and perceptions of governmental roles in the area. An initial online survey was conducted about EMRs among a sample of respondents (n = 138), and then surveyed a sub-sample after they had engaged in a deliberative discussion about EMR issues with peers and policymakers (n = 24). Significant changes in opinions about EMRs and governmental roles were found following the deliberative discussion. Overall support for EMRs increased significantly, although concerns about security and confidentiality remained. This indicates that one way to address concerns about EMRs is to provide opportunities for deliberation with policymakers. The policy and theoretical implications of these findings are briefly discussed within.

scholarly journals ELECTRONIC MEDICAL RECORD ALGORITHM TO IDENTIFY UNDIAGNOSED (PRE)DIABETES: A CASE STUDY FROM HAWAIʻI

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S934-S934
Author(s):  
David Stupplebeen ◽  
Tetine L Sentell ◽  
Lance Ching ◽  
Blythe Nett ◽  
Hermina Taylor ◽  
...  
Keyword(s):  
Older Adults ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Clinical Laboratory ◽  
Older Men ◽  
State Health ◽  
Missed Opportunities ◽  
The Past ◽  
Department Of Health

Abstract An estimated one-quarter of United States’ older adults (≥65 years) have diabetes (DM) while half have prediabetes (PreDM). Timely diagnosis can prevent disease progression, but significant proportions of PreDM/DM are undiagnosed. Among Hawai‘i adults, one-third of diabetes and two-thirds of prediabetes cases are undiagnosed; rates for older adults are unknown. Algorithms integrated into Electronic Medical Records (EMR) may improve care by identifying probable undiagnosed cases in patient panels using clinical/laboratory measures. We assessed one algorithm developed by the Hawai‘i Department of Health that identified individuals overdue for screening or with Pre/DM using the records of 20,362 adult patients (51.33% were >65) from a major state health system. 6,371 (31.3%) patients were excluded from analysis; they had no HbA1c screening in the past year or were overdue for screening (70%) based on standard guidelines. Of the remaining 13,991 patients, 7317 were older adults; 6130 (84%) had a PreDM (50.6%) or DM (33.2%) HbA1c value; the rest were controlled or false-positive. Of those older adults with probable PreDM/DM, 38.6% were undiagnosed. Adults >65 were significantly more likely to be flagged with undiagnosed PreDM compared to their younger counterparts (58 versus 54%, p<.001). Notably, 61% of older men flagged with PreDM were undiagnosed. Of the 5,737 patients identified with DM, 22% of those 65 were undiagnosed. Given the recognized high burden of diabetes among older adults, results indicate substantial missed opportunities for the prevention and early treatment of this condition as identified by an EMR algorithm.

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