scholarly journals Toward Standardized Monitoring of Patients With Chronic Diseases in Primary Care Using Electronic Medical Records: Systematic Review

10.2196/10879 ◽  
2019 ◽  
Vol 7 (2) ◽  
pp. e10879 ◽  
Author(s):  
Leandra Falck ◽  
Marco Zoller ◽  
Thomas Rosemann ◽  
Nahara Anani Martínez-González ◽  
Corinne Chmiel
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Chronic Diseases ◽  
Electronic Medical Records ◽  
Medical Records

scholarly journals Chronic Disease Case Definitions for Electronic Medical Records: A Canadian Validation Study

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Lisa Lix ◽  
Alexander Singer ◽  
Alan Katz ◽  
Marina Yogendran ◽  
Saeed Al-Azazi
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Prescription Drug ◽  
Chronic Diseases ◽  
Electronic Medical Records ◽  
Predictive Value ◽  
Medical Records ◽  
Case Definitions ◽  
Hospital Records ◽  
Disease Case

ABSTRACTObjectivesCanadians are investing heavily in electronic medical records (EMRs) to inform primary care practice improvements. The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) is a national practice-based network that has enrolled more than one million patients to date. Accurate CPCSSN EMR data are essential for unbiased research about chronic disease prevention and management. The study purpose was to test the accuracy of chronic disease case definitions in EMR data from one CPCSSN site. ApproachThis study linked CPCSSN EMR data, hospital records, physician billing claims, prescription drug records, and population registration files for the province of Manitoba. Individuals who had at least one encounter with a CPCSSN practice between 1998 and 2012, were at least 18 years of age, and had a minimum of two years of healthcare coverage before and after the study index date were included. Separate cohorts were defined for the following chronic diseases: chronic obstructive pulmonary disease (COPD), depression, diabetes, hypertension, and osteoarthritis. Validated case definitions based on diagnoses in physician and hospital records and prescription drug data were used estimate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa of each EMR chronic disease case definition. ResultsMore than 74,000 individuals were included in each cohort, except for COPD which had 51,000. Approximately half of each cohort was comprised of urban residents. The average age ranged from 45.9 years for individuals with depression to 65.3 years for individuals with COPD. Hypertension had the highest prevalence (22.0%) in EMR data followed by depression (14.6%). Estimates of agreement (i.e., kappa) for EMR and administrative data ranged from 0.47 for COPD to 0.58 for diabetes. Sensitivity of the EMR data was lowest for COPD (37.4%; 95% CI 36.0-38.8) and highest for diabetes (57.6%; 95% confidence interval [CI] 56.6-58.6). PPV estimates were lowest for osteoarthritis (66.9%; 95% CI 66.0-67.8) and highest for hypertension (78.3%; 95% CI 77.7-78.9). Specificity estimates were consistently above 90% and NPV estimates were always greater than 80%. Validity estimates for the EMR case definitions were associated with demographic and comorbidity characteristics of the study cohorts. ConclusionsValidity of EMR data, when compared to administrative health data, for ascertaining five different chronic diseases was fair to good; it varied with the disease under investigation. Further research is needed to identify methods for improving the accuracy of chronic disease case definitions in EMR data.

scholarly journals Toward Standardized Monitoring of Patients With Chronic Diseases in Primary Care Using Electronic Medical Records: Development of a Tool by Adapted Delphi Procedure

10.2196/14483 ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. e14483
Author(s):  
Leandra Falck ◽  
Marco Zoller ◽  
Thomas Rosemann ◽  
Nahara Anani Martínez-González ◽  
Corinne Chmiel
Keyword(s):  
Primary Care ◽  
Chronic Diseases ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Chronic Conditions ◽  
Evidence Based ◽  
Term Care ◽  
Delphi Procedure ◽  
User Friendly

Background Long-term care for patients with chronic diseases poses a huge challenge in primary care. There are deficits in care, especially regarding monitoring and creating structured follow-ups. Appropriate electronic medical records (EMR) could support this, but so far, no generic evidence-based template exists. Objective The aim of this study is to develop an evidence-based standardized, generic template that improves the monitoring of patients with chronic conditions in primary care by means of an EMR. Methods We used an adapted Delphi procedure to evaluate a structured set of evidence-based monitoring indicators for 5 highly prevalent chronic diseases (ie, diabetes mellitus type 2, asthma, arterial hypertension, chronic heart failure, and osteoarthritis). We assessed the indicators’ utility in practice and summarized them into a user-friendly layout. Results This multistep procedure resulted in a monitoring tool consisting of condensed sets of indicators, which were divided into sublayers to maximize ergonomics. A cockpit serves as an overview of fixed goals and a set of procedures to facilitate disease management. An additional tab contains information on nondisease-specific indicators such as allergies and vital signs. Conclusions Our generic template systematically integrates the existing scientific evidence for the standardized long-term monitoring of chronic conditions. It contains a user-friendly and clinically sensible layout. This template can improve the care for patients with chronic diseases when using EMRs in primary care.

scholarly journals Toward Standardized Monitoring of Patients With Chronic Diseases in Primary Care Using Electronic Medical Records: Development of a Tool by Adapted Delphi Procedure (Preprint)

2019 ◽  
Author(s):  
Leandra Falck ◽  
Marco Zoller ◽  
Thomas Rosemann ◽  
Nahara Anani Martínez-González ◽  
Corinne Chmiel
Keyword(s):  
Primary Care ◽  
Chronic Diseases ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Chronic Conditions ◽  
Evidence Based ◽  
Term Care ◽  
Delphi Procedure ◽  
User Friendly

BACKGROUND Long-term care for patients with chronic diseases poses a huge challenge in primary care. There are deficits in care, especially regarding monitoring and creating structured follow-ups. Appropriate electronic medical records (EMR) could support this, but so far, no generic evidence-based template exists. OBJECTIVE The aim of this study is to develop an evidence-based standardized, generic template that improves the monitoring of patients with chronic conditions in primary care by means of an EMR. METHODS We used an adapted Delphi procedure to evaluate a structured set of evidence-based monitoring indicators for 5 highly prevalent chronic diseases (ie, diabetes mellitus type 2, asthma, arterial hypertension, chronic heart failure, and osteoarthritis). We assessed the indicators’ utility in practice and summarized them into a user-friendly layout. RESULTS This multistep procedure resulted in a monitoring tool consisting of condensed sets of indicators, which were divided into sublayers to maximize ergonomics. A cockpit serves as an overview of fixed goals and a set of procedures to facilitate disease management. An additional tab contains information on nondisease-specific indicators such as allergies and vital signs. CONCLUSIONS Our generic template systematically integrates the existing scientific evidence for the standardized long-term monitoring of chronic conditions. It contains a user-friendly and clinically sensible layout. This template can improve the care for patients with chronic diseases when using EMRs in primary care.

scholarly journals Toward Standardized Monitoring of Patients With Chronic Diseases in Primary Care Using Electronic Medical Records: Systematic Review (Preprint)

2018 ◽  
Author(s):  
Leandra Falck ◽  
Marco Zoller ◽  
Thomas Rosemann ◽  
Nahara Anani Martínez-González ◽  
Corinne Chmiel
Keyword(s):  
Primary Care ◽  
Chronic Diseases ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Chronic Conditions ◽  
Long Term Care ◽  
Evidence Based ◽  
Term Care ◽  
Term Monitoring

BACKGROUND Long-term care for patients with chronic diseases poses a huge challenge in primary care. In particular, there is a deficit regarding monitoring and structured follow-up. Appropriate electronic medical records (EMRs) could help improving this but, so far, there are no evidence-based specifications concerning the indicators that should be monitored at regular intervals. OBJECTIVE The aim was to identify and collect a set of evidence-based indicators that could be used for monitoring chronic conditions at regular intervals in primary care using EMRs. METHODS We searched MEDLINE (Ovid), Embase (Elsevier), the Cochrane Library (Wiley), the reference lists of included studies and relevant reviews, and the content of clinical guidelines. We included primary studies and guidelines reporting about indicators that allow for the assessment of care and help monitor the status and process of disease for five chronic conditions, including type 2 diabetes mellitus, asthma, arterial hypertension, chronic heart failure, and osteoarthritis. RESULTS The use of the term “monitoring” in terms of disease management and long-term care for patients with chronic diseases is not widely used in the literature. Nevertheless, we identified a substantial number of disease-specific indicators that can be used for routine monitoring of chronic diseases in primary care by means of EMRs. CONCLUSIONS To our knowledge, this is the first systematic review summarizing the existing scientific evidence on the standardized long-term monitoring of chronic diseases using EMRs. In a second step, our extensive set of indicators will serve as a generic template for evaluating their usability by means of an adapted Delphi procedure. In a third step, the indicators will be summarized into a user-friendly EMR layout.

scholarly journals Factors affecting the mature use of electronic medical records by primary care physicians: a systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rana Melissa Rahal ◽  
Jay Mercer ◽  
Craig Kuziemsky ◽  
Sanni Yaya
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Electronic Medical Records ◽  
User Satisfaction ◽  
Medical Records ◽  
Financial Incentives ◽  
Primary Care Physicians ◽  
Transition Planning ◽  
Narrative Synthesis ◽  
Factors Influencing

Abstract Background Despite a substantial increase in the adoption of electronic medical records (EMRs) in primary health care settings, the use of advanced EMR features is limited. Several studies have identified both barriers and facilitating factors that influence primary care physicians’ (PCPs) use of advanced EMR features and the maturation of their EMR use. The purpose of this study is to explore and identify the factors that impact PCPs’ mature use of EMRs. Methods A systematic review was conducted in accordance with the Cochrane Handbook. The MEDLINE, Embase, and PsycINFO electronic databases were searched from 1946 to June 13, 2019. Two independent reviewers screened the studies for eligibility; to be included, studies had to address factors influencing PCPs’ mature use of EMRs. A narrative synthesis was conducted to collate study findings and to report on patterns identified across studies. The quality of the studies was also appraised. Results Of the 1893 studies identified, 14 were included in this study. Reported factors that influenced PCPs’ mature use of EMRs fell into one of the following 5 categories: technology, people, organization, resources, and policy. Concerns about the EMR system’s functionality, lack of physician awareness of EMR functionality, limited physician availability to learn more about EMRs, the habitual use of successfully completing clinical tasks using only basic EMR features, business-oriented organizational objectives, lack of vendor training, limited resource availability, and lack of physician readiness were reported as barriers to PCPs’ mature use of EMRs. The motivation of physicians, user satisfaction, coaching and peer mentoring, EMR experience, gender, physician perception, transition planning for changes in roles and work processes, team-based care, adequate technical support and training, sharing resources, practices affiliated with an integrated delivery system, financial incentives, and policies to increase EMR use all had a favorable impact on PCPs’ use of advanced EMR features. Conclusions By using a narrative synthesis to synthesize the evidence, we identified interrelated factors influencing the mature use of EMRs by PCPs. The findings underline the need to provide adequate training and policies that facilitate the mature use of EMRs by PCPs. Trial registration: PROSPERO CRD42019137526.

908-P: Predictive Model for Glycemic Level of People with Diabetes Mellitus Using Data Extracted from Electronic Medical Records in Primary Care

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 908-P
Author(s):  
SOSTENES MISTRO ◽  
THALITA V.O. AGUIAR ◽  
VANESSA V. CERQUEIRA ◽  
KELLE O. SILVA ◽  
JOSÉ A. LOUZADO ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Primary Care ◽  
Predictive Model ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Glycemic Level ◽  
Using Data

Electronic medical records and primary care quality: Evidence from Manitoba

2021 ◽  
Vol 30 (5) ◽  
pp. 1124-1138
Author(s):  
Elisabet Rodriguez Llorian ◽  
Gregory Mason
Keyword(s):  
Primary Care ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Care Quality ◽  
Primary Care Quality ◽  
Quality Evidence
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