scholarly journals Interoperable Electronic Health Records and Health Information Exchanges: Systematic Review (Preprint)

2018 ◽  
Author(s):  
Mark J Dobrow ◽  
Jessica P Bytautas ◽  
Sukirtha Tharmalingam ◽  
Simon Hagens
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Electronic Health Records ◽  
Health Information ◽  
Grey Literature ◽  
Evidence Base ◽  
Health Records ◽  
Health Care Settings ◽  
Specific Measurement ◽  
Health Information Exchanges

BACKGROUND As the availability of interoperable electronic health records (iEHRs) or health information exchanges (HIEs) continues to increase, there is greater need and opportunity to assess the current evidence base on what works and what does not regarding the adoption, use, and impact of iEHRs. OBJECTIVE The purpose of this project is to assess the international evidence base on the adoption, use, and impact of iEHRs. METHODS We conducted a systematic review, searching multiple databases—MEDLINE, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL)—with supplemental searches conducted in Google Scholar and grey literature sources (ie, Google, Grey Literature Report, and OpenGrey). All searches were conducted in January and February 2017. Articles were eligible for inclusion if they were published in English, were published from 2006 to 2017, and were either an original research study or a literature review. In order to be included, articles needed to focus on iEHRs and HIEs across multiple health care settings, as well as on the impact and effectiveness of iEHR adoption and use. RESULTS We included 130 articles in the synthesis (113 primary studies, 86.9%; 17 reviews, 13.1%), with the majority focused on the United States (88/130, 67.7%). The primary studies focused on a wide range of health care settings; the three most prevalent settings studied included acute care (59/113, 52.2%), primary care (44/113, 38.9%), and emergency departments (34/113, 30.1%). We identified 29 distinct measurement items in the 113 primary studies that were linked to 522 specific measurement outcomes. Productivity and quality were the two evaluation dimensions that received the most attention, accounting for 14 of 29 (48%) measurement items and 306 of 522 (58.6%) measurement outcomes identified. Overall, the majority of the 522 measurement outcomes were positive (298/522, 57.1%). We also identified 17 reviews on iEHR use and impact, 6 (35%) that focused on barriers and facilitators to adoption and implementation and 11 (65%) that focused on benefits and impacts, with the more recent reviews finding little generalizable evidence of benefit and impact. CONCLUSIONS This review captures the status of an evolving and active field focused on the use and impact of iEHRs. While the overall findings suggest many positive impacts, the quality of the primary studies were not evaluated systematically. When broken down by specific measurement item, the results directed attention both to measurement outcomes that were consistently positive and others that were mostly negative or equivocal.

scholarly journals Interoperable Electronic Health Records and Health Information Exchanges: Systematic Review

10.2196/12607 ◽  
2019 ◽  
Vol 7 (2) ◽  
pp. e12607 ◽  
Author(s):  
Mark J Dobrow ◽  
Jessica P Bytautas ◽  
Sukirtha Tharmalingam ◽  
Simon Hagens
Keyword(s):  
Systematic Review ◽  
Electronic Health Records ◽  
Health Information ◽  
Health Records ◽  
Health Information Exchanges ◽  
Electronic Health

scholarly journals Validity of acute cardiovascular outcome diagnoses in European electronic health records: a systematic review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e031373 ◽  
Author(s):  
Jennifer Anne Davidson ◽  
Amitava Banerjee ◽  
Rutendo Muzambi ◽  
Liam Smeeth ◽  
Charlotte Warren-Gash
Keyword(s):  
Systematic Review ◽  
Electronic Health Records ◽  
Predictive Value ◽  
Grey Literature ◽  
Cochrane Library ◽  
Free Text ◽  
Health Records ◽  
Coronary Syndrome ◽  
Validation Measure ◽  
Electronic Health

IntroductionCardiovascular diseases (CVDs) are among the leading causes of death globally. Electronic health records (EHRs) provide a rich data source for research on CVD risk factors, treatments and outcomes. Researchers must be confident in the validity of diagnoses in EHRs, particularly when diagnosis definitions and use of EHRs change over time. Our systematic review provides an up-to-date appraisal of the validity of stroke, acute coronary syndrome (ACS) and heart failure (HF) diagnoses in European primary and secondary care EHRs.Methods and analysisWe will systematically review the published and grey literature to identify studies validating diagnoses of stroke, ACS and HF in European EHRs. MEDLINE, EMBASE, SCOPUS, Web of Science, Cochrane Library, OpenGrey and EThOS will be searched from the dates of inception to April 2019. A prespecified search strategy of subject headings and free-text terms in the title and abstract will be used. Two reviewers will independently screen titles and abstracts to identify eligible studies, followed by full-text review. We require studies to compare clinical codes with a suitable reference standard. Additionally, at least one validation measure (sensitivity, specificity, positive predictive value or negative predictive value) or raw data, for the calculation of a validation measure, is necessary. We will then extract data from the eligible studies using standardised tables and assess risk of bias in individual studies using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Data will be synthesised into a narrative format and heterogeneity assessed. Meta-analysis will be considered when a sufficient number of homogeneous studies are available. The overall quality of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation tool.Ethics and disseminationThis is a systematic review, so it does not require ethical approval. Our results will be submitted for peer-review publication.PROSPERO registration numberCRD42019123898

scholarly journals Evaluation of interventions to improve inpatient hospital documentation within electronic health records: A Systematic Review

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Natalie Wiebe ◽  
Lucia Otero Varela ◽  
Daniel Niven ◽  
Paul E Ronksley ◽  
Nicolas Iraggori ◽  
...  
Keyword(s):  
Systematic Review ◽  
Electronic Health Records ◽  
Study Design ◽  
Grey Literature ◽  
Inpatient Setting ◽  
Study Quality ◽  
Services Research ◽  
Health Records ◽  
Documentation Quality ◽  
Electronic Health

IntroductionDespite increased use of electronic health records (EHRs), EHR documentation quality remains poor. Consequently, EHR data quality is also negatively affected. Many services, including disease surveillance and health services research, utilize EHR data. Accordingly, several studies have attempted to improve EHR documentation quality in the inpatient setting using various interventions. Objectives and ApproachThe purpose of this systematic review was to synthesize the literature, and assess the effectiveness of interventions seeking to improve inpatient EHR documentation quality. To identify relevant experimental, quasi-experimental and observational studies, a search strategy was developed based on elaborate inclusion/exclusion criteria using four main themes: EHR, documentation, interventions, and type of study. Four databases, Cochrane, Medline, EMBASE, and CINAHL, were searched. Study quality assessment and data extraction from selected studies were performed using a Downs and Black and Newcastle-Ottawa Scale hybrid tool, and a REDCap form, respectively. Data was then analyzed and synthesized in a narrative semi-quantitative manner. ResultsAn in-depth search of the identified databases, grey literature and reference lists, revealed a final 20 studies for inclusion in this systematic review. Due to high heterogeneity in study design, population, interventions, comparators, document types and outcomes, data could not be standardized for a quantitative comparison. However, statistically significant results in interventions and affected outcomes were further presented and discussed. A higher number of studies reported significantly improved EHR documentation when using the interventions: ‘Education’ and ‘Implementing a new EHR Reporting System’. When implementing two or more interventions, more outcome measures were affected. There was no association between study quality or study design and number of interventions used. Only one of the 20 studies found EHR documentation worsened with the interventions used. Conclusion/ImplicationsInterventions implemented to enhance EHR documentation are highly variable and require standardization. Emphasis should be placed on this novel area of research to improve communication between healthcare providers, enhance continuity of care, reduce the burden in health information management, and to facilitate data sharing between centers, provinces, and countries.

Using Electronic Health Records and Data Warehouse Collaboratively in Community Health Centers

2013 ◽  
Vol 15 (4) ◽  
pp. 45-62 ◽  
Author(s):  
Xiaoming Zeng ◽  
Elizabeth J. Forrestal ◽  
Leigh W. Cellucci ◽  
Michael H. Kennedy ◽  
Doug Smith
Keyword(s):  
Health Care ◽  
Electronic Health Records ◽  
Community Health ◽  
Health Information ◽  
Data Warehouse ◽  
Information Technologies ◽  
Community Health Centers ◽  
Health Centers ◽  
Health Records ◽  
Health Information Technologies

The organization Community Partners HealthNet (CPH), Inc. is a so-called Health-Center-Controlled Networks (HCCNs) that provide health information technologies, in particular Electronic Health Records and Data Warehouse, to participating community health centers (CHC) and rural health clinics (RHC). All 16 member organizations (CHCs and RHCs) in CPH are non-profit health care organizations providing primary health care to individuals in medically underserved areas. To provide quality and accessible health care to those medically needed, CPH and member organization rely heavily on funding from federal and state governments as well as charitable foundations. The investment in system-wide Health Information Technologies has been financially limited given the nature of the organizations. CPH and member organizations, through visionary leadership and cost-effective execution, have been able to adopt and implement advanced information technologies like EHR and data warehouse since early 1990s. There has been software updates and EHR upgrades, but the original design of the system still serve the information needs of the organization. This case study describes CPH in the health care environment, discusses the collaboration of six original individual CHCs to create CPH, the EHR and Data Warehouse projects at CPH, and then explains CPH’s on-going operations and new challenges in the context of meaningful use and big data movement.

scholarly journals An Evidence-Based Tool for Safe Configuration of Electronic Health Records: The eSafety Checklist

2018 ◽  
Vol 09 (04) ◽  
pp. 817-830 ◽  
Author(s):  
Pritma Dhillon-Chattha ◽  
Ruth McCorkle ◽  
Elizabeth Borycki
Keyword(s):  
Health Care ◽  
Information Technology ◽  
Electronic Health Records ◽  
Health Information Technology ◽  
Health Information ◽  
Expert Panel ◽  
Clinical Informatics ◽  
Evidence Based ◽  
Health Records ◽  
Electronic Health

Background Electronic health records (EHRs) are transforming the way health care is delivered. They are central to improving the quality of patient care and have been attributed to making health care more accessible, reliable, and safe. However, in recent years, evidence suggests that specific features and functions of EHRs can introduce new, unanticipated patient safety concerns that can be mitigated by safe configuration practices. Objective This article outlines the development of a detailed and comprehensive evidence-based checklist of safe configuration practices for use by clinical informatics professionals when configuring hospital-based EHRs. Methods A literature review was conducted to synthesize evidence on safe configuration practices; data were analyzed to elicit themes of common EHR system capabilities. Two rounds of testing were completed with end users to inform checklist design and usability. This was followed by a four-member expert panel review, where each item was rated for clarity (clear, not clear), and importance (high, medium, low). Results An expert panel consisting of three clinical informatics professionals and one health information technology expert reviewed the checklist for clarity and importance. Medium and high importance ratings were considered affirmative responses. Of the 870 items contained in the original checklist, 535 (61.4%) received 100% affirmative agreement among all four panelists. Clinical panelists had a higher affirmative agreement rate of 75.5% (656 items). Upon detailed analysis, items with 100% clinician agreement were retained in the checklist with the exception of 47 items and the addition of 33 items, resulting in a total of 642 items in the final checklist. Conclusion Safe implementation of EHRs requires consideration of both technical and sociotechnical factors through close collaboration of health information technology and clinical informatics professionals. The recommended practices described in this checklist provide systems implementation guidance that should be considered when EHRs are being configured, implemented, audited, or updated, to improve system safety and usability.

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