scholarly journals Usability of Electronic Health Record-generated Discharge Summaries: Heuristic Evaluation (Preprint)

2020 ◽  
Author(s):  
Patrice Tremoulet ◽  
Priyanka D Shah ◽  
Alisha A Acost ◽  
Christian W Grant ◽  
Jon Tyler Kurtz ◽  
...  
Keyword(s):  
Elderly Patient ◽  
Adverse Events ◽  
Elderly Patients ◽  
Electronic Health Record ◽  
Acute Care ◽  
Patient Discharge ◽  
Health Record ◽  
Electronic Health ◽  
Discharge Summaries

BACKGROUND Obtaining accurate clinical information about recent acute care visits is extremely important for outpatient providers. However, documents used to communicate this information are often difficult to use. This puts patients at risk of adverse events. Elderly patients who are seen by more providers and have more care transitions are especially vulnerable. OBJECTIVE 1) Identify the information about elderly patients’ recent acute care visits needed to coordinate their care. 2) Use this information to assess discharge summaries. 3) Provide recommendations to help improve the quality of electronic health record (EHR)-generated discharge summaries, thereby increasing patient safety METHODS A literature review, clinician interviews, and a survey of outpatient providers were used to identify and categorize data needed to coordinate care for recently-discharged elderly patients. Based upon that data, two heuristics for creating useful discharge summaries were created. The new heuristics, along with seventeen previously-developed medical documentation usability heuristics, were applied to assess four simulated elderly-patient discharge summaries. RESULTS The initial research effort yielded lists of 29 items that should always be included in elderly-patient discharge summaries, and 7 “helpful, but not always necessary” items. Evaluation of four elderly-patient discharge summaries revealed that none of the documents contained all 36 items; between 14 and 18 were missing. The documents each had several other issues and they differed significantly in organization, layout, and formatting. CONCLUSIONS Variations in content and structure of discharge summaries in the United States make them unnecessarily difficult to use. Standardization would benefit both patients, by lowering the risk of care-transition-related adverse events, and outpatient providers, by helping reduce frustration that can contribute to burnout. In the short term, acute care providers can help improve the quality of their discharge summaries by working with EHR vendors to follow recommendations based upon this study. Meanwhile, additional human factors work should determine the most effective way to organize and present information in discharge summaries, to facilitate effective standardization. CLINICALTRIAL not applicable.

scholarly journals Use of electronic health record data from diverse primary care practices to identify and characterize patients’ prescribed common medications

2018 ◽  
Vol 26 (1) ◽  
pp. 172-180 ◽  
Author(s):  
Allison M Cole ◽  
Kari A Stephens ◽  
Imara West ◽  
Gina A Keppel ◽  
Ken Thummel ◽  
...  
Keyword(s):  
Primary Care ◽  
Adverse Events ◽  
Electronic Health Record ◽  
Research Network ◽  
Health Record ◽  
Electronic Health Record Data ◽  
Record Data ◽  
Care Practices ◽  
Electronic Health ◽  
Primary Care Practices

We use prescription of statin medications and prescription of warfarin to explore the capacity of electronic health record data to (1) describe cohorts of patients prescribed these medications and (2) identify cohorts of patients with evidence of adverse events related to prescription of these medications. This study was conducted in the WWAMI region Practice and Research Network (WPRN)., a network of primary care practices across Washington, Wyoming, Alaska, Montana and Idaho DataQUEST, an electronic data-sharing infrastructure. We used electronic health record data to describe cohorts of patients prescribed statin or warfarin medications and reported the proportions of patients with adverse events. Among the 35,445 active patients, 1745 received at least one statin prescription and 301 received at least one warfarin prescription. Only 3 percent of statin patients had evidence of myopathy; 51 patients (17% of those prescribed warfarin) had a bleeding complication. Primary-care electronic health record data can effectively be used to identify patients prescribed specific medications and patients potentially experiencing medication adverse events.

scholarly journals An automated electronic health‐record derived frailty index is associated with adverse events after endoscopy

2021 ◽  
Author(s):  
Jared Rejeski ◽  
Ted Xiao ◽  
William Wheless ◽  
Nicholas M. Pajewski ◽  
Elizabeth Jensen ◽  
...  
Keyword(s):  
Adverse Events ◽  
Electronic Health Record ◽  
Frailty Index ◽  
Health Record ◽  
Electronic Health

scholarly journals 1082 Using an Electronic Health Record (EHR) to Collect and Use Quality-Of-Life Data for AASM Process and Outcomes Quality Measures

SLEEP ◽  
2018 ◽  
Vol 41 (suppl_1) ◽  
pp. A402-A402 ◽  
Author(s):  
B Staley ◽  
B T Keenan ◽  
S Simonsen ◽  
R Warrell ◽  
R Schwab ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Electronic Health Record ◽  
Quality Measures ◽  
Health Record ◽  
Life Data ◽  
Electronic Health

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

scholarly journals The Relationship between Electronic Health Record Use and Quality of Care over Time

2009 ◽  
Vol 16 (4) ◽  
pp. 457-464 ◽  
Author(s):  
L. Zhou ◽  
C. S. Soran ◽  
C. A. Jenter ◽  
L. A. Volk ◽  
E. J. Orav ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Electronic Health Record ◽  
Health Record ◽  
Electronic Health ◽  
The Relationship ◽  
Over Time

scholarly journals Potential of an Electronic Health Record-Integrated Patient Portal for Improving Care Plan Concordance during Acute Care

2019 ◽  
Vol 10 (03) ◽  
pp. 358-366 ◽  
Author(s):  
Anuj K. Dalal ◽  
Patricia Dykes ◽  
Lipika Samal ◽  
Kelly McNally ◽  
Eli Mlaver ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Acute Care ◽  
Transitions Of Care ◽  
Care Plan ◽  
Health Record ◽  
Patient Portal ◽  
Intention To Treat ◽  
Electronic Health ◽  
The Impact ◽  
Treat Analysis

Background Care plan concordance among patients and clinicians during hospitalization is suboptimal. Objective This article determines whether an electronic health record (EHR)-integrated patient portal was associated with increased understanding of the care plan, including the key recovery goal, among patients and clinicians in acute care setting. Methods The intervention included (1) a patient portal configured to solicit a single patient-designated recovery goal and display the care plan from the EHR for participating patients; and (2) an electronic care plan for all unit-based nurses that displays patient-inputted information, accessible to all clinicians via the EHR. Patients admitted to an oncology unit, including their nurses and physicians, were enrolled before and after implementation. Main outcomes included mean concordance scores for the overall care plan and individual care plan elements. Results Of 457 and 283 eligible patients approached during pre- and postintervention periods, 55 and 46 participated in interviews, respectively, including their clinicians. Of 46 postintervention patients, 27 (58.7%) enrolled in the patient portal. The intention-to-treat analysis demonstrated a nonsignificant increase in the mean concordance score for the overall care plan (62.0–67.1, adjusted p = 0.13), and significant increases in mean concordance scores for the recovery goal (30.3–57.7, adjusted p < 0.01) and main reason for hospitalization (58.6–79.2, adjusted p < 0.01). The on-treatment analysis of patient portal enrollees demonstrated significant increases in mean concordance scores for the overall care plan (61.9–70.0, adjusted p < 0.01), the recovery goal (30.4–66.8, adjusted p < 0.01), and main reason for hospitalization (58.3–81.7, adjusted p < 0.01), comparable to the intention-to-treat analysis. Conclusion Implementation of an EHR-integrated patient portal was associated with increased concordance for key care plan components. Future efforts should be directed at improving concordance for other care plan components and conducting larger, randomized studies to evaluate the impact on key outcomes during transitions of care. Clinical Trials Identifier NCT02258594.

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