Resident Identified Violations of Usability Heuristic Principles in Local Electronic Health Records

Introduction. Difficulties with the electronic health record (EHR) are known to be associated with high physician burnout. Usability studies can evaluate and identify usability issues with the EHR at the end user level. This study was conducted to determine physician perspectives and usability issues of local EHR systems. Methods. Survey and focus group methodology were employed. Participants were resident physicians who were members of a resident council in the Midwest. Survey data collected included demographics and perceptions. Focus group data included participants identification of usability principle violations and potential impact to end user. Results. There were 15 survey respondents (across 11 residency programs) who reported use of three different EHR systems: Cerner®, Meditech, and Computerized Patient Record System (CPRS). Satisfaction was greatest with Cerner® as well as most reported level of experience. Focus group respondents reported a variety of usability violations which lead to provider confusion, increased time, alert fatigue, and potential patient safety issues. Discussion. Violations of usability principles can result in disruption of physician workflow processes and lead to increased documentation time as well as fatigue. These issues have been associated with increased provider burnout. Continuous usability assessments should be conducted at the end user level to promote the development of more effective and efficient EHR interface designs.

2538. Directed Educational Intervention and Resident Physician Outpatient Antimicrobial Prescribing

Background Antimicrobial stewardship is the coordinated approach to optimal use of antimicrobials. Directed stewardship may benefit resident physicians and improve outpatient antimicrobial prescribing. Methods Internal medicine residents as of July 1, 2017 (n = 37) with continuity clinic at the Minneapolis Veterans Affairs Health Care System were eligible. Antimicrobial prescriptions and number of patient visits per month were extracted from the Computerized Patient Record System. Antimicrobial rate was calculated for 9 baseline months (July 1, 2017–March 31, 2018) and 12 intervention months (April 1, 2018–March 31, 2019). Residents were divided into high and low prescribing groups based on baseline antimicrobial rate. The low prescribing group received one email with links to antimicrobial stewardship resources. The high prescribing group received the same email and one in person meeting with an infectious disease fellow to discuss antimicrobial prescribing. Results Prescription and visit data were available for 37 residents. The low and high prescribing interventions were administered to 17/17 (100%) and 12/20 (60%) participants, respectively. Remaining high prescribing participants (8, 40%) graduated and did not complete the intervention. During the intervention period, there were a total of 171 prescriptions and 4,018 visits, for an average antimicrobial rate of 43 prescriptions/1,000 visits compared with baseline rate of 51 (P = 0.09). Antimicrobial rate per month is shown in Figure 1. Conclusion An educational intervention did not significantly change antimicrobial prescribing rates in a VA resident clinic. Antimicrobial prescribing rates were much lower than expected, suggesting that weekly continuity clinic may not be an optimal setting for learning how to manage outpatient antimicrobials. Our study was small and conducted at a single site without evaluation of antimicrobial appropriateness. Further studies should explore the optimal setting for residents to gain outpatient antimicrobial prescribing experience. Disclosures All authors: No reported disclosures.

PPX-TEC API APP: A unique approach to sending and receiving health and insurance data

In 1971, the U.S. Dept. of Veterans Affairs (VA) became one of the first large healthcare systems to fully implement a computerized patient record system. Shortly thereafter, in 1972, Regenstrief developed the Regenstrief Medical Record System (RMRS), a historically important EMR. The purpose of this early EMR was described in a quote that is still applicable today:

The Coming Age Of Electronic Medical Records: From Paper To Electronic

Medical records, first developed in the fifth century, have remained virtually unchanged until the explosion of new technology in the mid-1960s. The National Space and Aeronautics Administrations development of computerized patient record (CPR) brought life to the electronic medical record (EMR) industry. Preventable deaths due to medical errors drew the attention of public and health care professionals to the need for increased patient safety and improved quality measures in medicine. With health care costs compromising 16-17% of the U.S. Gross Domestic Product, Congress passed legislation to financially support providers to adopt electronic medical record (EMR). As a result, future efforts will focus on the sharing of information among all health care stakeholders. Across the world, governments, technology companies, and care providers are collaborating efforts to make the EMR a reality.

Use of a Computer Decision Support System and Antimicrobial Therapy Appropriateness

Objective.To determine whether antimicrobial (AM) courses ordered with an antimicrobial computer decision support system (CDSS) were more likely to be appropriate than courses ordered without the CDSS.Design.Retrospective cohort study. Blinded expert reviewers judged whether AM courses were appropriate, considering drug selection, route, dose, and duration.Setting.A 279-bed university-affiliated Department of Veterans Affairs (VA) hospital.Patients.A 500-patient random sample of inpatients who received a therapeutic AM course between October 2007 and September 2008.Intervention.An optional CDSS, available at the point of order entry in the VA computerized patient record system.Results.CDSS courses were significantly more likely to be appropriate (111/254, 44%) compared with non-CDSS courses (81/246, 33%, P = .013). Courses were more likely to be appropriate when the initial provider diagnosis of the condition being treated was correct (168/273, 62%) than when it was incorrect, uncertain, or a sign or symptom rather than a disease (24/227, 11%, P< .001). In multivariable analysis, CDSS-ordered courses were more likely to be appropriate than non-CDSS-ordered courses (odds ratio [OR], 1.83; 95% confidence interval [CI], 1.13–2.98). Courses were also more likely to be judged appropriate when the initial provider diagnosis of the condition being treated was correct than when it was incorrect, uncertain, or a sign or symptom rather than a disease (OR, 3.56; 95% CI, 1.4-9.0).Conclusions.Use of the CDSS was associated with more appropriate AM use. To achieve greater improvements, strategies are needed to improve provider diagnoses of syndromes that are infectious or possibly infectious.