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science pages

21
December, 2014
Sunday

usa

Where Are We on the Diffusion Curve? Trends and Drivers of Primary Care Physicians’ Use of Health Information Technology

Audet A-MJ et al, Health Serv Res, 49(1 Pt2)

Objective
To describe trends in primary care physicians’ use of health information technology (HIT) between 2009 and 2012, examine practice characteristics associated with greater HIT capacity in 2012, and explore factors such as delivery system and payment reforms that may affect adoption and functionality.

Data
We used data from the 2012 and 2009 Commonwealth Fund International Health Policy Surveys of Primary Care Physicians. The data were collected in both years by postal mail between March and July among a nationally representative sample of primary care physicians in the United States.
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Published: February 2014 |
Keyword(s): Adoption, Electronic Health Records, United States

Giving Patients Granular Control of Personal Health Information: Using an Ethics ‘Points to Consider’ to Inform Informatics System Designers

Objective
There are benefits and risks of giving patients more granular control of their personal health information in electronic health record (EHR) systems. When designing EHR systems and policies, informaticists and system developers must balance these benefits and risks. Ethical considerations should be an explicit part of this balancing. Our objective was to develop a structured ethics framework to accomplish this.

Methods
We reviewed existing literature on the ethical and policy issues, developed an ethics framework called a “Points to Consider” (P2C) document, and convened a national expert panel to review and critique the P2C.
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Published: 4 September 2013 |
Keyword(s): Benefits, Design, Electronic Health Records, Ethics, Medical records systems, Patient Record Access, Physician-Patient Relationship, Privacy, Risks, United States

Integration of Cognitive Modeling into the Evaluation of Electronic Health Records

Berg LP et al, Proceedings of the International Symposium of Human Factors and Ergonomics in Healthcare, 2(1)

Previous research has consistently cited the importance of a usable interface in the successful adoption of the electronic health record (EHR). Among the most time intensive EHR activities is Computerized Physician Order Entry (CPOE) a method of creating and modifying orders through an electronic interface. The Marshfield Clinic, a non-profit, regional health care organization in Wisconsin, is in the process of implementing a new CPOE system.
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Published: 1 June 2013 |
Keyword(s): CPOE, Electronic Health Records, United States, Usability

Operational Health Information Exchanges Show Substantial Growth, But Long-Term Funding Remains A Concern

Adler-Milstein J et al, Health affairs, 2013

Policy makers are actively promoting the electronic exchange of health information to improve the quality and efficiency of health care. We conducted a national survey of organizations facilitating health information exchange, to assess national progress. We found that 30 percent of hospitals and 10 percent of ambulatory practices now participate in one of the 119 operational health information exchange efforts across the United States, substantial growth from prior surveys.
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Published: 9 July 2013 |
Keyword(s): Electronic Health Records, Health Information Exchange, Survey, United States

Outpatient electronic health records and the clinical care and outcomes of patients with diabetes mellitus

Reed M et al, Annals of internal medicine, 157(7)

BACKGROUND: Physicians can receive federal payments for meaningful use of complete certified electronic health records (EHRs). Evidence is limited on how EHR use affects clinical care and outcomes.
OBJECTIVE: To examine the association between use of a commercially available certified EHR and clinical care processes and disease control in patients with diabetes.
DESIGN:
Quasi-experimental design with outpatient EHR implementation sequentially across 17 medical centers. Multivariate analyses adjusted for patient characteristics, medical center, time trends, and facility-level clustering.

SETTING:
Kaiser Permanente Northern California, an integrated delivery system.
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Published: 12 October 2012 |
Keyword(s): Ambulatory Care, Diabetes Mellitus, Electronic Health Records, United States

Let the left hand know what the right is doing: a vision for care coordination and electronic health records

Rudin RS and Bates DW. J Am Med Inform Assoc, 2013

Despite the potential for electronic health records to help providers coordinate care, the current marketplace has failed to provide adequate solutions. Using a simple framework, we describe a vision of information technology capabilities that could substantially improve four care coordination activities: identifying collaborators, contacting collaborators, collaborating, and monitoring.
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Published: 19 June 2013 |
Keyword(s): Coordinated Care, Electronic Health Records, United States

Quality and Safety Implications of Emergency Department Information Systems

Farley HL et al, Annals of Emergency Medicine, 2013

The Health Information Technology for Economic and Clinical Health Act of 2009 and the Centers for Medicare & Medicaid Services “meaningful use” incentive programs, in tandem with the boundless additional requirements for detailed reporting of quality metrics, have galvanized hospital efforts to implement hospital-based electronic health records. As such, emergency department information systems (EDISs) are an important and unique component of most hospitals’ electronic health records. System functionality varies greatly and affects physician decisionmaking, clinician workflow, communication, and, ultimately, the overall quality of care and patient safety. This article is a joint effort by members of the Quality Improvement and Patient Safety Section and the Informatics Section of the American College of Emergency Physicians. The aim of this effort is to examine the benefits and potential threats to quality and patient safety that could result from the choice of a particular EDIS, its implementation and optimization, and the hospital’s or physician group’s approach to continuous improvement of the EDIS. Specifically, we explored the following areas of potential EDIS safety concerns: communication failure, wrong order–wrong patient errors, poor data display, and alert fatigue.
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Published: 24 June 2013 |
Keyword(s): Electronic Health Records, Emergency Department, Hospitals, Quality, Safety, United States

Electronic health records and national patient-safety goals

Sittig DF and Singh H. N. Engl. J. Med., 367(19)

Hospitals and clinics are adapting to new technologies and implementing electronic health records, but the efforts need to be aligned explicitly with goals for patient safety. EHRs bring the risks of both technical failures and inappropriate use, but they can also help to monitor and improve patient safety.
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Published: 8 November 2012 |
Keyword(s): Computer Security, Electronic Health Records, Meaningful Use, Patient Safety, United States

Access to Digital Technology Among Families Coming to Urban Pediatric Primary Care Clinics

DeMartini TL et al. Pediatrics, 2013

OBJECTIVE:
Digital technologies offer new platforms for health promotion and disease management. Few studies have evaluated the use of digital technology among families receiving care in an urban pediatric primary care setting.

METHODS:
A self-administered survey was given to a convenience sample of caregivers bringing their children to 2 urban pediatric primary care centers in spring 2012. The survey assessed access to home Internet, e-mail, smartphone, and social media (Facebook and Twitter). A “digital technology” scale (0–4) quantified the number of available digital technologies and connections. Frequency of daily use and interest in receiving medical information digitally were also assessed.
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Published: 10 June 2013 |
Keyword(s): digital technology, Pediatrics, Primary Care, Social Media, United States

Meeting Meaningful Use Criteria and Managing Patient Populations: A National Survey of Practicing Physicians

DesRoches CM et al, Annals of Internal Medicine, 158(11)

Background:
Meaningful use, as defined by the Centers for Medicare & Medicaid Services, will require the aggregation of patient data to enable population assessment. Little is known about the proportion of physicians who are able to meet meaningful use criteria or their use of electronic health records (EHRs) to manage patient populations.

Objective:
To evaluate physicians’ reports of EHR adoption and ease of use and their ability to use EHRs for patient panel management.
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Published: 4 June 2013 |
Keyword(s): Data Aggregation, Electronic Health Records, Meaningful Use, United States

Guest editorial: compelling issues in telemedicine

Bashshur RL. Telemedicine journal and e-health, 19(5)

Recent and impendent changes resulting from the Health Information Technology for Economic and Clinical Health Act (HITECH) (part of Title XIII of the American Recovery and Reinvestment Act) of 2009 and the Patient Protection and Affordable Care Act (ACA) of 2011 offer unprecedented potential for telemedicine to play a significant role not only in reforming the current U.S. healthcare system but also in shaping innovative health systems of the future.
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Published: 5 February 2013 |
Keyword(s): ACO, e-Health, Electronic Health Records, Personal Health Records, Telemedicine, United States

Pharmacovigilance Using Clinical Notes

LePendu P et al, Clinical Pharmacology & Therapeutics, 2013

With increasing adoption of electronic health records (EHRs), there is an opportunity to use the free-text portion of EHRs for pharmacovigilance. We present novel methods that annotate the unstructured clinical notes and transform them into a deidentified patient–feature matrix encoded using medical terminologies. We demonstrate the use of the resulting high-throughput data for detecting drug–adverse event associations and adverse events associated with drug–drug interactions.
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Published: 10 April 2013 |
Keyword(s): Adverse Drug Events, Data Mining, Drug-drug interactions, Electronic Health Records, Free text, Pharmacology, United States

Paper- and computer-based workarounds to electronic health record use at three benchmark institutions

Flanagan ME et al, J Am Med Inform Assoc, 2013

BACKGROUND:
Healthcare professionals develop workarounds rather than using electronic health record (EHR) systems. Understanding the reasons for workarounds is important to facilitate user-centered design and alignment between work context and available health information technology tools.

OBJECTIVE:
To examine both paper- and computer-based workarounds to the use of EHR systems in three benchmark institutions.
[ More ]

Published: 14 March 2013 |
Keyword(s): Electronic Health Records, Primary Care, United States

Workflow Central

Baldwin G. Health Data Management Magazine, 21(4)

A little over a year ago, Deaconess Health System in Evansville, Ind., obtained a lofty perch on the digital health I.T. rung-the six-hospital system was named as a HIMSS Stage 7 organization, representing the pinnacle of electronic health record accomplishments.
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Published: 1 April 2013 |
Keyword(s): Electronic Health Records, HL7, Legal, Paper Conversion, United States, Workflow

A survey analysis suggests that electronic health records will yield revenue gains for some practices and losses for many

Adler-Milstein J et al, Health Affairs, 32(3)

Health care providers remain uncertain about how they will fare financially if they adopt electronic health record (EHR) systems. We used survey data from forty-nine community practices in a large EHR pilot, the Massachusetts eHealth Collaborative, to project five-year returns on investment. We found that the average physician would lose $43,743 over five years; just 27 percent of practices would have achieved a positive return on investment; and only an additional 14 percent of practices would have come out ahead had they received the $44,000 federal meaningful-use incentive.
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Published: March 2013 |
Keyword(s): Electronic Health Records, ROI, United States

Information overload and missed test results in electronic health record–based settings

Singh H et al, JAMA internal medicine, 2013

Electronic health record (EHR)-based alerts are often used to notify practitioners of abnormal test results, but follow-up failures (missed results) continue to occur in outpatient settings. In the Department of Veterans Affairs (VA), abnormal test result alerts are generated automatically for prespecified abnormal laboratory values or manually by the interpreting radiologist when an unexpected finding is noted.
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Published: 4 March 2013 |
Keyword(s): Alerts, Electronic Health Records, Primary Care Providers, Test results, United States

Types and Origins of Diagnostic Errors in Primary Care Settings

Singh H et al, JAMA internal medicine, 2013

IMPORTANCE
Diagnostic errors are an understudied aspect of ambulatory patient safety.

OBJECTIVES
To determine the types of diseases missed and the diagnostic processes involved in cases of confirmed diagnostic errors in primary care settings and to determine whether record reviews could shed light on potential contributory factors to inform future interventions.
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Published: 25 February 2013 |
Keyword(s): Ambulatory Care, Diagnostic Errors, Electronic Health Records, Patient Safety, United States

If We Offer it, Will They Accept? Factors Affecting Patient Use Intentions of Personal Health Records and Secure Messaging

Agarwal R et al, Journal of medical Internet research, 15(2)

Background:
Personal health records (PHRs) are an important tool for empowering patients and stimulating health action. To date, the volitional adoption of publicly available PHRs by consumers has been low. This may be partly due to patient concerns about issues such as data security, accuracy of the clinical information stored in the PHR, and challenges with keeping the information updated. One potential solution to mitigate concerns about security, accuracy, and updating of information that may accelerate technology adoption is the provision of PHRs by employers where the PHR is pre-populated with patients’ health data. Increasingly, employers and payers are offering this technology to employees as a mechanism for greater patient engagement in health and well-being.
[ More ]

Published: 26 February 2013 |
Keyword(s): Electronic Health Records, Messaging, Personal Health Records, United States

Early Results of the Meaningful Use Program for Electronic Health Records

Wright A et al, New England Journal of Medicine, 368(8)

In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act established Medicare and Medicaid incentive programs to encourage the adoption of electronic health records (EHRs) by hospitals and eligible professionals.
[ More ]

Published: 21 February 2013 |
Keyword(s): Electronic Health Records, Meaningful Use, United States

Use of Health IT for Higher-Value Critical Care

Chen LM et al, New England Journal of Medicine, 2013

The patient had not yet coded but was spiraling downward, prompting a request for a bed in the intensive care unit (ICU). But the ICU had no available beds. Hours passed before the decision was made that another patient could safely be “bumped” out of the unit to accommodate our patient.
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Published: 30 January 2013 |
Keyword(s): Critical Care, Electronic Health Records, Health Information Technology, Hospitals, Intensive Care Units, Meaningful Use, United States

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