Electronic Health Record Access Research Articles

The Current State of Teleradiology Across the United States: A National Survey of Radiologists’ Habits, Attitudes, and Perceptions on Teleradiology Practice

PurposeTo explore the current state of teleradiology practice, defined as the interpretation of imaging examinations at a different facility from where the examination was performed. MethodsA national survey addressing radiologists’ habits, attitudes, and perceptions regarding teleradiology was distributed by e-mail to a random sample of ACR members in early 2019. ResultsAmong 731 of 936 respondents who indicated a non-teleradiologist primary work setting, 85.6% reported performing teleradiology within the past 10 years and 25.4% reported that teleradiology represents a majority of their annual imaging volumes; 84.4% performed teleradiology for internal examinations and 45.7% for external examinations; 46.2% performed teleradiology for rural areas and 37.2% for critical access hospitals; 91.3% performed teleradiology during weekday normal business hours and 44.5% to 79.6% over evening, overnight, and weekend hours. In all, 76.9% to 86.2% perceived value from teleradiology for geographic, after-hours, and multispecialty coverage, as well as reduced interpretation turnaround times. The most common challenges for teleradiology were electronic health record access (62.8%), quality assurance (53.8%), and technologist proximity (48.4%). The strategy most commonly considered useful for improving teleradiology was technical interpretation standards (33.3%). Radiologists in smaller practices were less likely to perform teleradiology or performed teleradiology for lower fractions of work, were less likely to experience coverage advantages of teleradiology, and reported larger implementation challenges, particularly relating to electronic health records and prior examination access. ConclusionDespite historic concerns, teleradiology is widespread throughout modern radiology practice, helping practices achieve geographic, after-hours, and multispecialty coverage; reducing turnaround times; and expanding underserved access. Nonetheless, quality assurance of offsite examinations remains necessary. IT integration solutions could help smaller practices achieve teleradiology’s benefits.

Community pharmacists’ lack of access to health records and its impact on targeted MTM interventions

ObjectivesTo describe the adequacy of health record information available to community pharmacists when completing medication therapy management (MTM) interventions and to quantify the time spent on interventions that are ultimately revealed as invalid. MethodsThis prospective cross-sectional study analyzed cases of high-risk medication use in the elderly and statin use in persons with diabetes identified by 3 MTM platforms across 15 grocery chain pharmacies. MTM interventions were completed by phone and fax following a usual care protocol. Collected data included case validity (defined as the case truly requiring a pharmacist’s involvement), case success (defined as achieving the targeted goal of the intervention), time spent on the intervention, and a determination of whether information from an electronic health record (EHR) could have eliminated patient or prescriber contact. ResultsAmong 163 cases analyzed, 54% were found to be valid and 30% successful. The most common reasons for invalidity were allergy or contraindication, patient already taking a statin, and patient not having the targeted condition. Overall, 14% of cases were valid and successful, 40% valid and unsuccessful, 17% invalid and successful, and 29% invalid and unsuccessful. Valid successful cases averaged 15.3 minutes per case, valid unsuccessful cases averaged 9.2 minutes, invalid successful cases averaged 4.2 minutes, and invalid unsuccessful cases averaged 5.1 minutes. Based on the case-by-case determination of the researchers, EHR information would have completed 39% of cases without patient or prescriber contact. The average time spent on cases needing EHR access was 5.5 minutes, compared with 9.5 minutes for cases in which EHR access would not have helped. ConclusionCommunity pharmacists performing MTM interventions are hindered by lack of access to patient health information, imprecise patient targeting by MTM platforms, and cumbersome communication between pharmacists and prescribers.

Key factors for sustainable integration of pharmacists in team-based primary care physician practices

ObjectivesTo (1) identify strategies for financial justification of pharmacists integrated into team-based primary care, (2) describe the payment models currently used for integration of pharmacists into team-based primary care, and (3) elicit key factors facilitating sustainable pharmacist-provided patient care services in the primary care setting. DesignQualitative analysis using semistructured interviews. SettingNonacademic outpatient primary care physician practices throughout the United States from January to April 2014. ParticipantsPharmacists responsible for leadership of clinical pharmacists in primary care practices whose positions are supported through nondispensing patient care services. Main outcome measuresCurrent payment model, infrastructure, documentation strategies, and methods of quality assessment. ResultsTwelve interviews were conducted. Practices included a combination of single- and mixed-payer models in integrated and nonintegrated health systems. Various billing strategies were used, particularly in nonintegrated models, to sustain pharmacists in primary care practices utilizing both fee-for-service (FFS) and value-based incentives payments. Five main themes were elicited: (1) Pharmacists are integrated and valuable members of health care teams; (2) pharmacists are documenting in an accessible electronic health record; (3) data tracking is a facilitator for justifying and adapting practice; (4) systematized processes for pharmacist integration exist in each practice; and (5) pharmacists’ responsibilities on the team have grown and evolved over time. ConclusionPharmacists’ contributions to improving patients’ medication-related care are the same regardless of payment model. Financially sustainable integration of pharmacists on the team involves using a combination of FFS and value-based incentive payments, consistent documentation, meaningful collection of pharmacists’ contributions to improve the quality of care, and a firm understanding of the practice’s needs and financial structure. These themes can be used as a guide for pharmacists as they establish themselves in an FFS environment and adapt to a future in value-based care.

Quality of Hospital Communication and Patient Preparation for Home Health Care: Results From a Statewide Survey of Home Health Care Nurses and Staff

ObjectivesTo evaluate the quality of communication between hospitals and home health care (HHC) clinicians and patient preparedness to receive HHC in a statewide sample of HHC nurses and staff. DesignA web-based 48-question cross-sectional survey of HHC nurses and staff in Colorado to describe the quality of communication after hospital discharge and patient preparedness to receive HHC from the perspective of HHC nurses and staff. Questions were on a Likert scale, with optional free-text questions. Setting and participantsBetween January and June 2017, we sent a web-based survey to individuals from the 56 HHC agencies in the Home Care Association of Colorado that indicated willingness to participate. ResultsWe received responses from 50 of 122 individuals (41% individual response rate) representing 14 of 56 HHC agencies (25% agency response rate). Half of the respondents were HHC nurses, the remainder were managers, administrators, or quality assurance clinicians. Among respondents, 60% (n = 30) reported receiving insufficient information to guide patient management in HHC and 44% (n = 22) reported encountering problems related to inadequate patient information. Additional tests recommended by hospital clinicians was the communication domain most frequently identified as insufficient (58%). More than half of respondents (52%) indicated that patient preparation to receive HHC was inadequate, with patient expectations frequently including extended-hours caregiving, housekeeping, and transportation, which are beyond the scope of HHC. Respondents with electronic health record (EHR) access for referring providers were less likely to encounter problems related to a lack of information (27% vs 57% without EHR access, P = .04). Respondents with EHR access were also more likely to have sufficient information about medications and contact isolation. Conclusions/ImplicationsCommunication between hospitals and HHC is suboptimal, and patients are often not prepared to receive HHC. Providing EHR access for HHC clinicians is a promising solution to improve the quality of communication.

Use of Electronic Health Record Access and Audit Logs to Identify Physician Actions Following Noninterruptive Alert Opening: Descriptive Study.

BackgroundElectronic health record (EHR) access and audit logs record behaviors of providers as they navigate the EHR. These data can be used to better understand provider responses to EHR–based clinical decision support (CDS), shedding light on whether and why CDS is effective.ObjectiveThis study aimed to determine the feasibility of using EHR access and audit logs to track primary care physicians’ (PCPs’) opening of and response to noninterruptive alerts delivered to EHR InBaskets.MethodsWe conducted a descriptive study to assess the use of EHR log data to track provider behavior. We analyzed data recorded following opening of 799 noninterruptive alerts sent to 75 PCPs’ InBaskets through a prior randomized controlled trial. Three types of alerts highlighted new medication concerns for older patients’ posthospital discharge: information only (n=593), medication recommendations (n=37), and test recommendations (n=169). We sought log data to identify the person opening the alert and the timing and type of PCPs’ follow-up EHR actions (immediate vs by the end of the following day). We performed multivariate analyses examining associations between alert type, patient characteristics, provider characteristics, and contextual factors and likelihood of immediate or subsequent PCP action (general, medication-specific, or laboratory-specific actions). We describe challenges and strategies for log data use.ResultsWe successfully identified the required data in EHR access and audit logs. More than three-quarters of alerts (78.5%, 627/799) were opened by the PCP to whom they were directed, allowing us to assess immediate PCP action; of these, 208 alerts were followed by immediate action. Expanding on our analyses to include alerts opened by staff or covering physicians, we found that an additional 330 of the 799 alerts demonstrated PCP action by the end of the following day. The remaining 261 alerts showed no PCP action. Compared to information-only alerts, the odds ratio (OR) of immediate action was 4.03 (95% CI 1.67-9.72) for medication-recommendation and 2.14 (95% CI 1.38-3.32) for test-recommendation alerts. Compared to information-only alerts, ORs of medication-specific action by end of the following day were significantly greater for medication recommendations (5.59; 95% CI 2.42-12.94) and test recommendations (1.71; 95% CI 1.09-2.68). We found a similar pattern for OR of laboratory-specific action. We encountered 2 main challenges: (1) Capturing a historical snapshot of EHR status (number of InBasket messages at time of alert delivery) required incorporation of data generated many months prior with longitudinal follow-up. (2) Accurately interpreting data elements required iterative work by a physician/data manager team taking action within the EHR and then examining audit logs to identify corresponding documentation.ConclusionsEHR log data could inform future efforts and provide valuable information during development and refinement of CDS interventions. To address challenges, use of these data should be planned before implementing an EHR–based study.

Electronic health record access by patients as an indicator of information seeking and sharing for cardiovascular health promotion in social networks: Secondary analysis of a randomized clinical trial.

We investigated electronic health record (EHR) access as an indicator of cardiovascular health promotion by patients in their social networks, by identifying individuals who viewed their coronary heart disease (CHD) risk information in the EHR and shared this information in their social networks among various spheres of influence. In a secondary analysis of the Myocardial Infarction Genes trial, Olmsted County MN residents (2013–2015; n = 203; whites, ages 45–65 years) at intermediate CHD risk were randomized to receive their conventional risk score (CRS; based on traditional risk factors) alone or also their genetic risk score (GRS; based on 28 genomic variants). We assessed self-reported and objectively quantified EHR access via a patient portal at three and six months after risk disclosure, and determined whether this differed by GRS disclosure. Data were analyzed using logistic regression and adjusted for sociodemographic characteristics, family history, and baseline CRS/GRS. Self-reported EHR access to view CHD risk information was associated with a high frequency of objectively quantified EHR access (71(10) versus 37(5) logins; P = 0.0025) and a high likelihood of encouraging others to be screened for their CHD risk (OR 2.936, CI 1.443–5.973, P = 0.0030), compared to the absence of self-reported EHR access to view CHD risk information. We thereby used EHR access trends to identify individuals who may function as disseminators of CHD risk information in social networks, compared to individuals on the periphery of their social networks who did not exhibit this behavior. Partnering with such individuals could amplify CHD health promotion.Clinical Trial Registration: Myocardial Infarction Genes (MI-GENES) Study, NCT01936675, https://clinicaltrials.gov/ct2/show/NCT01936675.

OP140 Adult Patient Access To Electronic Health Records

IntroductionIn order to facilitate patient information, patient involvement, and to support patient-centered care, healthcare organizations are increasingly offering access to patient data that are stored in the institution-specific electronic health record (EHR). Patients can access these data, read, and print them, or download and integrate them into any type of patient-held record. This EHR access is typically web-based and called “patient portal” allowing the independent access via the Internet from everywhere. A patient portal may also offer additional features such as prescription requests, appointment booking, messaging, personal health-related reminders, individual therapeutic recommendations, personal diaries, and social networking with other patients. In a Cochrane review, we assessed the effects of providing access to EHR for adult patients on patient empowerment and health-related outcomes compared to usual care.MethodsAccording to the methods of evidence-based medicine, we developed a protocol for a Cochrane review, which is published in the Cochrane database.ResultsWe identified ten randomized controlled trials (RCTs) including 6,668 randomized participants. Seven RCTs took place in the USA, two in Canada, and one in Japan. Additional functionalities of interventions and disease conditions were heterogeneous. Three studies (n = 601) reported on patient empowerment. The risk differences reported were neither statistically significant nor clinically relevant. Eight studies (n = 2,070) reported on nine different risk factors (blood pressure, blood glucose, poor asthma control, 10-year Framingham risk score, cholesterol, body mass index, composite score of eight variables, intraocular pressure, composite score of three variables). The results were heterogeneous. Mostly there were no statistically significant risk differences between study groups.ConclusionsOverall, there is no evidence for a clear positive effect of patient portals on patient empowerment and health related outcomes (mainly risk factors). However, we identified only a small number of studies. The usage of portals was often low and several studies were older.

Creating an optimal care coordination model for patients with lung cancer on Medicaid.

273 Background: The Association of Community Cancer Centers (ACCC) created an Optimal Care Coordination Model (OCCM), which provides a comprehensive self-assessment tool designed to orient cancer programs to achieving patient-centered, multidisciplinary care. The OCCM is designed to help cancer programs, regardless of resources, location, or population, improve care for lung cancer patients, especially those on Medicaid. Methods: An environmental scan was conducted in early 2016 with a focus on coordination of care after lung cancer diagnosis to improve experiences and outcomes for Medicaid beneficiaries. Five ACCC Cancer Program Members each hosted 2-day site visits in mid-2016. Interview sessions were conducted to explore effective practices and current care models for patients with lung cancer insured by Medicaid. Key problems in care coordination were identified, as well as local solutions that had been put in place to overcome these barriers. The NCI Community Cancer Centers Program’s (NCCCP) Multidisciplinary Care (MDC) Assessment Tool was the foundational template to create the OCCM. The MDC Tool included 7 assessment areas that were identified as impactful to establishing multidisciplinary care and includes a Level 1-5 evaluation matrix. Results: The beta version of the OCCM was created in early 2017. The number of Assessment Areas was expanded to better capture current care coordination philosophies; (1) Patient Access to Care; (2) Prospective Multidisciplinary Case Planning; (3) Financial, Transportation, and Housing; (4) Management of Comorbid Conditions; (5) Care Coordination; (6) Treatment Team Integration; (7) Electronic Health Records (EHR) and Patient Access to Information; (8) Survivorship Care; (9) Supportive Care; (10) Tobacco Cessation; (11) Clinical Trials; (12) Physician Engagement; (13) Quality Measurement and Improvement. Conclusions: Seven ACCC Cancer Program Members are currently validating the model by each implementing at least one program-specific quality improvement project focused on an Assessment Area over a 12-month time period. All programs are collecting extensive data to determine the extent their program improved within an assessment area. Final results will be available for dissemination in 2019.

A Simple Tool Using AM-PAC “6-Clicks” to Measure Value Added in Acute Care Physical Therapy: The Therapy Value Quotient

Background and Purpose: Acute physical therapy practitioners and leaders continue to search for a practical method to measure value. The purpose of this case report is to introduce the Therapy Value Quotient and its simple yet effective use of Activity Measure for Post-Acute Care Inpatient Mobility Short Form, also known as “6-Clicks,” and common payroll data to measure changes in value added to patient care. Case Description: Health care service value should be measured by outcomes produced divided by the cost of services to produce those outcomes. Although acute physical therapy practice continues to progress toward consistent outcome measurement, widespread application of outcomes to quantify value is rare. This lack of value measurement leaves acute care practitioners' value measured primarily in terms of how many units or visits a therapist can code in a certain number of hours worked. Unfortunately, quantities of units or visits are not synonymous with value. Acute care managers and practitioners need a viable and easy-to-use tool that requires minimal data entry and uses existing, easily accessible payroll and electronic health record data. Outcomes: The goal of this project was to create a value calculation with commonly used systems (payroll, electronic health record) data and Activity Measure for Post-Acute Care Inpatient Mobility Short Form data to quantify value. Minimizing manual data entry decreases errors and improves real-time calculations. The purposely minimized design of the equation allows clinicians and managers freedom to create highest-value processes that achieve the maximal value added. Discussion: The Therapy Value Quotient can help managers and clinicians investigate and measure value-adding tactics while improving care delivery and efficiency instead of simply increasing the number of procedures per hour worked.

Implementation of Digital Health Technology at Academic Medical Centers in Saudi Arabia.

Academic Medical Centers (AMCs) in Saudi Arabia are dedicated to providing high-quality patient care and promoting the health and wellbeing of its citizens. Additionally, they provide medical education and conduct research in a wide range of clinical disciplines. A recent global trend in academic hospitals with mandates similar to those in Saudi Arabia is that they have started utilizing digital health technology in a bid to increase efficiency and improve the quality of patient care. This paper takes the position that such digital health technologies should also be utilized in AMC settings in Saudi Arabia. Electronic health records (EHRs), smartphones, video-imaging technologies, virtual desktop infrastructures, mobile EHR access, and smart-beds can help AMCs serve patients more effectively. Rural people can be connected to consultants at AMCs using these technologies using virtual self-care tools. Validation of new digital health devices can be performed in collaboration with digital health partners and serve to enrich the knowledge of medical students in the area of digital health. This review aims to draw the attention of stakeholders to the need to implement digital health technology in AMCs in Saudi Arabia and help improve the quality of healthcare.

Same, same but different: Perceptions of patients' online access to electronic health records among healthcare professionals.

In this study, we explore how healthcare professionals in primary care and outpatient clinics perceive the outcomes of giving patients online access to their electronic health records. The study was carried out as a case study and included a workshop, six interviews and a survey that was answered by 146 healthcare professionals. The results indicate that professionals working in primary care perceive that an increase in information-sharing with patients can increase adherence, clarify important information to the patient and allow the patient to quality-control documented information. Professionals at outpatient clinics seem less convinced about the benefits of patient accessible electronic health records and have concerns about how patients manage the information that they are given access to. However, the patient accessible electronic health record has not led to a change in documentation procedures among the majority of the professionals. While the findings can be connected to the context of outpatient clinics and primary care units, other contextual factors might influence the results and more in-depth studies are therefore needed to clarify the concerns.

Assessing the Status Quo of EHR Accessibility, Usability, and Knowledge Dissemination.

Aim:This study was performed to better characterize accessibility to electronic health records (EHRs) among informatics professionals in various roles, settings, and organizations across the United States and internationally.Background:The EHR landscape has evolved significantly in recent years, though challenges remain in key areas such as usability. While patient access to electronic health information has gained more attention, levels of access among informatics professionals, including those conducting usability research, have not been well described in the literature. Ironically, many informatics professionals whose aim is to improve EHR design have restrictions on EHR access or publication, which interfere with broad dissemination of findings in areas of usability research.Methods:To quantify the limitations on EHR access and publication rights, we conducted a survey of informatics professionals from a broad spectrum of roles including practicing clinicians, researchers, administrators, and members of industry. Results were analyzed and levels of EHR access were stratified by role, organizational affiliation, geographic region, EHR type, and restrictions with regard to publishing results of usability testing, including screenshots.Results:126 respondents completed the survey, representing all major geographic regions in the United States. 71.5 percent of participants reported some level of EHR access, while 13 percent reported no access whatsoever. Rates of no-access were higher among faculty members and researchers (19 percent). Among faculty members and researchers, 72 percent could access the EHR for usability and/or research purposes, but, of those, fewer than 1 in 3 could freely publish screenshots with results of usability testing and half could not publish such data at all. Across users from all roles, only 21 percent reported the ability to publish screenshots freely without restrictions.Conclusions:This study offers insight into current patterns of EHR accessibility among informatics professionals, highlighting restrictions that limit dissemination of usability research and testing. Further conversations and shared responsibility among the various stakeholders in industry, government, health care organizations, and informatics professionals are vital to continued EHR optimization.

Clinical Management of Unknown Group Beta Streptococcus Status [30O

INTRODUCTION: The objective of this study was to determine adherence to the Centers for Disease Control (CDC) guidelines for Group Beta Streptococcus (GBS) results available at the time of delivery. METHODS: A retrospective cohort review was conducted including women admitted for delivery who received prenatal care within the prior 6 weeks. Women were divided into groups including positive, negative and unknown GBS status. Source and effects of GBS status on adherence to CDC guidelines were collected. RESULTS: Of the 97 women who met study criteria, 20.6% (N=20) had unknown status, 26.8% (N=26) positive result and 52.6% (N=51) negative result. In 10% of women with unknown status, the result was available on electronic health record (EHR) with interface between outpatient with inpatient setting. The remaining 90% of cases did not have access to GBS results obtained in the prenatal setting. Adherence to CDC guidelines occurred in 45% (N=9) of these women in which antibiotics were administered only with known risk factors. Non-adherence occurred in 55% of cases such that 11 women received unnecessary antibiotic exposure even in the absence of risk factors. Moreover, when the GBS results were eventually available, 2 were negative. CONCLUSION: In our study, less than 50% of women with unknown GBS status received therapy in compliance with CDC recommendations. Efforts should be made to ensure EHR access to prenatally obtained GBS results and to educate health care providers regarding the potential harms of exposure of unindicated therapies.

Timing It Right - Patients' Online Access to Their Record Notes in Sweden.

In Sweden, and internationally, there is an ongoing debate about the effects of national implementations of Patient Accessible Electronic Health Records (PAEHRs). The purpose of this paper was to describe the current situation in Sweden and compare this with the expectations on reasonable waiting time for information access of users of the Swedish PAEHR. Data were collected from publicly available resources regarding current implementation in the 21 county councils, contrasted with patient experiences, gathered from a national online survey. The results indicate that patients have high expectations on immediate access to information, while this varies greatly in implementation across Sweden.

Barriers to Medical Students' Electronic Health Record Access Can Impede Their Preparedness for Practice.

Medical students need hands-on experience documenting clinical encounters as well as entering orders to prepare for residency and become competent physicians. In the era of paper medical records, students consistently acquired experience writing notes and entering orders as part of their clinical experience. Over the past decade, however, patient records have transitioned from paper to electronic form. This change has had the unintended consequence of limiting medical students' access to patient records. This restriction has meant that many students leave medical school without the appropriate medical record skills for transitioning to residency.In this article, the authors explore medical students' current access to electronic health records (EHRs) as well as policy proposals from medical societies, innovative models implemented at some U.S. medical schools, and other possible solutions to ensure that students have sufficient experiential learning opportunities with EHRs in clinical settings. They also contend that competence in the use of EHRs is necessary for students to become physicians who can harness the full potential of these tools rather than physicians for whom EHRs hinder excellent patient care. Finally, the authors argue that meaningful experiences using EHRs should be consistently incorporated into medical school curricula and that EHR-related skills should be rigorously assessed with other clinical skills.

Patients' Online Access to Electronic Health Records: Current Status and Experiences from the Implementation in Sweden.

The number of eHealth services for patients is rapidly increasing worldwide. This paper describes the status of a very important eHealth service for patients in Sweden, the Patient Accessible Electronic Health Record (PAEHR). As many countries are facing an introduction of national eHealth services providing health information to the patients, lessons learned from Sweden may improve the deployment and use of PAEHRs and similar eHealth services. Challenges that remain in Sweden relate to local differences in the implementation that lead to fragmentation and unequal access to information. Initiatives have been taken to reconcile some of the problems, e.g. an updated national regulatory framework for PAEHR. To date, evaluations are often performed from a healthcare provider perspective, focusing on aspects that are considered important by healthcare professionals and decision makers. Based on experiences of this nation-wide implementation we argue for the need to also base evaluations of eHealth on the perspective of the patients.

Analysis of the Updated Swedish Regulatory Framework of the Patient Accessible Electronic Health Record in Relation to Usage Experience.

In Sweden, all citizens can (in 2017) access their health data online from all county councils using one national eHealth service. However, depending on where the patient lives, different information is provided as care providers have assessed differently how to apply the National Regulatory Framework (NRF). The NRF recently was updated and this paper analyses version 2.0 should now serve as the guideline for all county councils. Potential improvements are analyzed in relation to patient experiences of using the service, and the rationale for each change in the NRF is discussed. Two real case quotations are used to illustrate potential implications for the patient when the new version is placed into operation. Results indicate that this NRF allows for opportunities to create a national eHealth service that better supports patient-centered care and improves health information outcome.

A Socio-Technical Analysis of Patient Accessible Electronic Health Records.

In Sweden, and internationally, there is a movement towards increased transparency in healthcare including giving patients online access to their electronic health records (EHR). The purpose of this paper is to analyze the Swedish patient accessible EHR (PAEHR) service using a socio-technical framework, to increase the understanding of factors that influence the design, implementation, adoption and use of the service. Using the Sitting and Singh socio-technical framework as a basis for analyzing the Swedish PAEHR system and its context indicated that there are many stakeholders engaged in these types of services, with different driving forces and incentives that may influence the adoption and usefulness of PAEHR services. The analysis was useful in highlighting important areas that need to be further explored in evaluations of PAEHR services, and can act as a guide when planning evaluations of any PAEHR service.

Primary Care Providers' Opening of Time-Sensitive Alerts Sent to Commercial Electronic Health Record InBaskets.

Time-sensitive alerts are among the many types of clinical notifications delivered to physicians' secure InBaskets within commercial electronic health records (EHRs). A delayed alert review can impact patient safety and compromise care. To characterize factors associated with opening of non-interruptive time-sensitive alerts delivered into primary care provider (PCP) InBaskets. We analyzed data for 799 automated alerts. Alerts highlighted actionable medication concerns for older patients post-hospital discharge (2010-2011). These were study-generated alerts sent 3days post-discharge to InBaskets for 75 PCPs across a multisite healthcare system, and represent a subset of all urgent InBasket notifications. Using EHR access and audit logs to track alert opening, we performed bivariate and multivariate analyses calculating associations between patient characteristics, provider characteristics, contextual factors at the time of alert delivery (number of InBasket notifications, weekday), and alert opening within 24h. At the time of alert delivery, the PCPs had a median of 69 InBasket notifications and had received a median of 379.8 notifications (IQR 295.0, 492.0) over the prior 7days. Of the 799 alerts, 47.1% were opened within 24h. Patients with longer hospital stays (>4days) were marginally more likely to have alerts opened (OR 1.48 [95% CI 1.00-2.19]). Alerts delivered to PCPs whose InBaskets had a higher number of notifications at the time of alert delivery were significantly less likely to be opened within 24h (top quartile >157 notifications: OR 0.34 [95% CI 0.18-0.61]; reference bottom quartile ≤42). Alerts delivered on Saturdays were also less likely to be opened within 24h (OR 0.18 [CI 0.08-0.39]). The number of total InBasket notifications and weekend delivery may impact the opening of time-sensitive EHR alerts. Further study is needed to support safe and effective approaches to care team management of InBasket notifications.

Adult patient access to electronic health records

Adult patient access to electronic health records