Development Of Electronic Health Record Research Articles

A Survey of Generative Adversarial Networks for Synthesizing Structured Electronic Health Records

Electronic Health Records (EHRs) are a valuable asset to facilitate clinical research and point of care applications; however, many challenges such as data privacy concerns impede its optimal utilization. Deep generative models, particularly Generative Adversarial Networks (GANs), show great promise in generating synthetic EHR data by learning underlying data distributions while achieving excellent performance and addressing these challenges. This work aims to survey the major developments in various applications of GANs for EHRs and provides an overview of the proposed methodologies. For this purpose, we combine perspectives from healthcare applications and machine learning techniques in terms of source datasets and the fidelity and privacy evaluation of the generated synthetic datasets. We also compile a list of the metrics and datasets used by the reviewed works, which can be utilized as benchmarks for future research in the field. We conclude by discussing challenges in GANs for EHRs development and proposing recommended practices. We hope that this work motivates novel research development directions in the intersection of healthcare and machine learning.

Perceptions of chief clinical information officers on the state of electronic health records systems interoperability in NHS England: a qualitative interview study

BackgroundIn the era of electronic health records (EHR), the ability to share clinical data is a key facilitator of healthcare delivery. Since the introduction of EHRs, this aspect has been extensively studied from the perspective of healthcare providers. Less often explored are the day-to-day challenges surrounding the procurement, deployment, maintenance, and use of interoperable EHR systems, from the perspective of healthcare administrators, such as chief clinical information officers (CCIOs).ObjectiveOur study aims to capture the perceptions of CCIOs on the current state of EHR interoperability in the NHS, its impact on patient safety, the perceived facilitators and barriers to improving EHR interoperability, and what the future of EHR development in the NHS may entail.MethodsSemi-structured interviews were conducted between November 2020 – October 2021. Convenience sampling was employed to recruit NHS England CCIOs. Interviews were digitally recorded and transcribed verbatim. A thematic analysis was performed by two independent researchers to identify emerging themes.ResultsFifteen CCIOs participated in the study. Participants reported that limited EHR interoperability contributed to the inability to easily access and transfer data into a unified source, thus resulting in data fragmentation. The resulting lack of clarity on patients' health status negatively impacts patient safety through suboptimal care coordination, duplication of efforts, and more defensive practice. Facilitators to improving interoperability included the recognition of the need by clinicians, patient expectations, and the inherent centralised nature of the NHS. Barriers included systems usability difficulties, and institutional, data management, and financial-related challenges. Looking ahead, participants acknowledged that realising that vision across the NHS would require a renewed focus on mandating data standards, user-centred design, greater patient involvement, and encouraging inter-organisational collaboration.ConclusionTackling poor interoperability will require solutions both at the technical level and in the wider policy context. This will involve demanding interoperability functionalities from the outset in procurement contracts, fostering greater inter-organisation cooperation on implementation strategies, and encouraging systems vendors to prioritise interoperability in their products. Only by comprehensively addressing these challenges would the full potential promised by the use of fully interoperable EHRs be realised.

Electronic Health Record Embedded Strategies for Improving Care of Patients With Heart Failure.

A majority of clinical decisions use the electronic health record (EHR) and there is an unmet need to use its capability to help providers to make evidence-based decisions that improve care for heart failure patients. These electronic nudges are rooted in the human psychology of decision-making and often target specific cognitive biases. This review outlines the development of novel EHR nudges and specific lessons learned from each experience to inform the development of future interventions. There have been several randomized clinical trials examining the impact of EHR alerts on quality of care for heart failure patients. These interventions have targeted both clinicians and patients. There are features of each trial that inform best practices and future directions for EHR nudges. Recent clinical trials have demonstrated that some EHR alerts can improve care for heart failure patients. These trials utilized default options, involved clinicians in the alert design process, provided actionable recommendations, and aimed to minimize disruptions to typical workflow. Alerts aimed at improving care should be examined in a randomized fashion in order to evaluate their impact on clinician satisfaction and patient care.

A guide to mitigating audit log-related risk in medical professional liability cases.

Following the American Recovery and Reinvestment Act in 2009, use of electronic health records (EHRs) has become ubiquitous. Accordingly, one should expect most medical professional liability cases to involve review of patient records produced from EHRs. When questions arise regarding who was involved in care of a patient, what they knew and when, or the meaning, completeness, integrity, validity, timeliness, confidentiality, accuracy, or legitimacy of data, or ways that the EHR's user interface or automated clinical decision support tools may have contributed to the alleged events, one often turns to the EHR and its audit log. This manuscript discusses lines of defense incorporated into the design, development, implementation, and use of EHRs to ensure their integrity and the types of EHR transaction logs (e.g., audit log) that exist. Using these logs can help one answer questions that often arise in medical malpractice cases. Finally, there are "best practices" surrounding EHR audit logs that health care organizations should implement. When used appropriately, EHRs and their audit logs provide another source of information to help hospital risk managers, legal counsel, and EHR expert witnesses to investigate adverse incidents and, if needed, prosecute or defend clinicians and/or health care organizations involved in the patient's care.

Involving Health Care Professionals in the Development of Electronic Health Records: Scoping Review.

Electronic health records (EHRs) are a promising approach to document and map (complex) health information gathered in health care worldwide. However, possible unintended consequences during use, which can occur owing to low usability or the lack of adaption to existing workflows (eg, high cognitive load), may pose a challenge. To prevent this, the involvement of users in the development of EHRs is crucial and growing. Overall, involvement is designed to be very multifaceted, for example, in terms of the timing, frequency, or even methods used to capture user preferences. Setting, users and their needs, and the context and practice of health care must be considered in the design and subsequent implementation of EHRs. Many different approaches to user involvement exist, each requiring a variety of methodological choices. The aim of the study was to provide an overview of the existing forms of user involvement and the circumstances they need and to provide support for the planning of new involvement processes. We conducted a scoping review to provide a database for future projects on which design of inclusion is worthwhile and to show the diversity of reporting. Using a very broad search string, we searched the PubMed, CINAHL, and Scopus databases. In addition, we searched Google Scholar. Hits were screened according to scoping review methodology and then examined, focusing on methods and materials, participants, frequency and design of the development, and competencies of the researchers involved. In total, 70 articles were included in the final analysis. There was a wide range of methods of involvement. Physicians and nurses were the most frequently included groups and, in most cases, were involved only once in the process. The approach of involvement (eg, co-design) was not specified in most of the studies (44/70, 63%). Further qualitative deficiencies in the reporting were evident in the presentation of the competences of members of the research and development teams. Think-aloud sessions, interviews, and prototypes were frequently used. This review provides insights into the diversity of health care professionals' involvement in the development of EHRs. It provides an overview of the different approaches in various fields of health care. However, it also shows the necessity of considering quality standards in the development of EHRs together with future users and the need for reporting this in future studies.

Physicians' Perspectives on EHR Usability: Results from Four Large Cross-Sectional Surveys from 2010 to 2021.

Usability and user experience are central quality attributes of electronic health record (EHR) systems. Usability evaluation studies typically focus on short-term use and situational usability, although feedback collected during operational use provides input for future information systems development. An abundance of studies report on physicians' dissatisfaction with the usability of their EHR systems and many show an association between poor usability and physician burnout. However, there is a scarcity of large long-term monitoring studies assessing end users' experiences with EHRs. We report on the results from four large (n=3,929-4,628) national cross-sectional usability surveys conducted among Finnish physicians in 2010, 2014, 2017, and 2021. The main finding was that the perceptions of physicians working in public health centres had changed for the better but those working in public hospitals reported similar or even more negative experiences in 2021 than in 2010-17; they rated only system responsiveness to inputs as having improved. Based on this finding, systematic research-based monitoring of EHR development from the end users' perspectives should be continued.

The Priorities of End Users of Emergency Department Electronic Health Records: Modified Delphi Study

The needs of the emergency department (ED) pose unique challenges to modern electronic health record (EHR) systems. A diverse case load of high-acuity, high-complexity presentations, and ambulatory patients, all requiring multiple transitions of care, creates a rich environment through which to critically examine EHRs. This investigation aims to capture and analyze the perspective of end users of EHR about the strengths, limitations, and future priorities for EHR in the setting of the ED. In the first phase of this investigation, a literature search was conducted to identify 5 key usage categories of ED EHRs. Using key usage categories in the first phase, a modified Delphi study was conducted with a group of 12 panelists with expertise in both emergency medicine and health informatics. Across 3 rounds of surveys, panelists generated and refined a list of strengths, limitations, and key priorities. The findings from this investigation highlighted the preference of panelists for features maximizing functionality of basic clinical features relative to features of disruptive innovation. By capturing the perspectives of end users in the ED, this investigation highlights areas for the improvement or development of future EHRs in acute care settings.

Identifying a Clinical Informatics or Electronic Health Record Expert Witness for Medical Professional Liability Cases.

The health care field is experiencing widespread electronic health record (EHR) adoption. New medical professional liability (i.e., malpractice) cases will likely involve the review of data extracted from EHRs as well as EHR workflows, audit logs, and even the potential role of the EHR in causing harm. Reviewing printed versions of a patient's EHRs can be difficult due to differences in printed versus on-screen presentations, redundancies, and the way printouts are often grouped by document or information type rather than chronologically. Simply recreating an accurate timeline often requires experts with training and experience in designing, developing, using, and reviewing EHRs and audit logs. Additional expertise is required if questions arise about data's meaning, completeness, accuracy, and timeliness or ways that the EHR's user interface or automated clinical decision support tools may have contributed to alleged events. Such experts often come from the sociotechnical field of clinical informatics that studies the design, development, implementation, use, and evaluation of information and communications technology, specifically, EHRs. Identifying well-qualified EHR experts to aid a legal team is challenging. Based on literature review and experience reviewing cases, we identified seven criteria to help in this assessment. The criteria are education in clinical informatics; clinical informatics knowledge; experience with EHR design, development, implementation, and use; communication skills; academic publications on clinical informatics; clinical informatics certification; and membership in informatics-related professional organizations. While none of these criteria are essential, understanding the breadth and depth of an individual's qualifications in each of these areas can help identify a high-quality, clinical informatics expert witness.

Trends in Electronic Health Record Capabilities for Tracking Documentation Time

To understand hospitals' access to and use of data from electronic health record (EHR) developers that quantify the amount of time clinicians spend documenting clinical care in EHRs. Descriptive analysis of 4 waves of a nationally representative survey of US nonfederal acute care hospitals from 2017 to 2019 and 2021 (N = 10,662 across years). We identified the share of hospitals that had access to EHR documentation time measures between 2017 and 2021 and how access varied by hospital and EHR characteristics. We then described how EHR data were used among hospitals with access and whether use varied by developer. The share of hospitals with access to EHR documentation time measures increased significantly each year between 2017 and 2021, when more than two-thirds of hospitals reported having access to these measures. Despite hospitals' increased access to measures that track EHR time, lower-resourced hospitals, nonteaching hospitals, and hospitals with non-market-leading EHR developers were less likely to report having access than their counterparts. In 2021, the 2 most common uses of EHR data were "identifying providers in need of training and support" and "identifying areas to improve clinical workflow." The share of hospitals indicating use of EHR data increased between 2019 and 2021 for all studied uses. A higher proportion of hospitals with access to EHR documentation time measures used them for more purposes over time, suggesting their increased value. Although hospitals' access to and use of EHR documentation measures increased significantly in the last 5 years, future research efforts should investigate whether the use of these measures translates into reduced burden for providers.

Broadening of horizons: a review of blockchains' influence on EHRs development trend

Electronic health records (EHR) improves the quality and effectiveness of healthcare. The introduction of blockchain opens up new paths in the development trend of EHR. This review aims to find the developmental trends of the EHR, blockchain-based EHR and its impact on EHR evolution. A total of 85 articles published in 2015 to 2021 were selected, addressing the general development of EHR. Development aspects of EHR addressed by each were analysed, hence tracing the path taken by each. Researchers for the betterment of traditional EHR sought to address usability, adaptability, needs of specialised areas, and patient inclusivity in the workflow, while stressing the application of EHR for predictive analysis, preventive healthcare, population health, etc. The literature on blockchain-based EHR contributed to mitigating the interoperability, promoting data sharing and patient-centric records. While traditional EHR deepens their reach into healthcare, blockchain-based EHR broadens the reach of healthcare itself.

The Development and Validation of Data Elements and Process Steps for an Electronic Health Record for Hand Surgery Outreach Trips

Background The surgical burden in low- and middle-income countries (LMICs) as reported by the number of surgical cases per capita is great. To improve global health and help address this burden, there has been a rise in surgical outreach to LMICs. In high-income countries, an electronic health record (EHR) is used to document and communicate data critical to the quality of care and patient safety. Despite this, there is little guidance or precedence on the data elements or processes for utilizing an EHR on outreach trips. We validated data elements and process steps for utilizing an EHR for hand surgery outreach trips.Methods We conducted a literature review to identify data elements collected during surgical outreach trips. A future-state process map for the collection and documentation of data elements within an EHR was developed through literature review and semistructured interviews with experts in global outreach. An expert consortium completed a modified RAND/University of California at Los Angeles Delphi process to evaluate the importance and feasibility of each data element and process step.Results In total, 65 data elements (e.g., date of birth) and 24 process steps (e.g., surgical site marking) were validated for use in an EHR for hand surgery outreach trips to LMICs.Conclusion This validated portfolio of data elements/process steps can serve as the foundation for pilot testing of an EHR to document and communicate critical patient data on hand surgery outreach trips. Utilization of an EHR during outreach trips to LMICs may serve to improve the safety and quality of care provided. The validated data elements/process steps can serve as a guide for EHR development and implementation of other surgical specialties.

Systematic review of electronic health records to manage chronic conditions among displaced populations

ObjectivesThe objective of this study was to assess the impact of electronic health records (EHRs) on health outcomes and care of displaced people with chronic health conditions and determine barriers...

Electronic health record developer market segmentation contributes to divide in physician interoperable exchange.

To assess whether previously observed differences in interoperable exchange by physician practice size persisted in 2019 and identify the role of 3 factors shaping interoperable exchange among physicians in practices of varying sizes: Federal incentive programs designed to encourage health IT use, value-based care, and selection of electronic health record (EHR) developer. Cross-sectional analysis of a 2019 survey of physicians. We used multivariable Poisson models to estimate the relative risk of interoperable exchange based on the size of the practice accounting for other characteristics and the mediating role of 3 factors. Seventeen percent of solo practice physicians integrated outside data relative to 51% of large practice physicians. This difference remained substantial in initial multivariable models including physician characteristics. When included in models, Federal incentive programs partially mediated the relationship between practice size and interoperable exchange status. In final models including EHR developer, developer was strongly associated with both exchange and integration while practice size was no longer an independent predictor. These trends persisted when comparing practices with 4 or fewer physicians to those with 5 or more. Public and private initiatives that increase the benefits of interoperable exchange may encourage small practices to pursue it. Technical and policy changes that reduce the costs and complexity of supporting exchange could make it easier for small developers to advance their capabilities to support small practices. Addressing the gap between small and large practices will take a 2-pronged approach that targets both small EHR developers and small practices.

Impact of artificial intelligence in healthcare

Artificial intelligence (AI) is prepared to become a transformational force in healthcare. From chronic diseases and cancer to radiology and risk assessment, there are nearly endless opportunities to influence technology to install more precise, efficient, and impactful interventions at exactly the right moment in a patient’s care.AI offers a number of benefits over traditional analytics and clinical decision-making techniques. Learning algorithms can become more specific and accurate as they interact with training data, allowing humans to gain unique insights into diagnostics, care processes, treatment variability, and patient outcomes (1). 
 
 Using computers to communicate is not a new idea by any means, but creating direct interfaces between technology and the human mind without the need for keyboards, mice, and monitors is a cutting-edge area of research that has significant applications for some patients. Neurological diseases and trauma to the nervous system can take away some patients’ abilities to speak, move, and interact meaningfully with people and their environments. Brain-computer interfaces (BCIs) backed by artificial intelligence could restore those fundamental experiences to those who feared them lost forever. Brain-computer interfaces could drastically improve quality of life for patients with ALS, strokes, or locked-in syndrome, as well as the 500,000 people worldwide who experience spinal cord injuries every year (2).
 
 Radiological images obtained by MRI machines, CT scanners, and x-rays offer non-invasive visibility into the inner workings of the human body. But many diagnostic processes still rely on physical tissue samples obtained through biopsies, which carry risks including the potential for infection. AI will enable the next generation of radiology tools that are accurate and detailed enough to replace the need for tissue samples in some cases, experts predict. Diagnostic imaging team with the surgeon and the pathologist can be brought together which will be a big challenge (3).
 
 Succeeding in the pursuit may allow clinicians to develop a more accurate understanding of how tumours behave as a whole instead of basing treatment decisions on the properties of a small segment of the malignancy. Providers may also be able to better define the aggressiveness of cancers and target treatments more appropriately. Artificial intelligence is helping to enable “virtual biopsies” and advance the innovative field of radiomics, which focuses on harnessing image-based algorithms to characterize the phenotypes and genetic properties of tumours (1).
 
 Shortages of trained healthcare providers, including ultrasound technicians and radiologists can significantly limit access to life-saving care in developing nations around the world. AI could help mitigate the impacts of this severe deficit of qualified clinical staff by taking over some of the diagnostic duties typically allocated to humans (4).
 
 For example, AI imaging tools can screen chest x-rays for signs of tuberculosis, often achieving a level of accuracy comparable to humans. This capability could be deployed through an app available to providers in low-resource areas, reducing the need for a trained diagnostic radiologist on site.
 
 However, algorithm developers must be careful to account for the fact that different ethnic groups or residents of different regions may have unique physiologies and environmental factors that will influence the presentation of disease.The course of a disease and population affected by the disease may look very different in India than in the US. As these algorithms are being developed, it is very important to make sure that the data represents a diversity of disease presentations and populations. we cannot just develop an algorithm based on a single population and expect it to work as well on others (1).
 
 Electronic health records (EHRs) have played an instrumental role in the healthcare industry’s journey towards digitalization, but the switch has brought myriad problems associated with cognitive overload, endless documentation, and user burnout. EHR developers are now using AI to create more intuitive interfaces and automate some of the routine processes that consume so much of a user’s time. Users spend the majority of their time on three tasks: clinical documentation, order entry, and sorting through the in-basket (5).
 
 Voice recognition and dictation are helping to improve the clinical documentation process, but natural language processing (NLP) tools might not be going far enough. Video recording a clinical encounter would be helpful while using AI and machine learning to index those videos for future information retrieval. And it would be just like in the home, where we are using Siri and Alexa. The future will bring virtual assistants to the bedside for clinicians to use with embedded intelligence for order entry(5). AI may also help to process routine requests from the inbox, like

A Landscape Study Highlights the Urgent Need for Evidence Based Strategies to Enable Electronic Health Records Integration in the National Healthcare Systems of Low- and Middle-Income Countries

A Review of: Kumar, M., & Mostafa, J. (2020). Electronic health records for better health in lower- and middle-income countries: A landscape study. Library Hi Tech, 38(4), 751–767. https://doi.org/10.1108/LHT-09-2019-0179 Abstract Objective – To identify how low- and middle-income countries (LMICs) approached the development of national and subnational electronic health records (EHRs) and to understand the challenges related to EHR research priorities and sustainability. Design – Landscape study consisting of a review of the scientific literature, country-focused grey literature, and consultation with international experts. Setting – Hospitals and healthcare systems within LMICs. Subjects – The 402 publications retrieved through a systematic search of four scientific electronic databases along with 49 publications found through a country-focused analysis of grey literature and 14 additional publications found through consultation with two international experts. Methods – On 15 May 2019, the authors comprehensively searched four major scientific databases: Global Health, PubMed, Scopus, and Web of Science. They also searched the grey literature and repositories in consultation with country-based international digital health experts. The authors subsequently used Mendeley reference management software to organize and remove duplicate publications. Peer-reviewed publications that focused on developing national EHRs within LMIC healthcare systems were included for the title and abstract screening. Data analysis was mainly qualitative, and the results were organized to highlight stakeholders, health information architecture (HIA), and sustainability. Main Results – The results were presented in three subsections. The first two described critical stakeholders for developing national and subnational EHRs and HIA, including country eHealth foundations, EHRs, and subsystems. The third section presented and discussed pressing challenges related to EHR sustainability. The findings of the three subsections were further explored through the presentation of three LMIC case studies that described stakeholders, HIA, and sustainability challenges. Conclusion – The results of this landscape study highlighted the scant evidence available to develop and sustain national and subnational EHRs within LMICs. The authors noted that there appears to be a gap in understanding how EHRs impact patient-level and population outcomes within the LMICs. The study revealed that EHRs were primarily designed to support monitoring and evaluating health programs focused on a particular disease or group of diseases rather than common health problems. While national governments and international donors focused on the role of EHRs to improve patient care, the authors highlighted the urgent need for further research on the development of EHRs, with a focus on efficiency, evaluation, monitoring, and quality within the national healthcare enterprise.

Beyond the relationship between the healthcare provider and the patient with an emerging next generation of electronic health records

IntroductionAn emerging next generation of electronic health records (EHRs) is expected to see greater realisation of benefits through empowering healthcare stakeholders including patients, providers, and researchers to do things differently. EHR technology is evolving because of the widespread availability of key enabling technologies, such as the Internet of Things (IoT), artificial intelligence (AI), genomic sequencing, and cloud storage. With the increasing adoption of EHRs and their ever-evolving functionality and utility, comes a wide spectrum of associated ethical and social concerns. Emerging technology, such as ePortals, AI decision support systems, voice recognition software and wearable devices, are expected to increase the prominence of EHR technology within the health domain.Policy context and objectiveThis research is timely because EHR technology is still at an early stage of adoption in many countries. For example, large improvements are projected in the next 10 years in the Irish health IT infrastructure. Several Irish government policies aim to transform healthcare through eHealth, e.g. Sláintecare eHealth pillar extends to 2030, the National Development Plan 2018 – 2027, the Department of Health Statement of Strategy 2016 – 2019, and Project Ireland 2040.We have conducted a scoping literature review, to explore which EHR related ethical concerns were being debated in the literature and why these ethical concerns were debated. This review will be useful to a range of stakeholders involved in a safe, legal and ethical development, implementation and use of EHRs including healthcare providers, policymakers, and IT developHighlights The literature identified a large range of ethical values associated with EHR technology. There was a strong consensus in the academic literature on the ethical values associated with EHR technology. Privacy has been identified as the most frequently mentioned value in the academic literature. The literature on the ethical and social effects of EHRs focuses predominantly on the relation between the healthcare professional and the patient.Comments on transferabilityThis abstract describes the academic discussion on the ethics of EHRs in the English language. The findings are therefore not limited to one jurisdiction.ConclusionsBecause of the growing prominence of EHR technology, the focus on the relationship between care provider and patient needs to be expanded. More emphasis is needed on relationships between the technology and healthcare stakeholders including patients, providers, and technologists.The growing awareness of the value of personal data is being experienced across all sectors incorporating digital technology. Recent scandals around technology in other sectors, for example around disinformation and news on social networks, can inform ethical inquiries into EHR technology. These inquiries should elucidate issues around the importance of relationships between stakeholders, transparency and accountability or lack thereof. The role of health technology assessment (HTA) to inform stakeholders about the social aspects, and ethical and legal issues is becoming more urgent. "

Classification of Electronic Health Record-Related Patient Safety Incidents: Development and Validation Study.

BackgroundIt is assumed that the implementation of health information technology introduces new vulnerabilities within a complex sociotechnical health care system, but no international consensus exists on a standardized format for enhancing the collection, analysis, and interpretation of technology-induced errors.ObjectiveThis study aims to develop a classification for patient safety incident reporting associated with the use of mature electronic health records (EHRs). It also aims to validate the classification by using a data set of incidents during a 6-month period immediately after the implementation of a new EHR system.MethodsThe starting point of the classification development was the Finnish Technology-Induced Error Risk Assessment Scale tool, based on research on commonly recognized error types. A multiprofessional research team used iterative tests on consensus building to develop a classification system. The final classification, with preliminary descriptions of classes, was validated by applying it to analyze EHR-related error incidents (n=428) during the implementation phase of a new EHR system and also to evaluate this classification’s characteristics and applicability for reporting incidents. Interrater agreement was applied.ResultsThe number of EHR-related patient safety incidents during the implementation period (n=501) was five-fold when compared with the preimplementation period (n=82). The literature identified new error types that were added to the emerging classification. Error types were adapted iteratively after several test rounds to develop a classification for reporting patient safety incidents in the clinical use of a high-maturity EHR system. Of the 427 classified patient safety incidents, interface problems accounted for 96 (22.5%) incident reports, usability problems for 73 (17.1%), documentation problems for 60 (14.1%), and clinical workflow problems for 33 (7.7%). Altogether, 20.8% (89/427) of reports were related to medication section problems, and downtime problems were rare (n=8). During the classification work, 14.8% (74/501) of reports of the original sample were rejected because of insufficient information, even though the reports were deemed to be related to EHRs. The interrater agreement during the blinded review was 97.7%.ConclusionsThis study presents a new classification for EHR-related patient safety incidents applicable to mature EHRs. The number of EHR-related patient safety incidents during the implementation period may reflect patient safety challenges during the implementation of a new type of high-maturity EHR system. The results indicate that the types of errors previously identified in the literature change with the EHR development cycle.

Integrating Web Services/Applications to Improve Pediatric Functionalities in Electronic Health Records.

The past decade has seen a substantial increase in the use of electronic health records (EHRs) by health care providers caring for children. However, gaps in pediatric-specific functionalities continue to exist in some EHR systems, including population-specific growth curves, immunization clinical decision support, weight-based medication dosing with rounding, calculation of pediatric hypertension percentiles, age-specific developmental assessment, newborn bilirubin nomograms, anticipatory guidance reminders, and other functionalities described elsewhere. Implementing pediatric functionalities into EHRs is critical to the provision of safe pediatric care. As an alternative to direct implementation in EHRs, EHR vendor agnostic Web applications, Web services, and application programming interfaces offer an opportunity to provide pediatric functionalities and eliminate the need for each vendor to develop these functionalities. Successful implementation of Web services and related technologies requires responsible attention from both EHR vendors and developers of Web services, Web applications, and application programming interfaces to the use of data terminology standards, adherence to privacy and security requirements, rigorous testing, change management processes, and robust system support and maintenance. Education of health care providers about opportunities to improve pediatric functionalities in EHRs by using these services can facilitate discussions in EHR user groups in which vendors can be lobbied to implement them. This policy statement emphasizes the need to address pediatric-specific functionalities in EHRs by providing insight and recommendations into the development, maintenance, integration, and support of these novel solutions.

Impact of the 2015 Health Information Technology Certification Edition on Interoperability among Hospitals

Abstract Objective Most nonfederal acute care hospitals use electronic health records (EHRs) certified by the Office of the National Coordinator for Health Information Technology. In 2015, the Office of the National Coordinator for Health Information Technology finalized the 2015 Health IT Certification Edition and adoption by hospitals began in 2016. We examine the impact of the 2015 Edition on rates of interoperable exchange among nonfederal acute hospitals. Materials and Methods The study applies a standard difference-in-differences design and a recently developed fixed effects estimator that relaxes the assumption of treatment effects being constant across groups and time. In the analysis, we identify separate effects of the 2015 Edition for hospitals that switched EHR developers and forecast hospitals’ interoperability over 2015 Edition adoption rates. Results The adoption of the 2015 Edition increased hospitals’ rates of interoperable exchange and especially benefited hospitals that switched EHR developers in the post-implementation period. Forecasting results indicate that if all hospitals adopted the 2015 Edition, 53% to 61% of hospitals would engage in interoperable health information exchange compared with the current rate of 46%. Discussion Hospitals’ levels of interoperability have been rising over the last few years. Adoption of newer technology improved hospitals’ interoperability and accounts for up to 12% of the rise in interoperability. Conclusions Certified technology is one mechanism to ensure providers use recent and safe technologies for interoperable exchange. Adoption of certified EHRs improves the nation’s interoperable exchange; however, it has a clear limited effect. Other mechanisms are necessary for achieving comprehensive interoperable exchange.

Factors affecting clinicians' adherence to principles of diagnosis documentation: A concept mapping approach for improved decision-making.

The quality of data in electronic health records (EHRs) depends on adherence of clinicians to principles of diagnosis documentation. A concept mapping (CM) approach was used to extract factors related to quality of clinicians' documentation that govern EHR data quality. Influential factors extracted from brainstorming sessions were sorted by individual participants, followed by a quantitative analysis using multidimensional scaling and cluster analysis to categorise sorted factors. Finally, a questionnaire was used to elicit the importance-feasibility of the extracted factors. Results were visualised by cluster maps and Go-Zone plots. Factors were classified into seven clusters: "knowledge about International Classification of Diseases and clinical coding," "need for facilitators and guidelines," "explaining the importance of the issue and defining responsibilities," "cooperation of other personnel," "codify legal requirements," "workload" and "clinical obstacles," as ranked by importance. To enhance the quality of EHR data, a collaboration between physicians, nurses, managers and EHR developers is required. CM is an acceptable approach to meet this objective. Our findings highlight the significance of clinical coding knowledge, awareness about its importance and applicability and use of well-structured information systems. In combination, these three factors can have a strong positive impact on the quality of EHR data. A list of solutions is provided for policymakers, and two interventions suggested, based on the findings of this study, including the adoption of EHRs that incorporate documentation guidelines. We further propose updated clinical training programs and a monitoring and feedback mechanism to facilitate the EHR documentation process.