Use Of Electronic Health Record Systems Research Articles

Exploring the impact of cybersecurity on using electronic health records and their performance among healthcare professionals: A multi-analytical SEM-ANN approach

Cybersecurity is critical in safeguarding sensitive information against evolving threats, especially in the healthcare sector, where Electronic Health Records (EHR) are central to the digital transformation of healthcare. This study takes a unique approach by investigating the influence of cybersecurity on healthcare professionals' use of EHR systems and its impact on their performance. It goes beyond the traditional adoption theories by integrating the Technology Acceptance Model (TAM) with cybersecurity and emotional trust and focuses on actual EHR system usage and its performance impact. The data from 459 healthcare professionals, analyzed using a Structural Equation Modeling-Artificial Neural Networks (SEM-ANN) approach, provides a comprehensive view of the dynamics involved. The findings suggest that cybersecurity's impact on the system's ease of use may vary by context. Ease of use was linked to trust but not directly to perceived usefulness. Importantly, systems perceived as efficient and beneficial are used more, leading to improved healthcare service quality. The study underscores the importance of robust cybersecurity measures and trust in effective EHR integration, offering valuable insights for enhancing EHR system acceptance and healthcare outcomes in Jordan.

Effectiveness and Challenges: The Current Situation of Electronic Health Records (EHRs) to Improve Health Care Outcomes

Background. In the Philippines, although software for Electronic Health Records (EHRs) is still new, knowledge about EHRs benefits is increasing.Objective: This study investigated the effectiveness of electronic health records to health care outcomes at selected health facilities in the National Capital Region (NCR) and CALABARZON regions of the Philippines. The effectiveness of the current EHRs in government and private health facilities were determined in terms of quality patient care, patient engagement, support team-based care, workload, and data liquidity; and the challenges facing health providers in the implementation of electronic health records were identified.Methods. The research utilized the descriptive, cross-sectional design. Three hundred seven (N=307) health providers from the medical, nursing, and paramedical departments were the study participants. A three-part adapted questionnaire was the main tool used for data collection. Mean, standard deviation, and Mann-Whitney & Kruskal-Wallis’s tests were utilized for data analysis.Results. The results revealed that in the Philippines, EHRs are moderately effective in improving health care outcomes. EHRs effectiveness is primarily achieved through better access and retrieval of health information. EHRs implementation poses major challenges in the Philippines’ health facilities which are central to socio-economic and organizational factors.Conclusions. The more effective the use of EHR systems, the greater the challenges experienced by care providers and health facilities.

The Impact of Meaningful Use and Electronic Health Records on Hospital Patient Safety.

The HITECH Act aimed to leverage Electronic Health Records (EHRs) to improve efficiency, quality, and patient safety. Patient safety and EHR use have been understudied, making it difficult to determine if EHRs improve patient safety. The objective of this study was to determine the impact of EHRs and attesting to Meaningful Use (MU) on Patient Safety Indicators (PSIs). A multivariate regression analysis was performed using a generalized linear model method to examine the impact of EHR use on PSIs. Fully implemented EHRs not attesting to MU had a positive impact on three PSIs, and hospitals that attested to MU had a positive impact on two. Attesting to MU or having a fully implemented EHR were not drivers of PSI-90 composite score, suggesting that hospitals may not see significant differences in patient safety with the use of EHR systems as hospitals move towards pay-for-performance models. Policy and practice may want to focus on defining metrics and PSIs that are highly preventable to avoid penalizing hospitals through reimbursement, and work toward adopting advanced analytics to better leverage EHR data. These findings will assist hospital leaders to find strategies to better leverage EHRs, rather than relying on achieving benchmarks of MU objectives.

EVALUATING THE IMPACT OF ELECTRONIC HEALTH RECORD SYSTEMS ON REDUCING MEDICATION ERRORS: A STUDY AT LADY READING HOSPITAL, PESHAWAR

Medication mistakes significantly threaten hospitals, leading to adverse events and increased healthcare costs. Electronic health records (EHRs) have been introduced to reduce the frequency of errors and mitigate these issues. This study aimed to determine if the EHR system reduced medical errors at Lady Reading Hospital (LRH) in Peshawar, Pakistan, thereby enhancing patient safety. A retrospective study was conducted from January 3, 2021, to July 3, 2021. The assessment involved a detailed analysis of medication error incidents at LRH, recorded during this period, involving 200 patients. Data from the Department of Pharmacy were collected and analyzed concerning the occurrence, types, and possible contributing causes of medication errors. The results showed a significant reduction in medication error rates following the implementation of the EHR system. The number of medication errors decreased from 80 incidents to 30 occurrences. Specifically, overall mistakes dropped from 25 to 5, omissions from 15 to 10, and wrong medication reports from 20 to 8. The most common types of errors included dosage errors (accounting for 50 incidents), followed by wrong medication (30 incidents), and omissions (25 incidents). Factors contributing to these errors included communication gaps (20 incidents), transcribing errors (15 incidents), and inadequate training (10 incidents). An evaluation of the severity of these errors revealed 15 minor, 25 moderate, and 10 severe problems. Implementing the EHR system significantly enhanced patient safety by improving communication and providing continuous access to accurate patient information. The findings indicate that EHRs are a crucial component of hospital drug safety, significantly reducing medication errors. Integrating electronic record-keeping facilitates medication management processes, provides real-time information access, and improves communication among healthcare professionals. However, addressing other aspects of system malfunctions and ensuring effective system distribution is essential for successful EHR implementation in healthcare facilities. Future research should focus on designing longitudinal studies to evaluate the long-term safety of medications, the use of EHR systems, and strategies to further improve patient care quality.

P027 Challenges and opportunities in embedding quality data into routine clinical practice using electronic health record systems

Abstract Background/Aims The emergence of the electronic health record system (EHRS) creates opportunities for standardising clinical data which can be used for service improvement and research. However, there are also challenges related to EHRS use particularly with respect to data quality and availability. In this project, our goal is to enhance the use of EHRS to enable timely access to reliable high quality clinical data which can be used for research and Quality Improvement. We aimed to improve the entry of structured clinical data starting with problem list, medication list and core outcome variables by 70% within 12 months. Methods We audited our current practice and developed an improvement strategy to incorporate standardized documentation into our adolescent and young adult (AYA) rheumatology clinics. We initially extracted a baseline report for AYA patients to establish our baseline data quality and availability. We also compared structured data to narrative data. Then we organised meetings to develop a shared understanding of the challenges. Subsequent departmental meetings were organised to prioritise and then agree on actions which were summarised in a driver diagram. Then we ran 5 cycles of change and measured data over time including the weekly proportion of clinic encounters using standardised problem lists, medication lists, core outcomes variables. We also measured the use of Smart tools built within our EHRS. Smart-Tools are processes that enable efficiency through easier ordering, navigation and documentation in an EHRS. Using the patient interface ‘MyCare’, we engaged with our patients to encourage them to prepare for their appointment including updating their medication list and completing health questionnaires. Results Initial audit comparing structured and narrative data, revealed poor quality data with 50% of problem lists documented in a structured manner. Of those, 20% were not entered correctly. 70% of medication lists were entered in a non-structured manner. 80% of those with structured medication lists were entered inaccurately. There was no structured documentation of core outcomes variables or joint examination in all encounters which was also inconsistently entered in the free text. Over the last 12 months, 5 cycles of change were implemented testing a number of interventions including developing clinic encounters templates and smart tools within EHRS. The weekly entry of structured problem list improved from 50% to 98%. The Smart-Phrase use and AYA template weekly use rate improved from 0% to 70% and the entry of core outcome variables has improved from 0% to 30% of cases. Conclusion This project supports the feasibility of implementing standardized data into routine clinical practice that can be used for research and service improvement. This has created an opportunity to improve data quality and accuracy. Most importantly, this work has facilitated a standardisation of clinical practice and better engagement between clinicians and patients. Disclosure A. Bouraoui: None. C. Fisher: None. D. Sen: None.

How Do Different Health Record Systems Affect Home Health Care? A Cross-Sectional Study of Electronic- versus Manual Documentation System

ObjectiveTo investigate electronic health record (EHR) systems compared to manual systems (MS) in home health care and how documentation and reporting activities are impacted regarding time use, variation, and accuracy.MethodsThis is a cross-sectional study of two municipalities (M1 and M2) that use statistical process control charts and interview with caregivers to discuss the issue. Regarding reporting, 309 observations were used for the control charts in M1 and 572 for those in M2. Concerning documentation, 831 observations were used for M1 and 572 for M2. In addition, interviews were conducted with four caregivers from each municipality.ResultsThe municipality with EHR system use 3% of their total time for documentation and 7% for reporting. The municipality with the MS uses 7% of their total time in documentation and 12% for reporting. There is less variation in the charts for the municipality with the EHR system, than for the municipality using an MS.ConclusionThe municipality using the EHR system uses less time for documentation and reporting than the other municipality. This is probably due to the standardization of information in M1, and that M2 needs to record documentation twice. The standardization arising from EHR use system may cause less variation in the process than the MS, but less variation might also negatively affect information accuracy. Reduced time for oral reporting also affects information accuracy.

Enhancing the use of EHR systems for pragmatic embedded research: lessons from the NIH Health Care Systems Research Collaboratory.

ObjectiveWe identified challenges and solutions to using electronic health record (EHR) systems for the design and conduct of pragmatic research.Materials and MethodsSince 2012, the Health Care Systems Research Collaboratory has served as the resource coordinating center for 21 pragmatic clinical trial demonstration projects. The EHR Core working group invited these demonstration projects to complete a written semistructured survey and used an inductive approach to review responses and identify EHR-related challenges and suggested EHR enhancements.ResultsWe received survey responses from 20 projects and identified 21 challenges that fell into 6 broad themes: (1) inadequate collection of patient-reported outcome data, (2) lack of structured data collection, (3) data standardization, (4) resources to support customization of EHRs, (5) difficulties aggregating data across sites, and (6) accessing EHR data.DiscussionBased on these findings, we formulated 6 prerequisites for PCTs that would enable the conduct of pragmatic research: (1) integrate the collection of patient-centered data into EHR systems, (2) facilitate structured research data collection by leveraging standard EHR functions, usable interfaces, and standard workflows, (3) support the creation of high-quality research data by using standards, (4) ensure adequate IT staff to support embedded research, (5) create aggregate, multidata type resources for multisite trials, and (6) create re-usable and automated queries.ConclusionWe are hopeful our collection of specific EHR challenges and research needs will drive health system leaders, policymakers, and EHR designers to support these suggestions to improve our national capacity for generating real-world evidence.

The use of electronic health records for recruitment in clinical trials: a mixed methods analysis of the Harmony Outcomes Electronic Health Record Ancillary Study

BackgroundThe electronic health record (EHR) contains a wealth of clinical data that may be used to streamline the identification of potential clinical trial participants. However, there is little empirical information on site-level facilitators of and barriers to optimal use of EHR systems with respect to trial recruitment.MethodsWe conducted qualitative focus groups and quantitative surveys as part of the EHR Ancillary Study, which is being conducted alongside the multicenter, global, Harmony Outcomes Trial comparing albiglutide to standard care for the prevention of cardiovascular events in type 2 diabetes. Subject matter experts used findings from focus groups to draft a 20-question survey examining the use of the EHR for participant identification, common site recruitment strategies, and variation in perceived barriers to optimal use of the EHR. The final survey was fielded with 446 site investigators actively enrolling participants in the main trial.ResultsNearly two-thirds of respondents were study coordinators (63.2%), 23.1% were principal investigators, and 13.7% held other research roles. Approximately half of the respondents reported using the EHR to find potential trial participants. Of these, 79.4% reported using EHR searches in conjunction with other recruitment methods, including reviewing of upcoming clinic schedules (75.3%) and contacting past trial participants (71.2%). Important barriers to optimal use of the EHR included the lack of availability of certain research-focused EHR modules and limitations on the ability to contact patients cared for by other providers. Of survey respondents who did not use the EHR to find potential participants, one-quarter reported that the EHR was not accessible in their country; this finding varied from 2.6% of respondents in North America to 50% of respondents in the Asia Pacific.ConclusionsWhile EHR screening was commonly used for recruitment in a cardiovascular outcomes trial, important technical, governance, and regulatory barriers persist. Multifaceted, scalable, and customizable strategies are needed to support the optimal use of the EHR for trial participant identification.Trial registrationClinicalTrials.gov NCT02465515. Registered on 8 June 2015

Persisting workarounds in Electronic Health Record System use: types, risks and benefits

BackgroundElectronic Health Records (EHRs) are now widely used to create a single, shared, and reliable source of patient data throughout healthcare organizations. However, health professionals continue to experience mismatches between their working practices and what the EHR allows or directs them to do. Health professionals adopt working practices other than those imposed by the EHR to overcome such mismatches, known as workarounds. Our study aims to inductively develop a typology of enduring EHR workarounds and explore their consequences by answering the question: What types of EHR workarounds persist, and what are the user-perceived consequences?MethodsThis single case study was conducted within the Internal Medicine department of a Dutch hospital that had implemented an organization-wide, commercial EHR system over two years ago. Data were collected through observations of six EHR users (see Additional file 1, observation scheme) and 17 semi-structured interviews with physicians, nurses, administrators, and EHR support staff members. Documents were analysed to contextualize these data (see Additional file 2, interview protocol).ResultsThrough a qualitative analysis, 11 workarounds were identified, predominantly performed by physicians. These workarounds are categorized into three types either performed while working with the system (in-system workflow sequence workarounds and in-system data entry workarounds) or bypassing the system (out-system workarounds). While these workarounds seem to offer short-term benefits for the performer, they often create threats for the user, the patient, the overall healthcare organization, and the system.ConclusionThis study increases our understanding of the enduring phenomenon of working around Electronic Health Records by presenting a typology of those workarounds that persist after adoption and by reflecting on the user-perceived risks and benefits. The typology helps EHR users and their managers to identify enduring types of workarounds and differentiate between the harmful and less harmful ones. This distinction can inform their decisions to discourage or obviate the need for certain workarounds, while legitimating others.

Implementation of Systematic Community Resource Referrals at Small Primary Care Practices to Promote Cardiovascular Disease Self-Management.

Quality improvement (QI) models and evidence-based self-management guidelines for reducing cardiovascular disease (CVD) risk require patients to access community resources. The purpose of this study is to describe outcomes from implementation of a community resource referral system into small clinical practices to reduce CVD risk. Practices were given the opportunity to complete an inventory of local CVD-related resources; these data were used to create a printed list of resources for patients ("HealtheRx-H3"). Practices could request updates to HealtheRx-H3s. We assessed implementation outcomes, including appropriateness, feasibility, and adoption. Practice populations were at high risk for CVD. It was feasible to create practice-specific HealtheRx-H3s. Systematic distribution of HealtheRx-H3s using digital electronic health record (EHR) integration was infeasible due to inconsistent use of EHR systems, workflow variation, and lacking data-sharing infrastructure. Of 76 practices, 38 completed the inventory; completion was similar by patient and practice characteristics. HealtheRx-H3 updates were requested by 39% of practices; practices that completed the inventory were significantly more likely to request an update compared with those that did not (61% vs. 18%, p-value <.01). Successful implementation of QI strategies to systematize community resource referral solutions is feasible at small practices, but more research is needed to understand what motivates small practices to participate in implementation of these solutions.

Using EHRs to advance epilepsy care.

The improved use of Electronic Health Record (EHR) Systems provides an opportunity to improve the overall efficiency and quality of care of patients with epilepsy. Tools and strategies that may be incorporated into the use of EHRs include utilizing patient generated data, clinical decision support systems and natural language processing systems. Standardization of data from EHR systems may lead to improvement in clinical research through the creation of data collections and multi-center collaborations. Challenges to collaborative use of EHR Systems across centers include costs and the diversity of EHR systems.

The used theories for the adoption of electronic health record: a systematic literature review

Electronic Health Record (EHR) is one of the most important applications in the healthcare domain which has many benefits for the healthcare community as a whole. The objective of our study is to conduct a comprehensive systematic literature review regarding the EHR adoption over the various healthcare contexts in order to identify the used adoption theories and their most significant factors in EHR adoption. We searched databases including ScienceDirect, PubMed, IEEE Digital Library, Web of Science, Springer, Scopus and Wiley between January 2005 and July 2017. Consequently, 18 identified papers appeared in 17 international journals and conferences. Eligible studies independently were critically appraised, collected within data extraction form and then thematically analyzed by two reviewers and if necessary, the third author. We found out 9 different models and theories including TAM, UTAUT, TOE, DOI, TPB, TIB, stakeholder theory, institutional theory and social network have been used in EHR adoption contexts and the most significant factors in this contexts were perceived usefulness and perceived ease of use. The results demonstrated that the most studies required the EHR adoption have been performed in the developed countries, in which them most of used questionnaires for data gathering. Adoption of EHR systems is multi-dimensional, complicated, and affected by different types of factors in healthcare organizations. Our findings provide valuable insights and shed some light on researchers, decision and policy makers and managers of healthcare domain to make more informed decisions about the adoption and use of EHR systems.

Medical Student Use of Electronic and Paper Health Records During Inpatient Clinical Clerkships: Results of a National Longitudinal Study.

An important goal of medical education is to teach students to use an electronic health record (EHR) safely and effectively. The purpose of this study is to examine medical student accounts of EHR use during their core inpatient clinical clerkships using a national sample. Paper health records (PHRs) are similarly examined. An online survey about health record use within the inpatient component of six core clerkships was administered to medical students after they completed Step 2 Clinical Knowledge of the United States Medical Licensing Examination. The sample included 17,202 U.S. medical students graduating between 2012 and 2016. Mean percentages of clerkships in which students engaged in various health record activities were computed, and analysis of variance was used to examine differences. The mean percentages of clerkships in which a student accessed or entered information into an EHR increased from 78% to 93% and 59% to 72%, respectively. For students who used an EHR, the mean percentage of clerkships in which they entered information remained constant at 76%. Students entered notes during the majority of their clerkships, with increases over time. However, students entered orders in less than a quarter of their clerkships, with decreases over time. The percentage of clerkships in which students used PHRs was lower and declining. Although students used an EHR in the majority of their inpatient core clerkships, they received limited educational experiences related to order and note writing, which could translate into a lack of preparedness for future training and practice.

Impact of a Web-Based Electronic Health Record on Behavioral Health Service Delivery for Children and Adolescents: Randomized Controlled Trial.

BackgroundElectronic health records (EHRs) have been widely proposed as a mechanism for improving health care quality. However, rigorous research on the impact of EHR systems on behavioral health service delivery is scant, especially for children and adolescents.ObjectiveThe current study evaluated the usability of an EHR developed to support the implementation of the Wraparound care coordination model for children and youth with complex behavioral health needs, and impact of the EHR on service processes, fidelity, and proximal outcomes.MethodsThirty-four Wraparound facilitators working in two programs in two states were randomized to either use the new EHR (19/34, 56%) or to continue to implement Wraparound services as usual (SAU) using paper-based documentation (15/34, 44%). Key functions of the EHR included standard fields such as youth and family information, diagnoses, assessment data, and progress notes. In addition, there was the maintenance of a coordinated plan of care, progress measurement on strategies and services, communication among team members, and reporting on services, expenditures, and outcomes. All children and youth referred to services for eight months (N=211) were eligible for the study. After excluding those who were ineligible (69/211, 33%) and who declined to participate (59/211, 28%), a total of 83/211 (39%) children and youth were enrolled in the study with 49/211 (23%) in the EHR condition and 34/211 (16%) in the SAU condition. Facilitators serving these youth and families and their supervisors completed measures of EHR usability and appropriateness, supervision processes and activities, work satisfaction, and use of and attitudes toward standardized assessments. Data from facilitators were collected by web survey and, where necessary, by phone interviews. Parents and caregivers completed measures via phone interviews. Related to fidelity and quality of behavioral health care, including Wraparound team climate, working alliance with providers, fidelity to the Wraparound model, and satisfaction with services.ResultsEHR-assigned facilitators from both sites demonstrated the robust use of the system. Facilitators in the EHR group reported spending significantly more time reviewing client progress (P=.03) in supervision, and less time overall sending reminders to youth/families (P=.04). A trend toward less time on administrative tasks (P=.098) in supervision was also found. Facilitators in both groups reported significantly increased use of measurement-based care strategies overall, which may reflect cross-group contamination (given that randomization of staff to the EHR occurred within agencies and supervisors supervised both types of staff). Although not significant at P<.05, there was a trend (P=.10) toward caregivers in the EHR group reporting poorer shared agreement on tasks on the measure of working alliance with providers. No other significant between-group differences were found.ConclusionsResults support the proposal that use of EHR systems can promote the use of client progress data and promote efficiency; however, there was little evidence of any impact (positive or negative) on overall service quality, fidelity, or client satisfaction. The field of children’s behavioral health services would benefit from additional research on EHR systems using designs that include larger sample sizes and longer follow-up periods.Trial RegistrationClinicalTrials.gov NCT02421874; https://clinicaltrials.gov/ct2/show/NCT02421874 (Archived by WebCite at http://www.webcitation.org/6yyGPJ3NA)

Evaluating the usability of speech recognition to create clinical documentation using a commercial electronic health record

ObjectiveTo conduct a usability study exploring the value of using speech recognition (SR) for clinical documentation tasks within an electronic health record (EHR) system. MethodsThirty-five emergency department clinicians completed a system usability scale (SUS) questionnaire. The study was undertaken after participants undertook randomly allocated clinical documentation tasks using keyboard and mouse (KBM) or SR. SUS scores were analyzed and the results with KBM were compared to SR results. ResultsSignificant difference in SUS scores between EHR system use with and without SR were observed (KBM 67, SR 61; P = 0.045; CI, 0.1 to 12.0). Nineteen of 35 participants scored higher for EHR with KBM, 11 higher for EHR with SR and 5 gave the same score for both. Factor analysis showed no significant difference in scores for the sub-element of usability (EHR with KBM 65, EHR with SR 62; P = 0.255; CI, −2.6 to 9.5). Scores for the sub-element of learnability were significantly different (KBM 72, SR 55; P < 0.001; CI, 9.8 to 23.5). A significant correlation was found between the perceived usability of the two system configurations (EHR with KBM or SR) and the efficiency of documentation (time to document) (P = 0.002; CI, 10.5 to −0.1) but not with safety (number of errors) (P = 0.90; CI, −2.3 to 2.6). DiscussionSR was associated with significantly reduced overall usability scores, even though it is often positioned as ease of use technology. SR was perceived to impose larger costs in terms of learnability via training and support requirements for EHR based documentation when compared to using KBM. Lower usability scores were significantly associated with longer documentation times. ConclusionThe usability of EHR systems with any input modality is an area that requires continued development. The addition of an SR component to an EHR system may cause a significant reduction in terms of perceived usability by clinicians.

Reducing Misses and Near Misses Related to Multitasking on the Electronic Health Record: Observational Study and Qualitative Analysis.

BackgroundClinicians’ use of electronic health record (EHR) systems while multitasking may increase the risk of making errors, but silent EHR system use may lower patient satisfaction. Delaying EHR system use until after patient visits may increase clinicians’ EHR workload, stress, and burnout.ObjectiveWe aimed to describe the perspectives of clinicians, educators, administrators, and researchers about misses and near misses that they felt were related to clinician multitasking while using EHR systems.MethodsThis observational study was a thematic analysis of perspectives elicited from 63 continuing medical education (CME) participants during 2 workshops and 1 interactive lecture about challenges and strategies for relationship-centered communication during clinician EHR system use. The workshop elicited reflection about memorable times when multitasking EHR use was associated with “misses” (errors that were not caught at the time) or “near misses” (mistakes that were caught before leading to errors). We conducted qualitative analysis using an editing analysis style to identify codes and then select representative themes and quotes.ResultsAll workshop participants shared stories of misses or near misses in EHR system ordering and documentation or patient-clinician communication, wondering about “misses we don’t even know about.” Risk factors included the computer’s position, EHR system usability, note content and style, information overload, problematic workflows, systems issues, and provider and patient communication behaviors and expectations. Strategies to reduce multitasking EHR system misses included clinician transparency when needing silent EHR system use (eg, for prescribing), narrating EHR system use, patient activation during EHR system use, adapting visit organization and workflow, improving EHR system design, and improving team support and systems.ConclusionsCME participants shared numerous stories of errors and near misses in EHR tasks and communication that they felt related to EHR multitasking. However, they brainstormed diverse strategies for using EHR systems safely while preserving patient relationships.

What Does Your EHR Documentation Say?

Electronic health records (EHRs) have great potential for capturing important health information and making that information readily available to providers of care. However, controversy abounds regarding the current features and uses of EHRs. This article discusses how to implement a compliance program to deter inappopriate use of EHR systems.

A Comprehensive Electronic Health Record Based Patient Navigation Module Including Technology Driven Colorectal Cancer Outreach and Education.

The purpose of this concept paper is to propose an innovative multifaceted patient navigation module embedded in the Electronic Health Record (EHR) to address barriers to efficient and effective colorectal cancer (CRC) care. The EHR-based CRC patient navigation module will include several patient navigation features: (1) CRC screening registry; (2) patient navigation data, including CRC screening data, outcomes of patient navigation including navigation status (CRC screening referrals, fecal occult blood test (FOBT) completed, colonoscopy scheduled and completed, cancelations, reschedules, and no-shows); (3) CRC counseling aid; and 4) Web-based CRC education application including interactive features such as a standardized colonoscopy preparation guide, modifiable CRC risk factors, and links to existing resources. An essential component of health informatics is the use of EHR systems to not only provide a system for storing and retrieval of patient health data but can also be used to enhance patient decision-making both from a provider and patient perspective.

Electronic Health Systems

The purpose of this article is to discuss specific challenges faced by hospitals adopting the use of electronic medical records and implementing electronic health record (EHR) systems. Challenges include user and information technology support; ease of technical use and software interface capabilities; compliance; and financial, legal, workforce training, and development issues. Electronic health records are essential to preventing medical errors, increasing consumer trust and use of the health system, and improving quality and overall efficiency. Government efforts are focused on ways to accelerate the adoption and use of EHRs as a means of facilitating data sharing, protecting health information privacy and security, quickly identifying emerging public health threats, and reducing medical errors and health care costs and increasing quality of care. This article will discuss physician and nonphysician staff training before, during, and after implementation; the effective use of EHR systems' technical features; the selection of a capable and secure EHR system; and the development of collaborative system implementation. Strategies that are necessary to help health care providers achieve successful implementation of EHR systems will be addressed.

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

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. To examine both paper- and computer-based workarounds to the use of EHR systems in three benchmark institutions. Qualitative data were collected in 11 primary care outpatient clinics across three healthcare institutions. Data collection methods included direct observation and opportunistic questions. In total, 120 clinic staff and providers and 118 patients were observed. All data were analyzed using previously developed workaround categories and examined for potential new categories. Additionally, workarounds were coded as either paper- or computer-based. Findings corresponded to 10 of 11 workaround categories identified in previous research. All 10 of these categories applied to paper-based workarounds; five categories also applied to computer-based workarounds. One new category, no correct path (eg, a desired option did not exist in the computer interface, precipitating a workaround), was identified for computer-based workarounds. The most consistent reasons for workarounds across the three institutions were efficiency, memory, and awareness. Consistent workarounds across institutions suggest common challenges in outpatient clinical settings and failures to accommodate these challenges in EHR design. An examination of workarounds provides insight into how providers adapt to limiting EHR systems. Part of the design process for computer interfaces should include user-centered methods particular to providers and healthcare settings to ensure uptake and usability.