Electronic Health Record Transition Research Articles

Conversion from paper to electronic acute care chemotherapy orders.

UNC Medical Center converted to an electronic health record (EHR) in 2014. This conversion allowed for the transition of paper chemotherapy orders to be managed electronically. This article describes the process for converting inpatient paper chemotherapy orders into the new EHR in a safe and effective manner. A collaborative interdisciplinary approach to the EHR transition enabled our organization to move from using paper chemotherapy orders to fully electronic chemotherapy treatment plans in both ambulatory and acute care areas. Active chemotherapy orders for acute care inpatients were reviewed and transcribed by two oncology pharmacists in the cancer hospital prior to being signed by an attending physician. The newly input orders were independently verified by two pharmacists in the cancer hospital inpatient pharmacy. Nurse review of the signed and verified treatment plans, along with reconciliation of the medication administration record ensured a safe transition to the new EHR workflow. Providers benefit from the ability to review treatment plans remotely, track changes, and include supportive medications in one consolidated location. The coordinated team effort allowed for a smooth transition with minimal interruptions to patient care. The pharmacist-led, multidisciplinary conversion to electronic chemotherapy orders was safe, accurate, and occurred ahead of schedule for the EHR go-live. Advance communication and planning around scheduled inpatient admissions helped to minimize the impact of the transition from paper to electronic treatment plans. Both pharmacist and physician engagement were necessary to ensure a smooth transition for active inpatient treatment plans.

Effect of an Electronic Health Record Transition on the Provision of Recommended Well Child Services in Pediatric Primary Care Practices.

We sought to determine the effect of transitioning between electronic health record (EHR) systems on the quality of preventive care in a large pediatric primary care network. To study this, we performed a retrospective chart analysis of 42 primary care practices from the Pediatric Physicians' Organization at Children's who transitioned EHRs. We reviewed 24 random encounters per week distributed evenly across 6 age categories before, during, and after a transition period. We reviewed encounter documentation for age-appropriate well child services, per American Academy of Pediatrics/Bright Futures guidelines. Logistic regression and statistical process control analysis were used. In the pretransition period, 84.5% of all recommended elements were documented versus 86.4% posttransition (P = .04). Documentation of age-appropriate anticipatory guidance showed significant positive change (69.0% to 80.2%, P = .005), but it was the only subdomain with a statistically significant increase. These increases suggest that EHR transitions have the opportunity to affect the delivery of preventive care.

Impact of an electronic health record transition on chemotherapy error reporting.

Incident reporting systems allow for frontline employees to report errors and are a critical component of healthcare patient safety programs. Although incident reporting systems cannot quantify total errors, organizations can utilize incident reporting systems to help identify risks and trends to act upon. The objective of this article is to utilize incident reporting systems to evaluate trends in medication error reporting before and after implementation of a new electronic health record system. A five-month pre- and post-analysis was completed in a cancer hospital following electronic health record conversion by reviewing medication errors reported via the institution's voluntary incident reporting systems. Error reports included medication error category, date error was reported/occurred, patient location at time of error, harm severity score, medication(s) involved, medication use system node error originated/discovered in, medication source, narrative summary, and contributing factors. Data were analyzed using descriptive statistics within Office Excel. Oncology medication error reports submitted pre- and post-electronic health record were 68 vs. 57, respectively. During the pre- and post-electronic health record conversion, a majority of errors had a harm severity index of 0 or 1; 12 (18%) in pre-electronic health record and 3 (5%) in post-electronic health record were level 2, and one (1%) in pre-electronic health record vs. 0 in post-electronic health record were level 3. Reported medication errors originated most commonly during the prescribing, administration, and preparation/dispensing phase and were primarily identified in the administration phase of the medication use process. The most frequently reported error category was 'wrong dose' followed by 'other' and 'overdose' in the pre-electronic health record phase and 'missing dose/delayed delivery' and 'order incorrect' in the post-electronic health record phase. The most frequently reported medications included methotrexate, chemotherapy (unspecified), and cisplatin. Analyzing data from incident reporting system reports allowed our institution to understand different trends of reporting in the cancer hospital following electronic health record adoption. Utilization of incident reporting systems must be combined with proactive risk identification approaches to enable systems-focused improvements to improve patient safety.

Implications of electronic health record transition on drug allergy labels

Implications of electronic health record transition on drug allergy labels

Impact of electronic health record transition on drug allergy labels: gains, losses, alterations and learning opportunities

Impact of electronic health record transition on drug allergy labels: gains, losses, alterations and learning opportunities

Surgical Safety Issues during an Electronic Health Record Transition

Gallagher, Margaret E. MD; Shroder, Megan M. BS; Jackson, Gretchen P. MD, PhD Author Information

EHR to EHR Transitions: Establishing and Growing a Knowledge Base

Although numerous healthcare organizations have transitioned from one electronic health record (EHR) to another or are currently planning a transition, there are few documented artifacts, such as published studies or operationalizable resources, that offer guidance on such transitions. This panel seeks to begin a conversation about human factors considerations in EHR transitions from a legacy system. Panel members will discuss current literature and research on the topic as well as experiences with and lessons learned from transitions within their organizations. Panel discussion can be expected to identify new research opportunities, needed resources, and guidance for EHR vendors or healthcare facilities in the midst of or preparing for an EHR transition. Panelists will also lay out systemic issues that need to be addressed at the national policy and regulatory level. This topic is relevant not only to full-scale EHR transitions, but also has applicability for significant EHR version changes.

An EPIC Switch: Preparing for an Electronic Health Record Transition at Vanderbilt University Medical Center.

An EPIC Switch: Preparing for an Electronic Health Record Transition at Vanderbilt University Medical Center.

Changes to Workflow and Process Measures in the PICU During Transition From Semi to Full Electronic Health Record.

Studies showing the changes in workflow during transition from semi to full electronic medical records are lacking. This objective study is to identify the changes in workflow in the PICU during transition from semi to full electronic health record. Prospective observational study. Children's Hospital of Wisconsin Institutional Review Board waived the need for approval so this study was institutional review board exempt. This study measured clinical workflow variables at a 72-bed PICU during different phases of transition to a full electronic health record, which occurred on November 4, 2012. Phases of electronic health record transition were defined as follows: pre-electronic health record (baseline data prior to transition to full electronic health record), transition phase (3 wk after electronic health record), and stabilization (6 mo after electronic health record). Data were analyzed for the three phases using Mann-Whitney U test with a two-sided p value of less than 0.05 considered significant. Seventy-two bed PICU. All patients in the PICU were included during the study periods. Five hundred and sixty-four patients with 2,355 patient days were evaluated in the three phases. Duration of rounds decreased from a median of 9 minutes per patient pre--electronic health record to 7 minutes per patient post electronic health record. Time to final note decreased from 2.06 days pre--electronic health record to 0.5 days post electronic health record. Time to first medication administration after admission also decreased from 33 minutes pre--electronic health record and 7 minutes post electronic health record. Time to Time to medication reconciliation was significantly higher pre-electronic health record than post electronic health record and percent of medication reconciliation completion was significantly lower pre--electronic health record than post electronic health record and percent of medication reconciliation completion was significantly higher pre--electronic health record than. There was no significant change in time between placement of discharge order and physical transfer from the unit [corrected].changes clinical workflow in a PICU with decreased duration of rounds, time to final note, time to medication administration, and time to medication reconciliation completion. There was no change in the duration from medical to physical transfer.

The Impact of an Electronic Health Record Transition on a Glaucoma Subspecialty Practice

To assess the impact of an electronic health record (EHR) on patient experience, physician behavior, and clinic workflow in a glaucoma subspecialty clinic. Case-control (before/after) study. One hundred thirty-one adult patients seeking treatment at a glaucoma subspecialty practice for a nonprocedural office visit who consented to direct observation and 273 patients whose progress through the clinic stations was timed. Three time points relative to the EHR transition were evaluated: a 2-week period before the transition, a 2-week period at 2 weeks after the transition, and a 2-week period at 6 months after the transition. At each of these time points, detailed timing of physician actions during the doctor-patient encounter were measured, a survey of patient attitudes regarding their visit and the method of documentation was conducted, and time spent by patients in each of the major aspects of the visit (screening/testing, physician, waiting) was recorded. Time spent by physicians on the clinical examination, computer, paper records, or multitasking; patient experience of their clinic visit; and time spent by patients at various clinic stations. Two weeks after the transition, physicians spent more time with patients overall compared with baseline (8.4 vs. 11.6 minutes), reviewing paper records (0.2 vs. 0.6 minutes), and on computer-related tasks (2.3 vs. 4.2 minutes). At 6 months after EHR transition, physicians also spent more time compared with baseline on the clinical examination (5.1 vs. 6.4 minutes). There was a relative decrease in the percentage of patient time spent waiting to see the physician, although patients' perceptions of their visit and the EHR remained largely unchanged. Annual clinic volumes also were unaffected by the new EHR. There were changes in the physician-patient encounter that manifested within 2 weeks of EHR transition and then stabilized, suggesting that although an EHR transition is not without consequences, these can be measured early. Some of these findings, such as increased time dedicated to the clinical examination and the lack of change in patient perception after the switch, were unexpected. This study supports the contention that EHR implementation can be accomplished in an ophthalmology practice without compromising the efficiency of or patient satisfaction with the clinical encounter.

EHR Transition Disrupted Pediatric MH Screenings

Back to table of contents Previous article Next article Professional NewsFull AccessEHR Transition Disrupted Pediatric MH ScreeningsJonathan WolfeJonathan WolfeSearch for more papers by this authorPublished Online:6 Apr 2012https://doi.org/10.1176/pn.47.7.psychnews_47_7_10-bAbstractThe implementation of an electronic health record (EHR) system was associated with a significant decline in the rate of behavioral health screenings conducted at a large pediatric practice in Massachusetts, according to a new study published in the March Psychiatric Services.Karen Hacker, M.D., M.P.H., of Cambridge Health Alliance and the Institute for Community Health led a team of researchers from Seattle’s Group Health Research Institute and the Harvard Pilgrim Health Care Institute’s Department of Population Medicine in assessing the practice’s screening rates before, during, and after the transition from paper to EHR reporting. The system the practice adopted was the Epic-Care EMR system.The practice’s seven pediatricians serve a diverse population of approximately 6,000 patients, of whom an average 180 per month are eligible for behavioral health screenings. The researchers noted that 54 percent of the clinic’s patients are nonwhite, 40 percent are publicly insured or self-paying, and 31 percent are non-English speakers. Roughly one-third of the patient population is below age 5.The practice began conducting behavioral health screenings in December 2003 using the Pediatric Symptom Checklist (PSC) for children aged 4.9 to 16 and the PSC-Youth Report for children aged 14 to 18.Prior to implementation of the EHR system in March 2005, patients or their caregivers would fill out paper screening forms for discussion with and scoring by their pediatrician, who would subsequently complete the form and insert it into the patient’s medical record.In the first nine months of conducting screenings, which the researchers defined as the study’s baseline period, the rate of behavioral health screenings, though variable, rose from approximately 70 percent to 91 percent. During this time, nurse management staff enhanced the screening process by conducting previsit medical-record reviews and attaching paper screening forms to the charts of those patients they deemed eligible for screenings.The practice’s transition to the EHR system was preceded by six months of planning and preparations, with all staff members receiving 40 hours of off-site training. During this period—from October 2004 to March 2005—the pediatric clinic’s screening rates fell from about 84 percent to 64 percent.To help the clinicians adjust to the new system, patient visits were halved during the first week of implementation and reduced by 25 percent in the second week. Additionally, in-house trainers were available on site. Yet despite these measures, the conversion was associated with a further drop in screening rates, with only 50 percent of eligible patients screened during the first month of electronic record reporting.The screening process remained the same following implementation of the EHR system, but the physicians were now tasked with entering results from the paper screening into a field-driven electronic database. The researchers also noted that paper screening forms were no longer attached to patients’ medical records prior to their visits, making it more difficult for front-desk staff to quickly identify which patients needed behavioral screenings.Over a period of three years, and with medical assistants eventually assuming responsibility for the entry of screening data, the practice’s behavioral health screening rates slowly returned to near baseline levels, reaching 82 percent by April 2008.The study was supported in part by a grant through the Integrated Health and Behavioral Health Care for Children, Adolescents, and Their Families program administered by the Health Resources and Services Administration’s Maternal and Child Health Bureau. The Harvard Pilgrim Health Care Foundation, the National Institute of Mental Health, and the Health Maintenance Organization Mental Health Research Network also provided partial support, as did the Health Maintenance Organization Research Network Centers for Education and Research on Therapeutics.Harvard Catalyst and the Harvard Clinical and Translational Science Center provided additional consultative support for the study, while Harvard University and affiliated academic health care centers provided additional funding. “Impact of Electronic Health Record Transition on Behavioral Health Screening in a Large Pediatric Practice” is posted at http://ps.psychiatryonline.org/article.aspx?articleid=1028614. ISSUES NewArchived

Impact of Electronic Health Record Transition on Behavioral Health Screening in a Large Pediatric Practice

The objective was to determine whether transitioning from paper to electronic health records affected behavioral health screening rates in a large Northeastern pediatric practice. The study setting was a pediatric practice with seven pediatricians, serving about 6,000 patients. The patient population was diverse (54% nonwhite, 40% publicly insured or self-paying, and 31% non-English speakers). An interrupted times series design was used to evaluate the impact of electronic record implementation on behavioral health screening rates. The main outcome measure was the rate of such screening 18 months before and 36 months after implementation. The rate of behavioral health screening increased from 70% to 91% during the baseline period. The training period-six months before electronic record implementation-was associated with a 28% decline in adjusted screening rates (from 83.3% to 55.5%). Only 50% of eligible youths were screened in the first month after implementation. The screening rate took more than three years to recover to baseline levels, climbing to 82% by April 2008. Practice changes resulting from electronic record adoption were highly disruptive of care, and disruptions took several years to resolve completely. When medical assistants rather than physicians were tasked with transferring data from paper screening forms to the electronic record, reporting compliance improved. Compliance with Healthcare Effectiveness Data and Information Set standards and Medicaid performance measures will likely be similarly affected as electronic records are implemented nationwide. Although implementing a fully automated medical record has some benefits, the unintended effects on care after implementation must be acknowledged.