Electronic Medical Record Reminder Research Articles

Electronic Medical Record (EMR) Reminders for Improving the HPV Vaccination Rates within the Pediatric Population

Despite the Human Papillomavirus Vaccine becoming available to the public in 2006, there has been a continuing rise of HPV-associated cancers documented in the United States. There is speculation as to why the rates of HPV is not rising. One possibility is the missed opportunity of introducing the subject …

Antepartum Vaccination Rates After Initiation of Electronic Medical Record Reminders [8L

INTRODUCTION: Tetanus, Diphtheria and acellular Pertussis (Tdap) vaccination is recommended by the CDC between 27 and 36 weeks gestation in order to maximize maternal antibody response and passive antibody transfer to the infant. This study was developed as a quality improvement project for increasing vaccination rates in our university-based clinic. METHODS: We developed a best practice advisory alert in the electronic medical record that was implemented September 8, 2016. This alert prompts providers to order the Tdap vaccine or document previous vaccination. It is triggered during clinic visits between 27 and 36 weeks gestation. A chart review was completed for all deliveries at our hospital during a 3 month period prior to implementation and 3 month period post-implementation. A χ2 test was completed to assess differences in Tdap uptake pre- and post-implementation. A Breslow-Day test was completed to identify any differences in uptake by age, parity, and time after initiation. RESULTS: A total of 531 pre-implementation and 574 post-implementation charts were reviewed and included in the analysis. The rates of appropriately timed Tdap vaccinations was significantly higher post-implementation than pre-implementation (60.28% versus 39.72% P<.0001). This change was most noticeable in the first month after implementation (P=.0123). CONCLUSION: Use of a pop-up reminder in the electronic medical record increased Tdap vaccination rates among women during their third trimester. Although with maximum vaccination rates less than 70% at the peak, more can be done to educate providers and patients about the importance of antepartum vaccination.

Impact of electronic reminder systems on hepatitis C screening in primary care.

Screening for hepatitis C virus (HCV) was recommended in 2012 by the Centers for Disease Control (CDC) for the population born between 1946 and 1965. Reminder systems are effective at promoting HCV screening, but the yield of positive tests among various population subgroups and the linkage to specialty HCV treatment is not well understood. We sought to determine: (i) the effect of the CDC recommendation alone, and the effect of an electronic medical record (EMR) reminder on the proportion of the population screened; (ii) the yield of positive HCV tests as screening strategies have evolved, and according to a patient's history of serum aminotransferase testing; (iii) the proportion of positive cases followed up for HCV treatment. This retrospective cohort study included 60000 primary care patients at a northeast US academic medical centre serving an urban and rural population in which an EMR reminder was instituted in 2014. Results demonstrated an increase in proportion tested for HCV from 12% prior to the CDC recommendation to 37% after the reminder system. The yield of positive HCV antibody (HCV Ab) tests decreased from 7% in the "case-finding" era to 1.6% after the EMR reminder prompted screening of a lower risk population (P<.001). Patients with a history of abnormal aminotransferase tests had a fivefold higher rate of positive HCV Ab testing (6.7% vs 1.5%, P<.001). Ninety per cent of patients with confirmed HCV infection were seen in specialty care.

Use of an electronic medical record reminder improves HIV screening

BackgroundMore than 1 in 7 patients with human immunodeficiency virus (HIV) infection in the United States are unaware of their serostatus despite recommendations of US agencies that all adults through age 65 be screened for HIV at least once. To facilitate universal screening, an electronic medical record (EMR) reminder was created for our primary care practice. Screening rates before and after implementation were assessed to determine the impact of the reminder on screening rates.MethodsA retrospective cohort analysis was performed for patients age 18–65 with visits between January 1, 2012-October 30, 2014. EMR databases were examined for HIV testing and selected patient characteristics. We evaluated the probability of HIV screening in unscreened patients before and after the reminder and used a multivariable generalized linear model to test the association between likelihood of HIV testing and specific patient characteristics.ResultsPrior to the reminder, the probability of receiving an HIV test for previously unscreened patients was 15.3%. This increased to 30.7% after the reminder (RR 2.02, CI 1.95–2.09, p < 0.0001). The impact was most significant in patients age 45–65. White race, English as primary language, and higher median household income were associated with lower likelihoods of screening both before and after implementation (RR 0.68, CI 0.65–0.72; RR 0.74, CI 0.67–0.82; RR 0.84, CI 0.80–0.88, respectively).ConclusionsThe EMR reminder increased rates of HIV screening twofold in our practice. It was most effective in increasing screening rates in older patients. Patients who were white, English-speaking, and had higher incomes were less likely to be screened for HIV both before and after the reminder.

P065 INTERNISTS’ PRACTICE AND PERCEPTIONS OF RESPONSIBILITY OF IBD-RELATED HEALTH MAINTENANCE

Health maintenance (HM) of patients with IBD is multifactorial and of well-established importance. However, the extent that it is practiced and whether the gastroenterologist (GI) or primary care provider (PP) would or should assume its responsibility are not clear. We anonymously surveyed a convenient sample of 94 internists who are affiliates or trainees of St. Louis University (SLU), St. Louis, MO (11.6% university faculty, 5.9% VA faculty, 82.5% medical residents), using electronic or paper self-administered instruments. Out of 87 respondents (response rate 92.5%), 47% stated that PP should manage IBD-related HM issues in general (vs. 52% stating that the GI should). However, only 9% reported that they assess these issues all the time (34% most of the time). Further, only 21% reported always assessing patients for depression and anxiety, 1% enrolling patients in skin protection/dermatological surveillance programs, 0% & 3% screening for melanoma and non-melanoma skin cancer in patients on immune-modulators,18% prescribing Ca & vit D to patients on corticosteroids, 16% screening for osteoporosis, 29% screening patients on anti-TNF therapy for tuberculosis, 11% performing nutritional assessment, & 33% checking appropriate laboratory investigations in patients treated with immune-modulators. On the other hand, 62% always assessed the need for surveillance colonoscopies and 70% counseled for smoking cessation. The data indicates a sharp divide in SLU internists’ perception of who should take responsibility of IBD-related HM issues and that these issues, except for surveillance colonoscopy and smoking cessation, are mostly not addressed by internists. The applicability of our results to internists in other settings is not known. We suggest that GIs maintain full responsibility for IBD-related HM issues. Alternatively, specific strategies, such as more explicit guidelines for internists and electronic medical record reminders and checkpoints would be required.

Electronic medical record reminders and smoking cessation activities in primary care

PurposeThe purpose of this paper is to assess electronic medical record (EMR) automatic reminder use in relation to smoking cessation activities among primary-care providers. BackgroundPrimary-care physicians are in the frontline of efforts to promote smoking cessation. Moreover, doctors' prescribing privileges give them additional tools to help patients successfully quit smoking. New EMR functions can provide automated reminders for physicians to counsel smokers and provide prescriptions to support quit attempts. Sample and methodsLogit regression is used to analyze the 2012 National Ambulatory Medical Care Survey (NAMCS). Variables related to the EMR's clinical reminder capability, patient's smoking status, the provision of cessation counseling and the prescribing of drugs that support quitting are analyzed. ResultsFor primary care visit documents, smoking status was recorded 77.7% of the time. Smoking cessation counseling was ordered/provided 16.4% of the time in physicians' offices using electronic reminders routinely compared to 9.1% in those lacking the functionality. Smoking cessation medication was ordered/prescribed for 3.7% of current smokers when reminders were routinely used versus 2.1% when no reminder was used. All the differences were statistically significant. ConclusionsThe presence of an EMR equipped with automated clinical reminders is a valuable resource in efforts to promote smoking cessation. Insurers, regulators, and organizations promulgating clinical guidelines should include the use of EMR technology as part of their programs.

An Evaluation of Human Immunodeficiency Virus (HIV) Screening After Implementation of an Electronic Medical Record (EMR) Reminder

An Evaluation of Human Immunodeficiency Virus (HIV) Screening After Implementation of an Electronic Medical Record (EMR) Reminder

Vaccinating Adult Patients with Cirrhosis: Trends over a Decade in the United States

Introduction. The progression of chronic liver disease to cirrhosis involves both innate and adaptive immune system dysfunction resulting in increased risk of infectious complications. Vaccinations against pneumococcus, hepatitis A virus (HAV), and hepatitis B virus (HBV) are well tolerated and effective in disease prevention and reduction in morbidity and mortality. Prior studies assessing vaccination rates in patients with cirrhosis have specific limitations and to date no study has provided a comprehensive evaluation of vaccination rates in patients with cirrhosis in the United States. Aim. This study assessed vaccination rates for pneumococcus, HAV, and HBV in patients with cirrhosis. Results. Overall 59.7% of patients with cirrhosis received at least 1 vaccination during the study period. Vaccination rates within the same or following year of cirrhosis diagnosis were 19.9%, 7.7%, and 11.0% against pneumococcus, HAV, and HBV, respectively. Trend analysis revealed significant increases in vaccination rates for pneumococcus in all patients with cirrhosis and within subgroups based on age, gender, and presence of concomitant diabetes. Conclusion. The study demonstrated that vaccination rates in patients with cirrhosis remain suboptimal. Ultimately, the use of electronic medical record (EMR) reminders improved communication between healthcare professionals and public health programs to increase awareness are fundamental to reducing morbidity, mortality, and health-care related costs of vaccine preventable diseases in patients with cirrhosis.

Incorporating ADA Best Practice Guidelines in Electronic Medical Records to Improve Glycemic Management in Health Care Facilities

Aggressive management of diabetes using American Diabetes Association (ADA) best practice guidelines in hospitalized patients reduces morbidity and mortality. Inpatient electronic medical records systems improve care in chronic diseases by identifying care needs and improving the data available for decision making and disease management. The purpose of this quality improvement project was to evaluate the impact of ADA best practice guidelines of glycemic management once they have been entered into the electronic medical record (EMR) of hospitalized diabetics. Kotter’s organizational change process guided the project. The project question investigated whether nurses’ use of ADA Best Practice Guidelines incorporated into the EMR improves glycemic management in hospitalized patients. A quality improvement project pretestposttest design evaluated the intervention to assess whether the program goals were met. A convenience sample of 8 nurses practicing in a subacute health care facility participated in the program with data obtained from a convenience sampling of diabetic patients admitted to the facility (n=50). A1C, diabetes types, and hypo/hyperglycemic treatment event data were compared 30 days pre- and post-intervention. Outcome data calculated using descriptive statistics revealed improved documentation for A1C results (4% to 96%), the different types of diabetes (from 100% documented as Type 1 to 28 % documented as Type2) and increased corrective measures for abnormal glycemic events (increased 16% to 44%). EMR alerts and reminders provided timely information to health care practitioners, resulting in better management for the diabetic patient, thus affecting social change of diabetes care.

Improving adherence to national recommendations for zoster vaccination through simple interventions.

In 2011, 15.8% of eligible patients in the United States were vaccinated against herpes zoster (HZ). To increase the usage of the HZ vaccine by studying physicians' knowledge, attitudes, practices, and perceived obstacles after interventions to overcome barriers. General internal medicine physicians were surveyed with a cross-sectional internet survey from October to December 2011 before interventions to increase the use of the HZ vaccine and 1 year later. Interventions included education, increasing availability at the medical center pharmacy, and electronic medical record reminders. Outcome measures included changes in knowledge, attitudes, and practices, and perceived barriers. McNemar chi-square tests were used to compare the changes from the baseline survey for physicians who completed the follow-up survey. Response rate for the baseline study was 33.5% (89/266) and for the follow-up was 29.8% (75/252). Fifty-five completed both surveys. There was a decrease from 57% at baseline to 40% at follow-up in the proportion of physicians who reported that less than 10% of their patients were vaccinated. They were more likely to know the HZ annual incidence (30% baseline; 70% follow-up; P=0.02), and report having educational information for physicians (7% baseline; 27% follow-up; P=0.003). The top helpful intervention was nursing administration of the vaccine. Average monthly HZ vaccine usage in the affiliated outpatient pharmacy increased in 10 months between surveys by 156% compared with the 3 months before the baseline survey. Interventions implemented during the study led to an increase in physicians' basic knowledge of the HZ vaccine and an increase in usage at the affiliated pharmacy.

Cochrane Review Brief: Email for Clinical Communication Between Healthcare Professionals

Keywords: Communication; email; healthcare professionals, systematic reviewRetiew question:What are the effects of healthcare professionals using email to communicate clinical information to each other, on healthcare professional outcomes; patient outcomes; health service performance; and service efficiency and acceptability compared to the usual forms of communication such as face-to-face, postal letters, telephone, and text messaging?Nursing Implications:Email is a popular and commonly-used method of communication, but its use in healthcare is not routine. Nurses often need to discuss cases and liaise with doctors and other healthcare allies to coordinate patient care. There are advantages and disadvantages in the use of email for clinical communication and the effects of email use for clinical communication have yet to be established.Study Characteristics :This is a summary of a Cochrane systematic review. The review included one randomized controlled trial involving a total of 327 patients and 159 healthcare providers. There were two intervention arms of the trial which assessed the use of electronic medical record (EMR) reminders alone, or EMR + patient reminder, compared to usual care (no email reminder). However, to meet the objective of the review, only the comparison between the EMR reminder group (101 patients) and the usual care group (101 patients) was considered. Participants were women aged between 50 and 89 years who had suffered a fracture in 1999 and had not received bone mineral density (BMD) measurement or medication for osteoporosis. The intervention (EMR) was delivered to the primary care physicians of the patients to remind them of the patient's risk of osteoporosis and the need for evaluation and treatment, as well as a reminder (three months later) for ordering a BMDMeasured outcomes Included: (1) health professional actions and performance in terms of whether the care provider ordered a BMD measurement, and/or prescribed osteoporosis medications; and (2) patient outcomes Including behaviors such as calcium intake and activity level and patient satisfaction with the care and services received for bone health.This study was at high risk of bias due to inadequate allocation concealment and blinding and unclear risk of bias due to other sources, including use of a patient questionnaire that had not been validated.Summary of Key Evidence:As the review included only one study, it was not possible to conduct meta-analysis and the main findings were described using narrative summary. …

Breaking the Bloodstream Infection Connection: Utilizing a Swab containing Chlorhexidine Gluconate (3.15%) and Isopropyl Alcohol (70%), Chlorascrub™

patients, including Hematology/Oncology patients should be a priority. Improved inpatient Influenza vaccination rates at our facility seemed to be linked to improved staff and physician vaccination rates and heightened staff and patient/family awareness, due to the introduction of the new Influenza (H1N1) strain, after the death of a Hematology/Oncology patient and mandatory masking for those staff and physicians declining to receive vaccine. Live attenuated Influenza vaccine seems to be infrequently administered to pediatric inpatients due to staff unfamiliarity with this vaccine and discomfort with using a live product on the inpatient service. Although the number of vaccines administered increased substantially by 2011, this was still a small percentage of inpatients and is unadjusted for patients who had received Influenza vaccine prior to admission. Standing protocols, electronic medical record reminders and linkage to computerized vaccine registries should help in this regard and may further reduce missed opportunities.

Adding a panel manager to EMR reminders improved some preventive care processes

Source Citation Loo TS, Davis RB, Lipsitz LA, et al. Electronic medical record reminders and panel management to improve primary care of elderly patients. Arch Intern Med. 2011;171:1552-8. 21949163

Electronic Medical Record Reminders and Panel Management to Improve Primary Care of Elderly Patients

Most elderly patients do not receive recommended preventive care, acute care, and care for chronic conditions. We conducted a controlled trial to assess the effectiveness of electronic medical record (EMR) reminders, with or without panel management, on health care proxy designation, osteoporosis screening, and influenza and pneumococcal vaccinations in patients older than 65 years. Physicians were assigned to 1 of the following 3 arms: EMR reminder, EMR reminder plus panel manager, or control. We assessed completion of recommended practices during a 1-year period. Among patients who had not already received the recommended care, health care proxy was designated in 6.5% of patients in the control arm, 8.8% of the EMR reminder arm, and 19.7% of the EMR reminder plus panel manager arm (P=.002). Bone density screening was completed in 17.7% of patients in the control arm, 19.7% of the EMR reminder arm, and 30.5% of the EMR reminder plus panel manager arm (P=.02). Pneumococcal vaccine was given to 13.1% of patients in the control arm, 19.5% of the EMR reminder arm, and 25.6% of the EMR reminder plus panel manager arm (P=.02). Influenza vaccine was given to 46.8% of patients in the control arm, 56.5% of the EMR reminder arm, and 59.7% of the EMR reminder plus panel manager arm (P=.002). Results were similar when adjusted for individual physician performance in the preceding year, patient age, patient sex, years cared for by the practice, and number of visits. Electronic medical record reminders alone facilitated improvement in vaccination rates and, when augmented by panel management, facilitated further improvement in vaccination rates and boosted the rates of health care proxy designation and bone density screening. clinicaltrials.gov Identifier: NCT01313169.

Incorporating Goals-of-Care Conversations Into Hospital Admissions at a System-Wide Level: Policy and Educational Strategies (306)

1.Discuss the evidence for the emerging quality standard of care for assessing patient goals of care on admission to the hospital unit and matching patient goals with the care plan.2.Identify an approach for efficiently and accurately assessing patient goals with two novel communication strategies: one for patients admitted without an expected alteration in prognosis and the other for those admitted with life-threatening or prognosis-changing conditions. Tools will be provided to help participants teach these skills in their own settings.3.Discuss how to develop in your own settings a novel system-wide approach to meeting the quality standard with a coordinated approach using policy, admission order sets, electronic medical record reminders and education with both online and in-person learning modules and video clips. Patient-centered, cost-effective medical care is at the core of our daily work. Quality standards emerging from Europe promote the assessment of patient goals of care within 12–24 hours of admission to the intensive care unit. Patient goals are then matched to appropriate beneficial care. The growth of hospitalist medicine, the advent of rapid response teams on hospital wards, and the need to provide care that maximizes patient benefit for resources used, means the need for early goals assessment and the level of care documentation on admission to the hospital is ever pressing. Yet few health centers have a reliable system for this process. This session reviews the literature evidence for this emerging quality standard of care. Then through case presentations discussion simulation and video clips spanning 10 years of interdisciplinary clinical practice and teaching presenters will introduce two strategies for patient goals assessment. One strategy, the three-step “SAM” discussion, is for non-emergent patients without life-threatening illness and no expected change in prognosis. The second strategy, the five-step “UFO-UFO” discussion, is for selected non-emergent patients with life-threatening illness or expected change in prognosis. Each tool facilitates patient- and family-centered conversations consistent with recommendations in critical care and palliative care literature. Finally the session will share the experience of one six-hospital health system with a concerted system-wide intervention to bring system practice in line with this quality standard. The strategy and tips for policy and admission order development will be presented. The session will provide copies of the policy and admission order set and an overview of the SAM- and UFO-UFO–based system-wide online educational interventions. Presenters will share teaching tools and presentation guides for those wishing to share this information policy and skills approach to meeting the standard. Structure and Processes of Care

EMF-7: Does an Electronic Medical Record Reminder Improve Triage Protocol Compliance Among Emergency Department Triage Nurses

EMF-7: Does an Electronic Medical Record Reminder Improve Triage Protocol Compliance Among Emergency Department Triage Nurses

Clinical risk factors for fracture among postmenopausal patients at risk for fracture: a historical cohort study using electronic medical record data

Osteoporosis represents a growing health burden, but recognition and screening rates are low. Electronic reminders for osteoporosis have been beneficial but are not based on clinical risk factors. Available risk screening tools may contain useful constructs for creating risk-based electronic medical record (EMR) reminders. Using a cohort study design among women ≥50 years with osteoporosis or osteoporosis risk, we searched the EMR for five World Health Organization (WHO) clinical risk factors including older age, lower body mass index (BMI), low bone mineral density (BMD), history of fracture since age 50, and maternal history of osteoporosis or fracture. Rates of reporting were lower than expected for BMD (6.8%), personal history of fracture (3.5%), and maternal history of fracture (0.3%). Despite the limitations, the EMR data were useful for identifying women at highest risk for fracture. Some evidence of bias in reporting rates was present. EMR data can be useful for identifying high fracture risk patients.

Improving colon cancer screening rates in primary care: a pilot study emphasising the role of the medical assistant

Background:Colorectal cancer (CRC) is the third-leading cause of cancer death for both men and women in the USA. Despite consensus recommendations for screening, just over half of eligible adults nationally...

Improved Therapeutic Monitoring With Several Interventions

Medication errors are frequently related to failure to appropriately select medications or adjust for laboratory parameters. Differences between guideline recommendations and actual frequency of therapeutic laboratory monitoring are substantial. This study evaluated interventions to improve laboratory monitoring at initiation of medication therapy. This cluster-randomized trial compared 3 interventions to usual care for 10 medications in 15 primary care clinics in a health maintenance organization with an electronic medical record system. Eligible patients, identified from electronic databases, had not received recommended laboratory monitoring within 5 days after new dispensing of a study medication. Interventions were an electronic medical record reminder to the prescribing health care professional, an automated voice message to the patient, and a pharmacy team outreach to the patient. Primary outcome was completion of all recommended baseline laboratory monitoring. A total of 961 patients participated in the study. At 25 days, 95 (48.5%) of 196 patients in the electronic medical record reminder group, 177 (66.3%) of 267 in the automated voice message group, 214 (82.0%) of 261 in the pharmacy team outreach group, and 53 (22.4%) of 237 in the usual care group had completed all recommended baseline laboratory monitoring (P<.001). After adjustments, the hazard ratios for completing laboratory monitoring compared with usual care were 2.5 (95% confidence interval, 1.8-3.5) for electronic medical record reminder, 4.1 (95% confidence interval, 3.0-5.6) for automated voice message, and 6.7 (95% confidence interval, 4.9-9.0) for pharmacy team outreach. All 3 interventions were effective in increasing laboratory monitoring when initiating new medications in primary care. Further work is necessary to determine if these interventions improve patient outcomes.

Electronic Medical Record Reminder Improves Osteoporosis Management After a Fracture: A Randomized, Controlled Trial

Osteoporosis treatment rates after a fracture are low. This study evaluated methods to increase guideline-recommended osteoporosis care postfracture. Participants were randomly assigned to usual care or one of two interventions. Analysis of primary outcomes used electronic data and linear regression. A Pacific Northwest nonprofit health maintenance organization. Female patients aged 50 to 89 who suffered a fracture in 1999 and had not received bone mineral density (BMD) measurement or medication for osteoporosis (n=311) and their primary care providers (n=159). Patient-specific clinical guideline advice to the primary care provider delivered by electronic medical record (EMR) message or electronic reminder to the provider plus an educational letter mailed to the patient. BMD measurement and osteoporosis medication. At 6 months, provider reminder resulted in 51.5% of patients receiving BMD measurement or osteoporosis medication, provider reminder plus patient education resulted in 43.1%, and usual care resulted in 5.9% (P<.001). The effect of provider advice combined with patient education was not significantly different from provider advice alone (P=.88). Patients aged 60 to 69 were 18% (95% confidence interval=3-34) more likely to receive BMD measurement or an osteoporosis medication than those aged 80 to 89. Patient-specific postfracture advice to the provider through an EMR message significantly increased BMD measurement and osteoporosis medication. As EMRs become more widespread, this intervention could improve osteoporosis management for many postfracture patients. Future research should identify barriers to and facilitators of care for older, high-risk patients.