Use Of EMR Research Articles

Résistance légitime sans technophobie : analyse des impacts de l'informatisation du dossier du patient sur le cœur du métier médical

The objective of this short narrative literature review is to highlight the different difficulties encountered by medical doctor in the daily use of EMR. We show that these are not simple transitional phenomena related to a "resistance to change", but rather the fact of a deeper and unfinished transformation. Beyond the "perception of misfit with work processes" or the threat of a loss of autonomy, we propose to analyze this so-called "resistance" in relation to the formalization of medical work induced by EMR. Our question concerns the compatibility of the multiple objectives of EMR, the potential influence of computerization on the steps of entering and consulting medical information, the impact on the clinical reasoning, the reality of assistance to medical "performance". The question is not so much what EMRs do less well than the paper record, but to provide insights into how tomorrow's EMRs will do better than today's.

Comparison between an electrochemical reactor with and without membrane for the nor oxidation using novel ceramic electrodes

The electrochemical oxidation of the antibiotic Norfloxacin (NOR) in chloride media on different anodic materials was studied at two different electrochemical reactors. The results were compared with those obtained in sulphate media. The anodes under study were a commercial boron-doped diamond (BBD) and two different ceramic electrodes based on tin oxide doped with antimony oxide in the presence (CuO) and absence (BCE) of copper oxide as sintering aid. The reactors employed were a one-compartment reactor (OCR) and a two-compartment one with a membrane separating both electrodes (EMR). The use of the membrane clearly enhanced both NOR degradation and TOC mineralization for all the anodic materials studied since some parallel reactions were avoided. Additionally, two different pathways for NOR oxidation were observed as a function of the reactor employed. The EMR also favoured the ionic by-products generation and the electrolyte dechlorination. NO3− increased with the oxidation power of the anode employed and it was also enhanced by the EMR use. Chloride media favours ceramic electrodes performance independently of the reactor employed as they did not generate an excess of oxidants as BDD did. The BCE electrode is an interesting alternative to BDD since although its oxidative power was lower, it presented similar current efficiency with lower energy consumption.

FACTORS AFFECTING THE SUCCESS OF THE USE OF ELECTRONIC MEDICAL RECORD (EMR) IN NURSING SERVICES IN HOSPITAL

The hospital is a health service facility that is integrated with the nursing service system. With the advancement of technology, the services of the congregation must be effective and efficient both in terms of service time so that the quality of service to patients is still prioritized. Nurses must be prepared to face challenges in the era of technological advances so that included in the use of electronic medical records, especially in the nursing service order, the factors that influence the success of EMR are nurses as users must be proficient in using computers, management must always evaluate and communicate with EMR use and IT systems themselves must be easier, faster and more flexible to use so nurses are more confident in using EMR

What are the most common medical errors/mistakes associated with EMR use?

What are the most common medical errors/mistakes associated with EMR use?

Trends in EMR for nonmalignant colorectal polyps in the United States

Although most large nonpedunculated colorectal lesions can be safely and efficaciously removed using EMR, the use of colectomy for benign colorectal lesions appears to be increasing. The reason(s) is unclear. We aimed to determine the use and adverse events of EMR in the United States. We used Optum's de-identified Clinformatics Data Mart Database (2003-2016), a database from a large national insurance provider, to identify all colonoscopies performed with either EMR or simple polypectomy on adult patients from January 1, 2011 to December 31, 2015. We measured time trends, regional variation, and adverse event rates. We assessed risk factors for adverse events using multivariate logistic regression. The rate of EMR use in the US increased from 1.62% of all colonoscopies in 2011 to 2.48% of colonoscopies in 2015 (P< .001). There were, however, significant regional differences in the use of EMRs, from 2.4% of colonoscopies in the western United States to 2.0% of colonoscopies in the southern United States. Between 2011 and 2015, we found stable rates of perforation, GI bleeding (GIB), infections, and cardiac adverse events and decreasing rates of admissions after EMR. In our multivariate model, EMR was an independent risk factor for adverse events, albeit the rates of adverse events were low (1.35% GIB, .22% perforation). Use of EMR is rising in the United States, although there is significant regional variation. The rates of adverse events after EMR and polypectomies were low and stable, confirming the continued safety of EMR procedures. A better understanding of the regional barriers and facilitators may improve the use of EMR as the standard management for benign colorectal lesions throughout the United States.

Interventions to improve the use of EMRs in primary health care: a systematic review and meta-analysis

BackgroundElectronic medical record (EMR) adoption in primary care has grown exponentially since their introduction in the 1970s. However, without their proper use benefits cannot be achieved. This includes: 1) the...

Evaluating the Implementation of Technology in Nursing Homes

Technology plays an important role in health care, but few studies have analyzed the implementation of technology in nursing homes. Fifty-two nursing homes were surveyed on the extent of their technology use, who was using the technology, and what or whom the use of technology was intended to impact. Characteristics associated with “high technology adopters” were identified and relationships between technology use, site characteristics, and quality outcomes were explored. Results showed that nonprofit and larger facilities utilize more technology, but a facility's technology score was not correlated with their star rating. EMR use was high, as was use of technology for increasing residents’ social interactions. Nursing homes who use more advanced technology and thoughtful use of social media can enhance communication with external constituents, such as families, prospective customers, and health care partners. The current study serves as a benchmark for facilities interested in enhancing their use of technology.

What's in a Name? Provider Perception of Injured John Doe Patients

BackgroundWe previously demonstrated that unidentified aliased patients, John Doe's (DOEs), are one of the highest risk and most medically fragile populations of injured patients. Aliasing can result in misplaced information and confusion that must be overcome by health care professionals. DOE alias use is institutionally dependent and not uniform, which may lead to significant variation in perception of confusion and error. We sought to determine if health care practitioners experience confusion that may result in compromised care when caring for injured DOE patients. MethodsAfter obtaining institutional review board approval, we surveyed critical care nurses, nurse practitioners, resident physicians, and surgeons who care for DOE patients at two academic level I trauma centers with separate DOE alias practices. Surveys asked whether caring for DOE patients created possible or actual confusion and possible or actual patient care errors. In one institution (Selective DOE), only unidentified patients were given an alias that was reconciled when information became available. At the other institution (All DOE), all trauma patients were admitted with an alias that was reconciled within 24 h. Respondents were invited to complete an anonymous questionnaire regarding the care for DOE patients. Results were analyzed with Wilcoxon rank-sum tests, and significance was assessed at a level of 0.05. ResultsOf 176 total respondents, 120 (68.2%) reported from Selective DOE and 56 (31.8%) from All DOE. Overall 53.1% reported that DOE use can cause serious confusion. Specifically, 31.3% reported experiencing actual confusion, although only 4% reported actual errors. Nurses had significantly higher perceived risk of confusion in the system of All DOE versus Selective DOE assignment (17.9% versus 4.2%, P < 0.01). Resident physicians reported significantly more frequent actual mistakes within the All DOE versus Selective DOE (24.1% versus 6.6%, P < 0.01), despite finding no significant difference in resident perception of confusion (21.4% versus 12.5%, respectively, P = 0.18). ConclusionsOur study sheds light on clinical consequences of EMR use and aliases for end users. We show that nurses perceive that there are greater potential complications associated with DOE aliases use, and this varies depending on the system used for managing unidentified patients. Minimizing DOE alias use may help to minimize provider confusion, risk for error, and patient safety.

Nurses' Perspectives of Person-Centered Spinal Cord Injury Rehabilitation in a Digital Hospital.

Nurses' perspectives on electronic medical record (eMR) use and compatibility with person-centered care (PCC) in rehabilitation were explored. This cross-sectional, qualitative study involved nurses practicing in a spinal cord injury service within the first Australian tertiary hospital to implement a large-scale eMR system. Ten focus groups were audio-recorded and transcribed for thematic analysis. The three themes were (1) discovering how eMR fits in a specialty setting, (2) making eMR work through adaptability, and (3) realizing the impact of eMR inclusion in the nurse-patient relationship. The eMR introduction triggered compensatory practices to manage the complexities and shortcomings of electronic documentation. Nurses adapted routines and reoriented workflows to preserve PCC. While absorbing eMR-driven changes in documentation, rehabilitation nurses must in parallel manage evolving nursing practice norms in the digital environment in order to sustain PCC. This requires strategic foresight and commitment.

Statues and Improvement of Electronic Medical Record System in Traditional Korean Medicine.

ObjectivesThe study was to survey use of electronic medical records in subjects of Korean medicine doctors working for Korean medicine organizations and to contemplate ways to develop utilization of electronic medical records.MethodsOn August 2017, it conducted online self-reported survey on subjects of Korean medicine doctors at Korean hospitals and clinics who agreed to participate in the study. A total 40 doctors in hospital and 279 doctors in clinic were included. The surveyed contents include kinds of electronic chart, reason for not using electronic medical records and problems with creation of medical records.ResultsIt finds that 100% of those working at Korean medicine hospitals and 86.4% of those at Korean medicine clinics have used electronic medical records. Subjects answered the biggest reason for not using electronic medical records was inconvenience. The most serious problems with creation of electronic medical records at Korean medicine organizations found in the study include there was no method of creation of medical records and no standardized terminology for use in electronic medical records.ConclusionFor utilization of electronic medical records at Korean medicine organizations, standardization of terminology, development of EMR in favour of its users and development of strategy that motivates use of EMR are required.

Framework to Enhance Nurses’ Use of EMR

The ability of nurses to adopt and successfully use EMR is expected to have a significant impact on achieving benefits such as reduction in healthcare costs and improvement in healthcare quality. A review of the current research literature reveals issues and concerns relating to the adoption and use of EMR by nurses in hospital environments. This article presents a literature review of such issues and concerns, and suggests a framework for enhancing the adoption and use of EMR by nurses and hospitals.

Completeness and accuracy of anthropometric measurements in electronic medical records for children attending primary care

BackgroundElectronic medical records (EMRs) from primary care may be a feasible source of height and weight data. However, the use of EMRs in research has been impeded by lack of...

Challenges in Using Real-world Clinical Practice Records for Validation of Clinical Trial Data in Inflammatory Bowel Disease: Lessons Learned.

Electronic medical records (EMRs) have gained widespread use in clinical practice and by default serve as a large patient database with potential for use in clinical research. Although there remains significant interest in leveraging EMRs for research purposes, extraction of data has proven to be complex and with insufficient accuracy. We describe the limitations of an EMR in our attempt to conduct a seemingly simple study aimed at validating variables identified in the PRECiSE 3, a 7-year open label safety and efficacy study of certolizumab pegol in Crohn's disease that identified clinical factors that predicted both short- and long-term efficacy. A multicenter, retrospective cohort study from 8 academic and large community practices was performed, and data were collected from each respective EMR. Significant challenges with reliable capture of key data elements were encountered, and overall a screen fail rate of 91.8% across all sites was seen. We describe these challenges and potential future directions to work together to advance accuracy and implementation of the use of EMRs in inflammatory bowel disease.

The burden of inbox-messaging systems and its effect on work-life balance in dermatology

The burden of inbox-messaging systems and its effect on work-life balance in dermatology

Optimizing the quality of endoscopy in inflammatory bowel disease: focus on surveillance and management of colorectal dysplasia using interactive image- and video-based teaching

Varying recommendations regarding the detection and management of dysplasia can lead to uncertainty and may impede the uptake of strategies that could improve surveillance in patients with inflammatory bowel disease (IBD). An educational event was held to assist in disseminating the recently published Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in Inflammatory Bowel Disease Patients: International Consensus Recommendations (SCENIC). Specialists in IBD and endoscopy led the Optimizing Quality of Endoscopy in IBD course. The American Society for Gastrointestinal Endoscopy (ASGE) organized the course, and the Crohn's and Colitis Foundation of America (CCFA) provided endorsement. One was held in March 2015 at the ASGE Institute for Training and Technology in Chicago, Illinois, and the second in September 2016 preceding the ASGE Endofest in Chandler, Arizona. The program included interactive case-based discussions and didactic presentations on topics including the rationale and current approach of surveillance in IBD; endoscopic characterization and nomenclature of active and quiescent disease; detection of dysplasia during IBD surveillance; role of image-enhanced endoscopy in IBD surveillance, with a focus on chromoendoscopy technique; and management of dysplasia in IBD. Participants were surveyed before and after the course to assess their perspectives and practice. Eighteen presenters or panel members and approximately 92 IBD and endoscopist physician leaders attended the meeting. Most attendees were aged 30 to 49 years (88.1%), had been in practice less than 10 years (89.7%), were from academic medical centers (90.7%), and spent >50% of their time caring for patients with IBD (59.7%). Recommended quality improvements for endoscopy in IBD included the use of endoscopic scoring systems to describe disease activity, the use of a modified Paris classification to characterize visible dysplastic lesions (polypoid, nonpolypoid with description of presence of ulcer and distinct or indistinct borders), the use of chromoendoscopy for dysplasia detection, and the endoscopic removal of visible dysplastic lesions. In the follow-up survey, participants were asked to indicate whether they had changed their practice as a result of attending the course. Ninety-three percent (93%) indicated they had changed their practice. For dysplasia detection, the use of chromoendoscopy increased: 51.7% of respondents reported using chromoendoscopy in most surveillance colonoscopies compared with 34.3% before the course. For dysplasia management, the use of EMR increased for polypoid and nonpolypoid lesions 10 to 20mm in size; and the referral of dysplastic lesions 20mm or larger that appeared endoscopically resectable shifted toward removal by an experienced endoscopist. Evidence-based advances in endoscopy have occurred in the characterization and nomenclature of active and quiescent disease, polypoid and nonpolypoid dysplasia in IBD, and in the detection and management of dysplasia in colonic IBD. Implementation of updated guidelines and recommendations into clinical practice may be facilitated by interactive image- and video-based courses on the topic.

Discrepancies between perceptions of students and deans regarding the consequences of restricting students\u2019 use of electronic medical records on quality of medical education

BackgroundElectronic medical records (EMR) are more used in university hospitals, but the use of EMR by medical students at the workplace is still a challenge, because the conflict of interest between medical accountability for hospitals and quality of medical education programs for students. Therefore, this study investigates the use of EMR from the perspective of medical school deans and students, and determines their perceptions and concerns about consequences of restricted use of EMR by students on quality of education and patient care.MethodsWe administered a large-scale survey about the existence of EMR, existing policies, students’ use for learning, and consequences on patient care to 42 deans and 789 Residency Physician Applicants in a private university in Colombia. Data from 26 deans and 442 former graduated students were compared with independent t tests and chi square tests.ResultsOnly half of medical schools had learning programs and policies about the use of EMR by students. Deans did not realize that students have less access to EMR than to paper-based MR. Perceptions of non-curricular learning opportunities how to write in (E)MR were significantly different between deans and students. Limiting students use of EMR has negative consequences on medical education, according to both deans and students, while deans worried significantly more about impact on patient care than students. Billing issues and liability aspects were their major concerns.ConclusionsThere is a need for a clear policy and educational program on the use of EMR by students. Discrepancies between the planned curriculum by deans and the real clinical learning environment as experienced by students indicate suboptimal learning opportunities for students. Creating powerful workplace-learning experiences and resolving concerns on students use of EMR has to be resolved in a constructive collaboration way between the involved stakeholders, including also EMR designers and hospital administrators. We recommend intense supervision of students’ work in EMR to take full advantage of the technological advances of EMR at the modern clinical site, both for patient care and for medical education.

Survivorship care plan utilization and challenges.

68 Background: Based on June and Dec. 2015 Survivorship Retreats hosted by WA Alliance for Cancer Survivorship (WACS), it was clear that staffing models, use of EMRs, cancer registry software programs or commercial products were program dependent with limited flexibility for facilities to adopt a single, state-wide, Survivorship Care Plan (SCP) model. Attendees at the retreats were concerned with financial sustainability of SCPs as the Commission on Cancer (CoC) requirement increased from 10-25-75% of all eligible patients by Dec. 31, 2018. The largest concern was the time spent on the preparation of the SCP. WACS wanted to validate resource needs across settings to identify needs/gaps being experienced. We asked the American Cancer Society (ACS) to conduct a survey of CoC accredited hospitals. Results would be limited to aggregate data and individual confidentiality would be maintained. Methods: ACS field staff made in-person appeals to each accredited program leveraging their existing relationship with CoC Liaisons. A 60% survey completion goal was set. A secure electronic survey was deployed in February. ACS staff promoted the project, followed up on non-responders, aggregated the data and prepared the results report. Results: We achieved a 70% participation rate for accredited programs. 75% of rural facilities, 71% urban but only 50% suburban facilities participated. Results showed they were spending 45 minutes to 2 hours to gather data to prepare the SCP and an equal amount of time being devoted to the patient SCP visit. There is a clear need and desire to have an efficient data gathering process for surveillance recommendations, latent side effect management and ready access for cancer site specific supportive care resources to reduce the time spent in preparation/delivery of the SCP and create a sustainable financial model. Conclusions: The transition from active treatment to survivorship care is a complex process, complicated by residual symptoms, educational needs and health risks. Our baseline information will inform our efforts to streamline the development of SCP as programs work to meet CoC goals. We plan to develop a survey to examine survivors recall and adoption of SCP recommendations to measure how SCPs are improving patient and facility outcomes.

AB019. Longitudinal asthma management profiles: visualisation of patient histories using multiple data sources

Background Electronic medical records (EMR) offer valuable information for research and clinical case management, but are currently underused. Barriers to EMR use include the limited information on medication use and health outcomes provided by single data sources, the challenge of linking multiple sources, and the lack of methods to integrate all information to reconstitute patients’ complete medical trajectories. The ASTRO-LAB cohort study, assessing the safety of long-acting β-agonists (LABA) in asthma, collected data from direct patient follow-up and healthcare databases, and thus allowed a more comprehensive exploration of medication use patterns, asthma control and exacerbations over time. To develop longitudinal asthma management patient profiles for the ASTROLAB cohort by integrating data on prescription and dispensation events, and patient-reported medication exposure and occurrence of severe asthma exacerbations (SAEx).

Linking Electronic Medical Records Use to Physicians’ Performance: A Contextual Analysis

ABSTRACTElectronic Medical Records (EMR) studies have broadly tested EMR use and outcomes, producing mixed and inconclusive results. This study carefully considers the healthcare delivery context and examines relevant mediating variables. We consider key characteristics of: (i) interdependence in healthcare delivery processes, (ii) physician autonomy, and (iii) the trend of hospital employment of physicians, and draw on theoretical perspectives in coordination, shared values, and agency to explain how the use of EMR can improve physicians’ performance. In order to examine the effects of physician employment on work practices in the hospital, we collected 583 data points from 302 hospitals in 47 states in the USA to test two models: one for employed and another for nonemployed physicians. Results show that information sharing and shared values among healthcare delivery professionals fully mediate the relationship between EMR use and physicians’ performance. Next, physician employment determines which mediating variable constitutes the pathway from EMR use to physicians’ performance. Finally, we highlight the impact of shared values between the hospital and physicians in enhancing information sharing and physicians’ performance, extending studies of these behaviors among network partners in industrial settings. Overall, our study shows that EMR use should be complemented by processual (information sharing), social (shared values), and structural (physician employment) mechanisms to yield positive effects on physicians’ performance.

Outcome of EMR as an alternative to surgery in patients with complex colon polyps

Patients with complex colon polyps were traditionally referred for surgery to avoid adverse events associated with endoscopic resection. Recent advances in endoscopic imaging as well as endoscopic hemostasis and clip closure allow for the use of EMR as an alternative to surgery for such lesions. To determine the outcome of treatment of complex colon polyps with EMR as an alternative to surgery, we conducted a retrospective observational study. Two hundred three patients with complex colon polyps were referred to an EMR center as an alternative to surgery. Patients underwent a protocol-driven EMR. The primary endpoint was the complete resection rate. Secondary endpoints were safety, residual adenoma rate, and incidence of missed synchronous polyps. EMR was performed in 155 patients and was deferred in 48 patients who were referred to surgery. EMR specimens revealed benign polyps in 149 and cancer in 6 patients. EMR adverse events occurred in 7 patients, requiring hospitalization in 5 of them. None of the patients died as a result of their adverse events. Surveillance colonoscopy at 4 to 6 months after resection of a benign lesion in 137 patients revealed residual adenoma at the scar site in 6 patients and additional synchronous precancerous lesions in 117 patients that were not removed by the referring endoscopist. None underwent surgery for failure of EMR. The overall precancerous lesion burden was 2.83 per patient, the adenoma burden was 2.13 per patient, and the serrated polyp burden was .69 per patient. EMR can be used instead of surgery for complex colon polyps in 75% of patients with few adverse events and few residual adenomas at resection sites. In addition, careful repeat examination of the entire colon forsynchronous lesions overlooked by the referring endoscopist is required for most patients. ( NCT01827241.).