Impact Of Electronic Health Record Research Articles

Implementing Electronic Health Records in the Emergency Department

The increasing presence of electronic health records (EHRs) in health care presents interesting and unique challenges in the Emergency Department (ED) setting. Unfortunately, scant literature exists addressing the implementation of EHRs in this setting. The authors, both involved in the implementation of such systems at their respective institutions, review the challenges and benefits that exist with such implementation, and the steps that EDs can take to facilitate this process. Unlike ambulatory and inpatient settings, where patient volume can be adjusted to help with this transition, EDs are unable to alter their volume and must maximize their efficiency during this process. Understanding and anticipating the EHR's impact on workflow is critical to successful implementation.

Nurses' Perceptions of the Impact of Electronic Health Records on Work and Patient Outcomes

This study addresses community hospital nurses' use of electronic health records and views of the impact of such records on job performance and patient outcomes. Questionnaire, interview, and observation data from 46 nurses in medical-surgical and intensive care units at two community hospitals were analyzed. Nurses preferred electronic health records to paper charts and were comfortable with technology. They reported use of electronic health records enhanced nursing work through increased information access, improved organization and efficiency, and helpful alert screens. They thought use of the records hindered nursing work through impaired critical thinking, decreased interdisciplinary communication, and a high demand on work time (73% reported spending at least half their shift using the records). They thought use of electronic health records enabled them to provide safer care but decreased the quality of care. Administrative implications include involving bedside nurses in system choice, streamlining processes, developing guidelines for consistent documentation quality and location, increasing system speed, choosing hardware that encourages bedside use, and improving system information technology support.

Electronic Health Records in Four Community Physician Practices: Impact on Quality and Cost of Care

ObjectiveTo assess the impact of the electronic health record (EHR) on cost (i.e., payments to providers) and process measures of quality of care. Study DesignRetrospective before-after-study-control. From the database of a large managed care organization (MCO), we obtained the claims of patients from four community physician practices that implemented the EHR and from about 50 comparison practices without the EHR in the same counties. The diverse patient and practice populations were chosen to be a sample more representative of typical private practices than has previously been studied. MeasurementsFor four chronic conditions, we used commercially-available software to analyze cost per episode over a year and the rate of adherence to clinical guidelines as a measure of quality. ResultsThe implementation of the EHR had a modest positive impact on the quality measure of guideline adherence for hypertension and hyperlipidemia, but no significant impact for diabetes and coronary artery disease. No measurable impact on the short-term cost per episode was found. Discussions with the study practices revealed that the timing and comprehensiveness of EHR implementation varied across practices, creating an intervention variable that was heterogeneous. ConclusionsGuideline adherence increased across practices without EHRs and slightly faster in practices with EHRs. Measuring the impact of EHRs on cost per episode was challenging, because of the difficulty of completely capturing the long-term episodic costs of a chronic condition. Few practices associated with the study MCO had implemented EHRs in any form, much less utilizing standardized protocols.

Health Technology Leader Describes What Lies Ahead

Back to table of contents Previous article Next article Annual MeetingFull AccessHealth Technology Leader Describes What Lies AheadRobert Plovnick, M.D.Robert PlovnickSearch for more papers by this author, M.D.Published Online:20 Apr 2007https://doi.org/10.1176/pn.42.8.0028Robert Kolodner, M.D., will provide an update on fast-moving developments in the adoption health information technology and the issues such technology raises. Photo courtesy of Office of the National Coordinator for Health Information TechnologyElect ron ic h e a l t h r e c o r d s are around the corner. Learn about what is happening in this and other areas of healt h information technology and how it will impact you by attending a series of sessions at APA's 2007 annual meeting led by psychiatrist Robert Kolodner, M.D., APA's Corresponding Committee on Electronic Health Records, and APA's Department on Quality Improvement and Psychiatric Services.Kolodner is the interim national coordinator for health information technology in the Department of Health and Human Services. He will present the lecture “Moving National Health Information Technology Agenda Forward” on Tuesday, May 22, from noon to 1:30 p.m. in room 26 A/B, Upper Level, San Diego Convention Center.The Office of the National Coordinator oversees a variety of national projects including electronic health record (EHR) technical standards, software certification, security, and privacy (Psychiatric News, January 5). Kolodner has been involved in over-seeing, promoting, and guiding health information technology initiatives in the VA for many years. According to various government agencies and health care experts, health information technology, including EHRs, has great potential to improve health care quality, improve communication and care coordination, and prevent medical errors.Kolodner will discuss the activities and plans of the Office of the National Coordinator for Health Information Technology; provide a psychiatrist's perspective on the national vision and direction for health information technology; outline benefits of HIT for psychiatry, such as improved communication with other providers and automated medication interaction checking; and comment on some of the key concerns that psychiatrists and other physicians have about HIT, including privacy protection of electronic health information, cost and training burden to physicians, and disruption of clinical work flow.In addition, APA's Corresponding Committee on Electronic Health Records and Department on Quality Improvement and Psychiatric Services are sponsoring two health information technology activities at the annual meeting and will delve more deeply into some of the issues that Kolodner will cover. The first is a workshop on the fast-moving shift from paper to electronic health records,“ The National Health Information Network and Psychiatry: How Will EHRs Impact Our Patients and Our Practice?” It will be held on Tuesday, May 22, from 9 a.m. to 10:30 a.m. in Room 30 B, Upper Level, San Diego Convention Center.Second, to showcase the benefits of EHRs and to provide a means for meeting attendees to compare how different products shown in the Exhibit Hall handle the same information, the committee has developed a demonstration scenario that will be distributed to EHR vendors in advance of the meeting. This scenario, as well as a list of vendors, will be available on the committee's Web site at<www.psych.org/members/ehr>.▪Robert Plovnick, M.D., is APA's informatics and performance-measure specialist. ISSUES NewArchived

Electronic health records: Is the evidence base any use?

Information-technology policies in many countries are full of aspirational statements and not generally based on the available evidence. This paper aims to contribute to a proper discussion of the evidence on electronic health records (EHR). The paper describes the methods we used in a review of the impact of EHR on clinical work and administration, summarizes our findings, and discusses their relevance in the context of policy makers' information requirements. We argue that the literature has, to date, largely failed to deliver usable findings.

The Impact of Electronic Health Records on Time Efficiency of Physicians and Nurses: A Systematic Review

A systematic review of the literature was performed to examine the impact of electronic health records (EHRs) on documentation time of physicians and nurses and to identify factors that may explain efficiency differences across studies. In total, 23 papers met our inclusion criteria; five were randomized controlled trials, six were posttest control studies, and 12 were one-group pretest-posttest designs. Most studies (58%) collected data using a time and motion methodology in comparison to work sampling (33%) and self-report/survey methods (8%). A weighted average approach was used to combine results from the studies. The use of bedside terminals and central station desktops saved nurses, respectively, 24.5% and 23.5% of their overall time spent documenting during a shift. Using bedside or point-of-care systems increased documentation time of physicians by 17.5%. In comparison, the use of central station desktops for computerized provider order entry (CPOE) was found to be inefficient, increasing the work time from 98.1% to 328.6% of physician's time per working shift (weighted average of CPOE-oriented studies, 238.4%). Studies that conducted their evaluation process relatively soon after implementation of the EHR tended to demonstrate a reduction in documentation time in comparison to the increases observed with those that had a longer time period between implementation and the evaluation process. This review highlighted that a goal of decreased documentation time in an EHR project is not likely to be realized. It also identified how the selection of bedside or central station desktop EHRs may influence documentation time for the two main user groups, physicians and nurses.