Impact Of Electronic Medical Record Research Articles

Evaluating the Impact of Electronic Medical Records on Patient Management and Service Integration in Mombasa County, Kenya

Evaluating the Impact of Electronic Medical Records on Patient Management and Service Integration in Mombasa County, Kenya

Retrospective analysis of the impact of electronic medical record alerts on low value care in a pediatric hospital.

Hospital costs continue to rise unsustainably. Up to 20% of care is wasteful including low value care (LVC). This study aimed to understand whether electronic medical record (EMR) alerts are effective at reducing pediatric LVC and measure the impact on hospital costs. Using EMR data over a 76-month period, we evaluated changes in 4 LVC practices following the implementation of EMR alerts, using time series analysis to control for underlying time-based trends, in a large pediatric hospital in Australia. The main outcome measure was the change in rate of each LVC practice. Balancing measures included the rate of alert adherence as a proxy measure for risk of alert fatigue. Hospital costs were calculated by the volume of LVC avoided multiplied by the unit costs. Costs of the intervention were calculated from clinician and analyst time required. All 4 LVC practices showed a statistically significant reduction following alert implementation. Two LVC practices (blood tests) showed an abrupt change, associated with high rates of alert adherence. The other 2 LVC practices (bronchodilator use in bronchiolitis and electrocardiogram ordering for sleeping bradycardia) showed an accelerated rate of improvement compared to baseline trends with lower rates of alert adherence. Hospital savings were $325 to $180 000 per alert. EMR alerts are effective in reducing pediatric LVC practices and offer a cost-saving opportunity to the hospital. Further efforts to leverage EMR alerts in pediatric settings to reduce LVC are likely to support future sustainable healthcare delivery.

Allied health professionals’ experiences and lessons learned in response to a big bang electronic medical record implementation: A prospective observational study

IntroductionThere is limited evidence describing the impact of electronic medical record (EMR) implementation on allied health professionals’ acceptance, expectations, and work efficiencies. This study aims to: A) identify clinician expectations and factors that influence EMR acceptance; B) evaluate perceived usability, technology proficiency and satisfaction; and C) assess the impact of EMR big bang implementation on allied health workflows at three Australian tertiary hospitals. MethodsRepeated measures study pre and six-months post EMR implementation. User acceptance was evaluated with online surveys: Unified Theory of Acceptance and Use of Technology (pre), System Usability Scale and open-ended questions (post). A four-hour time-motion study evaluated changes in allied health inpatient workflows. ResultsSurveys were completed by 224 allied health clinicians (47% response rate) pre, and 196 (41%) post-implementation. Pre-implementation, 96% of respondents felt using the EMR was a good idea and they would find it useful. Six-months post-implementation 88% liked interacting with the EMR. 64% found it easy to use and most didn’t require technical support (78%). While 68% of participants felt very confident, 51% believed they were not using the EMR’s full potential.Post-implementation half of participants agreed significant upskilling was required and that EMR workflows were not quick to learn. Live demonstrations were considered the most helpful activity prior to training; hands-on practice in the training environment and superuser support were invaluable preparing for and during go-live. Time-motion data (mean difference (MD) (95% CI)) indicated that following implementation participants spent 2.27% (−3.53, 8.09, p = 0.731) more time in clinical tasks. More time was spent performing clinical documentation (5.39% (1.98, 8.8), p = 0.002). ConclusionsMany factors can impact allied health professional’s adoption of a new EMR. Institution-wide, simultaneous big bang EMR implementation, with strong allied health leadership, can lead to positive benefits, particularly in user experience. Ongoing evaluation will drive future improvements.

Preliminary considerations for electronic medical record (EMR) in the public hospitals of Gandaki province in Nepal

Electronic Medical Record (EMR) is the digital tool to keep records of valuable information on computer or computer-like equipment, regarding health systems, including patient’s records and stock management which can provide real time evidence for better patient record, clinical care and health policy making. As Nepal does not have a national EMR system, and it is a challenge to get real time data, information and evidence required for effective health policy making. With an effective national EMR system in Nepal, the health system can be improved with reliable information of patients for the continuity of clinical care.
 
 There are existing scientific evidence of EMR on the lessons of implementation in Nepal, opportunities for the use of EMR in Malaysia, perspectives of health care workers on EMR after its implementation in Canada, on the development of success measuring tools and the use of questionnaires for the EMR implementation in Canada, best practices, impact of EMR on physician practice, and barriers for EMR implementation.
 
 EMR can improve the quality, effectiveness, transparency and efficiency of healthcare services and its management. Gandaki province is one of seven provinces in Nepal and is exploring ways to implement EMR in all the hospitals operated under the province government. There can be step wise approach to have EMR in all of these hospitals. This can give more strategies for the national EMR system.

Nurses' Experiences After Implementation of an Organization-Wide Electronic Medical Record: Qualitative Descriptive Study.

BackgroundReports on the impact of electronic medical record (EMR) systems on clinicians are mixed. Currently, nurses’ experiences of adopting a large-scale, multisite EMR system have not been investigated. Nurses are the largest health care workforce; therefore, the impact of EMR implementation must be investigated and understood to ensure that patient care quality, changes to nurses’ work, and nurses themselves are not negatively impacted.ObjectiveThis study aims to explore Australian nurses’ postimplementation experiences of an organization-wide EMR system.MethodsThis qualitative descriptive study used focus group and individual interviews and an open-ended survey question to collect data between 12 and 18 months after the implementation of an EMR across 6 hospital sites of a large health care organization in Victoria, Australia. Data were collected between November 2020 and June 2021, coinciding with the COVID-19 pandemic. Analysis comprised complementary inductive and deductive approaches. Specifically, reflexive thematic analysis was followed by framework analysis by the coding of data as barriers or facilitators to nurses’ use of the EMR using the Theoretical Domains Framework.ResultsA total of 158 nurses participated in this study. The EMR implementation dramatically changed nurses’ work and how they viewed their profession, and nurses were still adapting to the EMR implementation 18 months after implementation. Reflexive thematic analysis led to the development of 2 themes: An unintentional divide captured nurses’ feelings of division related to how using the EMR affected nurses, patient care, and the broader nursing profession. This time, it’s personal detailed nurses’ beliefs about the EMR implementation leading to bigger changes to nurses as individuals and nursing as a profession than other changes that nurses have experienced within the health care organization. The most frequent barriers to EMR use by nurses were related to the Theoretical Domains Framework domain of environmental context and resources. Facilitators of EMR use were most often related to memory, attention, and decision processes. Most barriers and facilitators were related to motivation.ConclusionsNurses perceived EMR implementation to have a mixed impact on the provision of quality patient care and on their colleagues. Implementing technology in a health care setting was perceived as a complex endeavor that impacted nurses’ perceptions of their autonomy, ways of working, and professional roles. Potential negative consequences were related to nursing workforce retention and patient care delivery. Motivation was the main behavioral driver for nurses’ adoption of EMR systems and hence a key consideration for implementing interventions or organizational changes directed at nurses.

Promoting β-lactam utilization through suppression of electronic medical record cross-allergy alerts.

Current literature surrounding management of patients with reported β-lactam allergies focuses on allergy delabeling. Standard clinical decision support tools have not been optimized to be compatible with the currently accepted cross-reaction rate of 1% to 2%. This potentially promotes use of non-β-lactam antibiotics, which are often not first-line therapy and may carry increased risks. The impact of electronic medical record (EMR) clinical decision support tool optimization on utilization of β-lactam antibiotics in β-lactam-allergic patients was evaluated. A retrospective pre-post β-lactam cross-allergy EMR alert suppression quality improvement intervention cohort study of β-lactam-allergic adult inpatients prescribed antibiotics was conducted. Preintervention baseline data were collected for an initial cohort admitted during September 2018. The intervention, in which clinical decision support rules were updated to display β-lactam cross-sensitivity allergy alerts only for β-lactam-allergic patients with documentation of organization-defined high-severity reactions of anaphylaxis, hives, and shortness of breath, was implemented August 20, 2019. The postintervention cohort included patients admitted during September 2019. A 91% increase in the percentage of β-lactam-allergic patients who received a β-lactam agent at any time during their admission was noted after the intervention (26.6% vs 51%, P < 0.001). Statistically significant decreases in prescribing of alternative antibiotic classes were seen for fluoroquinolones (decrease from 45.3% to 26%, P < 0.001), aminoglycosides (decrease from 9.4% to 2.9%, P = 0.002), and aztreonam (decrease from 30% to 16.7%, P < 0.001). EMR β-lactam cross-allergy alert optimization consistent with current literature significantly improved the utilization of alternative β-lactam subclasses, mostly through β-lactam prescribing as initial therapy in β-lactam-allergic patients.

Impact of Electronic Medical Records Within the Maternity Environment: An Ethnographic Exploration of Midwifery Practice.

Integration of care through digitalisation of paper records is important for childbearing women who may see multiple clinicians both within the hospital and the community. It is important that in the implementation of an EMR, the established benefits of a paper and handheld records are transferred and not lost. Acceptance and positive use of digital records in maternity settings has occurred despite concerns regarding workload interrupting women centred care.

The Impact of Electronic Medical Records on the Process of Care: Alignment with Complexity and Clinical Focus

ABSTRACTAlthough electronic medical records (EMR) have attracted significant academic and practitioner interest, findings regarding the impacts of EMR on hospital performance remain inconclusive. Drawing on organizational information processing theory, we examine whether EMR will improve the process of care to a greater extent when the complexity of hospital operations is higher. In addition, we investigate whether clinical focus complements or substitutes EMR in mitigating hospital complexity. We cluster hospitals into three stages based on their cumulative capabilities as identified by the EMR Adoption Model (EMRAM) and assemble a longitudinal database tracking hospitals’ EMR capabilities and their performance between 2005 and 2014. Our study reveals that advanced stages of EMR mitigate hospital complexity and thus improve the process of care to greater extents than lower stages of EMR. In addition, we find that clinical focus substitutes for lower stages of EMR whereas complements higher stages of EMR in mitigating the potential negative impacts of complexity on the process of care. These findings offer significant managerial implications in aligning EMR capabilities and the clinical focus strategy to mitigate complexity.

Cryoprecipitate Utilization Patterns Observed With a Required Prospective Approval Process vs Electronic Dosing Guidance.

We evaluated the impact of electronic medical record (EMR)-guided pooled cryoprecipitate dosing vs our previous practice of requiring transfusion medicine (TM) resident approval for every cryoprecipitate transfusion. At our hospital, cryoprecipitate pooled from five donors is dosed for adult patients, while single-donor cryoprecipitate is dosed for pediatric patients (defined as patients <50 kg in weight). EMR-based dosing guidance replaced a previously required TM consultation when cryoprecipitate pools were ordered, but a consultation remained required for single-unit orders. Usage was defined as thawed cryoprecipitate; wastage was defined as cryoprecipitate that expired prior to transfusion. In the 6 months prior to intervention, 178 ± 13 doses of pooled cryoprecipitate were used per month vs 187 ± 15 doses after the intervention (P = .68). Wastage of pooled cryoprecipitate increased from 7.7% ± 1.5% to 12.7% ± 1.4% (P = .038). There was no change in wastage of pediatric cryoprecipitate doses during the study period. These trends remained unchanged for a full year postimplementation. Electronic dosing guidance resulted in similar cryoprecipitate usage as TM auditing. Increased wastage may result from reduced TM oversight. Product wastage should be balanced against the possibility that real-time audits could delay a lifesaving therapy.

Improved efficiency and patient safety through bespoke electronic thalassaemia care module

ObjectivesTo investigate the impact of electronic medical record (EMR) on improvement of healthcare parameters in a thalassaemia centre located at the Fujairah Hospital, Fujairah, UAE.Materials and methodsA hospital-wide EMR system...

Impact of Electronic Medical Records on Patient-Provider Communication

Previous research found electronic medical records (EMRs) to have negative impact on patient-provider (PP) communication. However, very few studies were focused on specific age ranges especially young generation. The objectives of this study were to: (1) assess the perception of young adults and healthcare providers regarding the effect of EMRs on PP interaction; and (2) investigate the use of cognitive modeling as an analytical tool to predict the impact of EMRs on PP communication. Findings suggested that young adults have positive opinion regarding the use of EMRs during outpatient visits. Cognitive task perfor-mance modeling has the potential to predict visual, cognitive, and motor demands associated with using EMRs. Future studies should be conducted to improve the generalizability of findings.

Dietetics in the digital age: The impact of an electronic medical record on a tertiary hospital dietetic department.

The present study aimed to assess the impact of a hospital-wide electronic medical record (EMR) on the way dietitians collect routine data for their assessments and its impact on their clinical documentation and service provision. Data were collected retrospectively from the following sources: interdepartmental chart audit, the EMR itself (nutrition diagnosis), National Health Roundtable database (admissions requiring nutrition events) and the hospital-wide Pressure Injury Prevention Audits (height, weight and malnutrition screening). There were improvements in medical record accessibility (76.4% pre vs 100% post, P < 0.001), awareness of medical alerts (82.5% unaware pre vs 34.5% unaware post) and legibility of documentation (53.8% pre vs 99.2% post, P < 0.001). Improvements in accessing medical charts under 1 minute also occurred (65.8% pre vs 99.2% post, P < 0.001). The percentage of nutrition diagnoses resolved during admission increased from 20.0% in February 2016 to 34.0% in August 2017. A 72.0% increase in admissions requiring nutrition interventions was found with 4075 admissions pre- and 7035 post-EMR implementation. Time spent per nutrition event reduced by 22.0% (118 minutes pre and 92 minutes post). Hospital audit data revealed mean height and weight collected increased from 79.3 ± 3.8% (n = 8 audits totalling 3041/3834 patients) to 86.0 ± 2.6% (n = 5 audits totalling, 2544/2958 patients) post-EMR with malnutrition screening completion increasing from 57.5% to 74.0%. Findings indicate that EMR implementation has the potential to benefit the dietetic profession due to the potential to enhance the capacity and efficiency of dietetic departments.

A Comparison of Electronic Medical Record Data to Paper Records in Antiretroviral Therapy Clinic in Ethiopia: What is affecting the Quality of the Data?

BackgroundAnti-Retroviral Therapy (ART) care is a lifelong treatment, which needs accurate and reliable data collected for long period of time. Poor quality of medical records data remains a challenge and is directly related to the quality of care of patients. To improve this, there is an increasing trend to implement electronic medical record (EMR) in hospitals. However, there is little evidence on the impact of EMR on the quality of health data in low- resource setting hospitals like Ethiopia. This comparative study aims to fill this evidence gap by assessing the completeness and reliability of paper-based and electronic medical records and explore the challenges of ensuring data quality at the Anti-Retroviral Therapy (ART) clinic at the University of Gondar Referral Hospital in Northwest Ethiopia.MethodsAn institution-based comparative cross-sectional study, supplemented with a qualitative approach was conducted from February 1 to March 30, 2017 at the ART clinic of the University of Gondar Hospital. A total of 250 medical records having both electronic and paper-based versions were collected and assessed. A national ART registration form which consists of 40 ART data elements was used as a checklist to assess completeness and reliability dimensions of data quality on medical records of patients on HIV care. Kappa statistics were computed to describe the level of data agreement between paper-based and electronic records across patient characteristics. In-depth interviews were conducted using semi-structured questionnaires with ten key informants to explore the challenges related with the quality of medical records. Responses of the key informant interviews were analyzed using thematic analysis.ResultsThe overall completeness of medical records was 78% with 95% CI (70.8% - 85.1%) in paper-based and 76% with 95%CI (67.8% - 83.2%) EMR. The data reliability measured in Kappa statistics shows strong agreements on the socio-demographic data such as educational status 0.93 (0.891, 0.963), WHO staging 0.86 (0.808, 0.906); general appearance 0.83 (0.755, 0.892) and patient referral record 0.87 (0.795, 0.932). The major challenges hindering good data quality was the current side by side dual data documentation practice (the need to document both on the paper and the EMR for a single record), patient overload and low data documentation practice of health workers.ConclusionThe overall completeness of ART medical records was still slightly better in paper-based records than EMR. The main reason affecting the EMR data quality was the current dual documentation practice both on the paper and electronic for each patient in the hospital and the high load of patients in the clinic. The hospital management need to decide to use either the paper or the electronic system and build the capacity of health workers to improve data quality in the hospital.

The Impact of Electronic Medical Records on Hospital-Acquired Adverse Safety Events: Differential Effects Between Single-Source and Multiple-Source Systems.

The objective was to examine differential impacts between single-source and multiple-source electronic medical record (EMR) systems, as measured by number of vendor products, on hospital-acquired patient safety events. The data source was the 2009-2010 State Inpatient Databases of the Healthcare Cost and Utilization Project for California, New York, and Florida, and the Information Technology Supplement to the American Hospital Association's Annual Survey. Multivariable regression analyses were conducted to estimate the differential impacts of EMRs between single-source and multiple-source EMR systems on hospital-acquired patient safety events. In all, 1.98% of adult surgery hospitalizations had at least 1 hospital-acquired patient safety event. Basic EMRs with a single vendor or self-developed EMR systems were associated with a significant decrease in patient safety events by 0.38 percentage point, or 19.2%, whereas basic EMRs with multiple vendors had an insignificant association. A single-source EMR system enhances the impact of EMRs on reducing patient safety events.

Impact of Electronic Medical Records on Healthcare Delivery in Kisii Teaching and Referral Hospital

Despite electronic medical record (EMR) systems being in existence since 1972, it’s only recently that governments worldwide have begun to encourage digitalization of medical records (Agency for Healthcare Research and Quality, n.d.). With EMR systems being the current way of hospital management and also delivering healthcare in Kisii Teaching and Referral Hospital (KTRH), there is need for a review of their impact and to understand the challenges faced in their adaptation and use. The objective of the study was to determine the impact of EMR on healthcare delivery in KTRH. A cross-sectional qualitative study was carried out in KTRH among healthcare providers. An interview guide was used to collect data which was coded and analyzed using content analysis. The study revealed that the EMR systems have led to an increase in the productivity of healthcare delivery, better clinical decision making and better collaboration between healthcare providers. The major challenges identified were shortage of funding for the adaptation and utilization of the EMR systems, computer illiteracy among staff and shortage of ICT staff in the facility. The EMR systems in KTRH have had a great impact on health care delivery system by increasing collaboration between personnel, increased productivity of health care providers bringing about patient and provider satisfaction. There is need to increase the amount of funding for the utilization of the systems, to employ more ICT staff and carry out refresher training to the staff so as to increase the benefits of the EMR systems and tackle the shortcomings.

155. Impact of Electronic Medical Records on the Provision of Confidential Reproductive Care to Minors: Legal, Practical and Ethical Considerations

questions about a research study scenario where parental consent was not required for adolescent participation. Data analyzed in SPSS, version 19.0. Results:Respondents (n 153)were predominately female (73.2%), white (87.6%), and had a mean age of 39.4 years (SD 10.4). Most respondents were married or living with a partner (68.0%) and had some college (54.3%). Most respondents had at least one 13-17 year old living with them (58.2%). Most respondents reported it was important for adolescents to participate in H.E.R. about driving (84.7%), birth control (84.9%), STIs (88.9%), and sex education (90.2%). Respondents reported whether 14, 15, 16, and 17 year olds should be allowed to participate in H.E.R., with andwithout parental consent, for driving behavior, preventing teen pregnancy, and preventing sexually transmitted infections (STIs). Topics were grouped by age for analysis. Responses were scored from zero (indicating no participation should be allowed) to three (indicating adolescents should be allowed to participate inH.E.R. on all three topics). A significantmean difference in rank was found indicating that as adolescents aged, respondents increasingly agreed that teens should be allowed to participant in H.E.R with parental consent (x2 (3) 28.7, p .001) with mean rank increases from 2.37 at age 14 to 2.60 at age 17. Additionally, a significantmean difference in rankwas found indicating that as adolescents aged, respondents increasingly agreed that teens should be allowed to participant in H.E.R without parental consent (x2 (3) 131.5, p .001)withmean rank increases from2.02 at age 14 to 2.93 at age 17. Respondentswere then given a description of a research study where teen women could participate in an internet-based intervention without parental consent. Given a list of options, respondents wanted to know who would have access to their daughter’s information (75.2%), study conclusions (70.6%), to view the videos (69.9%), and to view the survey questions (65.4%) with the greatest frequency. They least frequently wanted to know reimbursement for participation (28.1%). Conclusions: Responses to perception questions did not significantly vary by respondent demographics. An open ended question about theoretical study participation elicited a range of supportive and unsupportive comments. For adolescents as young as 14; adults support adolescent participation in H.E.R. with and without parental consent. Support increases with older adolescents. Given options, adult respondents express concerns about privacy of information; have an interest in study outcomes and study content; and are least concerned about reimbursement for participation. Sources of Support: Subcontract through CarnegieMellon University with DHHROffice of Adolescent Health (5 TP1A40-03-00).

Impact of electronic medical record on physician practice in office settings: a systematic review.

BackgroundIncreased investments are being made for electronic medical records (EMRs) in Canada. There is a need to learn from earlier EMR studies on their impact on physician practice in office settings. To address this need, we conducted a systematic review to examine the impact of EMRs in the physician office, factors that influenced their success, and the lessons learned.ResultsFor this review we included publications cited in Medline and CINAHL between 2000 and 2009 on physician office EMRs. Studies were included if they evaluated the impact of EMR on physician practice in office settings. The Clinical Adoption Framework provided a conceptual scheme to make sense of the findings and allow for future comparison/alignment to other Canadian eHealth initiatives.In the final selection, we included 27 controlled and 16 descriptive studies. We examined six areas: prescribing support, disease management, clinical documentation, work practice, preventive care, and patient-physician interaction. Overall, 22/43 studies (51.2%) and 50/109 individual measures (45.9%) showed positive impacts, 18.6% studies and 18.3% measures had negative impacts, while the remaining had no effect. Forty-eight distinct factors were identified that influenced EMR success. Several lessons learned were repeated across studies: (a) having robust EMR features that support clinical use; (b) redesigning EMR-supported work practices for optimal fit; (c) demonstrating value for money; (d) having realistic expectations on implementation; and (e) engaging patients in the process.ConclusionsCurrently there is limited positive EMR impact in the physician office. To improve EMR success one needs to draw on the lessons from previous studies such as those in this review.

The Impact of Electronic Medical Records on Nursing Efficiency

The authors review the literature and describe the potential impact of electronic medical records on nursing efficiency, as measured by a reduction in the amount of time nurses spend on activities that are not part of direct patient care. They also identify factors leading to success or failure in achieving electronic medical record-enabled nursing efficiency and illustrate their impact using a case study.

Electronic Medical Records, HIPAA, and Patient Privacy

The continued growth of healthcare information systems (HCIS) promises to improve quality of care, lower costs, and streamline the entire healthcare system. But the resulting dependence on electronic medical records (EMRs) has also kindled patient concern about who has access to sensitive medical records. Healthcare organizations are obliged to protect patient records under HIPAA. The purpose of this study is to develop a formal privacy policy to protect the privacy and security of EMRs. This article describes the impact of EMRs and HIPAA on patient privacy in healthcare. It proposes access control and audit log policies to safeguard patient privacy. To illustrate the best practices in the healthcare industry, this article presents the case of the University of Texas M. D. Anderson Cancer Center. The case demonstrates that it is critical for a healthcare organization to have a privacy policy.

The Impact of Electronic Medical Records on Improvement of Health Care Delivery

(2008). The Impact of Electronic Medical records on improvement of health care delivery. Libyan Journal of Medicine: Vol. 3, No. 1, pp. 4-4.