Potential Of Electronic Health Records Research Articles

Towards Automated Evaluation of Patient Centered Care-Assessing the Potential of Electronic Health Records.

Providing patient centered care is a crucial element of high quality care. It can be defined as a responsive way of caring for and empowering patients, embodying compassion, empathy, and responsiveness to the patient's needs. The aim of this study was to assess the potential of using EHRs as information source in the development of tools for assessing PCC. An annotation guide following the Person-centred Practice Framework proposed by McCance and McCormack was developed for the purpose of this study. Twenty patients' documents were manually annotated, resulting in 539 expressions. All dimensions of the framework were covered in the documents, with 61.3% of expressions describing the activity of engaging authentically with the patient. The results of this study indicate that electronic health records are one potential source of information in automated evaluation of patient centered care, however more information is still needed on how to interpret this information.

Integration of Biobanks in National eHealth Ecosystems Facilitating Long-Term Longitudinal Clinical-Omics Studies and Citizens' Engagement in Research Through eHealthBioR.

Biobanks have long existed to support research activities with BBMRI-ERIC formed as a European research infrastructure supporting the coordination for biobanking with 20 country members and one international organization. Although the benefits of biobanks to the research community are well-established, the direct benefit to citizens is limited to the generic benefit of promoting future research. Furthermore, the advent of General Data Protection Regulation (GDPR) legislation raised a series of challenges for scientific research especially related to biobanking associate activities and longitudinal research studies. Electronic health record (EHR) registries have long existed in healthcare providers. In some countries, even at the national level, these record the state of the health of citizens through time for the purposes of healthcare and data portability between different providers. The potential of EHRs in research is great and has been demonstrated in many projects that have transformed EHR data into retrospective medical history information on participating subjects directly from their physician's collected records; many key challenges, however, remain. In this paper, we present a citizen-centric framework called eHealthBioR, which would enable biobanks to link to EHR systems, thus enabling not just retrospective but also lifelong prospective longitudinal studies of participating citizens. It will also ensure strict adherence to legal and ethical requirements, enabling greater control that encourages participation. Citizens would benefit from the real and direct control of their data and samples, utilizing technology, to empower them to make informed decisions about providing consent and practicing their rights related to the use of their data, as well as by having access to knowledge and data generated from samples they provided to biobanks. This is expected to motivate patient engagement in future research and even leads to participatory design methodologies with citizen/patient-centric designed studies. The development of platforms based on the eHealthBioR framework would need to overcome significant challenges. However, it would shift the burden of addressing these to experts in the field while providing solutions enabling in the long term the lower monetary and time cost of longitudinal studies coupled with the option of lifelong monitoring through EHRs.

Accessing routinely collected health data to improve clinical trials: recent experience of access

BackgroundRoutinely collected electronic health records (EHRs) have the potential to enhance randomised controlled trials (RCTs) by facilitating recruitment and follow-up. Despite this, current EHR use is minimal in UK RCTs, in part due to ongoing concerns about the utility (reliability, completeness, accuracy) and accessibility of the data. The aim of this manuscript is to document the process, timelines and challenges of the application process to help improve the service both for the applicants and data holders.MethodsThis is a qualitative paper providing a descriptive narrative from one UK clinical trials unit (MRC CTU at UCL) on the experience of two trial teams’ application process to access data from three large English national datasets: National Cancer Registration and Analysis Service (NCRAS), National Institute for Cardiovascular Outcomes Research (NICOR) and NHS Digital to establish themes for discussion. The underpinning reason for applying for the data was to compare EHRs with data collected through case report forms in two RCTs, Add-Aspirin (ISRCTN 74358648) and PATCH (ISRCTN 70406718).ResultsThe Add-Aspirin trial, which had a pre-planned embedded sub-study to assess EHR, received data from NCRAS 13 months after the first application. In the PATCH trial, the decision to request data was made whilst the trial was recruiting. The study received data after 8 months from NICOR and 15 months for NHS Digital following final application submission. This concluded in May 2020. Prior to application submission, significant time and effort was needed particularly in relation to the PATCH trial where negotiations over consent and data linkage took many years.ConclusionsOur experience demonstrates that data access can be a prolonged and complex process. This is compounded if multiple data sources are required for the same project. This needs to be factored in when planning to use EHR within RCTs and is best considered prior to conception of the trial. Data holders and researchers are endeavouring to simplify and streamline the application process so that the potential of EHR can be realised for clinical trials.

Habits of Highly Effective Alerting: Improved alert acceptance while reducing cognitive 'clutter'

Introduction Optimization of alerts in the electronic health records (EHR) has shown to be effective at improving efficacy and realizing some of the potential of EHRs. This project presents an overall alert strategy to improve efficacy: removing alerts that failed to achieve their clinical goals, curating those which were being overridden frequently, and adhering to a strict discipline of alert performance and taxonomy. The goal was to increase the desired behaviors the alerts were designed to achieve as reflected in increased alert acceptance. Methods An alert reduction strategy was deployed …

Delivering healthcare's 'triple aim': electronic health records and the health research participant in the UK National Health Service.

The UK National Health Service (NHS) is changing. Consecutive UK industrial strategies have supported the shift from an NHS that provides free-at-point-of-delivery healthcare to one that also facilitates research. Said to promote healthcare's triple aim of 'better health, better healthcare, and lower cost' (Wachter, 2016, 3), the digitisation of patient records is a core part in opening routine aspects of the health system to potential research. In this paper, we thematically analyse 11 policy documents and ask, how does the NHS discuss its decision to digitise patient records and what are the implications of such practices on the citizen? We document how (1) digitisation is presented as a collective endeavour for patients and NHS professionals, offering new possibilities for patients to participate in their own health and that of the population through research and, (2) digitisation contributes to the building of an efficient health system. Through this analysis we reflect on how discussions of digitisation present uncritically the potential of Electronic Health Records and big data analytics to improve care and generate wealth through research, and reconfigure patienthood, by placing research participation as a routine part of accessing NHS healthcare.

Unlocking the Potential of Electronic Health Records for Health Research.

Electronic health records (EHRs), originally designed to facilitate health care delivery, are becoming a valuable data source for health research. EHR systems have two components, both of which have various components, and points of data entry, management, and analysis. The “front end” refers to where the data are entered, primarily by healthcare workers (e.g. physicians and nurses). The second component of EHR systems is the electronic data warehouse, or “back-end,” where the data are stored in a relational database. EHR data elements can be of many types, which can be categorized as structured, unstructured free-text, and imaging data. The Sunrise Clinical Manager (SCM) EHR is one example of an inpatient EHR system, which covers the city of Calgary (Alberta, Canada). This system, under the management of Alberta Health Services, is now being explored for research use. The purpose of the present paper is to describe the SCM EHR for research purposes, showing how this generalizes to EHRs in general. We further discuss advantages, challenges (e.g. potential bias and data quality issues), analytical capacities, and requirements associated with using EHRs in a health research context.

Significant EHR Feature-Driven T2D Inference: Predictive Machine Learning and Networks.

Background: Electronic health records (EHR) play an important role for the redefinition of phenotypes in view of the wealth and heterogeneity of information now available from disparate data sources. A recent cross-sectional retrospective study has described the potential of EHR toward type 2 diabetes mellitus (T2D) screening when ad hoc models are used. About 10,000 US patients have been analyzed through a variety of inference techniques applied to all records with a variable degree of completeness. The analyses conducted in the reference study have indicated that EHR phenotypes significantly improved T2D detection.Methods: With these US patients and the T2D data evidenced in the above study, we propose an integrative inference approach that leverages the prediction power of EHR features selected by two well-known methods, Random Forests and Lasso. The goal is 2-fold: reducing the Big Data redundancies potentially harmful to the predictive learning task and exploiting the interconnectivity of EHR features. A mutual information (MI) network is the inference tool used to identify communities useful to prioritize significant T2D features underlying the similarity between patients.Results: Endowed with a different degree of granularity, the communities detected after the application of both methods were centered especially on T2D comorbidities and risk factors. As such, they appear very relevant for assessment of two main issues, T2D disease burden, and prevention.Conclusions: Our analytical approach offers a solution for managing the EHR scale factor in a complex disease context. EHR are rich sources of phenotypic diversity through which novel stratifications of patients are expected. To enable these results, both pre-screening of variables and calibration of risk prediction methods become necessary steps in EHR analyses. We have presented networks identifying major T2D communities. The specific significance assigned to comorbidities and risk factors in relation to T2D can be inferred with accuracy from just a suitably reduced number of EHR features.

Variation in electronic health record adoption in European public hospitals: a configurational analysis of key functionalities

The potential of electronic health record (EHR) to support the delivery of health care and save money and lives is well recognized; and their association with performance relies on the patterns of functionalities that are used by clinicians. However, the majority of research has investigated EHR adoption with a dichotomous dependent variable measuring EHR adoption or not. Other have studied individual EHR component or functionality. While these studies have contributed to understanding of EHR adoption, they provide an incomplete picture of hospital EHR capabilities and the study of EHR functionalities and associated configuration has only begun to be examined in detail, knowledge of which may generate important insights on actual practices of hospitals. It will assist healthcare executives to consider basing their decisions on empirically grounded knowledge rather than on purely normative discourses. Based on configurational approach, we use factor analysis and cluster analysis to uncover clusters of European public hospitals with similar patterns of EHR key functionalities made available to clinicians. As well we investigate the relationship between these patterns and hospital characteristics. Drawing on data from the European Hospital Survey, we empirically derive a 3-cluster solution, composed of three well-separated groups, from a data set of 711 European public hospitals. We find in addition that the three configurations exhibit great heterogeneity with regard to their polarity; that is the number and the nature of dominant categories of EHR key functionalities within each cluster. The three hospital profiles are: unipolar – hospitals with one dominant category of EHR functionalities (28% of the sample), tripolar - hospitals with three dominant categories of EHR functionalities (55%), and apolar - hospitals with no dominant category of EHR functionalities (17%), with tripolar being the largest and the most sophisticated. In particular, all the three clusters are distinct in terms of availability of key EHR functionalities namely, medical documentation, results viewing, and medication and prescription list functionalities available to their clinicians. The study also reveals the conditions under which these configuration occur. Our results provide an empirically and conceptually grounded taxonomy of European public hospitals with regard to EHR key functionalities.

Developing a new model for patient recruitment in mental health services: a cohort study using Electronic Health Records

ObjectivesTo develop a new model for patient recruitment that harnessed the full potential of Electronic Health Records (EHRs). Gaining access to potential participants’ health records to assess their eligibility for...

The electronic health record: boon or bust for good patient care?

The electronic health record: boon or bust for good patient care?

The Association Between Insurance Status and Cervical Cancer Screening in Community Health Centers: Exploring the Potential of Electronic Health Records for Population-Level Surveillance, 2008–2010

IntroductionCervical cancer incidence and mortality rates in the United States have decreased 67% over the past 3 decades, a reduction mainly attributed to widespread use of the Papanicolaou (Pap) test for cervical cancer screening. In the general population, receipt of cervical cancer screening is positively associated with having health insurance. Less is known about the role insurance plays among women seeking care in community health centers, where screening services are available regardless of insurance status. The objective of our study was to assess the association between cervical cancer screening and insurance status in Oregon and California community health centers by using data from electronic health records.MethodsWe used bilevel log-binomial regression models to estimate prevalence ratios and 95% confidence intervals for receipt of a Pap test by insurance status, adjusted for patient-level demographic factors and a clinic-level random effect.ResultsInsurance status was a significant predictor of cervical cancer screening, but the effect varied by race/ethnicity and age. In our study uninsured non-Hispanic white women were less likely to receive a Pap test than were uninsured women of other races. Young, uninsured Hispanic women were more likely to receive a Pap test than were young, fully insured Hispanic women, a finding not previously reported.ConclusionElectronic health records enable population-level surveillance in community health centers and can reveal factors influencing use of preventive services. Although community health centers provide cervical cancer screening regardless of insurance status, disparities persist in the association between insurance status and receipt of Pap tests. In our study, after adjusting for demographic factors, being continuously insured throughout the study period improved the likelihood of receiving a Pap test for many women.

Possibilities and Implications of Using the ICF and Other Vocabulary Standards in Electronic Health Records

There is now widespread recognition of the powerful potential of electronic health record (EHR) systems to improve the health-care delivery system. The benefits of EHRs grow even larger when the health data within their purview are seamlessly shared, aggregated and processed across different providers, settings and institutions. Yet, the plethora of idiosyncratic conventions for identifying the same clinical content in different information systems is a fundamental barrier to fully leveraging the potential of EHRs. Only by adopting vocabulary standards that provide the lingua franca across these local dialects can computers efficiently move, aggregate and use health data for decision support, outcomes management, quality reporting, research and many other purposes. In this regard, the International Classification of Functioning, Disability, and Health (ICF) is an important standard for physiotherapists because it provides a framework and standard language for describing health and health-related states. However, physiotherapists and other health-care professionals capture a wide range of data such as patient histories, clinical findings, tests and measurements, procedures, and so on, for which other vocabulary standards such as Logical Observation Identifiers Names and Codes and Systematized Nomenclature Of Medicine Clinical Terms are crucial for interoperable communication between different electronic systems. In this paper, we describe how the ICF and other internationally accepted vocabulary standards could advance physiotherapy practise and research by enabling data sharing and reuse by EHRs. We highlight how these different vocabulary standards fit together within a comprehensive record system, and how EHRs can make use of them, with a particular focus on enhancing decision-making. By incorporating the ICF and other internationally accepted vocabulary standards into our clinical information systems, physiotherapists will be able to leverage the potent capabilities of EHRs and contribute our unique clinical perspective to other health-care providers within the emerging electronic health information infrastructure.

It’s Past Time To Get Serious About Transforming Care

It’s Past Time To Get Serious About Transforming Care

Unlocking the Potential of Electronic Health Records for Translational Research

To review current excellent research and trend in the field of bioinformatics and translational informatics with direct application in the medical domain. Synopsis of the articles selected for the IMIA Yearbook 2012. Six excellent articles were selected in this Yearbook's section on Bioinformatics and Translational Informatics. They exemplify current key advances in the use of patient information for translational research and health surveillance. First, two proof-of-concept studies demonstrated the cross-institutional and -geographic use of Electronic Health Records (EHR) for clinical trial subjects identification and drug safety signals detection. These reports pave ways to global large-scale population monitoring. Second, there is further evidence on the importance of coupling phenotypic information in EHR with genotypic information (either in biobank or in gene association studies) for new biomedical knowledge discovery. Third, patient data gathered via social media and self-reporting was found to be comparable to existent data and less labor intensive. This alternative means could potentially overcome data collection challenge in cohort and prospective studies. Finally, it can be noted that metagenomic studies are gaining momentum in bioinformatics and system-level analysis of human microbiome sheds important light on certain human diseases. The current literature showed that the traditional bench to bedside translational research is increasing being complemented by the reverse approach, in which bedside information can be used to provide novel biomedical insights.

Implementing Electronic Health Record-Based Quality Measures for Developmental Screening

The goal was to examine the current abilities and future potential of electronic health record (EHR) systems to measure childhood developmental screening and follow-up rates in primary care settings. A group of pediatric clinicians and health informatics experts was convened to develop quality indicators reflecting different aspects of the developmental screening process. These indicators included the administration of a standardized, validated instrument to screen children for developmental delays, the documentation of abnormal screening results, and the provision of follow-up care. Six integrated provider systems across the United States, with fully implemented EHR systems, were evaluated to determine the feasibility of implementing these measures within each system. Barriers related to measure implementation were identified. The EHR systems of all 6 health care organizations could implement measures examining developmental screening rates and could identify and track children with abnormal screening results. However, most of the systems did not have the ability to capture data for more-complex EHR-based measures. In particular, data elements based on workflow actions could not be captured with current EHR system designs. This study identified 2 main barriers to the implementation of developmental quality measures: concerns about data reliability and the tracking of care coordination within patient records. Potential solutions to these problems, including terminology standardization, patient portal use, and use of a single developmental screening instrument, are discussed.

On the Potential Role of Independent Personal Health Record Platforms in the Digitization and Sharing of Health Records

As the United States begins to put a lot of attention and resources into digitizing its healthcare sector, it is instructive to understand why the adoption of electronic health records (EHR) remains so poor when compared with many other developed countries. The 2009 stimulus bill provides significant incentives for providers to digitize their records, but unless the records are made interoperable, the full potential of EHR will never be realized. We posit that the emergence of the independent personal health record (PHR) platforms from organizations such as Microsoft and Google is a major development towards the cause of interoperable health records. Not only do these platforms have a vested interest in facilitating interoperability, but they also can help promote the adoption of EHR among healthcare providers. In a pluralistic healthcare system like that which exists in the United States, where healthcare providers lack the incentive for adopting EHR and government intervention is often not the preferable solution, we believe that PHRs should be the focus of the debate on achieving interoperability in the healthcare sector.