Role Of Electronic Health Record Research Articles

Electronic health records and clinical documentation in medical residency programs: preparing residents to become master clinicians.

The ubiquity of electronic health records (EHRs) has made incorporating EHRs into medical practice an essential component of resident's training. Patient encounters, an important element of practice, are impacted by EHRs through factors that include increasing documentation requirements. This research sheds light on the role of EHRs on resident clinical skills development with emphasis on their role in patient encounters. We conducted qualitative semistructured interviews with 32 residents and 13 clinic personnel at an internal medicine residency program in a western US medical school focusing on the resident's clinic rotation. Residents were learning to use the EHR to support and enhance their patient encounters, but one factor making that more challenging for many was the need to address quality measures. Quality measures could shift attention away from the primary reason for the encounter and addressing them consumed time that could have been spent diagnosing and treating the patient's chief complaint. A willingness to learn on-the-job by asking questions was important for resident development in using the EHR to support their work and improve their clinical skills. Creating a culture where residents seek guidance on how to use the EHR and incorporate it into their work will support residents on their journey to become master clinicians. Shifting some documentation to the patient and other clinicians may also be necessary to keep from overburdening residents. Residency programs must support residents as they develop their clinical skills to practice in a world where EHRs are ubiquitous.

The Role of Electronic Health Records in Monitoring Communicable Diseases: The Case of Saudi Arabia

The Role of Electronic Health Records in Monitoring Communicable Diseases: The Case of Saudi Arabia

Artificial intelligence in personalized cardiovascular medicine and cardiovascular imaging.

The collection of large, heterogeneous electronic datasets and imaging from patients with cardiovascular disease (CVD) has lent itself to the use of sophisticated analysis using artificial intelligence (AI). AI techniques such as machine learning (ML) are able to identify relationships between data points by linking input to output variables using a combination of different functions, such as neural networks. In cardiovascular medicine, this is especially pertinent for classification, diagnosis, risk prediction and treatment guidance. Common cardiovascular data sources from patients include genomic data, cardiovascular imaging, wearable sensors and electronic health records (EHR). Leveraging AI in analysing such data points: (I) for clinicians: more accurate and streamlined image interpretation and diagnosis; (II) for health systems: improved workflow and reductions in medical errors; (III) for patients: promoting health with further education and promoting primary and secondary cardiovascular health prevention. This review addresses the need for AI in cardiovascular medicine by reviewing recent literature in different cardiovascular imaging modalities: electrocardiography, echocardiography, cardiac computed tomography, cardiac nuclear imaging, and cardiac magnetic resonance (CMR) imaging as well as the role of EHR. This review aims to conceptulise these studies in relation to their clinical applications, potential limitations and future opportunities and directions.

The Role of Electronic Health Records in Advancing Genomic Medicine.

Recent advances in genomic technology and widespread adoption of electronic health records (EHRs) have accelerated the development of genomic medicine, bringing promising research findings from genome science into clinical practice. Genomic and phenomic data, accrued across large populations through biobanks linked to EHRs, have enabled the study of genetic variation at a phenome-wide scale. Through new quantitative techniques, pleiotropy can be explored with phenome-wide association studies, the occurrence of common complex diseases can be predicted using the cumulative influence of many genetic variants (polygenic risk scores), and undiagnosed Mendelian syndromes can be identified using EHR-based phenotypic signatures (phenotype risk scores). In this review, we trace the role of EHRs from the development of genome-wide analytic techniques to translational efforts to test these new interventions to the clinic. Throughout, we describe the challenges that remain when combining EHRs with genetics to improve clinical care.

Determining the Role of Electronic Health Records in Quality of Services of Health Centers in Najafabad City, Iran

Determining the Role of Electronic Health Records in Quality of Services of Health Centers in Najafabad City, Iran

A Help or a Hindrance: The Role of Electronic Health Records in Implementing New Practices in Community Mental Health Clinics.

Practice innovation requires adequate organizational resources. Electronic health records (EHRs) are a key organizational resource affecting routine practice delivery, although their capacity to support practice innovation in mental health is largely unknown. This study examined the influence of EHR availability on community mental health clinic (CMHC) providers' fidelity to person-centered care planning (PCCP), an emergent practice that integrates person-centered principles into the mental health service planning process. Participants included direct providers and supervisors implementing PCCP in seven CMHCs. Fidelity to PCCP was measured by using chart reviews of 378 service plans across three time points. Mixed-effects regression models were used to examine the influence of EHR availability on fidelity to PCCP at each time point. Findings suggest that EHRs did not influence PCCP delivery at baseline but were positively associated with fidelity postimplementation. EHRs are an organizational resource that can support practice innovation in mental health when paired with clinic-wide implementation efforts.

1049. Using Alternative Alerts in the Electronic Health Record to Guide Antimicrobial Selection Decisionmaking at the Point of Order Entry

BackgroundIn a White Paper published in 2019, SHEA describes “The role of electronic health record and ‘add-on’ clinical decision support systems to enhance antimicrobial stewardship programs.” Modifications of the electronic health record and add-on clinical decision support systems are compared and contrasted. Some disadvantages of modification of the EHR include the need to include all end-user affiliates in modifications, lack of order set utilization, and heavy demands of IT staff to modify the EHR. We have utilized alternative alerts which may be customized to individual affiliates and are relatively easy to build which fire when specific medications are ordered (whether within order sets or not) and guide clinicians to more appropriate antibiotic choices.MethodsFrom an antimicrobial stewardship perspective, alternative alerts are activated during the ordering of antibiotics for which routine use is discouraged (e.g., carbapenems, fluoroquinolones). When a provider enters an order, the alternative alert will pop up. The alert consists of two sections: an alert section describing the reason for the alert and a list of therapeutic options for the targeted drug; and links to orders for alternative antibiotics/combinations. The alerts may be configured to allow or not allow the orderer to continue with the original order. Different alternative alerts can be created and used at different facilities using the same EHR platform. We designed alternative alerts for fluoroquinolones, carbapenems, and fifth-generation cephalosporins that allowed providers to continue with the original order. We tested their impact on antimicrobial prescribing for 18 months after implementation, measured as quarterly days of therapy (DOT)/1000 pt-days.ResultsWe noted marked reductions in quarterly DOT/1000 pt-days for fluoroquinolones (-70%) and fifth-generation cephalosporins (-90%). The impact on carbapenem prescribing was more variable.ConclusionAlternative alerts represent an easily created, customizable means to guide providers’ antimicrobial selections. We plan to incorporate more alternative alerts into our antimicrobial ordering process and strengthen the alert for carbapenems. Disclosures All authors: No reported disclosures.

The Role of Electronic Health Records in Improving Communication Between Health Professionals in Primary Healthcare Centres in Riyadh: Perception of Health Professionals.

Improving communication among healthcare providers is one of the critical components of safe and quality patient care. The study objective is to examine how occupation and training of health professionals in Riyadh, Saudi Arabia influence professionals' perception of the role of electronic health records (EHRs) in improving communication between healthcare providers in primary healthcare centres. A survey-based study method employing a descriptive, cross-sectional design was used. Health professionals' occupation and training were found to influence their perception of the role of the EHR in improving interprofessional communication. Physicians and professionals with training on EHRs had the highest rating for the system's role in improving communication between healthcare professionals. All healthcare providers should embrace EHR systems in their practice to promote interprofessional communication and collaboration in the patient care process.

The role of electronic health record and "add-on" clinical decision support systems to enhance antimicrobial stewardship programs.

Increasingly, demands are placed on healthcare systems to meet antimicrobial stewardship standards and reporting requirements. This trend, combined with reduced financial and personnel resources, has created a need to adopt information technology (IT) to help ease these burdens and facilitate action. The incorporation of IT into an antimicrobial stewardship program can help improve stewardship intervention efficiencies and facilitate the tracking and reporting of key metrics, including outcomes. This paper provides a review of the stewardship-related functionality within these IT systems, describes how these platforms can be used to improve antimicrobial use, and identifies how they can support current and potential future antimicrobial stewardship regulatory and accreditation standards. Finally, recommendations to help close the gaps in existing systems are provided and suggestions for future areas of development within these programs are delineated.

Oncologists' Views Regarding the Role of Electronic Health Records in Care Coordination.

Electronic health records (EHRs) play a significant role in complex health care processes, especially in information transfer with patients and care coordination among providers. EHRs may also generate unintended consequences, introducing new patient safety risks. To date, little investigation has been performed in oncology settings, despite the need for quality provider-patient communication and information transfer during oncology visits. In this qualitative study, we focused on oncology providers' perceptions of EHRs for supporting communication with patients and coordination of care with other providers. We conducted semistructured interviews with oncologists from an urban academic medical center to learn their perceptions of the use of EHRs before, during, and after clinic visits with patients. Our interview guide was developed on the basis of the work system model. We coded transcripts using inductive content analysis. Data analysis yielded four main themes regarding oncologists' practices in using the EHR and perceptions about EHRs: (1) EHR use for care coordination (eg, timeliness of receiving information, SmartSet documentation); (2) EHR use in the clinic visit (eg, educating patients, using as a reinforcement tool); (3) safety hazards in care coordination associated with EHRs (eg, incomplete documentation, error propagating, no filtering mechanism to capture errors); and (4) suggestions for improvements (eg, improved SmartSet functionalities, simplification of user interface). Current EHRs do not adequately support teamwork of oncology providers, which could lead to potential hazards in the care of patients with cancer. Redesigning EHR features that are tailored to support oncology care and addressing the concerns regarding information overload, improved organization of flagging abnormal results, and documentation-related workload are needed to minimize potential safety hazards.

The Role of Using EHR on Improving the Quality of Health Care in the Health Centers in Jordan

This study aims at investigating the role of EHR (electronic health record) on improving the quality of health care in the health centers in Jordan. A questionnaire was used as a tool to collect the primary data of the study out from the study sample that is consisted of (200) workers in the health centers in Jordan who were chosen randomly form all the job ranks in the health sector in Jordan. The study tool composed of four parts that examined the level of using EHR in Jordan, the effect of using it, the main challenges facing its implementation and the readiness that those centers have to have such technology in terms of human and organizational skills. The results showed that there is a high level of implementing EHR system in the health centers in Jordan, where those centers are equipped with the needed human and organizations skills. Reducing the effort, time, cost and affording safe treatment are the effects of implementing the electronic health record in the Jordanian health centers. The results showed also that the time spent and complicated interface are the major challenges facing implementing the EHR system.

SABER and MyDispense: Building better pharmacy education through innovation and sharing

Information technology (IT) is increasingly a part of everyday life for health professionals. Technology such as decision support systems (DSS) and electronic health records (EHR) have great potential in improving practice efficiency and standard, and improve patient outcomes; however, like most health IT, available programs are often lacking in usability and efficiency. To improve the quality of IT available, health professionals need to be actively involved in the developmental process, from early planning stages to final testing and feedback. Aims: To gain insight into the role of IT in the health sector and pharmacy. To explore what the general requirements are of complex DSS used by health professionals. To discuss if and how these requirements change depending on practice setting. To gain insight into what skills are needed to be involved in different stages of health IT development. Learning objectives: By the end of the session participants should be able to: Describe the different types of IT used in the health sector and pharmacy. Describe the role of EHR, computer physician order entry systems dispensing systems, DSS and how these systems are related. Involved in the development of a usable health IT. Description of Workshop Activities: This workshop is aimed at health practitioners, researchers, policy makers, and other parties interested in health IT. During this workshop participants will be shown a short presentation describing a) different types of health IT, and b) the development process of a prototype DSS to illustrate how health professionals can be involved in health IT development. This will be followed by small group discussions on the requirements for DSS in clinical practice and various environments, a demonstration of a DSS developed by the authors, and feedback. Additional information (if required): N/A

Health Professional Involvement in Health Information Technology Development: What Can Your Do to Improve Them?

Information technology (IT) is increasingly a part of everyday life for health professionals. Technology such as decision support systems (DSS) and electronic health records (EHR) have great potential in improving practice efficiency and standard, and improve patient outcomes; however, like most health IT, available programs are often lacking in usability and efficiency. To improve the quality of IT available, health professionals need to be actively involved in the developmental process, from early planning stages to final testing and feedback. Aims: To gain insight into the role of IT in the health sector and pharmacy. To explore what the general requirements are of complex DSS used by health professionals. To discuss if and how these requirements change depending on practice setting. To gain insight into what skills are needed to be involved in different stages of health IT development. Learning objectives: By the end of the session participants should be able to: Describe the different types of IT used in the health sector and pharmacy. Describe the role of EHR, computer physician order entry systems dispensing systems, DSS and how these systems are related. Involved in the development of a usable health IT. Description of Workshop Activities: This workshop is aimed at health practitioners, researchers, policy makers, and other parties interested in health IT. During this workshop participants will be shown a short presentation describing a) different types of health IT, and b) the development process of a prototype DSS to illustrate how health professionals can be involved in health IT development. This will be followed by small group discussions on the requirements for DSS in clinical practice and various environments, a demonstration of a DSS developed by the authors, and feedback. Additional information (if required): N/A

A review of the role of electronic health record in genomic research.

Electronic health record (EHR)-driven genomic research is a recent strategy used to answer research questions using EHR data linked to DNA samples. In models using EHR, after the subject's DNA is collected, a linkage between the DNA sample and the EHR data is maintained. This makes the EHR the paramount source of phenotypic information. The National Human Genome Research Institute sponsored Electronic Medical Records and Genomics (eMERGE) network began in five sites in 2007 and was expanded to nine sites in 2012. This network has developed the methods and best practices for utilizing EHR as a tool for genomic research. Therefore, it is vital to understand the configuration of EHR used to capture data in clinical practice and feasibility of integration with clinical genetic test results. We present a detailed review of the role and importance of EHR in the field of genomic research.

Design Principles in Health Information Technology

Electronic health record (EHR) systems are said to be the cornerstone of a modernized health service. They improve health care, allow for integrated information, and help prevent lost and duplicated records as well as occurrence of administrative errors. Studies have consistently shown, however, that introducing EHR systems is a complex task, with difficulties stemming from technical designs that fit poorly with the details of clinical work practices. Given the evolving role of EHRs and the importance of information design, the need exists for further exploration of EHRs with the purpose of advancing innovations in health IT with the potential for significant positive effects on clinical practice. This paper focuses on a subfield of EHR studies that is working to establish a foundation for applying information design principles to implementation of health information technology in primary care settings. Without loss of generality, the paper examines a specific attempt that includes documenting patterns of clinician information use and developing “use cases” and tools for evaluating EHR implementation. The paper proposes an alternative approach based on a new flow-based specification methodology. It is shown that the method can be applied uniformly at the conceptual requirements level and simultaneously at the user interface level. The new method seems to be a viable technique for expressing situations arising in clinical work practices.

Reducing the Costs of U.S. Health Care: The Role of Electronic Health Records

In this issue, Adler-Milstein and colleagues address the relationship between the use of EHRs and the costs of health care and found that EHRs in a community-based setting seem to slow ambulatory c...

Evidence for Electronic Health Record Systems in Physical Therapy

With increasing pressures to better manage clinical information, we investigated the role of electronic health record (EHR) systems in physical therapist practice through a critical review of the literature. We reviewed studies that met our predefined criteria after independent review by 3 authors. The investigators in all of the reviewed studies reported benefits, including improved reporting, operational efficiency, interdepartmental communication, data accuracy, and capability for future research. In 7 studies, the investigators reported barriers, including challenges with behavior modification, equipment inadequacy, and training. The investigators in all studies reported key success factors, including end-user participation, adequate training, workflow analysis, and data standardization. This review suggests that EHRs have potential benefits for physical therapists. The authors formed the following recommendations based on the studies' themes: (1) incorporate workflow analysis into system design and implementation; (2) include end users, especially clinicians, in system development; (3) devote significant resources for training; (4) plan and test carefully to ensure adequate software and hardware performance; and (5) commit to data standards.

Informed consent to the secondary use of EHRs: informatic rights and their limitations.

It is frequently asserted that the secondary use of data contained in electronic health records (EHRs) requires the informed consent of the subjects of these records. This paper argues that while correct in principle, this has four important ethically based limitations: when it seriously threatens the equal and competing right of others, when it undermines the ability of health care providers to carry out their mandates, when it imperils the possibility of establishing and maintaining a health care system in the first place, and when it makes bona fide research impossible. Nevertheless, as a general rule, when consent can be had, it should be had. This paper provides a theoretical basis for these claims by looking at the nature and role of EHRs and provides some possible approaches for incorporating them into the health care delivery process.