Electronic Health Record Usability Research Articles

Electronic Health Records Sharing Based on Consortium Blockchain.

In recent years, Electronic health records (EHR) has gradually become the mainstream in the healthcare field. However, due to the fact that EHR systems are provided by different vendors, data is dispersed and stored, which leads to the phenomenon of data silos, making medical information too fragmented and bringing some challenges to current medical services. Therefore, in view of the difficulties in sharing EHR between medical institutions, the risk of privacy leakage, and the lack of EHR usage control by patients, an EHR sharing model based on consortium blockchain is proposed in this paper. Firstly, the Interplanetary File System is combined with consortium blockchain, which forms a hybrid storage scheme of EHR, this technology effectively improves data security, privacy protection, and operational efficiency. Secondly, the model combines unidirectional multi-hop conditional proxy re-encryption based on type and identity with distributed key generation technology to achieve secure EHR sharing with fine grained control. At the same time, users are required to link the operation records of EHR, so as to realize the traceability of EHR usage. A dynamic Byzantine fault-tolerant algorithm based on reputation and clustering is then proposed to solve the problems of arbitrary master node selection, high latency and low throughput of PBFT, enabling the nodes to reach consensus more efficiently. Finally, the model is analyzed in terms of security and user control, showing that the model is less energy intensive in terms of communication overhead and time consumption, and can effectively achieve secure sharing between medical data.

Challenge of electronic health record interface: literature review

Abstract. Electronic Health Record (EHR) differences from the traditional patient medical history in which everything related to the patients past visits and records such as family history or lab results are being stored electronically. This system is supposed to innovate the world of healthcare into the next step as it intends to provide different advantages such as ensure transparency cross different medical institute and enhance quality of care. However, due to the lack of different aspects, there are some major flaws with HER. This literature review explores the challenges of EHR interface design and its impact on healthcare providers across various medical settings. The paper demonstrates through research that the significant effects of EHR usability on provider efficiency and error rates, highlighting a notable disconnect between the design of these systems and the practical needs of their users. In addition, the review reveals a critical need for user-centered EHR interfaces, emphasizing the importance of collaborative efforts among clinicians, developers, and healthcare organizations. Based on a synthesizes findings from diverse studies, this paper advocate for EHR systems that are not only technically proficient but also intuitively aligned with healthcare providers' workflows, ultimately aiming to enhance clinical outcomes and operational efficiency.

Relationships Among Physician Vendor-Derived Proficiency Score, Gender, and Time in the Electronic Health Record

Background and Objectives: Electronic health record (EHR) customization is proposed to mitigate EHR-related burnout. Gender disparities in EHR usage are established, though less is known regarding differences in customization and its impact on EHR time. This study examined gender differences in vendor-derived proficiency score (PS) and its relationship to EHR time. Methods: This was a retrospective observational study of ambulatory EHR use for adult primary care and medical subspecialty physicians at an academic safety-net health care system. The EHR vendor provided a physician PS (0–10), derived from customization and efficiency tool utilization. Primary outcomes were PS, time in system per day, and time in system per appointment stratified by gender. We used multiple variable linear regression to determine whether gender differences persisted with the inclusion of other factors. Results: A total of 228 physicians were included in the study; 122 were women, and 106 were men. Women had higher median PS (7.6 vs 6.6, P=.021) and EHR time per day (150.5 vs 119.9 minutes, P=.013), but no difference in time per appointment (24.7 vs 26.1 minutes, P=.665). After adjusting for potential confounders, gender remained a significant predictor of PS, but not time in EHR. Higher PS was significantly associated with greater time in the system per appointment, but not per day. Conclusions: While women had higher PS than men, gender was not significantly associated with measures of EHR time after adjusting for potential confounders. Higher PS was associated with greater time in the EHR per appointment, suggesting factors that influence EHR time are complex and varied.

Competency mapping among Rashtriya Bal Swasthya Karyakram nurses in Kerala

Background: In India, birth defects, nutritional deficiencies, disabilities, and developmental delays among children cause significant public health challenges. The Ministry of Health and Family Welfare, aims to address these issues through the Rashtriya Bal Swasthya Karyakram (RBSK) program. RBSK nurses are the crucial part of this program. They screen the children between zero to eighteen years as a part of early intervention. This study mainly aimed to map the competencies among RBSK nurses from randomly selected districts of Kerala. Methods: This qualitative study employed key informant interviews with the state nodal officer, district early intervention centre managers, and district coordinators; and in-depth interviews (IDIs) with RBSK nurses, as well as report and document review. Inductive coding was applied to two selected interview transcripts from each district, followed by deductive coding with the rest of the transcribed data to derive themes. Results: The findings are presented using the ‘core competencies of public health professionals’ as revised and adopted by the council on linkages between academia and public health practice in 2021. RBSK nurses in Kerala exhibited proficiency in multiple domains, including knowledge of child health issues, clinical skills, communication, patient education, care for vulnerable population, organizing activities, electronic health record usage, multitasking, teamwork, and problem-solving skills. Conclusions: This dedication and proficiency demonstrated by RBSK nurses in Kerala, serve as a global model for emphasising the importance of early intervention and comprehensive care for children.

Electronic Health Record User Dashboard for Optimization of Surgical Resident Procedural Reporting.

Background While necessary and educationally beneficial, administrative tasks such as case and patient tracking may carry additional burden for surgical trainees. Automated systems targeting these tasks are scarce, leading to manual and inefficient workflows. Methods We created an electronic health record (EHR)-based, user-specific dashboard for surgical residents to compile resident-specific data: bedside procedures performed, operative cases performed or participated in, and notes written by the resident as a surrogate for patients cared for. Usability testing was performed with resident volunteers, and residents were also surveyed post-implementation to assess for efficacy and satisfaction. Access log data from the EHR was used to assess dashboard usage over time. Descriptive statistics were calculated. Results The dashboard was implemented on a population of approximately 175 surgical residents in 5 different departments (General Surgery, Obstetrics and Gynecology, Neurosurgery, Orthopedics, and Otolaryngology) at a single academic medical center. 6 resident volunteers participating in usability testing completed an average of 96% of preset tasks independently. Average responses to five questions extracted from the System Usability Scale (SUS) questions ranged from 4.0 to 4.67 out of 5. Post-implementation surveys indicated high resident satisfaction (4.39 out of 5) and moderate rates of use, with 46.4% of residents using the dashboard at least monthly. Daily use of the dashboard has increased over time, especially after making the dashboard a default for surgical residents. Conclusion An EHR-based dashboard compiling resident-specific data can improve the efficiency of administrative tasks and supplement longitudinal education.

Blockchains in health information systems: A literature review on use cases and status of implementation of blockchains for electronic health records

BACKGROUND: The careful management of health data is crucial due to its immense value and high sensitivity. Blockchain technologies can manage data in a trustworthy way. OBJECTIVE: The central aim is to identify the current state of blockchain technologies applied to Electronic Health Records (EHR) to identify common structures and functionalities. This common ground could be the starting point for defining clear global standards. METHODS: A systematic literature review is used. RESULTS: The benefits of enhancing the digitalization and cross-institutional accessibility of health data are undoubted. Four main application areas of blockchain for the EHR can be identified: storing, sharing, audit logging, and managing the identity of data accessors. Since on-chain transactions are slow and inefficient, most research promotes a hybrid approach for handling transactions as a combination of off-chain and on-chain approaches. CONCLUSIONS: Several approaches, frameworks, and models exist for applying blockchain technologies in the context of EHR. The research revealed that a) only a few concepts are already implemented, b) the existing system implementations are based on different backgrounds and technology stacks, and c) a lack of comprehensive and global standards and norms. All these factors are barriers to a broader usage of blockchain-based EHRs.

Confidence in diagnosing and managing care for cognitive impairment in primary care: a survey comparing barriers by primary care clinician type.

As cognitive impairment (CI) prevalence rises and primary care screening becomes commonplace, it is critical to understand how to support clinicians. We describe clinician-reported barriers to diagnosing and managing care for patients with CI in a health system with standardized screening. We also explore whether barriers differ by clinician type-physician or advanced-practice clinician (APC). Theory-informed surveys were administered to primary care clinicians in a large integrated health system. The survey assessed barriers, confidence in diagnosing CI and managing CI care, beliefs about the consequences of diagnosing CI, and usability of the electronic health record (EHR) to diagnose and manage CI care; it also included open-ended response items. Descriptive statistics and content analysis were used to describe perceived barriers. Differences by clinician type were compared using chi-square. Of the 408 eligible clinicians, 249 started the survey and 247 completed the primary outcomes (61% response rate). Many said they were only a little or not at all confident in diagnosing (70%) and managing care for (60%) CI, with specific gaps in confidence in distinguishing types of dementia and having CI-related conversations with patients or family/care partners. APCs reported lower confidence than physicians. Other barriers were lack of time, low usability of EHR, and lack of family/care partner availability. These did not differ by clinician type. Open-ended responses suggest clinicians would like more support for CI care. Low levels of confidence among other barriers suggest an urgent need to develop and implement effective multifaceted strategies to improve CI care.

Preliminary Evaluation of Fine-Tuning the OpenDeLD Deidentification Pipeline Across Multi-Center Corpora.

Automatic deidentification of Electronic Health Records (EHR) is a crucial step in secondary usage for biomedical research. This study introduces evaluation of an intricate hybrid deidentification strategy to enhance patient privacy in secondary usage of EHR. Specifically, this study focuses on assessing automatic deidentification using OpenDeID pipeline across diverse corpora for safeguarding sensitive information within EHR datasets by incorporating diverse corpora. Three distinct corpora were utilized: the OpenDeID v2 corpus containing pathology reports from Australian hospitals, the 2014 i2b2/UTHealth deidentification corpus with clinical narratives from the USA, and the 2016 CEGS N-GRID identification corpus comprising psychiatric notes. The OpenDeID pipeline employs a hybrid approach based on deep learning and contextual rules. Pre-processing steps involved harmonizing and addressing encoding and format issues. Precision, Recall, F-measure metrics were used to assess the performance. The evaluation metrics demonstrated the superior performance of the Discharge Summary BioBERT model. Trained on three corpora with a total of 4,038 reports, the best performing model exhibited robust deidentification capabilities when applied to EHR. It achieved impressive micro-averaged F1-scores of 0.9248 and 0.9692 for strict and relaxed settings, respectively. These results offer valuable insights into the model's efficacy and its potential role in safeguarding patient privacy in secondary usage of EHR.

Usability evaluation of electronic health records at the trauma and emergency directorates at the Komfo Anokye teaching hospital in the Ashanti region of Ghana

BackgroundElectronic health records (EHRs) are currently gaining popularity in emerging economies because they provide options for exchanging patient data, increasing operational efficiency, and improving patient outcomes. This study examines how service providers at Ghana's Komfo Anokye Teaching Hospital adopt and use an electronic health records (EHRs) system. The emphasis is on identifying factors impacting adoption and the problems that healthcare personnel encounter in efficiently using the EHRs system.MethodA quantitative cross-sectional technique was utilised to collect data from 234 trauma and emergency department staff members via standardised questionnaires. The participants were selected using the purposive sampling method. The Pearson Chi-square Test was used to examine the relationship between respondents' acceptability and use of EHRs.ResultsThe study discovered that a sizable number of respondents (86.8%) embraced and actively used the EHRs system. However, other issues were noted, including insufficient system training and malfunctions (35.9%), power outages (18.8%), privacy concerns (9.4%), and insufficient maintenance (4.7%). The respondents' comfortability in using the electronic health record system (X2=11.30, p=0.001), system dependability (X2=30.74, p=0.0001), and EHR's ability to reduce patient waiting time (X2=14.39, p=0.0001) were all strongly associated with their degree of satisfaction with the system. Furthermore, respondents who said elects increase patient care (X2= 75.59, p = 0.0001) and income creation (X2= 8.48, p = 0.004), which is related to the acceptability of the electronic health records system.ConclusionThe study revealed that comfort, reliability, and improved care quality all had an impact on the EHRs system's acceptability and utilization. Challenges, including equipment malfunctions and power outages, were found. Continuous professional training was emphasized as a means of increasing employee confidence, as did the construction of a power backup system to combat disruptions. Patient data privacy was highlighted. In conclusion, this study highlights the relevance of EHRs system adoption and usability in healthcare. While the benefits are obvious, addressing obstacles through training, technical support, and infrastructure improvements is critical for increasing system effectiveness.

Perceptions of hospital electronic health record (EHR) training, support, and patient safety by staff position and tenure

BackgroundHospitals rely on their electronic health record (EHR) systems to assist with the provision of safe, high quality, and efficient health care. However, EHR systems have been found to disrupt clinical workflows and may lead to unintended consequences associated with patient safety and health care professionals’ perceptions of and burden with EHR usability and interoperability. This study sought to explore the differences in staff perceptions of the usability and safety of their hospital EHR system by staff position and tenure.MethodsWe used data from the AHRQ Surveys on Patient Safety Culture® (SOPS®) Hospital Survey Version 1.0 Database and the SOPS Health Information Technology Patient Safety Supplemental Items (“Health IT item set”) collected from 44 hospitals and 8,880 staff in 2017. We used regression modeling to examine perceptions of EHR system training, EHR support & communication, EHR-related workflow, satisfaction with the EHR system, and the frequency of EHR-related patient safety and quality issues by staff position and tenure, while controlling for hospital ownership type and bed-size.ResultsIn comparison to RNs, pharmacists had significantly lower (unfavorable) scores for EHR system training (regression coefficient = -0.07; p = 0.047), and physicians, hospital management, and the IT staff were significantly more likely to report high frequency of inaccurate EHR information (ORs = 2.03, 1.34, 1.72, respectively). Compared to staff with 11 or more years of hospital tenure, new staff (less than 1 year at the hospital) had significantly lower scores for EHR system training, but higher scores for EHR support & communication (p < 0.0001). Dissatisfaction of the EHR system was highest among physicians and among staff with 11 or more years tenure at the hospital.ConclusionsThere were significant differences in the Health IT item set’s results across staff positions and hospital tenure. Hospitals can implement the SOPS Health IT Patient Safety Supplemental Items as a valuable tool for identifying incongruity in the perceptions of EHR usability and satisfaction across staff groups to inform targeted investment in EHR system training and support.

Electronic Health Record Usability, Satisfaction, and Burnout for Family Physicians

Electronic health record (EHR) work has been associated with decreased physician well-being. Understanding the association between EHR usability and physician satisfaction and burnout, and whether team and technology strategies moderate this association, is critical to informing efforts to address EHR-associated physician burnout. To measure family physician satisfaction with their EHR and EHR usability across functions and evaluate the association of EHR usability with satisfaction and burnout, as well as the moderating association of 4 team and technology EHR efficiency strategies. This study uses data from a cross-sectional survey conducted from December 12, 2021, to October 17, 2022, of all family physicians seeking American Board of Family Medicine recertification in 2022. Physicians perceived EHR usability across 6 domains, as well as adoption of 4 EHR efficiency strategies: scribes, support from other staff, templated text, and voice recognition or transcription. Physician EHR satisfaction and frequency of experiencing burnout measured with a single survey item ("I feel burned out from my work"), with answers ranging from "never" to "every day." Of the 2067 physicians (1246 [60.3%] younger than 50 years; 1051 men [50.9%]; and 1729 [86.0%] practicing in an urban area) who responded to the survey, 562 (27.2%) were very satisfied and 775 (37.5%) were somewhat satisfied, while 346 (16.7%) were somewhat dissatisfied and 198 (9.6%) were very dissatisfied with their EHR. Readability of information had the highest usability, with 543 physicians (26.3%) rating it as excellent, while usefulness of alerts had the lowest usability, with 262 physicians (12.7%) rating it as excellent. In multivariable models, good or excellent usability for entering data (β = 0.09 [95% CI, 0.05-0.14]; P < .001), alignment with workflow processes (β = 0.11 [95% CI, 0.06-0.16]; P < .001), ease of finding information (β = 0.14 [95% CI, 0.09-0.19]; P < .001), and usefulness of alerts (β = 0.11 [95% CI, 0.06-0.16]; P < .001) were associated with physicians being very satisfied with their EHR. In addition, being very satisfied with the EHR was associated with reduced frequency of burnout (β = -0.64 [95% CI, -1.06 to -0.22]; P < .001). In moderation analysis, only physicians with highly usable EHRs saw improvements in satisfaction from adopting efficiency strategies. In this survey study of physician EHR usability and satisfaction, approximately one-fourth of family physicians reported being very satisfied with their EHR, while another one-fourth reported being somewhat or very dissatisfied, a concerning finding amplified by the inverse association between EHR satisfaction and burnout. Electronic health record-based alerts had the lowest reported usability, suggesting EHR vendors should focus their efforts on improving alerts. Electronic health record efficiency strategies were broadly adopted, but only physicians with highly usable EHRs realized gains in EHR satisfaction from using these strategies, suggesting that EHR burden-reduction interventions are likely to have heterogenous associations across physicians with different EHRs.

Measuring Documentation Burden in Healthcare.

The enactment of the Health Information Technology for Economic and Clinical Health Act and the wide adoption of electronic health record (EHR) systems have ushered in increasing documentation burden, frequently cited as a key factor affecting the work experience of healthcare professionals and a contributor to burnout. This systematic review aims to identify and characterize measures of documentation burden. We integrated discussions with Key Informants and a comprehensive search of the literature, including MEDLINE, Embase, Scopus, and gray literature published between 2010 and 2023. Data were narratively and thematically synthesized. We identified 135 articles about measuring documentation burden. We classified measures into 11 categories: overall time spent in EHR, activities related to clinical documentation, inbox management, time spent in clinical review, time spent in orders, work outside work/after hours, administrative tasks (billing and insurance related), fragmentation of workflow, measures of efficiency, EHR activity rate, and usability. The most common source of data for most measures was EHR usage logs. Direct tracking such as through time-motion analysis was fairly uncommon. Measures were developed and applied across various settings and populations, with physicians and nurses in the USA being the most frequently represented healthcare professionals. Evidence of validity of these measures was limited and incomplete. Data on the appropriateness of measures in terms of scalability, feasibility, or equity across various contexts were limited. The physician perspective was the most robustly captured and prominently focused on increased stress and burnout. Numerous measures for documentation burden are available and have been tested in a variety of settings and contexts. However, most are one-dimensional, do not capture various domains of this construct, and lack robust validity evidence. This report serves as a call to action highlighting an urgent need for measure development that represents diverse clinical contexts and support future interventions.

Impact of EHRs on Nursing Burnout in a Hospital Setting in Saudi Arabia: Mixed-Methods Study.

This study explores the association between nursing burnout and Electronic Health Record (EHR) use in a Saudi Arabian hospital adopting an advanced EHR system. Utilising a mixed-methods approach, the research combines quantitative analysis of 282 survey responses and qualitative interviews from 21 registered nurses. Despite high EHR acceptance, negative perceptions and stress related to EHR use were identified. Findings indicate a weak link between EHR use and burnout, with resilience acting as a mitigating factor. Specific stressors, including documentation workload and usability issues, were countered by individual and organisational resilience. The study introduces a novel conceptual model emphasising the pivotal role of resilience at both levels in mitigating EHR-related burnout. Recommendations include fostering resilience-building strategies in EHR implementation processes and usability to prevent burnout, emphasising self-care practices, promoting work-life balance, and improving health information infrastructure.

Use of Electronic Health Records and Documentation Burden Among Nurses in Acute and Critical Care.

Nurses who provide the majority of hands-on care for hospitalized patients are disproportionately affected by the current state of electronic health records (EHRs), and little is known about their lived perception of EHR use. Using a mixed-methods research design, we conducted an in-depth analysis and synthesis of data from EHR usage log files, interviews, and surveys and assessed factors contributing to the nurse documentation burden in acute and critical at a large academic medical center. There remain substantial spaces where we can develop viable solutions for enhancing the usability of multi-component EHR systems.

Leadership style, change management and job performance of health information management practitioners in tertiary hospitals in South-East, Nigeria

PurposeManaging patients’ health information is one of the building blocks of the health system and the adoption of health information technologies like electronic health records (EHRs) is expected to reduce the various challenges in keeping and accessing quality health-care data that aid decision-making among medical practitioners. This study aims to investigate how leadership styles and change management affected the job performance of health information management practitioners on their adoption of EHRs in tertiary hospitals in Nigeria.Design/methodology/approachThe study used primary data collected using a Likert scale questionnaire from 117 health information management officers and health information technicians in selected tertiary hospitals in South-Eastern Nigeria. The data were analysed using bivariate correlation and multiple regression techniques of inferential statistics.FindingsThe analyses revealed that transformational leadership style, transactional leadership style and change management had significant positive influence on the job performance of health information management practitioners. However, laissez-faire leadership style did not show any significant positive influence. A further analysis showed that the combined effects of leadership styles and change management were also affirmed to significantly influence the adoption of EHRs for quality health-care delivery in Nigerian tertiary hospitals.Originality/valueThe study contributes to health information management and the need to understand how leadership styles and change management can influence the adoption of EHRs. However, there is no adequate research that examined the role of leadership style and change management in influencing the job performance of Nigerian HIM practitioners regarding their usage of EHRs in tertiary hospitals in Nigeria.

Gender Differences in Electronic Health Record Usage Among Surgeons.

Understanding gender differences in electronic health record (EHR) use among surgeons is crucial for addressing potential disparities in workload, compensation, and physician well-being. To investigate gender differences in EHR usage patterns. This cross-sectional study examined data from an EHR system (Epic Signal) at a single academic hospital from January to December 2022. Participants included 224 attending surgeons with patient encounters in the outpatient setting. Statistical analysis was performed from May 2023 to April 2024. Surgeon's gender. The primary outcome variables were progress note length, documentation length, time spent in medical records, and time spent documenting patient encounters. Continuous variables were summarized with median and IQR and assessed via the Kruskal-Wallis test. Categorical variables were summarized using proportion and frequency and compared using the χ2 test. Multivariate linear regression was used with primary EHR usage variables as dependent variables and surgeon characteristics as independent variables. This study included 222 529 patient encounters by 224 attending surgeons, of whom 68 (30%) were female and 156 (70%) were male. The median (IQR) time in practice was 14.0 (7.8-24.3) years. Male surgeons had more median (IQR) appointments per month (78.3 [39.2-130.6] vs 57.8 [25.7-89.8]; P = .005) and completed more medical records per month compared with female surgeons (43.0 [21.8-103.9] vs 29.1 [15.9-48.1]; P = .006). While there was no difference in median (IQR) time spent in the EHR system per month (664.1 [301.0-1299.1] vs 635.0 [315.6-1192.0] minutes; P = .89), female surgeons spent more time logged into the system both outside of 7am to 7pm (36.4 [7.8-67.6] vs 14.1 [5.4-52.2] min/mo; P = .05) and outside of scheduled clinic hours (134.8 [58.9-310.1] vs 105.2 [40.8-214.3] min/mo; P = .05). Female surgeons spent more median (IQR) time per note (4.8 [2.6-7.1] vs 2.5 [0.9-4.2] minutes; P < .001) compared with male surgeons. Male surgeons had a higher number of median (IQR) days logged in per month (17.7 [13.8-21.3] vs 15.7 [10.7-19.7] days; P = .03). Female surgeons wrote longer median (IQR) inpatient progress notes (6025.1 [3692.1-7786.7] vs 4307.7 [2808.9-5868.4] characters/note; P = .001) and had increased outpatient document length (6321.1 [4079.9-7825.0] vs 4445.3 [2934.7-6176.7] characters/note; P < .001). Additionally, female surgeons wrote a higher fraction of the notes manually (17% vs 12%; P = .006). After using multivariable linear regression models, male gender was associated with reduced character length for both documentations (regression coefficient, -1106.9 [95% CI, -1981.5 to -232.3]; P = .01) and progress notes (regression coefficient, -1119.0 [95% CI, -1974.1 to -263.9]; P = .01). Male gender was positively associated with total hospital medical records completed (regression coefficient, 47.3 [95% CI, 28.3-66.3]; P < .001). There was no difference associated with gender for time spent in each note, time spent outside of 7 am to 7 pm, or time spent outside scheduled clinic hours. This cross-sectional study of EHR data found that female surgeons spent more time documenting patient encounters, wrote longer notes, and spent more time in the EHR system compared with male surgeons. These findings have important implications for understanding the differential burdens faced by female surgeons, including potential contributions to burnout and payment disparities.

Electronic Health Record Usage Among Surgeons-The Gender Gap.

Electronic Health Record Usage Among Surgeons-The Gender Gap.

"For the first time…I am seriously fighting burnout": clinician experiences with a challenging electronic health record transition.

The Department of Veterans Affairs (VA) is transitioning from its legacy electronic health record (EHR) to a new commercial EHR in a nationwide, rolling-wave transition. We evaluated clinician and staff experiences to identify strategies to improve future EHR rollouts. We completed a convergent mixed-methods formative evaluation collecting survey and interview data to measure and describe clinician and staff experiences. Survey responses were analyzed using descriptive statistics; interview transcripts were coded using a combination of a priori and emergent codes followed by qualitative content analysis. Qualitative and quantitative findings were compared to provide a more comprehensive understanding of participant experience. Employees of specialty and primary care teams at the first nationwide EHR transition site agreed to participate in our study. We distributed surveys at 1-month pre-transition, 2 months post-transition, and 10 months post-transition to each of the 68 identified team members and completed longitudinal interviews with 30 of these individuals totaling 122 semi-structured interviews. Interview participants reported profoundly disruptive experiences during the EHR transition that persisted at 1-year post implementation. Survey responses indicated training difficulties throughout the transition, and sharp declines (P ≤ .05) between pre- and post-go-live measures of EHR usability and increase in EHR burden that were perceived to be due in part to system inefficiencies, discordant positive messaging that initially ignored user challenges, and inadequate support for and attention to ongoing EHR issues. Participants described persistent high levels of stress associated with these disruptions. Our findings highlight strategies to improve employee experiences during EHR transitions: (1) working with Oracle Cerner to resolve known issues and improve usability; (2) role-based training with opportunities for self-directed learning; (3) peer-led support systems and timely feedback on issues; (4) messaging that responds to challenges and successes; and (5) continuous efforts to support staff with issues and address clinician and staff stress and burnout. Our findings provide relevant strategies to navigate future EHR transitions while supporting clinical teams.

Revealing misattributed parentage through the integration of genetic information into the electronic health record.

The integrationof genetic information (GI) into the electronic health record (EHR) seems inevitable as the mainstreaming of genomics continues. Such newly provided accessibility to GIcould be beneficial for improving health care, as well as for supporting clinical decision-making and health management. Notwithstanding these promising benefits, the automatic integration of GI into the EHR, allowing unrestricted access to one's GI through patient portals, carries various knowledge-related risks for patients. This articleis focused on the potential case of inadvertently revealing misattributed parentage through such practice. The articleaims to identify key clinical and ethical implications of such revelation for adult patients. Clinical implications include, for example, altering the physician-patient interactionand the need to enhance physician's genetic literacy to improve genetic-information-specific communication skills. Ethical implications yield arguments supporting disclosure of MP, such as autonomy, individuals' right to know medical information pertaining to them, and the right to know one's genetic origins. Arguments opposing disclosure of MPcentre on the right not to know GI and concerns for post-disclosure family relationships. Following the clinical and ethical analyses of these respective implications, we consider how such integration of GI into the EHR ought to be carried out, ethically. We therefore suggest a solution, featuring an autonomy-based approach, built around EHR users' right not to know. Our solution of nuanced consent options (including a 'genetic ignorance option')is designed to enable patients' informed exposure to GI through the EHR, allowing them some control over their self- and familial narrative.

Gender Disparities in Electronic Health Record Usage and Inbasket Burden for Internal Medicine Residents.

Studies have demonstrated patients hold different expectations for female physicians compared to male physicians, including higher expectations for patient-centered communication and addressing socioeconomic or emotional needs. Recent evidence indicates this gender disparity extends to the electronic health record (EHR). Similar studies have not been conducted with resident physicians. This study seeks to characterize differences in EHR workload for female resident physicians compared to male resident physicians. This study evaluated 12months of 156 Mayo Clinic internal medicine residents' inbasket data from July 2020 to June 2021 using Epic's Signal and Physician Efficiency Profile (PEP) data. Excel, BlueSky Statistics, and SAS analytical software were used for analysis. Paired t-tests and analysis of variance were used to compare PEP data by gender and postgraduate year (PGY). "Male" and "female" were used in substitute for "gender" as is precedent in the literature. Mayo Clinic internal medicine residents. Total time spent in EHR per day; time in inbasket and notes per day; time in notes per appointment; number of patient advice requests made through the portal; message turnaround time. Female residents received more patient advice requests per year (p = 0.004) with an average of 86.7 compared to 68, resulting in 34% more patient advice requests per day worked(p < 0.001). Female residents spent more time in inbasket per day (p = 0.002), in notes per day (p < 0.001), and in notes per appointment (p = 0.001). Resident panel comparisons revealed equivocal sizes with significantly more female patients on female (n = 55) vs male (n = 34) resident panels (p < 0.001).There was no difference in message turnaround time, total messages, or number of results received. Female resident physicians experience significantly more patient-initiated messages and EHR workload despite equivalent number of results and panel size. Gender differences in inbasket burden may disproportionally impact the resident educational experience.