Electronic Health Record Utilization Research Articles

Implementation of an electronic health record system during global surgical outreach: A prospective evaluation of success and sustainability.

The burden of musculoskeletal conditions continues to grow in low- and middle-income countries. Among thousands of surgical outreach trips each year, few organizations electronically track patient data to inform real-time care decisions and assess trip impact. We report the implementation of an electronic health record (EHR) system utilized at point of care during an orthopedic surgical outreach trip. In March 2023, we implemented an EHR on an orthopedic outreach trip to guide real-time care decisions. We utilized an effectiveness-implementation hybrid type 3 design to evaluate implementation success. Success was measured using outcomes adopted by the World Health Organization, including acceptability, appropriateness, feasibility, adoption, fidelity, and sustainability. Clinical outcome measures included adherence to essential quality measures and follow-up numerical rating system (NRS) pain scores. During the 5-day outreach trip, 76 patients were evaluated, 25 of which underwent surgery beforehand. The EHR implementation was successful as defined by: mean questionnaire ratings of acceptability (4.26), appropriateness (4.12), feasibility (4.19), and adoption (4.33) at least 4.00, WHO behaviorally anchored rating scale ratings of fidelity (6.8) at least 5.00, and sustainability (80%) at least 60% follow-up at 6months. All clinical quality measures were reported in greater than 80% of cases with all measures reported in 92% of cases. NRS pain scores improved by an average of 2.4 points. We demonstrate successful implementation of an EHR for real-time clinical use on a surgical outreach trip. Benefits of EHR utilization on surgical outreach trips may include improved documentation, minimization of medical errors, and ultimately improved quality of care.

Replacing the Scalpel With a Computer Mouse: An Evaluation of Time Spent on Electronic Health Record for Plastic Surgery Residents and Its Impact on Resident Training.

Following the integration of the electronic health record (EHR) into the healthcare system, concern has grown regarding EHR use on physician well-being. For surgical residents, time spent on the EHR increases the burden of a demanding, hourly restricted schedule and detracts from time spent honing surgical skills. To better characterize these burdens, we sought to describe EHR utilization patterns for plastic surgery residents. Integrated plastic surgery resident EHR utilization from March 2019 to March 2020 was extracted via Cerner Analytics at a tertiary academic medical center. Time spent in the EHR on-duty (0600-1759) and off-duty (1800-0559) in the form of chart review, orders, documentation, and patient discovery was analyzed. Statistical analysis was performed in the form of independent t tests and Analysis of Variance (ANOVA). Twelve plastic surgery residents spent a daily average of 94 ± 84 minutes on the EHR, one-third of which was spent off-duty. Juniors (postgraduate years 1-3) spent 123 ± 99 minutes versus seniors (postgraduate years 4-6) who spent 61 ± 49 minutes (P < 0.01). Seniors spent 19% of time on the EHR off-duty, compared with 37% for juniors (P < 0.01). Chart review comprised the majority (42%) of EHR usage, followed by patient discovery (22%), orders (14%), documentation (12%), other (6%), and messaging (1%). Seniors spent more time on patient discovery (25% vs 21%, P < 0.001), while juniors spent more time performing chart review (48% vs 36%, P = 0.19). Integrated plastic surgery residents average 1.5 hours on the EHR daily. Junior residents spend 1 hour more per day on the EHR, including more time off-duty and more time performing chart review. These added hours may play a role in duty hour violations and detract from obtaining operative skill sets.

Ambulatory Long Block: A Model of Precision Education and Assessment for Internal Medicine Residents.

High-quality precision education (PE) aims to enhance outcomes for learners and society by incorporating longitudinal data and analytics to shape personalized learning strategies. However, existing educational data collection methods often suffer from fragmentation, leading to gaps in understanding learner and program performance. In this article, the authors present a novel approach to PE at the University of Cincinnati, focusing on the Ambulatory Long Block, a year-long continuous ambulatory group-practice experience. Over the last 17 years, the Ambulatory Long Block has evolved into a sophisticated data collection and analysis system that integrates feedback from various stakeholders, as well as learner self-assessment, electronic health record utilization information, and clinical throughput metrics. The authors detail their approach to data prioritization, collection, analysis, visualization, and feedback, providing a practical example of PE in action. This model has been associated with improvements in both learner performance and patient care outcomes. The authors also highlight the potential for real-time data review through automation and emphasize the importance of collaboration in advancing PE. Generalizable principles include designing learning environments with continuity as a central feature, gathering both quantitative and qualitative performance data from interprofessional assessors, using this information to supplement traditional workplace-based assessments, and pairing it with self-assessments. The authors advocate for criterion referencing over normative comparisons, using user-friendly data visualizations, and employing tailored coaching strategies for individual learners. The Ambulatory Long Block model underscores the potential of PE to drive improvements in medical education and health care outcomes.

Improving care practices of the patient with type 2 diabetes in community health centers.

Diabetes ranks seventh in morbidity and mortality in the United States. In addition, more than 25 million Americans living with diabetes depend on community health centers (CHCs) for primary care. Preimplementation data in a group of CHCs indicated poor adherence to standards of care practices as recommended by the American Diabetes Association (ADA) with quarterly A1c (33.1%), annual serum laboratory tests (66.6%), and annual urine microalbumin (26.5%). Using a pre- and postimplementation comparison method, a NP-led practice improvement project was conducted in a group of CHCs, which sought to (1) identify adherence to ADA care standards; (2) determine whether an intervention could affect adherence to ADA standards; and (3) compare pre- and postimplementation occurrences of hemoglobin A1c greater than 7.1% and greater than 9%. Intervention composed of an educational component, standing orders to facilitate care practice changes, and electronic health record utilization changes. Postimplementation data reveal statistically significant improvements in quarterly hemoglobin A1c (93.6%), annual serum laboratory tests (96.5%), and annual urine microalbumin screening (85.5%). Improvements in translation to care for standardized guidelines facilitate improvements in health outcomes for patients. This project demonstrated improvements that can decrease the morbidity and mortality experienced by persons living with diabetes and being seen within a CHC. In addition, this project demonstrated that advanced practice nurses have the training and occupy a unique position within health care to spearhead initiatives for translation of evidence into care practices.

THE ADULT DAY CENTER: UNTAPPED TERRITORY FOR AGING RESEARCH

Abstract Adult day service centers (ADCs) in the United States are a vital, but overlooked source of community-based long-term care for diverse older adults with multiple chronic conditions, including dementia. The National Institute on Aging has called for more research on ADCs. In this interdisciplinary symposium, we present challenges and opportunities in conducting research in these congregate settings. First, we look at the operating status of ADCs nationally in the aftermath of the COVID-19 pandemic and disparities in access to care using longitudinal data from the National Post-acute and Long-term Care Study. Then we examine the lack of electronic health record utilization and clinical data capture in 4,035 ADCs nationally and discuss strategies to modernize technology in these settings to facilitate data collection. We subsequently present a new database, developed vis a vis an academic/community partnership between the National Adult Day Services Association and researchers, that centralizes and makes data collection feasible in ADCs with limited resources. We will also explore factors supporting intervention research that are unique to ADCs. Finally, we present a protocol adapted for the ADC setting, to test a mobile application that facilitates data collection and enables communication between ADCs, caregivers, and healthcare providers. Our findings show that, while research in ADCs has been limited historically, academic, government, and community partners are working together to spur pragmatic innovations that modernize these settings and better resource them to elevate standards of care.

Development and validation of the SickKids Enterprise-wide Data in Azure Repository (SEDAR)

ObjectivesTo describe the processes developed by The Hospital for Sick Children (SickKids) to enable utilization of electronic health record (EHR) data by creating sequentially transformed schemas for use across multiple user types. MethodsWe used Microsoft Azure as the cloud service provider and named this effort the SickKids Enterprise-wide Data in Azure Repository (SEDAR). Epic Clarity data from on-premises was copied to a virtual network in Microsoft Azure. Three sequential schemas were developed. The Filtered Schema added a filter to retain only SickKids and valid patients. The Curated Schema created a data structure that was easier to navigate and query. Each table contained a logical unit such as patients, hospital encounters or laboratory tests. Data validation of randomly sampled observations in the Curated Schema was performed. The SK-OMOP Schema was designed to facilitate research and machine learning. Two individuals mapped medical elements to standard Observational Medical Outcomes Partnership (OMOP) concepts. ResultsA copy of Clarity data was transferred to Microsoft Azure and updated each night using log shipping. The Filtered Schema and Curated Schema were implemented as stored procedures and executed each night with incremental updates or full loads. Data validation required up to 16 iterations for each Curated Schema table. OMOP concept mapping achieved at least 80 % coverage for each SK-OMOP table. ConclusionsWe described our experience in creating three sequential schemas to address different EHR data access requirements. Future work should consider replicating this approach at other institutions to determine whether approaches are generalizable.

End-users’ perspectives on factors affecting implementation and utilization of the Iranian electronic health record system: a qualitative study in a developing country

BackgroundAs one of the most important information technologies for storing, managing, and exchanging health information, the electronic health record (EHR) plays a major role in the health system. However, these systems in developing countries have been associated with multidimensional issues. The purpose of the present study was the assessment of nonclinical end-users’ points of view on the implementation and utilization of the Iranian electronic health record system.MethodsThis was a large qualitative study conducted in 2021 for 7 months from February to August. In this study, data were collected through in-depth semi-structured interviews with 70 non-clinical end-users in 22 public and six private hospitals of West Azerbaijan province in Iran. To analyze the data, the thematic analysis method was used.ResultsThe study results indicated that technical, human, cultural, managerial, and financial readiness are the most important factors affecting the implementation of EHRs in Iran. Among the mentioned factors, technical and human readiness were emphasized more by the users. Also, technical, organizational, human, and managerial factors were identified as factors influencing EHRs utilization, and technical and organizational factors had a stronger role in the system utilization.ConclusionsAccording to the results, several factors influence EHR implementation and adequate utilization in Iran. To achieve the predetermined goals of this system, implementation issues and problems of using the system should be considered and solved.

Establishment and Utilization of Electronic Health Records in Iran: A Review of the Policy Documents of the Past Four Decades

Background: This study presents the legal obligations set for the main stakeholders in the establishment and implementation of electronic health (e-health) records in Iran and investigates the fulfillment of these obligations. Methods: This qualitative study was conducted using document analysis. The research population comprised all the documents, laws, reports, and policies of the establishment and utilization of electronic health records in Iran. Sampling was purposive, and all the internal documents of Iran were included until the end of May 2022. A data extraction form was used to collect the data, and Scott's criterion was used to select the documents. Descriptive analysis was used to analyze the data. Results: Based on the documents, 56% of the sentences were implemented, and 22% were not enforced according to the assigned tasks. The status of the execution of tasks by the main players was also extracted. The most important of these included the drafting of the electronic health security and privacy regulations, not providing the conditions for receiving electronic copies in the e-records, creating internal automation for the Ministry of Health and Medical Education instead of the e-health records system, instability of the integrated portal for exchanging health information and disconnection of the majority of service centers, eliminating the extension of the validity of paper booklets, operationalizing the online entitlement system, using the first phase of the electronic prescription project, not inserting nursing notes in the records, recording financial and administrative information instead of clinical ones, refusal of numerous doctors to write electronic prescriptions, using an alternative method of two-step verification instead of electronic signature, the progress of coding and drug authenticity, and the non-implementation of medical equipment coding. Conclusions: Reviewing the status of the enforcement of approvals also revealed that the format of actions since 2018 has ended with a positive result. The main achievement so far has been electronic prescription, while it should be noted that prescription is only part of the electronic health record project.

Utilization of electronic health records and associated factors among nurses in a faith-based teaching hospital, Ilishan, Nigeria.

It has been documented that nurses' use of electronic health records (EHRs) impacts clients' health outcomes positively. Some health facilities, primarily privately owned institutions, introduced EHRs for optimal healthcare. Evidence of such and associated factors among nurses must be documented to improve utilization and quality. The study assessed the utilization of EHRs and associated factors among nurses in a faith-based teaching hospital. This sequential explanatory mixed-methods study involved a sample of all 240 nurses from a teaching hospital where EHRs have been introduced. Quantitative data through semistructured questionnaires were collected and analyzed using Chi-square and logistic regression. Qualitative data were collected from 10 purposively selected nurses using an in-depth interview guide and analyzed through content analysis. The majority of participants reported availability of EHR computer software (62.8%), internet facility (84.2%), and desktops (76.3%), but EHR was poorly utilized (27.3%). Factors significantly associated were nurses who were females [OR (odds ratio) = 1.5, 95% CI (confidence interval), 0.21-11.24], BNSc degrees holders [OR = 4.3; 95% CI, 1.06-17.43]; had computer EHR software [OR = 7.4, 95% CI, 0.83-3.81], and sponsored EHR training [OR = 2.10; 95% CI, 0.24-18.6]. Noncapturing of nursing tasks and nursing standardized language by EHR software, lack of institutional enforcement on EHR use, and absence of clear EHR policies were the main identified themes for the key barriers to using EHRs. EHR was poorly utilized among nurses. Gender, educational qualification, EHR resources, and sponsored training were factors significantly associated with the use. There is an urgent need for comprehensive EHR packages, sustained sponsored training, and formulation of EHR policy for effective EHR implementation.

A Deep-Learning Neural Network Approach for Secure Wireless Communication in the Surveillance of Electronic Health Records

The electronic health record (EHR) surveillance process relies on wireless security administered in application technology, such as the Internet of Things (IoT). Automated supervision with cutting-edge data analysis methods may be a viable strategy to enhance treatment in light of the increasing accessibility of medical narratives in the electronic health record. EHR analysis structured data structure code was used to obtain data on initial fatality risk, infection rate, and hazard ratio of death from EHRs for prediction of unexpected deaths. Patients utilizing EHRs in general must keep in mind the significance of security. With the rise of the IoT and sensor-based Healthcare 4.0, cyber-resilience has emerged as a need for the safekeeping of patient information across all connected devices. Security for access, amendment, and storage is cumulatively managed using the common paradigm. For improving the security of surveillance in the aforementioned services, this article introduces an endorsed joint security scheme (EJSS). This scheme recognizes the EHR utilization based on the aforementioned processes. For each process, different security measures are administered for sustainable security. Access control and storage modification require relative security administered using mutual key sharing between the accessing user and the EHR database. In this process, the learning identifies the variations in different processes for reducing adversarial interruption. The federated learning paradigm employed in this scheme identifies concurrent adversaries in the different processes initiated at the same time. Differentiating the adversaries under each process strengthens mutual authentication using individual attributes. Therefore, individual surveillance efficiency through log inspection and adversary detection is improved for heterogeneous and large-scale EHR databases.

Utilization of Electronic Health Records for Chronic Disease Surveillance: A Systematic Literature Review.

This study reviews the current utilization of electronic health records (EHRs) for chronic disease surveillance, discusses approaches that are used in obtaining EHR-derived disease prevalence estimates, and identifies health indicators that have been studied using EHR-based surveillance methods. PubMed was searched for relevant keywords: (electronic health records [Title/Abstract] AND surveillance [Title/Abstract]) OR (electronic medical records [Title/Abstract] AND surveillance [Title/Abstract]). Articles were assessed based on detailed inclusion and exclusion criteria and organized by common themes, as per the PRISMA review protocol. The study period was limited to 2015-2021 due to the wider adoption of EHR in the U.S. only since 2015. The review included only US studies and only those that focused on chronic disease surveillance. 17 studies were included in the review. The most common approaches the review identified focused on validating EHR-derived estimates against those from traditional national surveys. The most studied conditions were diabetes, obesity, and hypertension. The majority of reviewed studies demonstrated comparable prevalence estimates with traditional population health surveillance surveys. The most common approach for the estimation of chronic disease conditions was to use small-area estimation by geographic patterns, neighborhoods, or census tracts. The use of EHR-based surveillance systems for public health purposes is feasible, and the population health estimates appear comparable to those obtained through traditional surveillance surveys. The application of EHRs for public health surveillance appears promising and could offer a real-time alternative to traditional surveillance methods. A timely assessment of population health at local and regional levels would ensure a more targeted allocation of public health and healthcare resources as well as more effective intervention and prevention initiatives.

A Cross-sectional Study of Nurses’ Perception Toward Utilization and Barriers of Electronic Health Record

Background: The utilization of electronic health records (EHRs) is crucial. This study aimed to determine the perception of nurses on the utilization and barriers to the use of EHRs.

How Medical Societies Can Collaborate with Vendors to Improve EHR Utilization

Summary The electronic health record (EHR) is a key component of patient interactions, quality improvement efforts, patient safety, and research endeavors. Yet medical societies have not focused on collaborative efforts with EHR vendors to improve their systems. In October 2018, the Society for Maternal-Fetal Medicine (SMFM) formed a Clinical Informatics Committee to investigate the possibility of collaborating with EHR vendors to optimize systems. This committee surveyed the 2,718 clinical maternal-fetal medicine physician members to investigate EHR use, system problems, and future needs. The committee received 312 responses from 43 states. Practice patterns were diverse and generally represented the society membership. Responses from maternal-fetal medicine physicians revealed broad frustration with system usage, interfaces, and design provided by the EHR systems they used. In response to survey results, SMFM’s Clinical Informatics Committee formed subcommittees that collaborated with vendors’ EHR specialists to consider how to optimize EHR systems. Considerable progress was made: pushing society guidelines into the main EHR systems, adopting common term definitions to improve data quality, forming standardized clinical text statements for members and vendors to create common and consistent input for providers, and defining data within ultrasound systems to facilitate future interfaces involving information transfer from ultrasound equipment to ultrasound reporting systems and EHR systems. The success of the society’s efforts to improve EHR systems should encourage other societies to work with EHR vendors to enhance and optimize strategies to improve patient care, safety, and research.

Success and failure factors of patient recruitment for industry-sponsored clinical trials and the role of the electronic health records—a qualitative interview study in the Nordic countries

BackgroundPatient recruitment for clinical trials is challenging—only approximately one third of all trials recruit their participants as planned. The pharmaceutical industry’s views on recruitment success have not been comprehensively investigated, although the industry globally conducts almost one third of all clinical drug trials. This study explored patient recruitment success and failure factors and the role of electronic health records (EHR) in the recruitment of trial participants in the Nordic countries.MethodsA descriptive qualitative interview study was conducted with 21 representatives of the pharmaceutical industry or contract research organizations operating in Finland, Sweden, Denmark, and Norway. The interviews covered 34 clinical pre-market drug trials. Qualitative data were analyzed using inductive content analysis.ResultsFour main categories were derived to represent both success and failure factors, whereas a fifth category represented only failure factors: (1) sponsor-related (protocol and trial preparation and feasibility evaluations), (2) site/investigator-related (access to patients, motivation, commitment and resources), (3) patient-related recruitment factors (medical need, patients’ role in their care and attitudes towards trials), (4) Sponsor—sites—patients collaboration factors, and (5) start-up related factors. EHR was the most important source of recruitment, utilized in 29 out of 34 trials discussed. Revision of the legislation regulating the secondary use of EHR was highlighted as the most effective measure to facilitate the use of EHR in recruitment of trial participants.ConclusionsThe industry representatives recognized quite well their own role in contributing to the success or failure of the recruitment: to facilitate recruitment of trial participants, many obstacles can be avoided with better trial preparation and proper feasibility evaluations. As access to patients represents one of the key success or failure factors of recruitment, and as the EHR is regarded the main source of searching for and finding patients, the development of EHR utilization appears to represent a powerful tool to improve patient recruitment.

SemClinBr - a multi-institutional and multi-specialty semantically annotated corpus for Portuguese clinical NLP tasks

BackgroundThe high volume of research focusing on extracting patient information from electronic health records (EHRs) has led to an increase in the demand for annotated corpora, which are a precious resource for both the development and evaluation of natural language processing (NLP) algorithms. The absence of a multipurpose clinical corpus outside the scope of the English language, especially in Brazilian Portuguese, is glaring and severely impacts scientific progress in the biomedical NLP field.MethodsIn this study, a semantically annotated corpus was developed using clinical text from multiple medical specialties, document types, and institutions. In addition, we present, (1) a survey listing common aspects, differences, and lessons learned from previous research, (2) a fine-grained annotation schema that can be replicated to guide other annotation initiatives, (3) a web-based annotation tool focusing on an annotation suggestion feature, and (4) both intrinsic and extrinsic evaluation of the annotations.ResultsThis study resulted in SemClinBr, a corpus that has 1000 clinical notes, labeled with 65,117 entities and 11,263 relations. In addition, both negation cues and medical abbreviation dictionaries were generated from the annotations. The average annotator agreement score varied from 0.71 (applying strict match) to 0.92 (considering a relaxed match) while accepting partial overlaps and hierarchically related semantic types. The extrinsic evaluation, when applying the corpus to two downstream NLP tasks, demonstrated the reliability and usefulness of annotations, with the systems achieving results that were consistent with the agreement scores.ConclusionThe SemClinBr corpus and other resources produced in this work can support clinical NLP studies, providing a common development and evaluation resource for the research community, boosting the utilization of EHRs in both clinical practice and biomedical research. To the best of our knowledge, SemClinBr is the first available Portuguese clinical corpus.

Utilization of EHR to Improve Support Person Engagement in Health Care for Patients With Chronic Conditions.

Innovations in electronic health record (EHR) systems invite new patient and family engagement methods and create opportunities to reduce healthcare disparities. However, many patients and their identified support persons (ie, proxies) are unsure how to interface with the technology. This phenomenological qualitative study served as a pilot study to investigate the patient, proxy, and provider lived experiences utilizing patient-facing EHR portals. Individual interviews and focus groups were utilized to collect qualitative data from 21 patient, proxy, and healthcare provider participants across 3 time points. Colaizzi's phenomenological data analysis method was utilized to interpret the data. Four themes emerged highlighting critical benefits and obstacles for patients and support persons interfacing with a patient portal: (a) agency, (b) connection, (c) support, and (d) technology literacy. Results help highlight strategies and dispel myths essential to advancing patient and family engagement using EHR patient portal systems. The study's outcomes reflect recommendations for onboarding proxies and improving patient/family engagement and family-centered care models.

Application of the Consolidated Framework for Implementation Research Model to Design and Implement an Optimization Methodology within an Ambulatory Setting.

Background Following the implementation of a new electronic health record (EHR) system at Columbia University Irving Medical Center (CUIMC), the demands of the novel coronavirus disease 2019 (COVID-19) pandemic forced an abrupt reallocation of resources away from EHR adoption. To assist staff in focusing on techniques for improving EHR utilization, an optimization methodology was designed referencing the Consolidated Framework for Implementation Research (CFIR) approach. Methods The study was performed using a methodology that comprised of two primary components as follows: (1) analysis of qualitative and quantitative data and (2) participation of frontline staff in project work groups. Working groups mapped out the current state of the identified workflows, designed and implemented interventions, monitored the effectiveness of each intervention, and scaled the proposed changes. Results As a result of the optimization methodology, clinical and operational workflows improved in the pilot department. Operationally, the pilot department increased enrollment of patients in the virtual patient portal by 20%, increased schedule utilization by 25%, and reduced average check-in time by 19%. Clinically, the pilot department had a statistically significant increase in dictation and NoteWriter tool note composition from their baseline month to their observed month. Compared with the control department, the pilot department had a statistically significant increase in SmartTool and dictation note composition. The control department showed smaller increases, and in some cases a decline in performance, in these areas of operational and clinical workflows. Conclusion The CFIR framework helped design an optimization methodology by applying a set of constructs to support effective organizational optimization, accounting for inner and outer settings. Through this methodology, the inner setting was supported in leading the identification and execution of interventions targeted to impact the outer setting. The phase-1 data at CUIMC suggest this strategy is effective in identifying opportunities, implementing interventions and creating a scalable process for continued organizational optimization.

Meta-Analysis the Effect of Electronic Health Record Utilization on Mortality and Readmission

Background: The development of technology shows a very rapid development, especially in the health sector. One example of the use of technology in the health sector is the electronic health record. Electronic health records provide several benefits, one of which can reduce mortality and readmission rates in patients. The purpose of this study was to estimate the effect of electronic health records on mortality and readmission rates by metaanalysis. Subjects and Method: This was a metaanalysis study using PRISMA flowchart guidelines. The article search process was carried out between 20112022 using databases from PubMed, Google Scholar, ProQuest, Science Direct and Scopus. The PICO formula used is P = patients with asthma. I= using internetbased selfmanagement. C= without using internetbased selfmanagement. O= asthma control. Article searches were performed using the keywords “mhealth” OR “mobile health” OR “telemedicine” AND “self management” AND “asthma control” OR “asthma treatment” AND “asthma control”. The inclusion criteria were full paper articles with randomized controlled trial study design, articles using English, the intervention provided was the application of internetbased selfmanagement, and the outcome was asthma control. Based on the database, there were 9 articles that met the inclusion criteria. The analysis was carried out using Revman 5.3 software. Results: A total of 13 articles spread across 2 continents, namely Asia (Taiwan, Singapore, and South Korea) and North America (South America). Articles reviewed in the metaanalysis showed that electronic health records had an effect on reducing mortality by 0.74 times compared to those without using electronic health records (aOR= 0.74; 95% CI= 0.64 to 0.86; p&lt;0.001). In addition, it was also found that electronic health records had an effect on reducing readmission by 0.77 times compared to without using electronic health records (aOR= 0.77; CI 95%= 0.62 to 0.95; p= 0.010) Conclusion: The application of electronic health records has an effect on reducing mortality and readmission rates. Keywords: Electronic health record, mortalitas, readmission Correspondence: Desi Syahbaniar. Masters Program in Public Health, universitas Sebelas Maret. Jalan Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: desiniar15@gmail.com. Mobile: +6287708465646 Journal of Health Policy and Management (20220, 07(02): 103-111 https://doi.org/10.26911/thejhpm.2022.07.02.02

Cost-Effectiveness of a Web-Based Program for Residual Depressive Symptoms: Mindful Mood Balance.

Mindful Mood Balance (MMB) is an effective Web-based program for residual depressive symptoms that prevents relapse among patients with partial recovery from major depressive episodes. This cost-effectiveness analysis was conducted from the health plan perspective alongside a pragmatic randomized controlled trial of MMB. Adults were recruited from behavioral health and primary care settings in a large integrated health system and randomly assigned to MMB plus usual depression care (MMB+UDC) or UDC. Patients had at least one prior major depressive episode; a current score of 5-9 on the Patient Health Questionnaire-9, indicating residual depressive symptoms; and Internet access. Program costs included recruitment, coaching, and MMB licensing. Center for Medicare and Medicaid fee schedules were applied to electronic health record utilization data for psychotropic medications and psychiatric and psychotherapy visits. Effectiveness was measured as depression-free days (DFDs), converted from PHQ-9 scores collected monthly for 1 year. Incremental cost-effectiveness ratios were calculated with various sets of cost inputs. A total of 389 patients (UDC, N=210; MMB+UDC, N=179) had adequate follow-up PHQ-9 measures for inclusion. MMB+UDC patients had 29 more DFDs during follow-up. Overall, the incremental cost of MMB+UDC was $431.54 over 12 months. Incremental costs per DFD gained ranged from $9.63 for program costs only to $15.04 when psychiatric visits, psychotherapy visits, and psychotropic medications were included. MMB offers a cost-effective Web-based program for reducing residual depressive symptoms and preventing relapse. Health systems should consider adopting MMB as adjunctive to traditional mental health care services.

THE EVALUATION OF ELECTRONIC HEALTH RECORD ADOPTION AMONG HEALTH PROFESSIONALS IN HOSPITAL SETTING

Background: Electronic Health Record (EHR) utilization has been improved nowadays and it is believed that the adoption of Information Technology (IT) that has been implemented in various setting may also accelerate qualified implementation in health care setting. This study aimed to evaluate EHR utilization in various settings by systemic literature review. Methods: systemic literature research was conducted with keywords “(evaluat* model OR evaluat* framework) AND (health professional* OR health staff*) AND (electronic health record OR EHR) AND (us* OR engagement OR implementation OR adoption) AND hospital”. Result: 833 literatures found at the beginning of literature search, after apply limitations, remove duplicates and exclude of irrelevant literatures, finally total 7 articles were included in the review. Conclusion: there are benefits and drawbacks of EHR utilization among health professional in different healthcare settings in some countries that included in this review. Some health professionals had positive experience of using EHR that its use can improve clinicians’ involvement, better clinicians’ representation and decrease workload. Meanwhile, others had different views that EHR use are ineffectiveness due to inability of the systems to meet users’ need, poor integration with existing workflows, poor IT skills among users and limited resources and training of EHR. Recommendation: Therefore, it is important to improve better design of EHR system with customized functionalities so it could improve the implementation and adoption of EHR by health professionals as end user.