Utilization Of Electronic Medical Record Research Articles

Patient-reported pain and physical health for acupuncture and chiropractic care delivered by Veterans Affairs versus community providers.

Acupuncture and chiropractic care are evidence-based pain management alternatives to opioids. The Veterans Health Administration (VA) provides this care in some VA facilities, but also refers patients to community providers. We aimed to determine if patient-reported outcomes differ for acupuncture and chiropractic care from VA versus community providers. We conducted an observational study using survey outcome data and electronic medical record utilization data for acupuncture and chiropractic care provided in 18 VA facilities or in community facilities reimbursed by VA. Study participants were users of VA primary care, mental health, pain clinic, complementary and integrative therapies, coaching or education services in 2018-2019. Patients received 1) 4+ acupuncture visits (N = 201) or 4+ chiropractic care visits (N = 178) from a VA or community provider from 60 days prior to baseline to six-months survey and 2) no acupuncture or chiropractic visits from 1 year to 60 days prior to baseline. Outcomes measured included patient-reported pain (PEG) and physical health (PROMIS) at baseline and six-month surveys. Multivariate analyses examined outcomes at six months, adjusting for baseline outcomes and demographics. In unadjusted analyses, pain and physical health improved for patients receiving community-based acupuncture, while VA-based acupuncture patients experienced no change. Unadjusted analyses also showed improvements in physical health, but not pain, for patients receiving VA-based chiropractic care, with no changes for community-based chiropractic care patients. Using multivariate models, VA-based acupuncture was no different from community-based acupuncture for pain (-0.258, p = 0.172) or physical health (0.539, p = 0.399). Similarly, there were no differences between VA- and community-based chiropractic care in pain (-0.273, p = 0.154) or physical health (0.793, p = 0.191). Acupuncture and chiropractic care were associated with modest improvements at six months, with no meaningful differences between VA and community providers. The choice to receive care from VA or community providers could be based on factors other than quality, like cost or convenience.

Impact of electronic medical record utilization on obesity screening and intervention for obese patients with endometrial cancer

ObjectiveTo identify the prevalence of obesity documented within the electronic medical record problem list.MethodsWe conducted a retrospective cohort study of adult patients with obesity and endometrial cancer receiving care from...

Technology adoption of electronic medical records in developing economies: A systematic review on physicians' perspective.

Electronic Medical Records (EMRs) are a tool that could potentially improve the outcomes of patient care by providing physicians with access to up-to-date and accurate vital patient information. Despite this potential, EMR adoption in developing economies has been dilatory. This systematic review aims to synthesize the related literature on the adoption of EMRs in developing economies, with a focus on the perspective of physicians. With the aim to discern the key factors that impact EMR adoption as perceived by physicians and to offer guidance for future research on filling any gaps identified in the existing literature, this study utilized a systematic literature review by following the PRISMA guidelines. Out of 1160 initial articles, 21 were selected for analysis after eliminating duplicates and non-qualifying articles. Results show that common enablers of EMR adoption from physicians' perspective were identified to be computer literacy, education, voluntariness, and the system functionality including its features and user interface, implying that the provision of proper interventions focusing on the aspects of the health information system has an impact in maximizing the utilization and capabilities of EMRs among healthcare providers. The most prevalent barriers include the lack of training and IT usage experience along with resistance to changes associated with respondents' age and gender, the lack of time for learning complex EMR systems, and costs of the new technology. This indicates that a thorough planning and proper budget allocation is necessary prior to implementing and integrating EMR systems in healthcare institutions. From this synthesis of the common research conclusions, limitations, and recommendations from physicians' perspective, the result of this systematic review is expected to shed light on the optimal technology adoption of EMRs and its contribution to the health care systems of developing economies.

1804. A Hospital System Utilization of EMR towards New Jersey’s Goal of Viral Hepatitis and HIV Elimination

Abstract Background New Jersey plans to reduce 75% of new HIV infections and promote access to testing and linkage-to-care (LTC) to end the HIV epidemic by 2025. In the US, CDC 2020 hepatitis surveillance report indicated cases of hepatitis C in 2020 corresponded to a 124% increase from 2013. Globally, if the HBV effort remains unchanged, the annual deaths from HBV are projected to increase by 39% from 2015 to 2030. We implemented an electronic medical record (EMR) based screening algorithm to scale up HBV, HCV, and HIV screening and provide LTC. Methods In March 2018, the EMR was modified at Cooperman Barnabas Medical Center in the Emergency Department (ED) to start automated screening, we expanded the screening criteria to boost identifying the undiagnosed. Subsequently, the program expanded to Somerset Medical Center and Rahway Hospital. Patient Navigators receive a real-time alert of positive results to contact patients and arrange LTC, the multidisciplinary team offers evaluation and treatment.Figure 1.Expanding Automated Screening Program Results We found HIV prevalence in CBMC is 1.5%, close to 5 times the NJ statewide 397.2 per 100,000 population. HBV infection rates varied in three hospitals, representative of the diverse population in their service areas. The HBV patients we confirmed came from more than 170 countries with different insurance statuses, the majority are immigrants from endemic countries or with high-risk behaviors identified. From Aug 2022, new HbsAg + cases reflex to HDVAb test, where 5% resulted HDVAb+ and no HDVRNA+. HCV prevalence rates are more consistent among the three sites, however, the percentages of the birth cohort (1945-1965) are varied. LTC rates are higher in HBV patients than HCV, thus far, 41 patients were cured of HCV from our team.Figure 2.Total Numbers of HBV, HCV & HIV Tested, Prevalence & LTC Conclusion EMR automated screening significantly scales up the diagnosis of HBV, HCV and HIV, as well as identifying HIV at-risk patients to receive comprehensive preventative services. HBV, HCV and HIV share similar risks, LTC is crucial to treat current infections and is beneficial to prevent transmission and potential exposure. In summary, automated screening and LTC work robustly toward elimination. Disclosures All Authors: No reported disclosures

REKAM MEDIS ELEKTRONIK (RME) UNTUK PELAYANAN GIZI RUMAH SAKIT

Background: Electronic Medical Record (EMR) is mandatory for the healthcare provider in Indonesia. EMR were also developed for medical support services such as nutrition services. EMR application for nutrition services consists of nutrition assessment forms and patient-integrated clinical development records.Objective: To determine factors that influence the implementation of EMR for hospital nutrition services.Methods: This research is qualitative research with a single-case holistic design. The research location was in Instalasi Gizi RSUD Dr. Soetomo, from May to June 2023. The data collecting method was using in depth-interview and focus group discussions. Participants were selected using purposive sampling. Data was analyzed based on the Human, Organization, and Technology (HOT)–Fit Framework.Results: This research showed that the main factor influencing the success of EMR implementation for hospital nutrition is the digital competencies of the staff. These competencies could be increased by giving some training to the staff. Another essential factor is that organization should support by providing Standard Operating Procedures (SOPs) for EMR implementation and technical support from the Information Technology (IT) team. IT team has the responsibility to handle complaints and problems about EMR. Facilities such as computers and Local Area Networks (LAN) should be sufficient to make EMR implementation run well. The interface and features of EMR should answer the needs of the staff. So, staff would feel EMR is beneficial to help them finish their work, and they would show their acceptance toward this EMR.Conclusions: The success of EMR implementation for hospital nutrition services is determined by several factors like staff digital competencies, organizational support, and provision of computers and LAN for implementing EMR. Positive perception about the benefit of EMR encouraged the increase of EMR utilization in hospitals.

Abstract P6-05-52: Addressing Healthcare Gaps and Disparities in Electronic Medical Record Messages: A Quality Improvement Project Among Breast Cancer Patients

Abstract Introduction: Despite evidence that utilization of Electronic Medical Record (EMR) messaging positively impacts patients with cancer, there is little research on who uses EMR messaging and for what purpose. Methods: Sociodemographic and MyChart usage data was collected from Epic to identify patterns of EMR messaging by patients at an academic breast center. Study eligibility included breast cancer patients who completed a visit and sent at least one message to a provider during the study period (May 2021- May 2022). Chi-square and t-tests were used to describe differences between users and non-users of EMR messaging. ANOVA and chi-square were used to describe differences between race/ethnicity. Analyses were performed in R version 4.2 and p< 0.05 was considered statistically significant. Results: A total of 4069 patients who had MyChart account activated were included in the analysis sample. Of those, 3575 (87.9%) were messaging users and 494 (12.1%) were non-users. The mean age of users was significantly lower compared to the non-users (57.7 vs 61.2, p< .001). There were statistically significant racial/ethnic differences (p< 0.001) by user status with 83.9% and 9.5% of users being non-Hispanic White (NHW) and non-Hispanic Black (NHB) respectively. Among non-users 69.6% were NHW and 21.1% were NHB. There were also significant differences in preferred language (p< 0.001) and payor (p< 0.001) by user status. 99.2% of users were English speaking and 96.8% of non-users were non-English speaking. 54% and 38%, and 6.5% of users had Managed care, Medicare, and Medicaid respectively as their payor. Whereas 36.9%, 51%, and 10.5% of non-users had Managed care, Medicare, and Medicaid respectively. Lastly, there were statistically significant racial/ethnic differences in the types of messages sent among EMR users. Conclusions: There are significant differences in race/ethnicity among EMR users and non-users, and racial/ethnic differences in the types of messages sent among EMR messaging users. We believe that these differences may be in part due to disparities in access or comfort in using EMR. Future directions include conducting interviews with minority patients who are users and non-users of EMR messaging to identify barriers and gaps in use. Table 1. Patient Characteristics. Characteristics of users and non-users of EMR messaging. Chi-square and T-test for significance were performed to assess the difference between groups. P< .05 was considered significant. Table 2. Message Type by Race/Ethnicity. Types of message sent by race/ethnicity. ANOVA and chi-square were used to describe differences between race/ethnicity and type of message sent. P< .05 was considered significant. Citation Format: Meghan Conroy, Miracle Powell, Sneha Nagavally, Aprill Dawson, Anna Beckius, Heun Min, Maressa Sweeney, Elizabeth Weil, Angela Hallbach, Lubna N. Chaudhary, Yee Chung Cheng, Jutta Deiinger, John Burfeind, Janet Retseck, Tamiah Wright, John Charlson, Sailaja Kamaraju. Addressing Healthcare Gaps and Disparities in Electronic Medical Record Messages: A Quality Improvement Project Among Breast Cancer Patients [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-52.

Assessing Primary Care Clinic Operational Strategies via EMR Data Mining.

Understanding how operational strategies impact critical performance metrics is critical to the clinic's ability to provide a value-based service to patients. This study investigated the utility of electronic medical record (EMR) audit file data in assessing operational strategies. EMR data were used to assess patient appointment lengths and conclude that shorter scheduled patient visit lengths, which resulted from one operational strategy (physician choice of visit lengths), had a negative impact on a second operational strategy (minimizing patient wait times). Patients with 15-minute appointments had a higher total mean wait time and shorter provider care or contact time.

Electronic Medical Record System Use and Determinants in Ethiopia: Systematic Review and Meta-Analysis

The strategic plan of the Ethiopian Ministry of Health recommends an electronic medical record (EMR) system to enhance health care delivery and streamline data systems. However, only a few exhaustive systematic reviews and meta-analyses have been conducted on the degree of EMR use in Ethiopia and the factors influencing success. This will emphasize the factors that make EMR effective and increase awareness of its widespread use among future implementers in Ethiopia. This study aims to determine the pooled estimate of EMR use and success determinants among health professionals in Ethiopia. We developed a protocol and searched PubMed, Web of Sciences, African Journals OnLine, Embase, MEDLINE, and Scopus to identify relevant studies. To assess the quality of each included study, we used the Joanna Briggs Institute quality assessment tool using 9 criteria. The applicable data were extracted using Microsoft Excel 2019, and the data were then analyzed using Stata software (version 11; StataCorp). The presence of total heterogeneity across included studies was calculated using the index of heterogeneity I2 statistics. The pooled size of EMR use was estimated using a random effect model with a 95% CI. After reviewing 11,026 research papers, 5 papers with a combined total of 2439 health workers were included in the evaluation and meta-analysis. The pooled estimate of EMR usage in Ethiopia was 51.85% (95% CI 37.14%-66.55%). The subgroup study found that the northern Ethiopian region had the greatest EMR utilization rate (58.75%) and that higher (54.99%) utilization was also seen in publications published after 2016. Age groups <30 years, access to an EMR manual, EMR-related training, and managerial support were identified factors associated with EMR use among health workers. The use of EMR systems in Ethiopia is relatively low. Belonging to a young age group, accessing an EMR manual, receiving EMR-related training, and managerial support were identified as factors associated with EMR use among health workers. As a result, to increase the use of EMRs by health care providers, it is essential to provide management support and an EMR training program and make the EMR manual accessible to health professionals.

Electronic medical record use and associated factors among healthcare professionals at public health facilities in Dire Dawa, eastern Ethiopia: A mixed-method study.

Despite the significant benefits of digital health technologies (ITs), developing countries are lagging behind their developed counterparts in the adoption of electronic medical records (EMRs) in a healthcare setting. EMRs have long been considered essential elements in improving the quality of healthcare. However, the rate of utilization of EMRs among healthcare providers still remains low, particularly in developing countries. This study aimed at exploring EMR use and its determinants among healthcare providers at public health facilities in Dire Dawa, eastern Ethiopia. A quantitative cross-sectional study was conducted among 402 health professionals working at public health facilities supplemented with an exploratory qualitative study in Dire Dawa, Ethiopia. Descriptive summary statistics and binary and multivariable logistic regression analysis were used to explore the determinant factors of EMR use, while qualitative data were thematically analyzed. Overall, about a quarter (26.6%) of health professionals were using electronic medical records. A work experience of 6 years or less [adjusted odds ratio (AOR) = 2.23; 95% confidence interval (CI): [1.15-4.31]], a discussion on EMR (AOR = 14.47; 95% CI: [5.58-7.57]), the presence of an EMR manual (AOR = 3.10; 95% CI: [1.28-7.38]), and a positive attitude toward the EMR system (AOR = 11.15; 95% CI: [4.90-25.36]) and service quality (AOR = 8.02; 95% CI: [4.09-15.72]) were independent determinants of EMR use. Poor collaboration among stakeholders and dependence on the software programs of NGOs were the main challenges cited by key informants. The findings of this study indicate that EMR use by health professionals in the study area is very low. Several organizational, technical, and behavioral factors were identified for this low utilization. Therefore, there is a need to leverage EMRs through continuous technical support and commitment to enhance its use, which has the potential to improve health service performance. Developing locally applicable EMR software should be considered.

Impact of electronic medical record utilization on obesity screening and intervention for obese patients with endometrial cancer (412)

<b>Objectives:</b> Obesity has been identified as a modifiable risk factor associated with increased morbidity and mortality in endometrial cancer. The electronic medical record (EMR) problem list is a powerful but often underutilized tool for clinical decision-making. There is a paucity of data on how the EMR may be leveraged to optimize the management of obesity and initiate weight-loss interventions. Our study aimed to identify the prevalence of obesity documented on the EMR problem list and describe the completion of obesity interventions. <b>Methods:</b> We performed a retrospective cohort study of all obese patients with endometrial cancer receiving care at our institution from January 1, 2018, to August 20, 2021. Tumor registry confirmed endometrial cancer cases were identified using International Classification of Disease - Oncology (ICD-O) codes from our institution's Research Derivative database. The inclusion criteria were age >18, BMI ≥30 kg/m², and at least two visits with a gynecologic oncologist at our institution. The first BMI on record at the index visit was used for inclusion. Patients were excluded if BMI data was not available. Obesity intervention was defined as any of the following metrics: referral to a medical weight loss clinic, referral to nutrition, completion of the obesity intervention tab in EPIC, or counseling about the importance of weight loss. Completion of referral to nutrition and obesity weight loss clinic were captured. Weight loss counseling was defined by documentation of weight loss counseling in any gynecologic oncology provider visit note. <b>Results:</b> We identified 158 patients who met our inclusion criteria. Median BMI was 38 (range: 30-73), the median age was 66 years, and most patients identified as White (89%). Of eligible patients, 73 (46%) had obesity, or BMI documented on their problem list; 39 (25%) had completion of any obesity intervention. Specific interventions included weight loss counseling (<i>n</i> = 34, 22%), obesity health maintenance intervention completed in EPIC (<i>n</i> = 30, 19%), nutrition referral (<i>n</i> = 4, 3%), and medical weight loss center referral (<i>n</i> = 8, 5%). Only two patients who were referred to nutrition completed those visits, and only three patients who were referred to the medical weight loss center completed these visits. In the univariate logistic regression, patients with BMI or obesity on the problem list were 2.6 times more likely to have completion of obesity intervention (OR: 2.6, 95% CI: 1.24-5.59, p<0.001). <b>Conclusions:</b> EMR problem list to document obesity among endometrial cancer patients was used less than half of the time. Less than a quarter of eligible patients had the opportunity to engage in an obesity intervention. The EMR is not being leveraged to its full potential to encourage the usage of obesity interventions for this patient population. Improved compliance with these tools in the EMR may improve referral to and completion of weight-loss interventions.

The role of electronic medical records in improving health care quality: A quasi-experimental study.

The Teleprimary Care—Oral Health Clinical Information System (TPC-OHCIS) is an updated electronic medical record (EMR) that has been applied in Malaysian primary healthcare. Recognizing the level of patient satisfaction following EMR implementation is crucial for assessing the performance of health care services. Hence, the main objective of this study was to compare the level of patient satisfaction between EMR-based clinics and paper-based clinics.The study was a quasi-experimental design that used a control group and was conducted among patients in 14 public primary healthcare facilities in the Seremban district of Malaysia from May 10, to June 30, 2021. Patient satisfaction was assessed using the validated Short-Form Patient Satisfaction Questionnaire, which consisted of 7 subscales. All data were analyzed using the IBM Statistical Package for Social Sciences version 21.A total of 321 patients consented to participate in this study, and 48.9% of them were from EMR clinics. The mean score for the communication subscale was the highest at 4.08 and 3.96 at EMR-adopted clinics and paper-based record clinics. There were significant differences in general satisfaction and communication subscales, with higher patient satisfaction found in clinics using EMR.With the utilization of EMR, patient satisfaction and communication in delivering healthcare services have improved.

A Micro-analysis Approach in Understanding Electronic Medical Record Usage in Rural Communities: Comparison of Frequency of Use on Performance Before and During the COVID-19 Pandemic

In strengthening eHealth in the Philippines to support the universal health care (UHC) law, the scaling up and full adoption of electronic medical record (EMR) systems was strategically scheduled and supposedly completed in 2020. The Covid-19 pandemic, however, delayed these strengthening efforts. We wanted to assess the status of EMR adoption in primary clinics of rural health units (RHUs) and understand the frequency of use, particularly during the pandemic. Through analyses of EMR usage logs from selected RHUs in 2020, we estimated frequency of EMR usage based on duration of use and tested if this was influenced by the performing RHU and pandemic event. We also determined the most frequent EMR activities through process maps and tested if there were differences in the conduct of these activities before and during the pandemic. Results showed that EMR use during work hours was significantly dependent on the performing RHU (p<0.001). High-performing RHUs used EMRs more than 3 hours/day while low-performing RHUs used the systems for less. The pandemic either significantly decreased or increased EMR use during work hours by around 5 hours/day in some RHUs (p<0.01). Process maps revealed that there were additional activities performed by RHUs during the pandemic. Except for Update Patient Profile and Add Patient EMR features, significant differences (p<0.01) were observed in accessing frequently used features before and during the pandemic. The results suggest some uneven level of utilization of EMRs at the primary care level which can impact readiness to support full implementation of the UHC law. The study shows the potential of using a more granular approach in studying adoption to help improve the quality of EMR use and contribute to improving health service delivery and financing.

Utilization, Determinants, and Prospects of Electronic Medical Records in Ethiopia.

Background A lot of effort is being done in the electronic medical record (EMR) system. However, it has not been implemented and used at the expected scale for maximal effectiveness. There is limited evidence on the factors affecting the utilization of EMR in this particular context, which are critical for targeted strategies. Objective To assess the magnitude and factors affecting the utilization of EMR among health professionals in eastern Ethiopia. Methods An institutional-based cross-sectional study was conducted among randomly selected 412 health professionals from Harari and Dire Dawa, eastern Ethiopia, using a pretested self-administered questionnaire. The tool was developed from previous literature, and a pilot survey was done before the actual study. Bivariable and multivariable binary logistic regression were done to assess the relationship between an independent variable with EMR use. Crude and an adjusted odds ratio with a 95% confidence interval were reported. A P value of less than 0.05 was used to declare a statistically significant association. Results A total of 412 health professionals with a mean age of 29 years (±6.4 years) were included. A total of 229 (55.6%) and 300 (72.8%) of them had good knowledge and attitude towards the EMR, while 279 (67.7%) used the service (54% used it on a daily basis). About 272 (66%) of the respondents reported that they prefer EMRs to paper-based systems. Health professionals with more than five years of experience had two times higher odds of using the service (AOR = 2.22; 95% CI; 1.12-4.42) than early-career workers. Health professionals trained in EMR would use the service more (AOR = 5.88; 95% CI; 2.93-11.88) compared to those who did not take the training. In addition, having good knowledge (AOR = 1.52; 95% CI; 0.92-1.5) and a good attitude towards the EMR system (AOR = 2.4; 95% CI; 1.35-4.31) showed to use EMR as compared to counterparts. Conclusions The utilization of EMR was found to be optimal. Age, work experience, knowledge, attitude, and training of professionals were positively associated with the use of the service in their facility.

Epidemiology of Craniofacial Pathology in Northern Vietnam Using Digital Platforms: Utilization of Electronic Medical Records and an SMS-Based Reporting System in a Low-Middle Income Country.

Current disease surveillance in Vietnam relies on underdeveloped electronic medical record (EMR) systems, which are insufficient for timely standardized data collection about craniofacial and cleft pathologies. Concurrently, the World Bank reports Vietnamese mobile cellular subscription rates (per 100 people) of 128, some of the highest in the world. Herein, we discuss the development of a short messaging service (SMS)-based surveillance system based in Hanoi, Vietnam, and its utility in contrast to an EMR-based approach to craniofacial epidemiology study. Vietnam National Children's Hospital (VNCH) is a pediatric tertiary care center serving approximately 12 million children. Four plastic surgeons were trained in SMS data entry. The SMS database was designed using FrontlineSMS, a 2-way mobile gateway software application with automated messaging capabilities. The VNCH EMR database was queried for individual demographic data for patients seen by the department from 2010 to 2019. A corrected prevalence for cleft lip and palate of 0.098% (1 in 1020 live births) was calculated based on EMR data. Six rural provinces greater than 150 km from Hanoi were found to be significantly (P < 0.01) underserved surgically by the VNCH. A significantly (P < 0.01) higher rate of Pierre Robin in Lang Son province and facial clefts in Ha Tinh province were identified. The prospective data collection system received 7 patient data sets over 4 months, resulting in a capture rate of 2.9%. This feasibility study offers valuable insight into the true cleft and craniofacial prevalence in Vietnam and alternative methods to study in low- and middle-income countries.

Medication Errors Despite the Utilization of Electronic Medical Record: Examining The Missing Link From Nurses’ Perspective

Background: The Electronic Medical Record (EMR) system has proven to be very reliable in reducing medication errors and improving patient safety. It offers quick access to patient's medical information and alerts clinicians on safety issues such as allergies to medication, wrong patient, wrong medication, or other factors such as contraindication or potential drug interactions. Despite widespread implementation of the use of the EMR system in hospitals across the United States, medication errors still occur, with thousands of medication error-related incident reports being filed yearly. Antibiotics, anticoagulants, anti-hypertensive agents, and oral hypoglycemic agents are the most reported medicines involved in medication errors. To lock the loopholes leading to such errors, the missing links must be identified and fixed. Objective: The study sought to find out the missing links that lead to medication errors despite utilizing the EMR system from the nurses’ perspectives and proffer solutions to close the missing links. Method: The study was a qualitative analysis from case studies with incident reports filed by nurses on medication errors in hospitals in different States across the United States. Results: Eight missing links that lead to medication errors while using the EMR were identified in the study. Solutions for medication error prevention were recommended. Conclusion and Recommendation: Medication errors still occur despite the deployment of the EMR system. The study identified medication errors that still occur despite the utilization of EMR from nurses' perspectives and recommended solutions for fixing the missing links. It was recommended that as hospitals review each incident report involving medication errors, the error should be reviewed as a breakdown in the system and not as intentional.

Information system use antecedents of nursing employee turnover in a hospital setting.

Voluntary turnover (VTO) of nursing employees is expensive for hospital systems and is often associated with lower levels of patient satisfaction, as well as adverse patient outcomes such as falls and medication errors. The aim of this study was to establish nurses' electronic medical record (EMR) use patterns and test if they can be used to predict VTO. The study followed 1,836 hospital nurses via the collection of EMR metadata through two 1-month time periods that were 1 year apart. Machine learning algorithms were then used to derive patterns of EMR utilization using VTO as a key variable for classification. Post hoc analysis of the most predictive variables was conducted. The predictive model was effective in identifying which nurses would turnover 73.4% of the time and which nurses would not turnover 84.1% of the time. The ability to accurately predict nurses' intentions to leave is critical to reducing turnover. Early identification can lead to specific interventions to mitigate factors that are adversely impacting the nursing experience. Post hoc analysis and the key informant interviews indicated that many nurses do not appear to have good EMR navigation skills and spend significant effort in search of patient information.

What is Stopping Primary Health Centers to Go Digital? Findings of a Mixed-method Study at a District Level Health System in Southern India.

Introduction:Electronic medical records (EMRs) are computerized medical information systems that collect, store, and display patient information and essential for the achievement of primary health-care goals. This study explores the availability and utilization of EMR and analyzed the barriers inhibiting their implementation at primary health centers (PHCs) in Nalgonda district of Telangana, India.Methods:The research employed a sequential mixed-method design. Quantitative data were collected using a questionnaire by conducting facility surveys across 75 PHCs and in-depth interviews with district health authorities were conducted using a predesigned guide. Quantitative data were analyzed using descriptive statistics and thematic analysis of interviews resulted in four themes focusing on the factors inhibiting PHCs to use EMR.Results:The availability of EMR facility was low (19.14%) and they are routinely used for maintaining immunization data in 83% of the PHCs. In contrast, none of the PHCs used EMR for prescribing medications to patients. Budgetary constraints, unavailability of dedicated information technology staff, gaps in technical knowledge, and perceptions about EMR as a time-consuming system were the commonly reported barriers inhibiting PHCs to go digital.Conclusion:The availability and utilization of EMR keeping was low across PHCs of Nalgonda district. The study identified multiple barriers which hinder the implementation of EMR facilities at PHCs. Addressing these barriers is crucial for the successful implementation of EMR.

279 Quantifying Electronic Medical Record Utilization by Emergency Medicine Residents Using Event Log Data

279 Quantifying Electronic Medical Record Utilization by Emergency Medicine Residents Using Event Log Data

Willingness to Use Electronic Medical Record (EMR) System in Healthcare Facilities of Bahir Dar City, Northwest Ethiopia.

Background Globally, electronic information and communication technology has been applied and much expanded in the healthcare industry. However, in developing counties including Ethiopia, EMR system adoption and utilization for medical practice are still inconsistent, and healthcare institutions which started utilization currently have also failed to sustain. A desirable readiness of healthcare experts is mandatory to expand digital health service delivery. Thus, this study is aimed at estimating the proportion of the willingness of professionals in Bahir Dar city to use EMR and at identifying factors associated with this proportion. Methods An institution-based cross-sectional study was conducted from September 1 to October 30, 2019, among 634 health professionals. Respondents were selected using a simple random sampling method. Data were entered into EpiData version 3.1 and exported to SPSS version 23 for further analysis. Descriptive statistics were computed to describe study variables and presented using tables. Willingness to use the EMR system was computed. Bivariable and multivariable binary logistic regression models were fitted to identify the associated factors. The odds ratio with 95% confidence interval was used to measure the strength of association. Results A total of 616 health professionals participated in the study with a response rate of 97%. The proportion of willingness to use the EMR system was 85.9%. Among health professionals who were not willing to use EMR, lack of access to EMR training (73.4%) was a major barrier to the willingness to use EMR. A multivariable logistic regression analysis showed that those health professionals who had good computer skill (AOR = 2.5; 95% CI: 1.3-4.6), good knowledge on EMR (AOR = 2.1; 95% CI: 1-4.4), gotten EMR training (AOR = 3.8; 95% CI: 1.7-8.1), EMR guideline access (AOR = 2.8; 95% CI: 1.4-5.6), and management support (AOR = 2.6; 95% CI: 1.4-4.8) were more likely willing to use the EMR system. Conclusions Majority of the professionals were willing to use the EMR system. EMR program should involve computer illiterate, less knowledgeable, those unable to access EMR guidelines, and managerially unsupported professionals. Enhancing health professionals' attitude and contextualizing EMR training in the healthcare curricula are highly recommended to scale up EMR use.

&lt;p&gt;Implementation of Electronic Medical Record Template Improves Screening for Complications in Children with Type 1 Diabetes Mellitus&lt;/p&gt;

ObjectiveHealth professionals and patients should follow comprehensive screening guidelines to recognize early signs of long-term complications for insulin-dependent type 1 diabetes mellitus (T1DM). The aim of this study is to demonstrate that utilization of electronic medical record (EMR) templates for diabetes management improves adherence to International Society for Pediatric and Adolescent Diabetes (ISPAD) screening guidelines.MethodsAll patients with T1DM who were seen in the outpatient pediatric endocrine clinic (age 0–22 years old) at an urban community-based community hospital during the 2014 calendar year were enrolled in the study (n=49). A retrospective chart review was performed and audited against ISPAD guidelines. An EMR template and order set was then created based on ISPAD screening guidelines with the aim of improving compliance. The templates were implemented in 2015 (initial phase) and 2016 (maintenance phase) and these data were compared to baseline data. A chi-squared test was performed to analyze the differences between the data using SAS version 9.4 (SAS Institute, Inc). A p-value less than 0.05 was considered significant.ResultsSignificant improvements (p< 0.05) in screening guideline adherence from baseline to maintenance phase data were found for annual retinopathy (0% to 45%) and neuropathic foot (0% to 64%) exams, screening for microalbuminuria (49% to 79%), celiac disease (6% to 81%), lipids (63% to 86%), and basic metabolic panel (69% to 88%). Of note, thyroid function testing was also increased, but was not statistically significant between the years.ConclusionThe utilization of EMR templates and order sets for T1DM are valuable tools to aid medical providers in adhering to ISPAD screening guideline.