A qualitative evaluation of the crucial attributes of contextual Information necessary in EHR design to support patient-centered medical home care

Weir, Charlene R.; Staggers, Nancy; Gibson, Bryan; Doing-Harris, Kristina; Barrus, Robyn; Dunlea, Robert

doi:10.1186/s12911-015-0150-x

Cited by 24 publications

(30 citation statements)

References 36 publications

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“…[2][3][4] While knowledge of SBDH is clinically meaningful information and can lead to tailored care plans, evidence suggests that providers often struggle to retrieve information related to SBDH from electronic health records (EHRs), and that when SBDH are neglected the overall quality of care may suffer. 5,6 Recent research in the informatics community has focused on integrating SBDH into the EHR. 7 However, these efforts have been impeded by both the infrequent documentation of SBDH in the patient record and the lack of national standards for collecting data related to SBDH.…”

Section: Background and Significancementioning

confidence: 99%

Detecting Social and Behavioral Determinants of Health with Structured and Free-Text Clinical Data

et al. 2020

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Background Social and behavioral determinants of health (SBDH) are environmental and behavioral factors that often impede disease management and result in sexually transmitted infections. Despite their importance, SBDH are inconsistently documented in electronic health records (EHRs) and typically collected only in an unstructured format. Evidence suggests that structured data elements present in EHRs can contribute further to identify SBDH in the patient record. Objective Explore the automated inference of both the presence of SBDH documentation and individual SBDH risk factors in patient records. Compare the relative ability of clinical notes and structured EHR data, such as laboratory measurements and diagnoses, to support inference. Methods We attempt to infer the presence of SBDH documentation in patient records, as well as patient status of 11 SBDH, including alcohol abuse, homelessness, and sexual orientation. We compare classification performance when considering clinical notes only, structured data only, and notes and structured data together. We perform an error analysis across several SBDH risk factors. Results Classification models inferring the presence of SBDH documentation achieved good performance (F1 score: 92.7–78.7; F1 considered as the primary evaluation metric). Performance was variable for models inferring patient SBDH risk status; results ranged from F1 = 82.7 for LGBT (lesbian, gay, bisexual, and transgender) status to F1 = 28.5 for intravenous drug use. Error analysis demonstrated that lexical diversity and documentation of historical SBDH status challenge inference of patient SBDH status. Three of five classifiers inferring topic-specific SBDH documentation and 10 of 11 patient SBDH status classifiers achieved highest performance when trained using both clinical notes and structured data. Conclusion Our findings suggest that combining clinical free-text notes and structured data provide the best approach in classifying patient SBDH status. Inferring patient SBDH status is most challenging among SBDH with low prevalence and high lexical diversity.

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Section: Background and Significancementioning

confidence: 99%

Detecting Social and Behavioral Determinants of Health with Structured and Free-Text Clinical Data

et al. 2020

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“…15 Yet we found no papers that looked holistically at all aspects of primary care physicians' work environment, limiting the ability to identify most critical operational failures, the overlaps or knock-on effects. 20,21,23 Without closer examination of how the overall health system supports primary care and the "basic science" of what happens in primary care practice, efforts to improve operational systems themselves risk limited success. 32…”

Section: Discussionmentioning

confidence: 99%

“…64 "Information scatter" described health records cluttered with entries from other health care clinicians. 21,44,66,68 Difficulties finding "buried" information" 21,23,34 led many physicians to simply ask patients for required information instead 23,32,36,44,68 , while others kept memos for themselves on complex cases, or developed tracking systems for important outgoing correspondence, prescriptions, and test requests. 16,19,20,22,25,27,29,30,32,36,44,47,57,63,65,[67][68][69]…”

Section: Synthesizing Argument: Operational Failures Configure Primarmentioning

confidence: 99%

Impacts of Operational Failures on Primary Care Physicians’ Work: A Critical Interpretive Synthesis of the Literature

et al. 2020

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PURPOSE Operational failures are system-level errors in the supply of information, equipment, and materials to health care personnel. We aimed to review and synthesize the research literature to determine how operational failures in primary care affect the work of primary care physicians. METHODS We conducted a critical interpretive synthesis. We searched 7 databases for papers published in English from database inception until October 2017 for primary research of any design that addressed problems interfering with primary care physicians' work. All potentially eligible titles/abstracts were screened by 1 reviewer; 30% were subject to second screening. We conducted an iterative critique, analysis, and synthesis of included studies. RESULTS Our search retrieved 8,544 unique citations. Though no paper explicitly referred to "operational failures," we identified 95 papers that conformed to our general definition. The included studies show a gap between what physicians perceived they should be doing and what they were doing, which was strongly linked to operational failures-including those relating to technology, information, and coordination-over which physicians often had limited control. Operational failures actively configured physicians' work by requiring significant compensatory labor to deliver the goals of care. This labor was typically unaccounted for in scheduling or reward systems and had adverse consequences for physician and patient experience. CONCLUSIONS Primary care physicians' efforts to compensate for suboptimal work systems are often concealed, risking an incomplete picture of the work they do and problems they routinely face. Future research must identify which operational failures are highest impact and tractable to improvement.

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“…[10][11][12] A fine balance between being able to express the idiosyncrasies of the individual person and a structured format needs to be achieved. 13 In the context of personcentered care, not only medical aspects but also healthrelated aspects, such as social, functional, and financial status, have been identified as being important for documentation 14 and are essential for supporting people with chronic health conditions in the self-management of their health and related needs. 15,16 The need for documenting not only disease-specific information but also psychosocial aspects in health has also been expressed by the World Health Organization (WHO) in the conceptualization of functioning in the International Classification of Functioning, Disability, and Health (ICF).…”

Section: Background and Significancementioning

confidence: 99%

Documenting Routinely What Matters to People: Standardized Headings for Health Records of Patients with Chronic Health Conditions

et al. 2018

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A qualitative evaluation of the crucial attributes of contextual Information necessary in EHR design to support patient-centered medical home care

Cited by 24 publications

References 36 publications

Detecting Social and Behavioral Determinants of Health with Structured and Free-Text Clinical Data

Detecting Social and Behavioral Determinants of Health with Structured and Free-Text Clinical Data

Impacts of Operational Failures on Primary Care Physicians’ Work: A Critical Interpretive Synthesis of the Literature

Documenting Routinely What Matters to People: Standardized Headings for Health Records of Patients with Chronic Health Conditions

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