Electronic Medical Records: A Path Forward

Bernd, David L; Fine, Peter S

doi:10.1097/01974520-201107000-00002

Cited by 6 publications

(3 citation statements)

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“…Numerous general articles discussed the need to engage a diverse set of experts and end users, and the need for extensive planning with reasonable timelines [24,[27][28][29][30][31][38][39][40][41][42][43][44][45][46][47][48][49][50]. Many of these articles highlighted the rushed timelines health institutions face; however, there were few concrete guidelines on how to address usability needs within compressed timelines.…”

Section: Governance and Consensus Building Findings In The Published mentioning

confidence: 99%

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Ratwani¹,

Fairbanks²,

Savage³

et al. 2016

Appl Clin Inform

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SummaryObjective: Decisions made during electronic health record (EHR) implementations profoundly affect usability and safety. This study aims to identify gaps between the current literature and key stakeholders' perceptions of usability and safety practices and the challenges encountered during the implementation of EHRs. Materials and Methods: Two approaches were used: a literature review and interviews with key stakeholders. We performed a systematic review of the literature to identify usability and safety challenges and best practices during implementation. A total of 55 articles were reviewed through searches of PubMed, Web of Science and Scopus. We used a qualitative approach to identify key stakeholders' perceptions; semi-structured interviews were conducted with a diverse set of health IT stakeholders to understand their current practices and challenges related to usability during implementation. We used a grounded theory approach: data were coded, sorted, and emerging themes were identified. Conclusions from both sources of data were compared to identify areas of misalignment. Results: We identified six emerging themes from the literature and stakeholder interviews: cost and resources, risk assessment, governance and consensus building, customization, clinical workflow and usability testing, and training. Across these themes, there were misalignments between the literature and stakeholder perspectives, indicating major gaps. Discussion: Major gaps identified from each of six emerging themes are discussed as critical areas for future research, opportunities for new stakeholder initiatives, and opportunities to better disseminate resources to improve the implementation of EHRs. Conclusion: Our analysis identified practices and challenges across six different emerging themes, illustrated important gaps, and results suggest critical areas for future research and dissemination to improve EHR implementation. Citation: Ratwani R et al.: Review to identify usability and safety challenges and practices during EHR implementation.

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Section: Governance and Consensus Building Findings In The Published mentioning

confidence: 99%

Mind the Gap

Ratwani¹,

Fairbanks²,

Savage³

et al. 2016

Appl Clin Inform

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“…OSCEs have been used to teach and evaluate communication of adverse outcomes and medical errors [ 11 , 13 ]. Calls for establishing and documenting competency in using EMRs have also been made by the American Medical Informatics Association and others who highlighted the impact of such competency on patient safety and quality of care [ 14 , 15 ]. Although several studies found OSCE valid and reliable in various settings [ 16 – 19 ]; others found it not fully reliable with variable results across the six competencies [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Proficiency in identifying, managing and communicating medical errors: feasibility and validity study assessing two core competencies

Dabrh

Murad

Newcomb³

et al. 2016

BMC Med Educ

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Background: Communication skills and professionalism are two competencies in graduate medical education that are challenging to evaluate. We aimed to develop, test and validate a de novo instrument to evaluate these two competencies.Methods: Using an Objective Standardized Clinical Examination (OSCE) based on a medication error scenario, we developed an assessment instrument that focuses on distinctive domains [context of discussion, communication and detection of error, management of error, empathy, use of electronic medical record (EMR) and electronic medical information resources (EMIR), and global rating]. The aim was to test feasibility, acceptability, and reliability of the method.Results: Faculty and standardized patients (SPs) evaluated 56 trainees using the instrument. The inter-rater reliability of agreement between faculty was substantial (Fleiss k = 0.71) and intraclass correlation efficient was excellent (ICC = 0.80). The measured agreement between faculty and SPs evaluation of resident was lower (Fleiss k = 0.36). The instrument showed good conformity (ICC = 0.74). The majority of the trainees (75 %) had satisfactory or higher performance in all six assessed domains and 86 % found the OSCE to be realistic. Sixty percent reported not receiving feedback on EMR use and asked for subsequent training.Conclusion: An OSCE-based instrument using a medical error scenario can be used to assess competency in professionalism, communication, using EMRs and managing medical errors.

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“…Recent healthcare reform has placed a high emphasis on the electronic health record (EHR). 1 The Centers for Medicare and Medicaid Services has gone as far as rewarding hospitals to implement EHR and computerized physician order entry (CPOE) systems through incentive programs. Accompanying these incentives is a 2015 deadline that threatens to decrease reimbursement for institutions that do not implement these systems.…”

Section: Introductionmentioning

confidence: 99%

Typed versus Voice Recognition for Data Entry in an Electronic Health Record: Emergency Department Physician Time Utilization and Interruptions

Cruz¹,

Shabosky²,

Albrecht³

et al. 2014

WestJEM

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IntroductionUse of electronic health record (EHR) systems can place a considerable data entry burden upon the emergency department (ED) physician. Voice recognition data entry has been proposed as one mechanism to mitigate some of this burden; however, no reports are available specifically comparing emergency physician (EP) time use or number of interruptions between typed and voice recognition data entry-based EHRs. We designed this study to compare physician time use and interruptions between an EHR system using typed data entry versus an EHR with voice recognition.MethodsWe collected prospective observational data at 2 academic teaching hospital EDs, one using an EHR with typed data entry and the other with voice recognition capabilities. Independent raters observed EP activities during regular shifts. Tasks each physician performed were noted and logged in 30 second intervals. We compared time allocated to charting, direct patient care, and change in tasks leading to interruptions between sites.ResultsWe logged 4,140 minutes of observation for this study. We detected no statistically significant differences in the time spent by EPs charting (29.4% typed; 27.5% voice) or the time allocated to direct patient care (30.7%; 30.8%). Significantly more interruptions per hour were seen with typed data entry versus voice recognition data entry (5.33 vs. 3.47; p=0.0165).ConclusionThe use of a voice recognition data entry system versus typed data entry did not appear to alter the amount of time physicians spend charting or performing direct patient care in an ED setting. However, we did observe a lower number of workflow interruptions with the voice recognition data entry EHR. Additional research is needed to further evaluate the data entry burden in the ED and examine alternative mechanisms for chart entry as EHR systems continue to evolve.

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Electronic Medical Records: A Path Forward

Cited by 6 publications

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Mind the Gap

Mind the Gap

Proficiency in identifying, managing and communicating medical errors: feasibility and validity study assessing two core competencies

Typed versus Voice Recognition for Data Entry in an Electronic Health Record: Emergency Department Physician Time Utilization and Interruptions

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