Progress in the Enhanced Use of Electronic Medical Records: Data From the Ontario Experience

Jones, Mavis; Koziel, Chad; Larsen, Darren; Berry, Plumaletta; Kubatka-Willms, Elena

doi:10.2196/medinform.6928

Cited by 23 publications

(12 citation statements)

References 18 publications

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“…The ability to process large amounts of data is especially important in heterogeneous diseases like COPD that exhibit varying symptoms. Use of EHR in primary care practices had increased to 53% in Canada in 2014 [ 107 ]. Proper implementation involves monitoring usage by clinicians and nurses, record maintenance and security.…”

Section: Electronic Health Records: a Helpful Tool For Precision Medimentioning

confidence: 99%

Precision medicine in COPD: where are we and where do we need to go?

2018

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Chronic obstructive pulmonary disease (COPD) was the fourth leading cause of death worldwide in 2015. Current treatments for patients ease discomfort and help decrease disease progression; however, none improve lung function or change mortality. COPD is heterogeneous in its molecular and clinical presentation, making it difficult to understand disease aetiology and define robust therapeutic strategies. Given the complexity of the disease we propose a precision medicine approach to understanding and better treating COPD. It is possible that multiOMICs can be used as a tool to integrate data from multiple fields. Moreover, analysis of electronic medical records could aid in the treatment of patients and in the predictions of outcomes. The Precision Medicine Initiative created in 2015 has made precision medicine approaches to treat disease a reality; one of these diseases being COPD.

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Section: Electronic Health Records: a Helpful Tool For Precision Medimentioning

confidence: 99%

Precision medicine in COPD: where are we and where do we need to go?

2018

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“…Moreover, even though the data gathered by different health devices [ 10 ] and the Internet of Things [ 11 , 12 ] can serve as a complement to PHRs and help to identify patients’ health risks [ 11 ], the success of PHRs will be dependent on general practitioners’ attitudes and actions. Additional workload coupled with the lack of time, remuneration, information and communication technology (ICT) skills, interoperability, confidentiality, and clear rules about their liability stand out as the main barriers to eHealth usage alongside organizational issues and resistance to change [ 1 , 13 - 17 ].…”

Section: Introductionmentioning

confidence: 99%

Modeling and Predicting Outcomes of eHealth Usage by European Physicians: Multidimensional Approach from a Survey of 9196 General Practitioners

et al. 2018

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BackgroundThe literature has noted the need to use more advanced methods and models to evaluate physicians’ outcomes in the shared health care model that electronic health (eHealth) proposes.ObjectiveThe goal of our study was to design and evaluate a predictive multidimensional model of the outcomes of eHealth usage by European physicians.MethodsWe used 2012-2013 survey data from a sample of 9196 European physicians (general practitioners). We proposed and tested two composite indicators of eHealth usage outcomes (internal practices and practices with patients) through 2-stage structural equation modeling. Logistic regression (odds ratios, ORs) to model the predictors of eHealth usage outcomes indicators were also calculated.ResultsEuropean general practitioners who were female (internal practices OR 1.15, 95% CI 1.10-1.20; practices with patients OR 1.19, 95% CI 1.14-1.24) and younger—aged <35 years (internal practices OR 1.14, 95% CI 1.02-1.26; practices with patients OR 1.32, 95% CI 1.13-1.54) and aged 36-45 years (internal practices OR 1.16, 95% CI 1.06-1.28; practices with patients OR 1.21, 95% CI 1.10-1.33)—had a greater propensity toward favorable eHealth usage outcomes in internal practices and practices with patients. European general practitioners who positively valued information and communication technology (ICT) impact on their personal working processes (internal practices OR 5.30, 95% CI 4.73-5.93; practices with patients OR 4.83, 95% CI 4.32-5.40), teamwork processes (internal practices OR 4.19, 95% CI 3.78-4.65; practices with patients OR 3.38, 95% CI 3.05-3.74), and the doctor-patient relationship (internal practices OR 3.97, 95% CI 3.60-4.37; practices with patients OR 6.02, 95% CI 5.43-6.67) had a high propensity toward favorable effects of eHealth usage on internal practices and practices with patients. More favorable eHealth outcomes were also observed for self-employed European general practitioners (internal practices OR 1.33, 95% CI 1.22-1.45; practices with patients OR 1.10, 95% CI 1.03-1.28). Finally, general practitioners who reported that the number of patients treated in the last 2 years had remained constant (internal practices OR 1.08, 95% CI 1.01-1.17) or increased (practices with patients OR 1.12, 95% CI 1.03-1.22) had a higher propensity toward favorable eHealth usage outcomes.ConclusionsWe provide new evidence of predictors (sociodemographic issues, attitudes toward ICT impacts, and working conditions) that explain favorable eHealth usage outcomes. The results highlight the need to develop more specific policies for eHealth usage to address different realities.

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“…With this customizable approach, EPEP consultants can virtually help any practice uncover gaps, achieve more efficient workflow, and improve data capture. Our previous analysis suggested that steps to improve EMR proficiency (maturity) can lead to improvements in care [16]. The examples described here add further layers to our understanding of EMR maturity—measurable improvements in data quality and ability to monitor patients can be achieved by individual practices as they work to improve EMR workflow and data quality.…”

Section: Discussionmentioning

confidence: 82%

An Optimization Program to Help Practices Assess Data Quality and Workflow With Their Electronic Medical Records: Observational Study

Jones¹,

Talebi²,

Littlejohn³

et al. 2018

JMIR Hum Factors

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BackgroundElectronic medical record (EMR) adoption among Canadian primary care physicians continues to grow. In Ontario, >80% of primary care providers now use EMRs. Adopting an EMR does not guarantee better practice management or patient care; however, EMR users must understand how to effectively use it before they can realize its full benefit. OntarioMD developed an EMR Practice Enhancement Program (EPEP) to overcome challenges of clinicians and staff in finding time to learn a new technology or workflow. EPEP deploys practice consultants to work with clinicians onsite to harness their EMR toward practice management and patient care goals.ObjectiveThis paper aims to illustrate the application of the EPEP approach to address practice-level factors that impede or enhance the effective use of EMRs to support patient outcomes and population health. The secondary objective is to draw attention to the potential impact of this practice-level work to population health (system-level), as priority population health indicators are addressed by quality improvement work at the practice-level.MethodsEPEP’s team of practice consultants work with clinicians to identify gaps in their knowledge of EMR functionality, analyze workflow, review EMR data quality, and develop action plans with achievable tasks. Consultants establish baselines for data quality in key clinical indicators and EMR proficiency using OntarioMD-developed maturity assessment tools. We reassessed and compared postengagement, data quality, and maturity. Three examples illustrating the EPEP approach and results are presented to illuminate strengths, limitations, and implications for further analysis. In each example, a different consultant was responsible for engaging with the practice to conduct the EPEP method. No standard timeframe exists for an EPEP engagement, as requirements differ from practice to practice, and EPEP tailors its approach and timeframe according to the needs of the practice.ResultsAfter presenting findings of the initial data quality review, workflow, and gap analysis to the practice, consultants worked with practices to develop action plans and begin implementing recommendations. Each practice had different objectives in engaging the EPEP; here, we compared improvements across measures that were common priorities among all 3—screening (colorectal, cervical, and breast), diabetes diagnosis, and documentation of the smoking status. Consultants collected postengagement data at intervals (approximately 6, 12, and 18 months) to assess the sustainability of the changes. The postengagement assessment showed data quality improvements across several measures, and new confidence in their data enabled practices to implement more advanced functions (such as toolbars) and targeted initiatives for subpopulations of patients.ConclusionsApplying on-site support to analyze gaps in EMR knowledge and use, identify efficiencies to improve workflow, and correct data quality issues can make dramatic improvements in a practice’s EMR proficiency, allowing practice...

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Progress in the Enhanced Use of Electronic Medical Records: Data From the Ontario Experience

Cited by 23 publications

References 18 publications

Precision medicine in COPD: where are we and where do we need to go?

Precision medicine in COPD: where are we and where do we need to go?

Modeling and Predicting Outcomes of eHealth Usage by European Physicians: Multidimensional Approach from a Survey of 9196 General Practitioners

An Optimization Program to Help Practices Assess Data Quality and Workflow With Their Electronic Medical Records: Observational Study

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