Structured clinical documentation in the electronic medical record to improve quality and to support practice‐based research in epilepsy

Narayanan, Jaishree; Dobrin, Sofia; Choi, Janet S.; Rubin, Susan M.; Pham, Anna; Patel, Vimal; Frigerio, Roberta; Maurer, Darryck; Gupta, P. P.; Link, Lourdes; Walters, Shaun; Wang, Chi; Ji, Yuan; Maraganore, Demetrius M.

doi:10.1111/epi.13607

Cited by 24 publications

(29 citation statements)

References 24 publications

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“…This might be caused by the fact that our previous fixed clinical pathway templates limit our physicians' role in clinical decision-making. Therefore, based on evidence-based medicine, we used historical data to help clinicians build clinical pathway templates adapted to the actual situation of local hospitals, and developed a clinical pathway management system [8].…”

Section: Discussionmentioning

confidence: 99%

“…A multidisciplinary team consisting physicians, nurses, pharmacists, statisticians and data analysts developed detailed flow charts of treatment processes for patients undergoing cerebral infarction treatment. This team collects all data from patients during hospitalization in order to provide decision support for the construction and optimization of clinical pathways [8]. The final path requires consistent approval from team members.…”

Section: Development Of a New Clinical Pathway (Description Of Solutimentioning

confidence: 99%

“…In order to integrate the characteristics of the diagnosis and treatments of cerebral infarction used in traditional Chinese medicine and in Western medicine, we revised the clinical pathway templates, compiled the data from HIS, LIS, PACS and EMR in our hospital [8], and evaluated its application by assessing LOS and hospital costs in patients with cerebral infarction in our hospital. and May 31, 2016.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the application of Clinical Pathways in therapy of Cerebral infarction Patients in China Using the Hospital Database: a Real-world Study

Wang¹,

L²,

Chen³

et al. 2019

Preprint

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BACKGROUND A real-world study was performed to evaluate the application of clinical pathways (CP) in treatment of cerebral infarction patients compared with normal medical care. The benefit of clinical pathways application was evaluated by assessing the length of in-hospital stay (LOS) and hospitalization costs in treatment of cerebral infarction patients. METHODSData were derived from our hospital database. We enrolled all patients who underwent stroke treatment (International Classification of Diseases, 10th rev. ed., Clinical Modification [ICD-10-CM] procedure I63.90) between June 1, 2015 and May 31, 2016. The criteria within this evaluation included the average LOS and costs (hospitalization, drugs, laboratory and radiology). Student's t-test

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Section: Discussionmentioning

confidence: 99%

Section: Development Of a New Clinical Pathway (Description Of Solutimentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of the application of Clinical Pathways in therapy of Cerebral infarction Patients in China Using the Hospital Database: a Real-world Study

Wang¹,

L²,

Chen³

et al. 2019

Preprint

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“…Data was collected at the point of care during the outpatient clinic visit, using structured clinical documentation support tools that we have built within our commercial electronic medical records (EMR) system (Epic). 14,15 The tools navigate care according to best practices, capture several hundred fields of epilepsy data per office visit and write notes at initial and annual follow-up visits. A validated screening tool for depressive symptoms was administered using the NDDIE.…”

Section: Design Methodsmentioning

confidence: 99%

Factors Affecting Cognition and Depression in Adult Patients with Epilepsy

Narayanan¹,

Simon²,

Choi³

et al. 2019

J Epilepsy Res

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Epilepsy patients are more likely to experience depressive symptoms and cognitive impairment compared to individuals in the general population. As the reasons for this are not definitively known, we sought to determine what factors correlate most strongly with cognition and a screening test for depression in epilepsy patients. Methods: Our study population included 379 adult patients diagnosed with epilepsy or seizure in our neurology clinic. We collected detailed demographic and clinical data during patient visits using structured clinical documentation support tools that we have built within our commercial electronic medical records system (Epic), including a depression score (Neurological Disorders Depression Inventory for Epilepsy, NDDIE) and cognition score test measures (specifically in this study, Mini-Mental State Examination [MMSE]). Medication, age, gender, body mass index, duration of epilepsy, seizure frequency, current number of anti-epileptic medications, years of education were assessed in relation to baseline score as well as change in score from initial visit to first annual follow-up. Results: Of the analyzed factors, two statistically significant associations were found after correction for multiple testing. Male gender and lower anti-seizure medication count were associated with better mood, as assessed by NDDIE score, at initial visit. Specifically, male gender was associated with a 1.3 decrease in NDDIE and for each additional anti-seizure medication, there was an associated 1.2 increase in NDDIE. Conclusions: However, these factors were not associated with change in NDDIE score from initial to first annual follow-up visit. These findings, although interesting, are preliminary. Additionally, these findings were based on a homogenous (mainly Caucasian) clinic-based population and detailed information on previous medication use was lacking. Further work is needed to replicate these findings and to understand any mechanisms that may explain these associations.

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“…It provides efficient communication of clinical care, allows data accessibility for quality review, and improves clinician efficiency. 16,17 Electronic documents that are developed, customized, and well integrated to a clinician's workflow can also assist a provider in identifying potential errors and deviations from practice, and may enhance patient care. EHRs are able to create and customize structured electronic documents.…”

Section: Future Directionsmentioning

confidence: 99%

Assessing and Improving Documentation of Pediatric Brain Death Determination within an Electronic Health Record

2018

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Background/Objective Pediatric brain death determination (BDD) can be subject to interprovider variability of documentation, resulting in diagnosis credibility. The aim of this study was to describe our approach to assessing pediatric BDD documentation and documentation variation in the electronic health record (EHR). Methods This was a single institution cross-sectional review of pediatric patients younger than 18 years determined to meet brain death criteria. We assessed electronic documentation and evaluated for the presence of contributing factors that can interfere with the brain death documentation based on our institutional brain death evaluation policy (core body temperature, systolic blood pressure within an acceptable range, sedative/analgesic drug effects, and neuromuscular blockade). Results In total, 33 pediatric brain death patients were identified. This review revealed pediatric BDD documentation consistency (n, %) as follows: performance of the first pediatric brain death clinical examination with temperature above 36°C (27, 81.8%), systolic blood pressure above the defined range (29, 87.9%), more than 24 hours following admission (28, 84.8%); performance of the second pediatric brain death clinical examination with temperature above 36°C (32, 97%), more than 12 hours following the first examination (26, 89.7%); and ensuring sedative infusions were discontinued within the recommended cutoff period prior to pediatric BDD (28, 84.8%). Clinical neurologic examinations were fully documented. Conclusions Pediatric BDD is a rare process subject to documentation omissions and error. Our findings highlight the variability of pediatric BDD electronic documentation among different providers and specialties at our institution. An approach to improving pediatric BDD documentation may start with completing a standardized electronic brain death document.

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Structured clinical documentation in the electronic medical record to improve quality and to support practice‐based research in epilepsy

Cited by 24 publications

References 24 publications

Evaluation of the application of Clinical Pathways in therapy of Cerebral infarction Patients in China Using the Hospital Database: a Real-world Study

Evaluation of the application of Clinical Pathways in therapy of Cerebral infarction Patients in China Using the Hospital Database: a Real-world Study

Factors Affecting Cognition and Depression in Adult Patients with Epilepsy

Assessing and Improving Documentation of Pediatric Brain Death Determination within an Electronic Health Record

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