The Digitization of Patient Care: A Review of the Effects of Electronic Health Records on Health Care Quality and Utilization

Atasoy, Hilal; Greenwood, Brad N.; McCullough, Jeffrey S.

doi:10.1146/annurev-publhealth-040218-044206

Cited by 188 publications

(128 citation statements)

References 106 publications

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“…The EHR may be an underappreciated risk factor for unsafe prescribing. The vast majority of medications are prescribed electronically, and prescribers rely on proposed doses and dosing instructions embedded in EHRs 14,15 . Default doses and frequencies in EHRs are designed for the general adult population and fail to account for age‐related changes that affect drug metabolism and safety in older adults.…”

Section: Introductionmentioning

confidence: 99%

Safer Prescribing for Hospitalized Older Adults with an Electronic Health Records‐Based Prescribing Context

Drago

Sharpe

Lima

et al. 2020

J American Geriatrics Society

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BACKGROUND/OBJECTIVES Hospitalized older adults are at risk of receiving potentially inappropriate medication (PIM) doses, driven in part by age‐independent dose defaults used by electronic health records (EHRs), leading providers to prescribe for older adults as they do for younger adults. We studied whether an automated EHR‐based medication support tool would reduce PIM dosing for hospitalized older adults. DESIGN Pre‐post study design. SETTING Tertiary care, level 1 trauma, academic medical center in Oregon. PARTICIPANTS Hospitalized adults 75 years and older in the inpatient, nonemergency setting prescribed medications with geriatric‐specific dose considerations. INTERVENTION An EHR‐based, automated set of evidence‐based, age‐specific dose and frequency defaults called the Geriatric Prescribing Context (GPC). MEASUREMENTS The process measure is percentage of orders consistent with geriatric dose recommendations, and outcome measures are average dose (AD) in milligrams and total daily dose (TDD) in milligrams in the 12 months before and after implementation. RESULTS Use of recommended geriatric doses with the context improved for all 10 of the most commonly ordered medications. In the year after implementation, there was a trend toward decreasing TDD and AD across all drug classes. CONCLUSION The GPC is a simple, elegant, and effective means to align prescribing practices with safety standards for older adults, improving prescribing safety for all. It works within the current prescriber workflow without triggering alert fatigue and requires minimal resources for development and maintenance.

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Section: Introductionmentioning

confidence: 99%

Safer Prescribing for Hospitalized Older Adults with an Electronic Health Records‐Based Prescribing Context

Drago

Sharpe

Lima

et al. 2020

J American Geriatrics Society

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“…• The landscape health policies are constantly created and updated to drive healthcare research and influence health achievements. Legislative and regulatory guidelines also impact biomedical and health research (53). These are intendend to standardize and control types of scholarly nad organizational behavior, monitor, and enforce policies and licensing, and accreditation.…”

Section: Core Curriculummentioning

confidence: 99%

Modernizing the Methods and Analytics Curricula for Health Science Doctoral Programs

Dinov

2020

Front. Public Health

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This perspective provides a rationale for redesigning and a framework for expanding the graduate health science analytics and biomedical doctoral program curricula. It responds to digital revolution pressures, ubiquitous proliferation of big biomedical data, substantial recent advances in scientific technologies, and rapid progress in health analytics. Specifically, the paper presents a set of common prerequisites, a proposal for core computational and data analytic curriculum, and a list of expected outcome competencies for graduates of doctoral health science and biomedical programs. The manuscript emphasizes the necessity for coordinated efforts of all stakeholders, including trainees, educators, academic institutions, funding agencies, and policy makers. Concrete recommendations are presented of how to ensure graduates with terminal health science analytics and biomedical degrees are trained and able to continuously self-learn, effectively communicate across disciplines, and promote adaptation and change to counteract the relentless pace of automation and the law of diminishing returns.

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“…A potential solution is the use of health information exchanges, which allow the sharing of data even if EHR systems are incompatible. Adoption of health information exchanges has been shown to reduce duplication of tests and imaging and decrease readmissions [35].…”

Section: Can Improving Continuity Of Care At Hospital Discharge Impromentioning

confidence: 99%

Improving continuity of care of patients with respiratory disease at hospital discharge

Dummer

Stokes

2020

Breathe

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Continuity of care refers to the delivery of coherent, logical and timely care to an individual. It is threatened during the transition of care at hospital discharge, which can contribute to worse patient outcomes. In a traditional acute care model, the roles of hospital and community healthcare providers do not overlap and this can be a barrier to continuity of care at hospital discharge. Furthermore, the transition from inpatient to outpatient care is associated with a transition from acute to chronic disease management and, in a busy hospital, attention to this can be crowded out by the pressures of providing acute care. This model is suboptimal for the large proportion of patients admitted to hospital with acute-on-chronic respiratory disease.In a chronic care model, the healthcare system is designed to give adequate priority to care of chronic disease. Integrated care for the patient with respiratory disease fits the chronic care model and responds to the fragmentation of care in a traditional acute care model: providers integrate their respiratory services to provide continuous, holistic care tailored to individuals. This promotes greater continuity of care for individuals, and can improve patient outcomes both at hospital discharge and more widely.Educational aimsTo understand the concept of continuity of care and its effect at the transition between inpatient and outpatient care.To understand the difference between the acute and chronic models of healthcare.To understand the effect of integration of care on continuity of care for patients with respiratory disease and their health outcomes.

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The Digitization of Patient Care: A Review of the Effects of Electronic Health Records on Health Care Quality and Utilization

Cited by 188 publications

References 106 publications

Safer Prescribing for Hospitalized Older Adults with an Electronic Health Records‐Based Prescribing Context

Safer Prescribing for Hospitalized Older Adults with an Electronic Health Records‐Based Prescribing Context

Modernizing the Methods and Analytics Curricula for Health Science Doctoral Programs

Improving continuity of care of patients with respiratory disease at hospital discharge

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