Use of Epic Electronic Health Record System for Health Care Research: Scoping Review

Chishtie, Jawad; Sapiro, Natalie; Wiebe, Natalie; Rabatach, Leora; Lorenzetti, Diane; Leung, Alexander A; Rabi, Doreen; Quan, Hude; Eastwood, Cathy A

doi:10.2196/51003

Cited by 11 publications

(1 citation statement)

References 243 publications

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“…Strengths of our study include the innovative study design combining an RCT and observational study, the creative EHR-based screening strategies 30 and assessment of patient-reported outcomes.…”

Section: Discussionmentioning

confidence: 99%

Comparing Midline and Peripherally Inserted Central Catheters – a Randomized Feasibility Trial

Burek,

Porada,

Plunk

et al. 2024

Preprint

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ObjectivesThe most effective use of midline catheters in children is not well understood. We aimed to test the feasibility of a trial comparing peripherally inserted central catheters (PICCs) to midline catheters in hospitalized children in need of durable vascular access.MethodsOur study combined a single site, randomized controlled feasibility trial and a prospective observational study comparing PICCs to midline catheters. Hospitalized children ages 2-17 years old in need of non-central, medium-term vascular access (5-14 days) were enrolled for one year; enrollment goal of 30 participants/trial arm. The primary outcome was a four-measure feasibility outcome. Secondary outcomes included time-to-device removal and all-cause failure. Multi-method approaches explored patient/family experience.ResultsBetween 8/2022-8/2023, only 43 of 260 screened patients met eligibility criteria due to a decrease in eligible PICCs used at our site. A total of 35 patients were enrolled: 8/10 in the trial (4 in each arm) and 27/33 in the observational study (21 midline catheters, 6 PICCs). Our trial eligibility goal was not met. The other feasibility measures were met (n=10): (1) 80% of eligible patients enrolled; (2) 100% received the assigned intervention; (3) 96% of catheter inserters found the study acceptable; (4) no missing data.ConclusionsDue to a decrease in PICC use for non-central, medium-term vascular access needs, a trial comparing devices may not be a practical way to assess the effective use of midline catheters in hospitalized children. Next steps may include an implementation-based study evaluating an intravenous catheter selection algorithm that incorporates midline catheters.

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Section: Discussionmentioning

confidence: 99%

Comparing Midline and Peripherally Inserted Central Catheters – a Randomized Feasibility Trial

Burek,

Porada,

Plunk

et al. 2024

Preprint

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Using implementation science to encourage Serious Illness Conversations on general medicine inpatient services: An interrupted time series

Serna,

Yoon,

Fiskio

et al. 2024

Journal of Hospital Medicine

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BackgroundSerious Illness Conversations (SICs) are not consistently integrated into existing inpatient workflows.ObjectiveWe assessed the implementation of multiple interventions aimed at encouraging SICs with hospitalized patients.MethodsWe used the Consolidated Framework for Implementation Research to identify determinants for conducting SICs by interviewing providers and the Expert Recommendations for Implementing Change to develop a list of interventions. Adult patient encounters with a Readmission Risk Score (RRS) > 28% admitted to a general medicine service from January 2019 to October 2021 and without standardized SIC documentation in the prior year were included. A multivariable segmented logistic regression model, suitable for an interrupted time series analysis, was used to assess changes in the odds of standardized SIC documentation.ResultsBarriers included those associated with the COVID‐19 pandemic, such as extreme census. Facilitators included the presence of the Speaking About Goals and Expectations program and palliative care consultations. Key interventions included patient identification via the existing Quality and Safety Dashboard (QSD), weekly emails, in‐person outreach, and training for faculty and trainees. There was no significant change in the odds of standardized SIC documentation despite interventions (change in temporal trend odds ratio (OR) 1.16, 95% Confidence Interval (CI) 0.98–1.39).ConclusionThe lack of significant change in standardized SIC documentation may be attributed to insufficient or ineffective interventions and COVID‐19‐related challenges. Although patient identification is a known barrier to SICs, this issue was minimized with the use of the QSD and RRS. Further research is needed to enhance the implementation of SICs in inpatient settings.

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Quality improvement for parenteral nutrition in hospital: Applying a gap analysis to an electronic health record to review parenteral nutrition processing

Kulyk,

Dahmer,

Gramlich

2024

Nut in Clin Prac

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BackgroundIn light of the complex and high‐risk nature of parenteral nutrition (PN), reviewing PN processing steps is essential to minimize patient harm. The main steps include ordering, verification, compounding, and administration. Electronic health records (EHRs) have become increasingly utilized and can play a critical role in enhancing the safety of PN processin. Epic EHR is used throughout all PN processing steps within our health system. There is limited literature on health system quality improvement initiatives in PN processing.MethodsWe reviewed the steps of PN processing in our health region and applied a gap analysis to assess Epic's functionality in PN processing. This gap analysis aimed to identify opportunities to enhance PN safety.ResultsEpic applies 32 of 40 functions that enhance PN safety. We selected three functions to prioritize adding into future EHR iterations; these include (1) bidirectional automatic interfacing between the automated compounding device and EHR reflecting real‐time updates on product availability/shortages, (2) automatically transmitting a pharmacist‐modified PN order back to the prescriber for approval, and (3) adding additional clinical decision support tools, one of which is incorporating a 3‐in‐1 qualification calculator and the second is requiring prescriber justification for using compounded formulations over multichamber bags. Additional opportunities for improving safety in PN processing were identified and added to the gap analysis.ConclusionUsing a gap analysis is a simple process to review a health system's EHR to identify opportunities to enhance patient care.

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Use of Epic Electronic Health Record System for Health Care Research: Scoping Review

Cited by 11 publications

References 243 publications

Comparing Midline and Peripherally Inserted Central Catheters – a Randomized Feasibility Trial

Comparing Midline and Peripherally Inserted Central Catheters – a Randomized Feasibility Trial

Using implementation science to encourage Serious Illness Conversations on general medicine inpatient services: An interrupted time series

Quality improvement for parenteral nutrition in hospital: Applying a gap analysis to an electronic health record to review parenteral nutrition processing

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