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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 25 of 113 Research Studies DisplayedHeintzman J, Marino M, Hoopes M
Supporting health insurance expansion: do electronic health records have valid insurance verification and enrollment data?
The researchers sought to validate electronic health record (EHR) insurance information for low-income pediatric patients at Oregon community health centers (CHCs), compared to reimbursement data and Medicaid coverage data. They concluded that EHR coverage data for children had a high overall correspondence with Medicaid data and reimbursement data, suggesting that in some systems EHR data could be utilized to promote insurance stability in their patients.
AHRQ-funded; HS021522.
Citation: Heintzman J, Marino M, Hoopes M .
Supporting health insurance expansion: do electronic health records have valid insurance verification and enrollment data?
J Am Med Inform Assoc 2015 Jul;22(4):909-13. doi: 10.1093/jamia/ocv033..
Keywords: Electronic Health Records (EHRs), Health Insurance, Medicaid, Low-Income, Children/Adolescents
Press A, Khan S, McCullagh L
Avoiding alert fatigue in pulmonary embolism decision support: a new method to examine 'trigger rates.'
The authors developed a new and innovative usability process named 'sensitivity and specificity trigger analysis' (SSTA) as part of a larger project around a pulmonary embolism decision support tool. They explored a unique methodology, SSTA, used to limit inaccurate triggering of a clinical decision support tool prior to integration into the electronic health record. They concluded that their methodology can be applied to other studies aiming to decrease triggering rates and increase adoption rates of previously validated clinical decision support system tools.
AHRQ-funded; HS022061.
Citation: Press A, Khan S, McCullagh L .
Avoiding alert fatigue in pulmonary embolism decision support: a new method to examine 'trigger rates.'
Evid Based Med 2016 Dec;21(6):203-07. doi: 10.1136/ebmed-2016-110440.
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Keywords: Clinical Decision Support (CDS), Respiratory Conditions, Electronic Health Records (EHRs), Provider: Health Personnel, Patient Safety
Roosan D, Samore M, Jones M
Big-data based decision-support systems to improve clinicians' cognition.
This study focused on answers from the experts on how clinical reasoning can be supported by population-based Big-Data. It found cognitive strategies such as trajectory tracking, perspective taking, and metacognition has the potential to improve clinicians' cognition to deal with complex problems. These cognitive strategies all have important implications for the design of Big-Data based decision-support tools that could be embedded in electronic health records.
AHRQ-funded; HS023349.
Citation: Roosan D, Samore M, Jones M .
Big-data based decision-support systems to improve clinicians' cognition.
IEEE Int Conf Healthc Inform 2016;2016:285-88. doi: 10.1109/ichi.2016.39.
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Keywords: Clinical Decision Support (CDS), Decision Making, Data, Electronic Health Records (EHRs)
Russo E, Sittig DF, Murphy DR
Challenges in patient safety improvement research in the era of electronic health records.
The researchers used a case study involving a project on missed or delayed follow-up of test results to discuss real-world challenges in using electronic health records data for patient safety research. They suggested that many current data access and security policies and procedures must be rewritten and standardized across health care organization sin order to advance progress toward safer health care.
AHRQ-funded; HS022901.
Citation: Russo E, Sittig DF, Murphy DR .
Challenges in patient safety improvement research in the era of electronic health records.
Healthc 2016 Dec;4(4):285-90. doi: 10.1016/j.hjdsi.2016.06.005.
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Keywords: Electronic Health Records (EHRs), Health Services Research (HSR), Health Information Technology (HIT), Patient Safety, Quality Improvement
Topaz M, Seger DL, Goss F
Standard information models for representing adverse sensitivity information in clinical documents.
This study aimed to identify and compare the existing common adverse sensitivity information models. Overall, the models had many similarities in the central attributes which covered between 75% and 95% of adverse sensitivity information contained within the notes. However, representations of some attributes (especially the value-sets) were not well aligned between the models, which is likely to present an obstacle for achieving data interoperability.
AHRQ-funded; HS022728.
Citation: Topaz M, Seger DL, Goss F .
Standard information models for representing adverse sensitivity information in clinical documents.
Methods Inf Med 2016;55(2):151-7. doi: 10.3414/me15-01-0081.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT)
McAlearney AS, Sieck CJ, Hefner JL
High touch and high tech (HT2) proposal: transforming patient engagement throughout the continuum of care by engaging patients with portal technology at the bedside.
This study measures how access to a patient portal tailored to the inpatient stay can improve patient experience and increase patient engagement by (1) improving patients' perceptions of the process of care while in the hospital; (2) increasing patients' self-efficacy for managing chronic conditions; and (3) facilitating continued use of a patient portal for care management after discharge.
AHRQ-funded; HS024091.
Citation: McAlearney AS, Sieck CJ, Hefner JL .
High touch and high tech (HT2) proposal: transforming patient engagement throughout the continuum of care by engaging patients with portal technology at the bedside.
JMIR Res Protoc 2016 Nov 29;5(4):e221. doi: 10.2196/resprot.6355.
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Keywords: Electronic Health Records (EHRs), Patient and Family Engagement, Patient Experience, Patient Experience, Patient Self-Management
Jensen RE, Snyder CF, Basch E
All together now: findings from a PCORI workshop to align patient-reported outcomes in the electronic health record.
The goal of this paper was to report key findings from a 2013 Patient-Centered Outcomes Research Institute workshop on patient-reported outcomes, to report a summary of actions that followed from the workshop, and to present resulting recommendations that address patient, clinical and research/quality improvement barriers to regular use.
AHRQ-funded; HS000029.
Citation: Jensen RE, Snyder CF, Basch E .
All together now: findings from a PCORI workshop to align patient-reported outcomes in the electronic health record.
J Comp Eff Res 2016 Nov;5(6):561-67. doi: 10.2217/cer-2016-0026.
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Keywords: Comparative Effectiveness, Electronic Health Records (EHRs), Evidence-Based Practice, Patient-Centered Outcomes Research, Quality Improvement
Yazdany J, Robbins M, Schmajuk G
Development of the American College of Rheumatology's rheumatoid arthritis electronic clinical quality measures.
The researchers sought to develop and test electronic clinical quality measures for rheumatoid arthritis. Disease activity assessment, functional status assessment, disease-modifying antirheumatic durg use, and tuberculosis screening measures have achieved national endorsement and are recommended for use in federal quality reporting programs.
AHRQ-funded; HS024412.
Citation: Yazdany J, Robbins M, Schmajuk G .
Development of the American College of Rheumatology's rheumatoid arthritis electronic clinical quality measures.
Arthritis Care Res 2016 Nov;68(11):1579-90. doi: 10.1002/acr.22984.
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Keywords: Electronic Health Records (EHRs), Medication, Quality Measures, Arthritis, Outcomes
Fong A, Hoffman DJ, Zachary Hettinger A
Identifying visual search patterns in eye gaze data; gaining insights into physician visual workflow.
The authors propose an algorithmic approach to identify different visual search patterns. They demonstrate this approach by identifying common physician visual search patterns using a simulated prototype emergency department patient tracking system. They then discuss the benefits and limitations as well as insights from this initial evaluation.
AHRQ-funded; HS020433.
Citation: Fong A, Hoffman DJ, Zachary Hettinger A .
Identifying visual search patterns in eye gaze data; gaining insights into physician visual workflow.
J Am Med Inform Assoc 2016 Nov;23(6):1180-84. doi: 10.1093/jamia/ocv196.
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Keywords: Healthcare Delivery, Electronic Health Records (EHRs), Health Information Technology (HIT), Workflow
Ramos SR, Gordon P, Bakken S
Sociotechnical analysis of health information exchange consent processes in an HIV clinic.
The purpose of this study was to describe sociotechnical factors that influence health information exchange (HIE) consent for persons living with HIV (PLWH) at one clinic in New York City. The authors' approach revealed multiple interruptions in clinical workflow, staff and providers' time constraints, and lack of dedicated personnel focused on HIE consent as the major barriers to HIE consent, and they recommended having a dedicated person for facilitating HIE consent.
AHRQ-funded; HS023963.
Citation: Ramos SR, Gordon P, Bakken S .
Sociotechnical analysis of health information exchange consent processes in an HIV clinic.
J Assoc Nurses AIDS Care 2016 Nov - Dec;27(6):792-803. doi: 10.1016/j.jana.2016.08.001.
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Keywords: Electronic Health Records (EHRs), Health Information Exchange (HIE), Health Information Technology (HIT), Human Immunodeficiency Virus (HIV)
Mazur LM, Mosaly PR, Moore C
Toward a better understanding of task demands, workload, and performance during physician-computer interactions.
The researchers assessed the relationship between (1) task demands and workload, (2) task demands and performance, and (3) workload and performance, all during physician-computer interactions in a simulated environment. Two experiments were performed in 2 different electronic medical record environments: WebCIS and Epic. Results suggest that task demands as experienced by participants are related to participants' performance.
AHRQ-funded; HS023458; HS024062.
Citation: Mazur LM, Mosaly PR, Moore C .
Toward a better understanding of task demands, workload, and performance during physician-computer interactions.
J Am Med Inform Assoc 2016 Nov;23(6):1113-20. doi: 10.1093/jamia/ocw016.
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Keywords: Health Information Technology (HIT), Electronic Health Records (EHRs), Provider Performance
Abramson EL, Patel V, Pfoh ER
How physician perspectives on E-prescribing evolve over time. a case study following the transition between EHRs in an outpatient clinic.
The study objective was to examine how perceptions about using the new electronic health record (EHR) evolved over time, with focus on electronic prescribing. It found that for even experienced e-prescribers, achieving prior levels of perceived prescribing efficiency took nearly two years. Despite the fact that speed in performing prescribing-related tasks was highly important, most were still not utilizing system short cuts or customization features designed to maximize efficiency.
AHRQ-funded; R18 HS017029.
Citation: Abramson EL, Patel V, Pfoh ER .
How physician perspectives on E-prescribing evolve over time. a case study following the transition between EHRs in an outpatient clinic.
Appl Clin Inform 2016 Oct 26;7(4):994-1006. doi: 10.4338/aci-2016-04-ra-0069.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Physician, Provider
Lyles CR, Allen JY, Poole D
"I want to keep the personal relationship with my doctor": Understanding barriers to portal use among African Americans and Latinos.
The investigators sought to understand specific barriers to portal use among African American and Latino patients at Kaiser Permanente, which has had a portal in place for over a decade. Their findings suggest that uniform adoption of portal use across diverse patient groups requires more usable, more personalized websites, which may be particularly important for reducing health care disparities.
AHRQ-funded; HS022408.
Citation: Lyles CR, Allen JY, Poole D .
"I want to keep the personal relationship with my doctor": Understanding barriers to portal use among African Americans and Latinos.
J Med Internet Res 2016 Oct 3;18(10):e263. doi: 10.2196/jmir.5910.
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Keywords: Disparities, Electronic Health Records (EHRs), Clinician-Patient Communication, Racial and Ethnic Minorities, Web-Based
Fulford D, Tuot DS, Mangurian C
Electronic psychiatric consultation in primary care in the safety net.
The authors examined the feasibility and acceptability of implementing a psychiatric eReferral program in a publicly funded, community-based primary care clinic in San Francisco staffed by eight primary care practitioners (PCPs). They found feasibility and acceptability of implementing an integrated electronic psychiatry consultation and referral service in a community-based primary care clinic and recommended future trials designed to examine the impact of this type of service on the delivery of high-quality mental health care and its cost-effectiveness in a safety-net health care system.
AHRQ-funded; HS021700.
Citation: Fulford D, Tuot DS, Mangurian C .
Electronic psychiatric consultation in primary care in the safety net.
Psychiatr Serv 2016 Oct;67(10):1160-61. doi: 10.1176/appi.ps.671003.
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Keywords: Community-Based Practice, Electronic Health Records (EHRs), Behavioral Health, Primary Care, Health Information Technology (HIT)
Yazdany J, Myslinski R, Miller A
Methods for developing the American College of Rheumatology's electronic clinical quality measures.
The authors discuss the methodologic approach recommended by the American College of Rheumatology (ACR) to develop new electronic clinical quality measures (eCQMs) in priority areas. They recommend that the ACR’s eCQM development program evolve to address newly-identified gaps in care that are amenable to quality improvement and that input from rheumatologists continue to be a key ingredient for a measurement strategy that seeks not just to assess performance but to improve outcomes for patients.
AHRQ-funded; HS024412.
Citation: Yazdany J, Myslinski R, Miller A .
Methods for developing the American College of Rheumatology's electronic clinical quality measures.
Arthritis Care Res 2016 Oct;68(10):1402-9. doi: 10.1002/acr.22985.
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Keywords: Electronic Health Records (EHRs), Quality of Care, Health Information Technology (HIT), Quality Measures, Quality Measures
Murphy DR, Meyer AN, Bhise V
Computerized triggers of big data to detect delays in follow-up of chest imaging results.
A "trigger" algorithm was used to identify delays in follow-up of abnormal chest imaging results in a large national clinical data warehouse of electronic health record (EHR) data. In this study, the authors applied a trigger in a repository hosting EHR data from all Department of Veterans Affairs health-care facilities and analyzed data from seven facilities. The investigators concluded that application of triggers on "big" EHR data may aid in identifying patients experiencing delays in diagnostic evaluation of chest imaging results suspicious for malignancy.
Citation: Murphy DR, Meyer AN, Bhise V .
Computerized triggers of big data to detect delays in follow-up of chest imaging results.
Chest 2016 Sep;150(3):613-20. doi: 10.1016/j.chest.2016.05.001..
Keywords: Imaging, Electronic Health Records (EHRs), Health Information Technology (HIT), Data, Diagnostic Safety and Quality, Cancer
Curtis LM, Mullen RJ, Russell A
An efficacy trial of an electronic health record-based strategy to inform patients on safe medication use: the role of written and spoken communication.
The researchers tested the feasibility and efficacy of an electronic health record (EHR) strategy that automated the delivery of print medication information at the time of prescribing. They found that written information and physician counseling were independently associated with patient understanding of risk information and that receiving both was most beneficial. They concluded that although an EHR can be a reliable means to deliver tangible, print medication education to patients, it cannot replace physician-patient communication, and that offering both written and spoken information resulted in a synergistic effect for informing patients.
AHRQ-funded; HS017220.
Citation: Curtis LM, Mullen RJ, Russell A .
An efficacy trial of an electronic health record-based strategy to inform patients on safe medication use: the role of written and spoken communication.
Patient Educ Couns 2016 Sep;99(9):1489-95. doi: 10.1016/j.pec.2016.07.004.
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Keywords: Electronic Health Records (EHRs), Communication, Education: Patient and Caregiver, Medication: Safety, Medication
Gao Y, Nocon RS, Gunter KE
Characteristics associated with patient-centered medical home capability in health centers: a cross-sectional analysis.
The patient-centered medical home (PCMH) model is being implemented in health centers (HCs) that provide comprehensive primary care to vulnerable populations. The researchers identified characteristics associated with HCs' PCMH capability. EHR adoption likely played a role in HCs' improvement in PCMH capability. Other factors include a greater number of types of financial performance incentives, more types of hospital-HC affiliations, and state-level support and payment for PCMH activities.
AHRQ-authored; AHRQ-funded; HS000084.
Citation: Gao Y, Nocon RS, Gunter KE .
Characteristics associated with patient-centered medical home capability in health centers: a cross-sectional analysis.
J Gen Intern Med 2016 Sep;31(9):1041-51. doi: 10.1007/s11606-016-3729-8.
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Keywords: Patient-Centered Healthcare, Electronic Health Records (EHRs), Primary Care, Community-Based Practice, Vulnerable Populations
Curtis JR, Harrold LR, Asgari MM
Diagnostic prevalence of ankylosing spondylitis using computerized health care data, 1996 to 2009: underrecognition in a US health care setting.
The authors sought to estimate the prevalence of axial spondyloarthritis (axSpA) and ankylosing spondylitis in Kaiser Permanente Northern California (KPNC). They found that observed prevalence in the KPNC population, compared with national estimates for axSpA and ankylosing spondylitis, suggests underrecognition of these conditions in routine clinical practice. They suggested the use of computerized data to identify true cases of ankylosing spondylitis in order to facilitate population-based research.
AHRQ-funded; HS021589; HS018517.
Citation: Curtis JR, Harrold LR, Asgari MM .
Diagnostic prevalence of ankylosing spondylitis using computerized health care data, 1996 to 2009: underrecognition in a US health care setting.
Perm J 2016 Fall;20(4):4-10. doi: 10.7812/tpp/15-151.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Practice Patterns
Zhou L, Dhopeshwarkar N, Blumenthal KG
Drug allergies documented in electronic health records of a large healthcare system.
The authors studied the prevalence of common drug allergies and patient characteristics documented in electronic health records of two large tertiary care hospitals in Boston from 1990 to 2013. They found that drug allergies in general were most prevalent among females and white patients, but that allergies to NSAIDs, ACE inhibitors, and thiazide diuretics were more prevalent in black patients.
AHRQ-funded; HS022728.
Citation: Zhou L, Dhopeshwarkar N, Blumenthal KG .
Drug allergies documented in electronic health records of a large healthcare system.
Allergy 2016 Sep;71(9):1305-13. doi: 10.1111/all.12881.
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Keywords: Adverse Drug Events (ADE), Electronic Health Records (EHRs), Medication: Safety, Medication
Bush RA, Stahmer AC, Connelly CD
Exploring perceptions and use of the electronic health record by parents of children with autism spectrum disorder: a qualitative study.
This study used structured interviews with nine parents to examine perceptions of electronic health records and related patient portals in the treatment of their children. The authors recommend further research to increase portal registration and integration in patient care.
AHRQ-funded; HS022404.
Citation: Bush RA, Stahmer AC, Connelly CD .
Exploring perceptions and use of the electronic health record by parents of children with autism spectrum disorder: a qualitative study.
Health Informatics J 2016 Sep;22(3):702-11. doi: 10.1177/1460458215581911.
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Keywords: Autism, Electronic Health Records (EHRs), Web-Based, Patient Experience, Education: Patient and Caregiver
Gold JA, Stephenson LE, Gorsuch A
Feasibility of utilizing a commercial eye tracker to assess electronic health record use during patient simulation.
The researchers reported on their use of eye- and screen-tracking technology to understand factors associated with poor error recognition during an intensive care unit-based electronic health record simulation. They concluded that eye tracking can be successfully integrated into electronic health record-based simulation and provides a surrogate measure of cognitive decision making and electronic health record usability.
AHRQ-funded; HS021637.
Citation: Gold JA, Stephenson LE, Gorsuch A .
Feasibility of utilizing a commercial eye tracker to assess electronic health record use during patient simulation.
Health Informatics J 2016 Sep;22(3):744-57. doi: 10.1177/1460458215590250.
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Keywords: Electronic Health Records (EHRs), Intensive Care Unit (ICU), Patient Safety
Farrow NE, Lau BD, JohnBull EA
Is the meaningful use venous thromboembolism VTE-6 measure meaningful? A retrospective analysis of one hospital's VTE-6 cases.
The researchers assessed the validity of the Meaningful Use VTE-6 measure by reviewing the quality of venous thromboembolism (VTE) prophylaxis provided to patients. Sixty percent of the patients identified as having sustained potentially preventable VTE were false positives. For the remaining forty percent, VTE was considered to be truly potentially preventable and those patients therefore provided targets for quality improvement measures.
AHRQ-funded; HS017952.
Citation: Farrow NE, Lau BD, JohnBull EA .
Is the meaningful use venous thromboembolism VTE-6 measure meaningful? A retrospective analysis of one hospital's VTE-6 cases.
Jt Comm J Qual Patient Saf 2016 Sep;42(9):410-6.
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Keywords: Blood Clots, Quality Improvement, Quality Measures, Quality Measures, Electronic Health Records (EHRs)
Sakata KK, Stephenson LS, Mulanax A
Professional and interprofessional differences in electronic health records use and recognition of safety issues in critically ill patients.
The authors conducted this study to determine how each professional group - physicians, nurses, and pharmacists - reviews electronic health records (EHR) data in preparation for rounds and their ability to identify patient safety issues. They found significant and non-overlapping differences in individual profession recognition of patient safety issues in the EHR which may be attributed to differences in EHR use.
AHRQ-funded; HS023793; HS021637.
Citation: Sakata KK, Stephenson LS, Mulanax A .
Professional and interprofessional differences in electronic health records use and recognition of safety issues in critically ill patients.
J Interprof Care 2016 Sep;30(5):636-42. doi: 10.1080/13561820.2016.1193479.
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Keywords: Critical Care, Electronic Health Records (EHRs), Provider: Health Personnel, Intensive Care Unit (ICU), Patient Safety
Pevnick JM, Shane R, Schnipper JL
The problem with medication reconciliation.
The authors discussed medication reconciliation and the issue that benefits reaped by organizations focused on interventions have not generalized easily to other institutions. They specified that medication reconciliation interventions need to be carefully matched to organizational strengths, workflows, and goals based on institutional priorities, and that there are several broad recommendations that can be targeted to organizational leaders, clinicians and investigators.
AHRQ-funded; HS019598; HS023757.
Citation: Pevnick JM, Shane R, Schnipper JL .
The problem with medication reconciliation.
BMJ Qual Saf 2016 Sep;25(9):726-30. doi: 10.1136/bmjqs-2015-004734.
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Keywords: Electronic Health Records (EHRs), Medication, Patient Safety, Provider: Pharmacist
