National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 159 Research Studies DisplayedRule A, Melnick ER, Apathy NC
Using event logs to observe interactions with electronic health records: an updated scoping review shows increasing use of vendor-derived measures.
The purpose of this study was to compare studies that utilize vendor-derived and investigator-derived measures of electronic health records (EHR) and to evaluate consistency across studies. The researchers reviewed PubMed for articles published between July 2019 and December 2021 that utilized measures of EHR use obtained from EHR event logs. The study found that 102 articles met the criteria for inclusion; of those, 40 utilized vendor-derived measures, 61 utilized investigator-derived measures, and 1 utilized both. Those studies utilizing vendor-derived measures had a greater likelihood of observing EHR use only in ambulatory settings and only by physicians or advanced practice providers compared with those employing investigator-derived measures. Studies utilizing vendor-derived measures also had a greater likelihood of measuring durations of EHR use, but definitions of measures (such as time outside scheduled hours) varied broadly. The researchers concluded that vendor-derived measures are being used more to study EHR use, but only by certain clinical roles. The amount of studies employing event logs to observe EHR use continues to increase, but with lack of consistency in measure definitions and significant differences between studies that utilize vendor-derived and investigator-derived methods.
AHRQ-funded; HS026116.
Citation: Rule A, Melnick ER, Apathy NC .
Using event logs to observe interactions with electronic health records: an updated scoping review shows increasing use of vendor-derived measures.
J Am Med Inform Assoc 2022 Dec 13;30(1):144-55. doi: 10.1093/jamia/ocac177..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT)
Bell SK, Bourgeois F, Dong J
Patient identification of diagnostic safety blindspots and participation in "good catches" through shared visit notes.
The goal of this study was to investigate whether sharing clinical notes with patients supported identification of potential breakdowns in the diagnostic process that might be difficult for clinical staff to observe -- "diagnostic safety blindspots." Researchers analyzed patient-reported ambulatory documentation errors among patients at 3 U.S. healthcare centers. Older, female, unemployed, disabled, or sicker patients, or patients who worked in healthcare, were more likely to identify blindspots; patients who self-identified as Black, Asian, multiple races and those with less formal education as well as those who deferred decision-making to their providers were less likely to report blindspots. The researchers concluded that patients who read notes have unique insight about potential errors in their medical records and that organizations should encourage patient review of notes and create systems to track patient-reported blindspots.
AHRQ-funded; HS027367.
Citation: Bell SK, Bourgeois F, Dong J .
Patient identification of diagnostic safety blindspots and participation in "good catches" through shared visit notes.
Milbank Q 2022 Dec; 100(4):1121-65. doi: 10.1111/1468-0009.12593..
Keywords: Diagnostic Safety and Quality, Patient Safety, Electronic Health Records (EHRs), Health Information Technology (HIT)
Wu A, Huang RJ, Colón GR
Low rates of structured advance care planning documentation in electronic health records: results of a single-center observational study.
This study’s objective was to determine rates of structured advanced care planning (S-ACP) documentation in electronic health records (EHRs) using a single, large university medical center in California. This retrospective cohort study used records from all patients 65 and older with at least one ambulatory encounter at Stanford Health Care between 2012 and 2020, and without concurrent hospice care. Analysis of 187,316 unique outpatient encounters between 2012 and 2020 showed only 7,902 (4.2%) contained S-ACP documentation in the EHR. The most common methods of S-ACP documentation were through problem list diagnoses (40.3%) and scanned documents (40.0%). Senior Care (46.6%) and Palliative Care (25%) demonstrated the highest rates at the clinical level.
AHRQ-funded; HS028747.
Citation: Wu A, Huang RJ, Colón GR .
Low rates of structured advance care planning documentation in electronic health records: results of a single-center observational study.
BMC Palliat Care 2022 Nov 22;21(1):203. doi: 10.1186/s12904-022-01099-9..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT)
MacEwan SR, Sieck CJ, McAlearney AS
Geographic location impacts patient portal use via desktop and mobile devices.
The purpose of this study was to assess patient portal use by geographic location according to: proximity to the medical center offering the portal, urban/rural classification, and degree of digital distress. The study found that patients living further from the medical center, in rural areas, or in areas of higher digital distress were less likely to be active portal users. Patients living in areas of higher digital distress were more likely to use the mobile portal application instead of the desktop portal website. Users of the mobile portal application used portal functions more frequently, and being a mobile user had a greater impact on the use of some portal functions by patients residing in areas of higher digital distress. The researchers concluded that mobile patient portal applications have the potential to increase the use of patient portals.
AHRQ-funded; HS024091; HS024379.
Citation: MacEwan SR, Sieck CJ, McAlearney AS .
Geographic location impacts patient portal use via desktop and mobile devices.
J Med Syst 2022 Nov 16;46(12):97. doi: 10.1007/s10916-022-01881-5..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT)
Gupta AK, Kasthurirathne SN, Xu H
A framework for a consistent and reproducible evaluation of manual review for patient matching algorithms.
The authors proposed a robust framework for creating and evaluating manually reviewed gold standard data sets for measuring the performance of patient matching algorithms. They indicated that their framework can help record linkage method developers provide necessary transparency when creating and validating gold standard reference matching data sets. They concluded that this transparency will support both the internal and external validity of recording linkage studies and improve the robustness of new record linkage strategies.
AHRQ-funded; HS023808.
Citation: Gupta AK, Kasthurirathne SN, Xu H .
A framework for a consistent and reproducible evaluation of manual review for patient matching algorithms.
J Am Med Inform Assoc 2022 Nov 14;29(12):2105-09. doi: 10.1093/jamia/ocac175..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT)
Sittig DF, Sherman JD, Eckelman MJ
i-CLIMATE: a "clinical climate informatics" action framework to reduce environmental pollution from healthcare.
This article describes an action framework called “Information technology-enabled Clinical cLimate InforMAtics acTions for the Environment” (i-CLIMATE) to reduce environmental pollution from healthcare. The framework has 5 actionable components: (1) create a circular economy for health IT, (2) reduce energy consumption through smarter use of health IT, (3) support more environmentally friendly decision-making by clinicians and health administrators, (4) mobilize healthcare workforce environmental stewardship through informatics, and (5) inform policies and regulations for change.
AHRQ-funded; HS027363.
Citation: Sittig DF, Sherman JD, Eckelman MJ .
i-CLIMATE: a "clinical climate informatics" action framework to reduce environmental pollution from healthcare.
J Am Med Inform Assoc 2022 Nov 14;29(12):2153-60. doi: 10.1093/jamia/ocac137..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT)
Ganeshan S, Pierce L, Mourad M
Impact of patient portal-based self-scheduling of diagnostic imaging studies on health disparities.
The purpose of this study was to explore the impact of self-scheduling on equitable access to care. The researchers utilized an electronic health record patient portal at the University of California San Francisco which deployed a self-scheduling tool allowing patients to self-schedule diagnostic imaging studies. The study found that among all patient portal users, Latinx, Black/African American, and non-English speaking patients, as well as patients with Medi-Cal, California's Medicaid program, and Medicare insurance were less likely to self-schedule studies. were all less likely to self-schedule when compared with commercially insured patients.
AHRQ-funded; HS026383.
Citation: Ganeshan S, Pierce L, Mourad M .
Impact of patient portal-based self-scheduling of diagnostic imaging studies on health disparities.
J Am Med Inform Assoc 2022 Nov 14;29(12):2096-100. doi: 10.1093/jamia/ocac152..
Keywords: Disparities, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT)
Kang D, Charlton P, Applebury DE
Utilizing eye tracking to assess electronic health record use by pharmacists in the intensive care unit.
The authors conducted a study using high-fidelity electronic health record (EHR)-based simulations with incorporated eye tracking to understand the workflow of critical care pharmacists within the EHR, with specific attention to the data elements most frequently viewed. They found that, in addition to medication information, laboratory data and clinical notes are key focuses of intensive care unit pharmacist review of patient records and that navigation to multiple screens is required in order to view these data with the EHR.
AHRQ-funded; HS023793.
Citation: Kang D, Charlton P, Applebury DE .
Utilizing eye tracking to assess electronic health record use by pharmacists in the intensive care unit.
Am J Health Syst Pharm 2022 Nov 7;79(22):2018-25. doi: 10.1093/ajhp/zxac158..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Intensive Care Unit (ICU), Critical Care, Provider: Pharmacist
Malik MA, Motta-Calderon D, Piniella N
A structured approach to EHR surveillance of diagnostic error in acute care: an exploratory analysis of two institutionally-defined case cohorts.
The purpose of this study was to examine a structured electronic health record (EHR) case review process to identify diagnostic errors (DE) and diagnostic process failures (DPFs) in acute care. The researchers created two test cohorts of all preventable cases (n=28) and an equal number of randomly sampled non-preventable cases (n=28) from 365 adult general medicine patients who expired and were part of the mortality case review process at the research institution. Twenty-seven preventable and 24 non-preventable cases were included in the review process. The study found that the frequency of DE contributing to death was significantly higher for the preventable cohort compared to the non-preventable cohort. The researchers concluded that substantial agreement was observed among final consensus and expert panel reviews using their structured EHR case review process, and DEs contributing to death associated with DPFs were identified in institutionally designated preventable and non-preventable cases.
AHRQ-funded; HS026613.
Citation: Malik MA, Motta-Calderon D, Piniella N .
A structured approach to EHR surveillance of diagnostic error in acute care: an exploratory analysis of two institutionally-defined case cohorts.
Diagnosis 2022 Nov;9(4):446-57. doi: 10.1515/dx-2022-0032..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Diagnostic Safety and Quality, Medical Errors
Russell LB, Huang Q, Lin Y
The electronic health record as the primary data source in a pragmatic trial: a case study.
Electronic health records are a series of overlapping and legacy systems that require time and expertise to use efficiently. Commonly measured patient characteristics are relatively easy to locate for most trial enrollees but less common characteristics are not. Acquiring essential supplementary data - in this trial, state data on hospital admission - can be a lengthy and difficult process.
AHRQ-funded; HS026372.
Citation: Russell LB, Huang Q, Lin Y .
The electronic health record as the primary data source in a pragmatic trial: a case study.
Med Decis Making 2022 Nov;42(8):975-84. doi: 10.1177/0272989x211069980..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Research Methodologies
Hitsman B, Matthews PA, Papandonatos GD B, Matthews PA, Papandonatos GD
An EHR-automated and theory-based population health management intervention for smoking cessation in diverse low-income patients of safety-net health centers: a pilot randomized controlled trial.
The purpose of this study was to test the initial effectiveness of an electronic health record (EHR)-automated population health management (PHM) intervention for smoking cessation among adult patients. The researchers included 190 participants from a federally qualified health center in Chicago who self-identified as smokers as documented in the electronic health records and who completed a longitudinal "needs assessment of health behaviors to strengthen health programs and services” baseline survey. Participants were then randomly assigned to the PHM intervention (N=97) or the enhanced usual care (EUC) group (N=93). Primary outcomes were treatment engagement, utilization, and self-reported smoking cessation. In the PHM group, 25.8% of participants engaged in treatment, 21.6% used treatment, and 16.3% were abstinent at 28 weeks. There was no engagement of the quitline among EUC participants, and an abstinence rate of 6.4%. The researchers concluded that a PHM approach that can address unique barriers for low-income individuals may be an important addition to clinic-based care.
AHRQ-funded; HS021141.
Citation: Hitsman B, Matthews PA, Papandonatos GD B, Matthews PA, Papandonatos GD .
An EHR-automated and theory-based population health management intervention for smoking cessation in diverse low-income patients of safety-net health centers: a pilot randomized controlled trial.
Transl Behav Med 2022 Oct 7;12(9):892-99. doi: 10.1093/tbm/ibac026..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Tobacco Use, Tobacco Use: Smoking Cessation, Low-Income
Florig ST, Corby S, Devara T
Medical record closure practices of physicians before and after the use of medical scribes.
This study used electronic health record data to evaluate medical record closure outcomes before and after the use of medical scribes at the Oregon Health & Science University, a large academic medical center with an internal scribe program. The authors identified 3 medical record closure performance metrics: medical record closure (date-time stamp difference between the encounter and physician signature), proportion of delinquent medical records (>14 days), and proportion of medical records closed after hours (7pm-7am on weekdays or anytime on weekends). The data set included over 1.2 million encounters across 55 clinical specialties, 430 physicians, and 134 scribes. Of the total physicians, 23% used scribes and 69% of encounters were with physicians who never used scribes. Median encounters per week for physicians was 11 for never users and 13 for scribe users at baseline. At baseline scribe-using physicians had significantly higher median medical record closure times, proportion of delinquent medical records, and proportion of medical records closed after hours compared to physicians who never used scribes. The physicians who didn’t use scribes were assigned them, and after assignment physicians had nonsignificantly higher median medical record closure time and lower proportion of delinquent and after-hour medical record completion compared with baseline.
AHRQ-funded; HS25141.
Citation: Florig ST, Corby S, Devara T .
Medical record closure practices of physicians before and after the use of medical scribes.
JAMA 2022 Oct 4;328(13):1350-52. doi: 10.1001/jama.2022.13558..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT)
Weiner SJ, Schwartz A, Weaver F
Effect of electronic health record clinical decision support on contextualization of care: a randomized clinical trial.
Researchers sought to determine whether contextualized clinical decision support (CDS) tools in the electronic health record (EHR) improve clinician contextual probing, attention to contextual factors in care planning, and the presentation of contextual red flags. In this randomized clinical trial, they found that contextualized CDS did not improve patients' outcomes but did increase contextualization of their care, suggesting that use of this technology could ultimately help to improve outcomes.
AHRQ-funded; HS025374.
Citation: Weiner SJ, Schwartz A, Weaver F .
Effect of electronic health record clinical decision support on contextualization of care: a randomized clinical trial.
JAMA Netw Open 2022 Oct;5(10):e2238231. doi: 10.1001/jamanetworkopen.2022.38231..
Keywords: Electronic Health Records (EHRs), Clinical Decision Support (CDS), Health Information Technology (HIT), Shared Decision Making
Ozonoff A, Milliren CE, Fournier K A, Milliren CE, Fournier K
Electronic surveillance of patient safety events using natural language processing.
The purpose of this study was to describe the surveillance of reportable safety events captured in hospital data including free-text clinical notes. The researchers created a training data set for a machine learning model and applied the model to complete sets of clinical notes which were then reviewed to identify safety events of interest. The study found that in Phase 1, the researchers reviewed 2,342 clinical notes of the 21,362 gathered. 125 PIV events were identified, of which 44 cases (35%) were not identified by other patient safety systems. In Phase 2 of the study, the researchers identified 440 infiltrate events of the 60,735 clinical notes collected. The study classifier provided accuracy above 90%.
AHRQ-funded; HS026246.
Citation: Ozonoff A, Milliren CE, Fournier K A, Milliren CE, Fournier K .
Electronic surveillance of patient safety events using natural language processing.
Health Informatics J 2022 Oct-Dec; 28(4):14604582221132429. doi: 10.1177/14604582221132429..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Shafer GJ, Singh H, Thomas EJ
Frequency of diagnostic errors in the neonatal intensive care unit: a retrospective cohort study.
The objective of this study was to determine the frequency and etiology of diagnostic errors during the first 7 days of admission for inborn neonatal intensive care unit (NICU) patients. The "Safer Dx NICU Instrument" was used to review electronic health records. The reviewers discovered that the frequency of diagnostic error in inborn NICU patients during the first 7 days of admission was 6.2%.
AHRQ-funded; HS027363.
Citation: Shafer GJ, Singh H, Thomas EJ .
Frequency of diagnostic errors in the neonatal intensive care unit: a retrospective cohort study.
J Perinatol 2022 Oct;42(10):1312-18. doi: 10.1038/s41372-022-01359-9..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Critical Care, Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety, Electronic Health Records (EHRs), Health Information Technology (HIT)
Lobach DF, Boxwala A, Kashyap N
AHRQ Author: Lomotan EA, Harrison MI, Dymek C, Swiger J
Integrating a patient engagement app into an electronic health record-enabled workflow using interoperability standards.
The authors sought to use interoperability standards to integrate the COVID-19 Tracker, a patient mobile application, with an EHR. Their clinical decision support integration project benefited from a standards-based approach, but they encountered challenges due to issues concerning implementation and experience of the standards-based application programming interface, Health Level 7 Fast Healthcare Interoperability Resources (FHIR) in the EHR. The authors concluded that FHIR standards may provide a promising mechanism for overcoming barriers in the integration of patient engagement apps with EHRs, but that expansion of available FHIR resources will improve workflow integration.
AHRQ-authored; AHRQ-funded; 233201500023I.
Citation: Lobach DF, Boxwala A, Kashyap N .
Integrating a patient engagement app into an electronic health record-enabled workflow using interoperability standards.
Appl Clin Inform 2022 Oct;13(5):1163-71. doi: 10.1055/s-0042-1758736..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient and Family Engagement, Workflow, COVID-19
Li X, Xu H, Grannis S
The data-adaptive fellegi-sunter model for probabilistic record linkage: algorithm development and validation for incorporating missing data and field selection.
The purpose of this study was to assess the extent to which including the missing at random (MAR)-assumption in the Fellegi-Sunter model and using data-driven selected fields improve patient-matching accuracy using real-world use cases. The researchers adapted the Fellegi-Sunter model to include missing data using the MAR assumption and compared the adaptation to the typical strategy of treating missing values as disagreement with matching fields selected by data-driven methods or specified by experts. Four use cases were utilized, including health information exchange (HIE) record deduplication, linkage of public health registry records to HIE, linkage of Social Security Death Master File records to HIE, and deduplication of newborn screening records. The study found that including the MAR assumption in the Fellegi-Sunter model maintained or improved F1-scores, regardless of whether matching fields were expert-specified or selected by data-driven methods. The researchers concluded that combining the MAR assumption and data-driven fields optimized the F1-scores in the 4 use cases regardless of whether matching fields are expert-specified or data-driven.
AHRQ-funded.
Citation: Li X, Xu H, Grannis S .
The data-adaptive fellegi-sunter model for probabilistic record linkage: algorithm development and validation for incorporating missing data and field selection.
J Med Internet Res 2022 Sep 29;24(9):e33775. doi: 10.2196/33775..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT)
Corby S, Ash JS, Whittaker K
Translating ethnographic data into knowledge, skills, and attitude statements for medical scribes: a modified Delphi approach.
This paper describes the curricular framework that was developed for standardized scribe training including desired core knowledge, skills, and attitudes (KSAs). First an ethnographic study was performed at 5 varied health care organizations in the US to gather qualitative data about knowledge, skills, and attitudes. Preliminary KSA related themes were generated from the team’s analysis, followed by a modified Delphi study to finalize the KSA lists. The team identified 90 descriptions of scribe-related KSAs with three lists ultimately defined as: (1) Hands-On Learning KSA list with 47 items amenable to simulation training, (2) Didactic KSA list consisting of 32 items appropriate for didactic lecture teaching, and (3) Prerequisite KSA list consisting of 11 items centered around items scribes should learn prior to being hired or soon after being hired.
AHRQ-funded; 290200810010.
Citation: Corby S, Ash JS, Whittaker K .
Translating ethnographic data into knowledge, skills, and attitude statements for medical scribes: a modified Delphi approach.
J Am Med Inform Assoc 2022 Sep 12;29(10):1679-87. doi: 10.1093/jamia/ocac091..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT)
Bradford A, Shofer M, Singh H
AHRQ Author: Shofer M, Singh H
Measure Dx: implementing pathways to discover and learn from diagnostic errors.
This paper discusses Measure Dx, a new AHRQ resource that translates knowledge from diagnostic measurement research into actionable recommendations. This resource guides healthcare organizations to detect, analyze, and learn from diagnostic safety events as part of a continuous learning and feedback cycle. The goal of Measure Dx is to advance new frontiers in reducing preventable diagnostic harm to patients.
AHRQ-authored; AHRQ-funded; 233201500022I; HS027363.
Citation: Bradford A, Shofer M, Singh H .
Measure Dx: implementing pathways to discover and learn from diagnostic errors.
Int J Qual Health Care 2022 Sep 10;34(3). doi: 10.1093/intqhc/mzac068..
Keywords: Diagnostic Safety and Quality, Patient Safety, Quality Improvement, Quality of Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Systems, Learning Health Systems
Jiang Y, Mason M, Cho Y
Tolerance to oral anticancer agent treatment in older adults with cancer: a secondary analysis of data from electronic health records and a pilot study of patient-reported outcomes.
The purpose of this study was to explore the tolerance of capecitabine oral chemotherapy among older adults with cancer and investigate factors associated with related side effects and treatment changes. The researchers combined data from electronic health records and a pilot study of patient-reported outcomes, and found that older adults were more likely to experience fatigue and experienced more severe fatigue and hand-foot syndrome (HFS) than younger adults. The severity of fatigue and HFS were associated with the number of outpatient medications and the duration of treatment respectively. Female sex, breast cancer diagnosis, capecitabine monotherapy, and severe HFS were found to be associated with subsequent dose reductions. The study concluded that older adults were less likely to tolerate capecitabine treatment and had different co-occurring side effects compared to younger adults.
AHRQ-funded; HS027846.
Citation: Jiang Y, Mason M, Cho Y .
Tolerance to oral anticancer agent treatment in older adults with cancer: a secondary analysis of data from electronic health records and a pilot study of patient-reported outcomes.
BMC Cancer 2022 Sep 3;22(1):950. doi: 10.1186/s12885-022-10026-3..
Keywords: Elderly, Cancer, Medication, Adverse Drug Events (ADE), Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT)
Jin DP, Samuel S, Bowden K
Just-in-time electronic health record retraining to support clinician redeployment during the COVID-19 surge.
The purpose of this study was to examine the use of training in ICU-specific electronic health record (EHR) workflows prior to redeployment of certified registered nurse anesthetists (CRNAs) as ICU clinicians during the COVID-19 surge. The researchers utilized clinical informatics (CI) fellows to lead a multidisciplinary team to deploy a customized HER curriculum consisting of in-person classes and online video modules. Eighteen CRNAs participated, with 15 completing surveys immediately after the in-person training session, and 12 participants completing a post-deployment survey. The study found that all respondents of the post-training survey thought the training was useful and improved their EHR skills. Of the 12 participants who completed the post-deployment survey, all said that the training both increased their comfort in the ICU and that the concepts learned would be useful in their anesthesia role, and 91% indicated the training prepared them to work in the ICU with minimal guidance. The researchers concluded that CI fellows are uniquely prepared to deliver EHR training for clinician deployment in operational crisis response.
AHRQ-funded; HS02373.
Citation: Jin DP, Samuel S, Bowden K .
Just-in-time electronic health record retraining to support clinician redeployment during the COVID-19 surge.
Appl Clin Inform 2022 Aug 29;13(5):949-55. doi: 10.1055/a-1933-1798..
Keywords: COVID-19, Electronic Health Records (EHRs), Health Information Technology (HIT), Public Health, Training, Workforce
Huffstetler AN, Epling J, Krist AH
The need for electronic health records to support delivery of behavioral health preventive services.
In this article the authors discuss adaptations to electronic health records to improve behavioral health preventive services. They recommend a refocus in digital health away from best business practices that help EHR vendors and toward best health-related practice in order to improve patient care and make work easier for clinicians.
AHRQ-funded; HS027077.
Citation: Huffstetler AN, Epling J, Krist AH .
The need for electronic health records to support delivery of behavioral health preventive services.
JAMA 2022 Aug 23;328(8):707-08. doi: 10.1001/jama.2022.13391..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Behavioral Health, Prevention, Healthcare Delivery
Young JC, Dasgupta N, Stürmer T
Considerations for observational study design: comparing the evidence of opioid use between electronic health records and insurance claims.
The authors linked electronic health record (EHR) data from a large academic health system to Medicare insurance claims for patients undergoing surgery. When characterizing opioid exposure, they found substantial discrepancies between EHR medication orders and prescription claims data. In all time periods assessed, most patients' use was reflected only in the EHR, or only in the claims, but not both.
AHRQ-funded; HS000032.
Citation: Young JC, Dasgupta N, Stürmer T .
Considerations for observational study design: comparing the evidence of opioid use between electronic health records and insurance claims.
Pharmacoepidemiol Drug Saf 2022 Aug;31(8):913-20. doi: 10.1002/pds.5452..
Keywords: Research Methodologies, Electronic Health Records (EHRs), Health Information Technology (HIT)
Livaudais M, Deng D, Frederick T
Perceived value of the electronic health record and its association with physician burnout.
The objective of this study was to investigate how seniority/years of practice, gender, and screened burnout status were associated with opinions of electronic health record (EHR) use on quality, cost, and efficiency of care. Ambulatory primary care and subspecialty clinicians at three different institutions were surveyed. Findings showed that burnout status was significantly associated with clinicians' perceived value of EHR technologies, while years of practice and gender were not.
AHRQ-funded; HS022065.
Citation: Livaudais M, Deng D, Frederick T .
Perceived value of the electronic health record and its association with physician burnout.
Appl Clin Inform 2022 Aug;13(4):778-84. doi: 10.1055/s-0042-1755372..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Burnout, Provider: Physician
Hinson JS, Klein E, Smith A
Multisite implementation of a workflow-integrated machine learning system to optimize COVID-19 hospital admission decisions.
This study’s objective was to develop, implement, and evaluate an electronic health record (EHR) embedded clinical decision support (CDS) system that leveraged machine learning (ML) to estimate short-term risk for clinical deterioration in patients with or under investigation for COVID-19. The system translates model-generated risk for critical care needs within 24 hours and inpatient care needs within 72 hours into rapidly interpretable COVID-19 Deterioration Risk Levels made viewable within ED clinician workflow. A retrospective cohort of 21,452 ED patients who visited one of five ED study sites was used to derive ML models and were prospectively validated in 15,670 ED visits that occurred before (n = 4322) or after (n = 11,348) CDS implementation. Model performance and numerous patient-oriented outcomes including in-hospital mortality were measured across study periods. ML model performance was excellent under all conditions. AUC ranged from 0.85 to 0.91 for prediction of critical care needs and 0.80-0.90 for inpatient care needs. Total mortality was unchanged across study periods but was reduced among high-risk patients after the implementation.
AHRQ-funded; HS026640.
Citation: Hinson JS, Klein E, Smith A .
Multisite implementation of a workflow-integrated machine learning system to optimize COVID-19 hospital admission decisions.
NPJ Digit Med 2022 Jul 16;5(1):94. doi: 10.1038/s41746-022-00646-1..
Keywords: COVID-19, Clinical Decision Support (CDS), Health Information Technology (HIT), Implementation, Electronic Health Records (EHRs), Emergency Department, Shared Decision Making