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- Access to Care (1)
- Adverse Events (4)
- (-) Ambulatory Care and Surgery (26)
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- Asthma (1)
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- Clinical Decision Support (CDS) (2)
- Colonoscopy (1)
- Decision Making (1)
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- Electronic Health Records (EHRs) (5)
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- Healthcare-Associated Infections (HAIs) (3)
- Healthcare Costs (2)
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- Healthcare Utilization (1)
- Health Information Technology (HIT) (7)
- Health Services Research (HSR) (1)
- Health Systems (1)
- Hospitalization (2)
- Hospitals (2)
- Implementation (1)
- Injuries and Wounds (1)
- Learning Health Systems (1)
- Medication (2)
- Organizational Change (1)
- Palliative Care (1)
- Patient-Centered Healthcare (3)
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- Quality Indicators (QIs) (1)
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- Social Determinants of Health (1)
- Surgery (6)
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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 26 Research Studies DisplayedAncker JS, Stabile C, Carter J
Informing, reassuring, or alarming? Balancing patient needs in the development of a postsurgical symptom reporting system in cancer.
After ambulatory surgeries, patients who recover at home have multiple questions about wound healing, symptoms and medication side effects, and recovery expectations. In this study, the investigators conducted user testing and rapid application development of a symptom reporting system that supports home-based recovery by inviting patients to self-report symptoms in the days after surgery and receive an immediate feedback report giving context for their reported symptoms.
AHRQ-funded; HS021531.
Citation: Ancker JS, Stabile C, Carter J .
Informing, reassuring, or alarming? Balancing patient needs in the development of a postsurgical symptom reporting system in cancer.
AMIA Annu Symp Proc 2018 Dec 5;2018:166-74..
Keywords: Adverse Events, Ambulatory Care and Surgery, Cancer, Education: Patient and Caregiver, Health Information Technology (HIT), Patient Safety, Surgery
Federman A, Sarzynski E, Brach C
AHRQ Author: Brach C
Challenges optimizing the after visit summary.
The purpose of this study was to describe experiences of health systems implementing a redesigned outpatient after visit summary (AVS) in commercially available electronic health record (EHR) systems to inform future optimization. The authors noted limitations to AVS modifications in EHR systems present challenges to optimizing the tool. They recommended that EHR vendors should incorporate learning from healthcare systems innovation efforts and consider building more flexibility into their product development.
AHRQ-authored; AHRQ-funded; HS023844.
Citation: Federman A, Sarzynski E, Brach C .
Challenges optimizing the after visit summary.
Int J Med Inform 2018 Dec;120:14-19. doi: 10.1016/j.ijmedinf.2018.09.009..
Keywords: Ambulatory Care and Surgery, Electronic Health Records (EHRs), Health Information Technology (HIT), System Design
Cherrington AL, Khodneva Y, Richman JS
Impact of peer support on acute care visits and hospitalizations for individuals with diabetes and depressive symptoms: a cluster-randomized controlled trial.
This study examined the impact of peer support on the number of acute care visits and hospitalizations for individuals with diabetes with and without depressive symptoms. This randomized controlled trial was conducted from 2010-2012. One year of peer support was given to intervention participants, and the usual care to control participants. A Patient Health Questionnaire (PHQ-8) was given to participants to assess depression symptoms at the beginning of the trial, at 6 months and then at 12 months. There was a lower rate of acute care visits and hospitalizations in those patients with depressive symptoms in the intervention group, but it made no difference for individuals without depressive symptoms.
AHRQ-funded; HS013852.
Citation: Cherrington AL, Khodneva Y, Richman JS .
Impact of peer support on acute care visits and hospitalizations for individuals with diabetes and depressive symptoms: a cluster-randomized controlled trial.
Diabetes Care 2018 Dec;41(12):2463-70. doi: 10.2337/dc18-0550..
Keywords: Ambulatory Care and Surgery, Chronic Conditions, Depression, Diabetes, Hospitalization, Behavioral Health, Patient Self-Management
Khoong EC, Cherian R, Rivadeneira NA
Accurate measurement In California's safety-net health systems has gaps and barriers.
The purpose of this study was to measure California’s pay-for-performance program in safety-net hospitals. Results showed both suboptimal performance in aspects of ambulatory safety and questionable reliability in data reporting. Health care systems that lack seamlessly integrated electronic health records and patient registries encountered barriers to reporting reliable ambulatory safety data, precluding accurate performance measurement in many areas. The authors recommended that policymakers and safety advocates support the development of information systems and measures that facilitate the accurate ascertainment of the health systems, patients, and clinical tasks at greatest risk for ambulatory safety failures.
AHRQ-funded; HS024412; HS024426.
Citation: Khoong EC, Cherian R, Rivadeneira NA .
Accurate measurement In California's safety-net health systems has gaps and barriers.
Health Aff 2018 Nov;37(11):1760-69. doi: 10.1377/hlthaff.2018.0709..
Keywords: Ambulatory Care and Surgery, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety, Provider Performance, Quality Indicators (QIs), Payment
Karavite DJ, Miller MW, Ramos MJ
User testing an information foraging tool for ambulatory surgical site infection surveillance.
Surveillance for surgical site infections (SSIs) after ambulatory surgery in children requires a detailed manual chart review to assess criteria defined by the National Health and Safety Network. Electronic health records (EHRs) impose an inefficient search process. Using text mining and business intelligence software, the authors developed an information foraging application, the SSI Workbench, to visually present which postsurgical encounters included SSI-related terms and synonyms, antibiotic, and culture orders. This study compares the Workbench and EHR.
AHRQ-funded; HS020921.
Citation: Karavite DJ, Miller MW, Ramos MJ .
User testing an information foraging tool for ambulatory surgical site infection surveillance.
Appl Clin Inform 2018 Oct;9(4):791-802. doi: 10.1055/s-0038-1675179..
Keywords: Surgery, Ambulatory Care and Surgery, Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare-Associated Infections (HAIs), Patient Safety
Harrison MI, Grantham S
AHRQ Author: Harrison MI
Learning from implementation setbacks: identifying and responding to contextual challenges.
The authors addressed organizational learning about implementation context during setbacks to primary care redesign in an ambulatory system. They found that redesigned teams were not implemented as widely or rapidly as anticipated and did not deliver hoped-for gains in operational metrics; however, team redesign was leading to improvements in chronic care and prevention and eased provider burden. Redesign and system leaders engaged in more thorough organizational learning. Their responses to challenges helped to strengthen the redesign's prospects, improved the delivery system's position in its labor market, and helped the system prepare to meet emerging requirements for value-based care and population health.
AHRQ-authored; AHRQ-funded; 2902010000341.
Citation: Harrison MI, Grantham S .
Learning from implementation setbacks: identifying and responding to contextual challenges.
Learn Health Syst 2018 Oct;2(4):e10068. doi: 10.1002/lrh2.10068..
Keywords: Organizational Change, Learning Health Systems, Health Systems, Primary Care: Models of Care, Primary Care, Ambulatory Care and Surgery, Implementation
Grundmeier RW, Xiao R, Ross RK
Grundmeier RW, Xiao R, Ross RK, Ramos MJ, Karavite DJ, Michel JJ, Gerber JS, et al. Identifying surgical site infections in electronic health data using predictive models,.
The objective of this study was to prospectively derive and validate a prediction rule for detecting cases warranting investigation for surgical site infections (SSI) after ambulatory surgery. The investigators concluded that electronic health record data can facilitate SSI surveillance with adequate sensitivity and positive predictive value.
AHRQ-funded; HS020921.
Citation: Grundmeier RW, Xiao R, Ross RK .
Grundmeier RW, Xiao R, Ross RK, Ramos MJ, Karavite DJ, Michel JJ, Gerber JS, et al. Identifying surgical site infections in electronic health data using predictive models,.
J Am Med Inform Assoc 2018 Sep;25(9):1160-66. doi: 10.1093/jamia/ocy075..
Keywords: Healthcare-Associated Infections (HAIs), Injuries and Wounds, Surgery, Electronic Health Records (EHRs), Health Information Technology (HIT), Risk, Patient Safety, Adverse Events, Ambulatory Care and Surgery
Saleem JJ, Weiler DT, Satterly T
Field investigation of ambulatory clinic exam room design with respect to computing devices: a pilot study.
The authors of this paper conducted observations and interviews with primary care providers and their patients from three locations within the Phoenix VA Health Care System, in a pilot study comparing the new exam room design standard with the older legacy exam rooms. The study results suggested that the new exam room design did contribute to a greater degree of patient centeredness, though more thorough evaluations are required to support these preliminary results.
AHRQ-funded; HS024488.
Citation: Saleem JJ, Weiler DT, Satterly T .
Field investigation of ambulatory clinic exam room design with respect to computing devices: a pilot study.
Proc Hum Factors Ergon Soc Annu Meet 2018 Sep;62(1):518-22. doi: 10.1177/1541931218621118..
Keywords: Ambulatory Care and Surgery, Patient-Centered Healthcare, Primary Care
Nocon RS, Gunter KE, Gao Y
Development and validation of a short-form safety net medical home scale.
The purpose of this study was to develop a short-form Safety Net Medical Home Scale (SNMHS) for assessing patient-centered medical home (PCMH) capability in safety net clinics. The investigators found that short-form versions of SNMHS showed strong correlations with full scale and may be useful for brief assessment of safety net PCMH capability. They suggested that each short-form SNMHS version may be appropriate for different research, quality improvement, and assessment purposes.
AHRQ-funded; HS000084.
Citation: Nocon RS, Gunter KE, Gao Y .
Development and validation of a short-form safety net medical home scale.
Health Serv Res 2018 Aug;53 Suppl 1:3207-26. doi: 10.1111/1475-6773.12809..
Keywords: Ambulatory Care and Surgery, Patient-Centered Healthcare
Hollingsworth JM, Oerline MK, Ellimoottil C
Effects of the Medicare Modernization Act on spending for outpatient surgery.
The objective of the study was to examine the effects of Medicare's revised ambulatory surgery center (ASC) payment schedule on overall payments for outpatient surgery. The study concluded that despite lessening demand, reduced ASC facility payments did not curb spending for outpatient surgery. In fact, overall payments actually increased following the policy change, driven by higher average episode payments.
AHRQ-funded; HS024525; HS024728.
Citation: Hollingsworth JM, Oerline MK, Ellimoottil C .
Effects of the Medicare Modernization Act on spending for outpatient surgery.
Health Serv Res 2018 Aug;53 Suppl 1:2858-69. doi: 10.1111/1475-6773.12807..
Keywords: Payment, Policy, Ambulatory Care and Surgery, Surgery
Pandolfe F, Wright A, Slack WV
Rethinking the outpatient medication list: increasing patient activation and education while architecting for centralization and improved medication reconciliation.
The purpose of this study was to identify barriers impacting the time consuming and error fraught process of medication reconciliation and to design and implement an electronic medication management system where patient and trusted healthcare proxies can participate in establishing and maintaining an inclusive and up-to-date list of medications.
AHRQ-funded; HS021495.
Citation: Pandolfe F, Wright A, Slack WV .
Rethinking the outpatient medication list: increasing patient activation and education while architecting for centralization and improved medication reconciliation.
J Am Med Inform Assoc 2018 Aug;25(8):1047-53. doi: 10.1093/jamia/ocy047..
Keywords: Education: Patient and Caregiver, Health Information Technology (HIT), Medication, Ambulatory Care and Surgery, Patient and Family Engagement
Ricciardi R, Shofer M
AHRQ Author: Ricciardi R, Shofer M.
Moving patient safety into ambulatory settings and beyond.
This paper discusses patient safety across various clinical settings, the importance of patient and family engagement, and innovations in patient safety such as the Patient Safety Learning Laboratories.
AHRQ-authored.
Citation: Ricciardi R, Shofer M .
Moving patient safety into ambulatory settings and beyond.
J Nurs Care Qual 2018 Jul/Sep;33(3):195-99. doi: 10.1097/ncq.0000000000000329.
Keywords: Ambulatory Care and Surgery, Patient and Family Engagement, Patient Safety
Havele SA, Pfoh ER, Yan C
Physicians' views of self-monitoring of blood glucose in patients with type 2 diabetes not on insulin.
This qualitative study examines to what extent and why physicians still prescribe self-monitoring of blood glucose in patients with non-insulin-treated type 2 diabetes when the evidence shows it increases cost without improving hemoglobin A1c, general well-being, or health-related quality of life.
AHRQ-funded; HS024128.
Citation: Havele SA, Pfoh ER, Yan C .
Physicians' views of self-monitoring of blood glucose in patients with type 2 diabetes not on insulin.
Ann Fam Med 2018 Jul;16(4):349-52. doi: 10.1370/afm.2244..
Keywords: Diabetes, Evidence-Based Practice, Ambulatory Care and Surgery, Patient-Centered Outcomes Research, Patient Self-Management
Beebe L, Smith KD, Oppizzi LM
Telephone Intervention-Problem Solving (TIPS) for schizophrenia spectrum disorders: responses of stable outpatients over nine months.
In this study, the investigators conducted a descriptive analysis of data gathered during calls to 87 stable outpatients with schizophrenia spectrum disorders, receiving weekly telephone intervention-problem solving (TIPS) for nine months. The investigators suggest that their findings regarding racial differences in antipsychotic delivery method warrant further investigation.
AHRQ-funded; HS022166.
Citation: Beebe L, Smith KD, Oppizzi LM .
Telephone Intervention-Problem Solving (TIPS) for schizophrenia spectrum disorders: responses of stable outpatients over nine months.
Issues Ment Health Nurs 2018 Jul;39(7):561-67. doi: 10.1080/01612840.2018.1431824..
Keywords: Ambulatory Care and Surgery, Medication, Behavioral Health, Patient Adherence/Compliance
Shah PD, Marciniak MW, Golden SD
Pharmacies versus doctors' offices for adolescent vaccination.
This study sought to understand the relative advantage of pharmacies compared to doctors' offices for delivering HPV vaccination to adolescents. The authors concluded that to be more appealing to parents as HPV vaccine providers, pharmacy providers within community and hospital settings should build on their relative advantage with respect to accessibility and enhance their appeal of their healthcare environment.
AHRQ-funded; HS000032.
Citation: Shah PD, Marciniak MW, Golden SD .
Pharmacies versus doctors' offices for adolescent vaccination.
Vaccine 2018 Jun 7;36(24):3453-59. doi: 10.1016/j.vaccine.2018.04.088..
Keywords: Children/Adolescents, Health Services Research (HSR), Ambulatory Care and Surgery, Provider: Pharmacist, Vaccination
Wallace DJ, Ray KN, Degan A
Transportation characteristics associated with non-arrivals to paediatric clinic appointments: a retrospective analysis of 51 580 scheduled visits.
The researchers’ objectives were: (1) to evaluate transportation characteristics and patient factors associated with clinic non-arrival, (2) to evaluate the comparability of bus and car drive time estimates, and (3) to evaluate the combined effects of transportation accessibility and income on scheduled appointment non-arrival. They concluded that clinic non-arrival is associated with the interaction of longer travel time and lower income.
AHRQ-funded; HS022989.
Citation: Wallace DJ, Ray KN, Degan A .
Transportation characteristics associated with non-arrivals to paediatric clinic appointments: a retrospective analysis of 51 580 scheduled visits.
BMJ Qual Saf 2018 Jun;27(6):437-44. doi: 10.1136/bmjqs-2017-007168.
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Keywords: Access to Care, Children/Adolescents, Ambulatory Care and Surgery, Patient-Centered Healthcare
Wang P, Xu T, Ngamruengphong S
Rates of infection after colonoscopy and osophagogastroduodenoscopy in ambulatory surgery centres in the USA.
This study aimed to estimate the rates of infections after colonoscopy and osophagogastroduodenoscopies (OGD) performed in ambulatory surgery centres (ASCs). The study found that postendoscopic infections are more common than previously thought and vary widely by facility. Although screening colonoscopy is not without risk, the risk is lower than diagnostic endoscopic procedures.
AHRQ-funded; HS024806.
Citation: Wang P, Xu T, Ngamruengphong S .
Rates of infection after colonoscopy and osophagogastroduodenoscopy in ambulatory surgery centres in the USA.
Gut 2018 May 18;67(9):1626-36. doi: 10.1136/gutjnl-2017-315308..
Keywords: Adverse Events, Colonoscopy, Healthcare-Associated Infections (HAIs), Risk, Ambulatory Care and Surgery
Hersh AL, Olson J, Stockmann C
Impact of antimicrobial stewardship for pediatric outpatient parenteral antibiotic therapy.
In this study, the investigators developed an outpatient parenteral antibiotic therapy (OPAT) stewardship program in a freestanding children's hospital to improve the appropriateness of OPAT prescribing.
AHRQ-funded; HS023320.
Citation: Hersh AL, Olson J, Stockmann C .
Impact of antimicrobial stewardship for pediatric outpatient parenteral antibiotic therapy.
J Pediatric Infect Dis Soc 2018 May 15;7(2):e34-e36. doi: 10.1093/jpids/pix038..
Keywords: Antibiotics, Antimicrobial Stewardship, Children/Adolescents, Ambulatory Care and Surgery
Keller SC, Tamma PD, Cosgrove SE
AHRQ Author: Miller MA
Ambulatory antibiotic stewardship through a human factors engineering approach: a systematic review.
The authors conducted a systematic review to identify controlled interventions and qualitative studies of ambulatory antibiotic stewardship (AS) interventions and determine whether and how they incorporated principles from a human factors engineering model, the Systems Engineering Initiative for Patient Safety 2.0 model. They concluded that studies have not focused on clinic-wide approaches to AS.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Keller SC, Tamma PD, Cosgrove SE .
Ambulatory antibiotic stewardship through a human factors engineering approach: a systematic review.
J Am Board Fam Med 2018 May-Jun;31(3):417-30. doi: 10.3122/jabfm.2018.03.170225.
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Keywords: Antibiotics, Clinical Decision Support (CDS), Primary Care: Models of Care, Ambulatory Care and Surgery, Patient Safety
San Juan J, Hou H, Ghani KR
Variation in spending around surgical episodes of urinary stone disease: findings from Michigan.
This study examined variations in outpatient procedure costs for patients undergoing uretoscopy or shock wave lithotripsy at 62 hospitals in Michigan from 2012 to 2015. Expenditures were totals for all relevant procedures during the 30-day surgical episodes. A total of 9,449 uteroscopy and 6,446 shock wave lithotripsy procedures were performed. The main variations were explained by payment differences for the index procedure and postacute care services.
AHRQ-funded; HS024525; HS024728.
Citation: San Juan J, Hou H, Ghani KR .
Variation in spending around surgical episodes of urinary stone disease: findings from Michigan.
J Urol 2018 May;199(5):1277-82. doi: 10.1016/j.juro.2017.11.075..
Keywords: Ambulatory Care and Surgery, Healthcare Costs, Hospitals, Surgery
Aldina S, Goldhaber-Fiebert SN, Hannenberg AA
Factors associated with the use of cognitive aids in operating room crises: a cross-sectional study of US hospitals and ambulatory surgical centers.
This study examined organizational context and implementation process factors influencing the use of cognitive aids for OR crises. It found that small facility size was associated with a fourfold increase in the odds of a facility reporting more successful implementation. Completing more implementation steps was also significantly associated with more successful implementation.
AHRQ-funded; HS024235.
Citation: Aldina S, Goldhaber-Fiebert SN, Hannenberg AA .
Factors associated with the use of cognitive aids in operating room crises: a cross-sectional study of US hospitals and ambulatory surgical centers.
Implement Sci 2018 Mar 26;13(1):50. doi: 10.1186/s13012-018-0739-4.
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Keywords: Adverse Events, Ambulatory Care and Surgery, Patient Safety, Quality Improvement, Quality of Care, Hospitals, Decision Making, Clinical Decision Support (CDS)
Carey K, Mitchell JM
Specialization and production cost efficiency: evidence from ambulatory surgery centers.
This study took a multiple output cost function approach to an empirical investigation that compared production economies in single specialty ambulatory surgery centers (ASCs) with those in multispecialty ASCs. The study results indicated that both types of ASC had small room for expansion. The results provided support for the focused factory model of production in the ASC sector.
AHRQ-funded; HS023768.
Citation: Carey K, Mitchell JM .
Specialization and production cost efficiency: evidence from ambulatory surgery centers.
Int J Health Econ Manag 2018 Mar;18(1):83-98. doi: 10.1007/s10754-017-9225-9..
Keywords: Surgery, Ambulatory Care and Surgery, Healthcare Costs
Fulton JJ, LeBlanc TW, Cutson TM
Integrated outpatient palliative care for patients with advanced cancer: a systematic review and meta-analysis.
In this study, the authors evaluated the effects of integrated outpatient palliative and oncology care for advanced cancer on patient and caregiver outcomes. The investigators found that moderately integrated palliative and oncology outpatient interventions had positive effects on short-term quality of life, symptom burden, and survival.
AHRQ-funded; HS023681.
Citation: Fulton JJ, LeBlanc TW, Cutson TM .
Integrated outpatient palliative care for patients with advanced cancer: a systematic review and meta-analysis.
Palliat Med 2018 Feb;33(2):123-34. doi: 10.1177/0269216318812633..
Keywords: Cancer, Ambulatory Care and Surgery, Palliative Care
Stone C, Gebretsadik T, Lee RL
Trends in health care utilization for asthma exacerbations among diverse populations with asthma in the United States.
This article discusses trends in asthma hospitalization and outpatient visit rates from 2004 to 2010. The rates for all populations included in this study went down during the time period, in particular the population from the Tennessee Medicaid program (49%). Other populations used in the study included subjects 4 to 50 years enrolled in the US Department of Defense Military Health System (MHS), and 3 large integrated health delivery systems (IHCDS) of the Population Based Effectiveness in Asthma and Lung Diseases (PEAL) Network. The 3 PEAL health plans included Harvard Pilgrim Health Care, Kaiser Permanente Georgia, and Kaiser Permanent Northern California. A total of 473,524 subjects in those 3 study populations were identified. These downward trends are encouraging but need to continue, particularly in diverse populations.
AHRQ-funded; HS019669; HS022093.
Citation: Stone C, Gebretsadik T, Lee RL .
Trends in health care utilization for asthma exacerbations among diverse populations with asthma in the United States.
J Allergy Clin Immunol Pract 2018 Jan - Feb;6(1):295-97.e5. doi: 10.1016/j.jaip.2017.07.038..
Keywords: Asthma, Healthcare Utilization, Hospitalization, Healthcare Delivery, Chronic Conditions, Ambulatory Care and Surgery
Rumball-Smith J, Shekelle P, Damberg CL
Electronic health record "super-users" and "under-users" in ambulatory care practices.
This study explored variation in the extent of use of electronic health record (EHR)-based health information technology (IT) functionalities across US ambulatory care practices. It found that seventy-three percent of practices were not using EHR technologies to their full capability, and nearly 40 percent were classified as under-users. Under-user practices were more likely to be of smaller size, situated in the West, and located outside a metropolitan area.
AHRQ-funded; HS024067.
Citation: Rumball-Smith J, Shekelle P, Damberg CL .
Electronic health record "super-users" and "under-users" in ambulatory care practices.
Am J Manag Care 2018 Jan;24(1):26-31.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Ambulatory Care and Surgery