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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
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1 to 25 of 604 Research Studies Displayed
Wesley DB, Blumenthal J, Shah S
A novel application of SMART on FHIR architecture for interoperable and scalable integration of patient-reported outcome data with electronic health records.
Despite a proliferation of applications (apps) to conveniently collect patient-reported outcomes (PROs) from patients, PRO data are yet to be seamlessly integrated with electronic health records (EHRs) in a way that improves interoperability and scalability. In this study the investigators applied the newly created PRO standards from the Office of the National Coordinator for Health Information Technology to facilitate the collection and integration of standardized PRO data.
AHRQ-funded; 2332015000221.
Citation:
Wesley DB, Blumenthal J, Shah S .
A novel application of SMART on FHIR architecture for interoperable and scalable integration of patient-reported outcome data with electronic health records.
J Am Med Inform Assoc 2021 Sep 18;28(10):2220-25. doi: 10.1093/jamia/ocab110..
Keywords:
Electronic Health Records (EHRs), Health Information Technology (HIT)
Holmgren AJ, Kuznetsova M, Classen D
Assessing hospital electronic health record vendor performance across publicly reported quality measures.
The authors measured hospital performance, stratified by electronic health record (EHR) vendor, across 4 quality metrics. They found that no EHR vendor was associated with higher quality across all measures, and the 2 largest vendors were not associated with the highest scores. Only a small fraction of quality variation was explained by EHR vendor choice. They concluded that top performance on quality measures can be achieved with any EHR vendor, as much of quality performance is driven by the hospital and how it uses the EHR.
AHRQ-funded; HS023696.
Citation:
Holmgren AJ, Kuznetsova M, Classen D .
Assessing hospital electronic health record vendor performance across publicly reported quality measures.
J Am Med Inform Assoc 2021 Sep 18;28(10):2101-07. doi: 10.1093/jamia/ocab120..
Keywords:
Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Indicators (QIs), Quality Measures, Hospitals, Quality of Care, Provider Performance
Nguyen OK, Washington C, Clark CR
Man vs. machine: comparing physician vs. electronic health record-based model predictions for 30-day hospital readmissions.
Electronic health record (EHR)-based readmission risk prediction models can be automated in real-time but have modest discrimination and may be missing important readmission risk factors. Clinician predictions of readmissions may incorporate information unavailable in the EHR, but the comparative usefulness is unknown. In this study, the investigators sought to compare clinicians versus a validated EHR-based prediction model in predicting 30-day hospital readmissions.
AHRQ-funded; HS022418.
Citation:
Nguyen OK, Washington C, Clark CR .
Man vs. machine: comparing physician vs. electronic health record-based model predictions for 30-day hospital readmissions.
J Gen Intern Med 2021 Sep;36(9):2555-62. doi: 10.1007/s11606-020-06355-3..
Keywords:
Electronic Health Records (EHRs), Health Information Technology (HIT), Hospital Readmissions
Fong A, Adams K, Samarth A
Assessment of automating safety surveillance from electronic health records: Analysis for the quality and safety review system.
Researchers provided a heuristic assessment of the feasibility of automatically populating the Quality and Safety Review System (QSRS) questions from electronic health record (EHR) data. They developed the Relative Abstraction Complexity Framework to assess relative complexity of data abstraction questions. Their results suggested that Blood and Hospital Acquired Infections-Clostridium Difficile Infection (HAI-CDI) modules would be relatively easier to automate, whereas Surgery and HAI-Surgical Site Infection would be more difficult to automate.
AHRQ-authored; AHRQ-funded; 290201400008I.
Citation:
Fong A, Adams K, Samarth A .
Assessment of automating safety surveillance from electronic health records: Analysis for the quality and safety review system.
J Patient Saf 2021 Sep 1;17(6):e524-e28. doi: 10.1097/pts.0000000000000402..
Keywords:
Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Joseph CLM, Alexander GL, Lu M
Pilot study of a brief provider and EMR-based intervention for overweight teens with asthma.
The authors piloted an electronic medical record-based tailored discussion guide (TDG) and a brief provider training to address weight management in overweight teens with asthma. They observed modest improvements in patient-reported asthma outcomes and health behaviors. They found strong evidence that the TDG supports provider discussion of weight and asthma to create a more patient-centered conversation from the perspective of participating teens. They recommended addressing challenges to recruitment and clinic adaptation prior to advancing to a full-scale trial.
AHRQ-funded; HS022417.
Citation:
Joseph CLM, Alexander GL, Lu M .
Pilot study of a brief provider and EMR-based intervention for overweight teens with asthma.
Pilot Feasibility Stud 2021 Aug 30;7(1):167. doi: 10.1186/s40814-021-00848-6..
Keywords:
Children/Adolescents, Obesity: Weight Management, Obesity, Asthma, Chronic Conditions, Respiratory Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT)
Apathy NC, Holmgren AJ, Adler-Milstein J
A decade post-HITECH: critical access hospitals have electronic health records but struggle to keep up with other advanced functions.
This study compared electronic health record (EHR) adoption and advanced use over time at critical access hospitals (CAHs) and non-CAHs. Data used was 2008 to 2018 American Hospital Information Technology survey data to update national EHR adoption statistics. In 2018, almost 100% (98.3%) of hospitals had adopted EHRs with no difference by CAH status. More than half had adopted advanced patient engagement (PE) and clinical data analytics (CDA). CAHs were less likely to adopt both advanced uses. This digital divide prevents CAH patients from benefitting from a fully digitized healthcare system.
AHRQ-funded; HS026116.
Citation:
Apathy NC, Holmgren AJ, Adler-Milstein J .
A decade post-HITECH: critical access hospitals have electronic health records but struggle to keep up with other advanced functions.
J Am Med Inform Assoc 2021 Aug 13;28(9):1947-54. doi: 10.1093/jamia/ocab102..
Keywords:
Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitals
Angier H, Giebultowicz S, Kaufmann J
Creation of a linked cohort of children and their parents in a large, national electronic health record dataset.
Researchers sought to identify a national cohort of children that link to at least one parent in the same electronic health record dataset and describe their demographics. They were able to link 33% of children to a parent in electronic health record data from a large network of community health centers across the United States. They stated that further analyses utilizing these linkages will allow examination of the multi-level factors that impact a child's receipt of recommended health care.
AHRQ-funded; HS025962.
Citation:
Angier H, Giebultowicz S, Kaufmann J .
Creation of a linked cohort of children and their parents in a large, national electronic health record dataset.
Medicine 2021 Aug 13;100(32):e26950. doi: 10.1097/md.0000000000026950..
Keywords:
Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare Delivery
Dorr DA, D'Autremont C, Pizzimenti C
Assessing data adequacy for high blood pressure clinical decision support: a quantitative analysis.
This study examined guideline-based high blood pressure (HBP) and hypertension recommendations and evaluated the suitability and adequacy of the data and logic required for a Fast Healthcare Interoperable Resources-based, patient-facing clinical decision support HBP application. Findings showed that data quality from the electronic health record required to implement recommendations for HBP was highly inconsistent, reflecting a fragmented health care system and incomplete implementation of standard terminologies and workflows. Although imperfect, data were deemed adequate for two test use cases.
AHRQ-funded; HS026849.
Citation:
Dorr DA, D'Autremont C, Pizzimenti C .
Assessing data adequacy for high blood pressure clinical decision support: a quantitative analysis.
Appl Clin Inform 2021 Aug;12(4):710-20. doi: 10.1055/s-0041-1732401..
Keywords:
Hypertension, Blood Pressure, Clinical Decision Support (CDS), Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT), Guidelines
Strasberg HR, Rhodes B, Del Fiol G
Contemporary clinical decision support standards using Health Level Seven International Fast Healthcare Interoperability Resources.
To facilitate the development of standards-based clinical decision support (CDS) systems, the investigators reviewed the current set of CDS standards that were based on Health Level Seven International Fast Healthcare Interoperability Resources (FHIR). The investigators conclude that widespread adoption of these standards may help reduce healthcare variability, improve healthcare quality, and improve patient safety.
AHRQ-funded; HS026198.
Citation:
Strasberg HR, Rhodes B, Del Fiol G .
Contemporary clinical decision support standards using Health Level Seven International Fast Healthcare Interoperability Resources.
J Am Med Inform Assoc 2021 Jul 30;28(8):1796-806. doi: 10.1093/jamia/ocab070..
Keywords:
Clinical Decision Support (CDS), Electronic Health Records (EHRs), Health Information Technology (HIT)
Wu P, Nelson SD, Zhao J
DDIWAS: high-throughput electronic health record-based screening of drug-drug interactions.
In this study, the investigators developed and evaluated Drug-Drug Interaction Wide Association Study (DDIWAS). This novel method detected potential drug-drug interactions (DDIs) by leveraging data from the electronic health record (EHR) allergy list. The investigators concluded that they demonstrated the value of incorporating information mined from existing allergy lists to detect DDIs in a real-world clinical setting. They indicate that since allergy lists are routinely collected in EHRs, DDIWAS has the potential to detect and validate DDI signals across institutions.
AHRQ-funded; HS026395.
Citation:
Wu P, Nelson SD, Zhao J .
DDIWAS: high-throughput electronic health record-based screening of drug-drug interactions.
J Am Med Inform Assoc 2021 Jul 14;28(7):1421-30. doi: 10.1093/jamia/ocab019..
Keywords:
Adverse Drug Events (ADE), Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Medication: Safety, Patient Safety
Watterson TL, Stone JA, Brown R
CancelRx: a health IT tool to reduce medication discrepancies in the outpatient setting.
Medication list discrepancies between outpatient clinics and pharmacies can lead to medication errors. Within the last decade, a new health information technology (IT), CancelRx, emerged to send a medication cancellation message from the clinic's electronic health record (EHR) to the outpatient pharmacy's software. The objective of this study was to measure the impact of CancelRx on reducing medication discrepancies between the EHR and pharmacy dispensing software.
AHRQ-funded; HS025793.
Citation:
Watterson TL, Stone JA, Brown R .
CancelRx: a health IT tool to reduce medication discrepancies in the outpatient setting.
J Am Med Inform Assoc 2021 Jul 14;28(7):1526-33. doi: 10.1093/jamia/ocab038..
Keywords:
Medication: Safety, Medication, Medical Errors, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Electronic Health Records (EHRs), Health Information Technology (HIT), Ambulatory Care and Surgery
Kutney-Lee A, Brooks Carthon M, Sloane DM
Electronic health record usability: associations with nurse and patient outcomes in hospitals.
Researchers examined associations between electronic health record (EHR) usability and nurse job and surgical patient outcomes. Data from the American Hospital Association, state patient discharges, and nurse surveys were linked in a cross-sectional analysis. The researchers found that employing EHR systems with suboptimal usability was associated with higher odds of adverse nurse job outcomes and surgical patient mortality and readmission.
AHRQ-funded; HS023805.
Citation:
Kutney-Lee A, Brooks Carthon M, Sloane DM .
Electronic health record usability: associations with nurse and patient outcomes in hospitals.
Med Care 2021 Jul;59(7):625-31. doi: 10.1097/mlr.0000000000001536..
Keywords:
Electronic Health Records (EHRs), Health Information Technology (HIT), Surgery, Outcomes, Nursing, Provider: Nurse
Corby S, Whittaker K, Ash JS
The future of medical scribes documenting in the electronic health record: results of an expert consensus conference.
This study looked at the future of medical scribes with the use of electronic health records (EHRs) increasing and causing unintended negative consequences. An expert consensus conference was held in April 2019 representing different stakeholder perspectives to discuss the results from site visits and to predict the future of medical scribing. Experts thought if EHR usability increases there might be a decrease in the need for medical scribes. The experts also felt that the role of medical scribe could be expanded to include workflow analysis, acting as EHR-related subject-matter experts, and becoming integrated more effectively into the clinical care delivery team. The authors feel that standardized training is needed as tele-scribing continues to grow in popularity.
AHRQ-funded; HS025141.
Citation:
Corby S, Whittaker K, Ash JS .
The future of medical scribes documenting in the electronic health record: results of an expert consensus conference.
BMC Med Inform Decis Mak 2021 Jun 29;21(1):204. doi: 10.1186/s12911-021-01560-4..
Keywords:
Electronic Health Records (EHRs), Health Information Technology (HIT)
Thompson HM, Kronk CA, Feasley K
Implementation of gender identity and assigned sex at birth data collection in electronic health records: where are we now?
In 2015, the United States Department of Health and Human Services instantiated rules mandating the inclusion of sexual orientation and gender identity (SO/GI) data fields for systems certified under Stage 3 of the Meaningful Use of Electronic Health Records (EHR) program. To date, no published assessments have benchmarked implementation penetration and data quality. To establish a benchmark for a U.S. health system collection of gender identity and sex assigned at birth, the investigators analyzed one urban academic health center's EHR data.
AHRQ-funded; HS026385.
Citation:
Thompson HM, Kronk CA, Feasley K .
Implementation of gender identity and assigned sex at birth data collection in electronic health records: where are we now?
Int J Environ Res Public Health 2021 Jun 19;18(12). doi: 10.3390/ijerph18126599..
Keywords:
Electronic Health Records (EHRs), Health Information Technology (HIT)
Cemballi AG, Karter AJ, Schillinger D
Descriptive examination of secure messaging in a longitudinal cohort of diabetes patients in the ECLIPPSE study.
This longitudinal study looked at trends in secure messaging (SM) use in health care system patient portals using a diverse cohort of diabetes patients enrolled in the ECLIPPSE study from 2006 to 2015. The authors found a 10-fold increase in overall messaging volume during that time period. A majority of patients were using SM by 2015, including those with lower income or with self-reported limited health literacy. At the beginning of the survey period more physicians than nurses were using SM, but that changed over time as well.
AHRQ-funded; HS026383.
Citation:
Cemballi AG, Karter AJ, Schillinger D .
Descriptive examination of secure messaging in a longitudinal cohort of diabetes patients in the ECLIPPSE study.
J Am Med Inform Assoc 2021 Jun 12;28(6):1252-58. doi: 10.1093/jamia/ocaa281..
Keywords:
Diabetes, Chronic Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT)
Wang X, Blumenthal HJ, Hoffman D
Modeling patient-related workload in the emergency department using electronic health record data.
Understanding and managing clinician workload is important for clinician (nurses, physicians and advanced practice providers) occupational health as well as patient safety. Efforts have been made to develop strategies for managing clinician workload by improving patient assignment. The goal of the current study was to use electronic health record (EHR) data to predict the amount of work that individual patients contributed to clinician workload (patient-related workload).
AHRQ-funded; HS022542.
Citation:
Wang X, Blumenthal HJ, Hoffman D .
Modeling patient-related workload in the emergency department using electronic health record data.
Int J Med Inform 2021 Jun;150:104451. doi: 10.1016/j.ijmedinf.2021.104451..
Keywords:
Emergency Department, Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Physician
Enayati M, Sir M, Zhang X
Monitoring diagnostic safety risks in emergency departments: protocol for a machine learning study.
This study’s objective will be to identify variables associated with diagnostic errors in emergency departments using large-scale EHR data and machine learning techniques. It will use trigger algorithms with electronic health record (EHR) data repositories to generate a large data set of records that are labeled trigger-positive or trigger-negative, depending on if they meet certain criteria. This study will be conducted by 2 academic medical centers with affiliated community hospitals.
AHRQ-funded; HS027363; HS026622.
Citation:
Enayati M, Sir M, Zhang X .
Monitoring diagnostic safety risks in emergency departments: protocol for a machine learning study.
JMIR Res Protoc 2021 Jun 14;10(6):e24642. doi: 10.2196/24642..
Keywords:
Emergency Department, Diagnostic Safety and Quality, Patient Safety, Risk, Electronic Health Records (EHRs), Health Information Technology (HIT)
Kandaswamy S, Pruitt Z, Kazi S
Clinician perceptions on the use of free-text communication orders.
The aim of this study was to investigate (1) why ordering clinicians use free-text orders to communicate medication information; (2) what risks physicians and nurses perceive when free-text orders are used for communicating medication information; and (3) how electronic health records (EHRs) could be improved to encourage the safe communication of medication information. The investigators concluded that clinicians' use of free-text orders as a workaround to insufficient structured order entry can create unintended patient safety risks.
AHRQ-funded; HS025136; HS024755.
Citation:
Kandaswamy S, Pruitt Z, Kazi S .
Clinician perceptions on the use of free-text communication orders.
Appl Clin Inform 2021 May;12(3):484-94. doi: 10.1055/s-0041-1731002..
Keywords:
Electronic Prescribing (E-Prescribing), Health Information Technology (HIT), Electronic Health Records (EHRs), Medication: Safety, Medication, Patient Safety, Communications, Provider: Clinician, Provider, Risk
Korach ZT, Gradwohl S, Messinger A
Unsupervised clinical relevancy ranking of structured medical records to retrieve condition-specific information in the emergency department.
Investigators compared knowledge-based and unsupervised statistical methods for ranking electronic health record (EHR) information by relevancy to a chief complaint of chest or back pain among emergency department patients. They found that a fully unsupervised statistical method can provide a reasonably accurate, low-effort, and scalable means for situation-specific ranking of clinical information within the EHR.
AHRQ-funded; HS024541.
Citation:
Korach ZT, Gradwohl S, Messinger A .
Unsupervised clinical relevancy ranking of structured medical records to retrieve condition-specific information in the emergency department.
Int J Med Inform 2021 May;149:104410. doi: 10.1016/j.ijmedinf.2021.104410.
.
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Keywords:
Emergency Department, Electronic Health Records (EHRs), Health Information Technology (HIT)
Sockolow PS, Bowles KH, Le NB
There's a problem with the problem list: incongruence of patient problem information across the home care admission.
The purpose of this observational field study was to illustrate patterns of patient problem information received and documented across the home health care (HHC) admission process and offer practice, policy, and health information technology recommendations to improve information transfer. The investigators concluded that diagnosis or problem information transferred from the referral source or gathered during an in-home assessment did not appear in the plan of care. Because of the EHR structure, clinicians could not identify inactive problem or problem priority.
AHRQ-funded; HS024537.
Citation:
Sockolow PS, Bowles KH, Le NB .
There's a problem with the problem list: incongruence of patient problem information across the home care admission.
J Am Med Dir Assoc 2021 May;22(5):1009-14. doi: 10.1016/j.jamda.2020.06.032..
Keywords:
Home Healthcare, Electronic Health Records (EHRs), Health Information Technology (HIT)
Powell KR, Deroche CB, Alexander GL
Health data sharing in US nursing homes: a mixed methods study.
The purposes of this study were to understand the extent to which nursing homes have the capability for data sharing and to explore nursing home leaders' perceptions of data sharing with other health care facilities and with residents and family members. Findings showed that perceived challenges to health data sharing included variance in systems and software, privacy and security concerns, and organizational factors slowing uptake of technology. Perceived benefits included improved communication, improved care planning, and anticipating future demand. Recommendations included working to mitigate barriers and to capitalize on potential benefits of implementing this technology in nursing homes.
AHRQ-funded; HS022497.
Citation:
Powell KR, Deroche CB, Alexander GL .
Health data sharing in US nursing homes: a mixed methods study.
J Am Med Dir Assoc 2021 May;22(5):1052-59. doi: 10.1016/j.jamda.2020.02.009..
Keywords:
Nursing Homes, Electronic Health Records (EHRs), Health Information Technology (HIT)
Hill JR, Visweswaran S, Ning X
Use, impact, weaknesses, and advanced features of search functions for clinical use in electronic health records: a scoping review.
The purpose of this study was to conduct a scoping review of the literature on the use of EHR search functions within a single patient's record in clinical settings to characterize the current state of research on the topic and identify areas for future study. The review found that search functions generally facilitated patient information retrieval by clinicians and were positively received by users. A limited number of articles described the use of EHR search functions in a clinical setting, despite evidence that they benefit clinician workflow and productivity.
AHRQ-funded; HS027185.
Citation:
Hill JR, Visweswaran S, Ning X .
Use, impact, weaknesses, and advanced features of search functions for clinical use in electronic health records: a scoping review.
Appl Clin Inform 2021 May;12(3):417-28. doi: 10.1055/s-0041-1730033..
Keywords:
Electronic Health Records (EHRs), Health Information Technology (HIT)
Dymek C, Kim B, Melton GB
Building the evidence-base to reduce electronic health record-related clinician burden.
This paper looks at the evidence-base to reduce electronic health record-related (EHR-related) clinician burden. Evidence-based informatics approaches, pragmatic next steps, and future research directions are presented to improve three of the highest contributors to EHR burden: documentation, chart review, and inbox tasks. Perspectives are also offered on how EHR vendors, healthcare system leaders, and policymakers can play an integral role to make EHR easier to use.
AHRQ-authored; AHRQ-funded; HS027363.
Citation:
Dymek C, Kim B, Melton GB .
Building the evidence-base to reduce electronic health record-related clinician burden.
J Am Med Inform Assoc 2021 Apr 23;28(5):1057-61. doi: 10.1093/jamia/ocaa238..
Keywords:
Electronic Health Records (EHRs), Health Information Technology (HIT), Burnout, Evidence-Based Practice, Provider: Clinician, Provider: Physician, Provider
Hettinger AZ, Melnick ER, Ratwani RM
Advancing electronic health record vendor usability maturity: progress and next steps.
Investigators asked four electronic health record (EHR) vendors to provide written descriptions of their usability practices and then reviewed these descriptions to identify areas where there has been advancement and areas for improvement. All four described user-centered design processes and usability testing methods that demonstrated advancement from previous studies of vendor practices, and vendors were beginning to address aspects of EHR implementation that play a critical role in shaping EHR usability. Areas for improvement included greater focus on safety and on measurement and benchmarking.
AHRQ-funded; HS025136.
Citation:
Hettinger AZ, Melnick ER, Ratwani RM .
Advancing electronic health record vendor usability maturity: progress and next steps.
J Am Med Inform Assoc 2021 Apr 23;28(5):1029-31. doi: 10.1093/jamia/ocaa329..
Keywords:
Electronic Health Records (EHRs), Health Information Technology (HIT)
Beam KS, Lee M, Hirst K
Specificity of International Classification of Diseases codes for bronchopulmonary dysplasia: an investigation using electronic health record data and a large insurance database.
This study analyzed the accuracy of International Classification of Diseases (ICD) codes to identify bronchopulmonary dysplasia (BPD) in newborns. A retrospective cohort study in a single-center NICU (n=166) was conducted to evaluate sensitivity and specificity of ICD-10 codes for BPD diagnosis. The sensitivity of any BPD-related codes ranged from 0.82 to 0.95, while specificity range was 0.25 to 0.36. The most common date of BPD diagnosis was the day of birth, which is inconsistent with the clinical definition. The authors conclude that the ICD codes for BPD are unlikely to accurately reflect the current clinical definition and should be interpreted with caution.
AHRQ-funded; HS000063.
Citation:
Beam KS, Lee M, Hirst K .
Specificity of International Classification of Diseases codes for bronchopulmonary dysplasia: an investigation using electronic health record data and a large insurance database.
J Perinatol 2021 Apr;41(4):764-71. doi: 10.1038/s41372-021-00965-3..
Keywords:
Newborns/Infants, Respiratory Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT)
