Medicine and Health Sciences Commons^™

Regulatory Issues In Electronic Health Records For Adolescent Hiv Research: Strategies And Lessons Learned, Sara Ali Shaw Green, Sung-Jae Lee, Samantha Chahin, Meardith Pooler-Burgess, Monique Green-Jones, Sitaji Gurung, Angulique Y. Outlaw, Sylvie Naar

Publications and Research

Background: Electronic health records (EHRs) are a cost-effective approach to provide the necessary foundations for clinical trial research. The ability to use EHRs in real-world clinical settings allows for pragmatic approaches to intervention studies with the emerging adult HIV population within these settings; however, the regulatory components related to the use of EHR data in multisite clinical trials poses unique challenges that researchers may find themselves unprepared to address, which may result in delays in study implementation and adversely impact study timelines, and risk noncompliance with established guidance.

Objective: As part of the larger Adolescent Trials Network (ATN) for HIV/AIDS …

Reducing Nursing Documentation Burden: Evaluation Of An Electronic Health Record Optimization Plan, Jessica Collins

DNP Projects

Background: UK HealthCare transitioned to a new enterprise electronic health record (EHR) system, offered by Epic Systems Corporation, in June 2021. Approximately 2,000 inpatient nurses use the EpicCare Inpatient Module in the 1,086 licensed bed facilities. Compared to other academic medical centers, UK HealthCare nurses take more time documenting in this EHR inpatient module’s Basic Assessment Flowsheet (documentation burden) and have a longer delay between assessment and documentation (timeliness) potentially contributing to nursing dissatisfaction with using this new EHR.

Purpose: The purpose of this project was to evaluate the effectiveness of a phase of the Epic Nurse Well-Being Project, a …

Partner Discussion Using An Ehr And Chatgpt, Anne Bodensteiner

AI Assignment Library

This assignment requires students to complete a worksheet using a simulated EHR (which is a subscription software purchase) and meet with a partner to discuss AI in nutrition care and compare their results to the worksheet with answers they get from ChatGPT.

Effectiveness Of An Electronic Health Record Embedded Evidence-Based Testing Algorithm For Clostridioides Difficile Infection., Sarah Marie Bishop

Doctor of Nursing Practice Papers

Background: Clostridioides difficile infection (CDI) commonly impacts hospitalized patients with almost half a million cases reported in the United States annually. C. difficile colonization is more common than infection. Identifying true infection versus colonization is critical to avoiding inappropriate treatment, unnecessary exposure to antibiotics, and increased cost of care. Implementation of evidenced-based CDI testing criteria can help reduce inappropriate CDI testing and avoid the misidentification of colonized patients as true CDI.

Purpose: The purpose of this project was to evaluate the effectiveness of an evidence-based electronic health record (EHR) integrated CDI testing algorithm in reducing inappropriate CDI testing among adult …

Personalized Health Care In A Data-Driven Era: A Post–Covid-19 Retrospective, Arnob Zahid, Ravishankar Sharma

All Works

No abstract provided.

Benchmark Study: Impact Of Electronic Health Records Vs. Paper-Based Records, Erin Emmerich

MSN Capstone Projects

Medical documentation is an essential part of healthcare and conducted at the highest standard; documentation ensures the delivery of safe and high-quality healthcare services (Noureldin et al., 2014). Performance Improvement team reports the same poor outcomes each quarter that may be a result of the paper-based documentation system. These outcomes include patient safety, patient satisfaction and cost-effectiveness. This narrative review’s purpose is to determine whether the implementation of an electronic health record (EHR) system could improve outcomes. Evidence-based guidelines for the implementation of an EHR need special consideration to have a successful transition. Further studies may need to be reviewed …

Assessing And Improving Pediatric Nurses' Documentation Of Childhood Immunization Status Using The Electronic Health Record, Katherine Engalichev

Master's Theses and Capstones

BACKGROUND: Adherence to the standardized childhood immunization schedule put forth by the American Academy of Pediatrics is the gold standard for decreasing vaccine-preventable disease morbidity. The first step to improving adherence with the recommended immunization schedule is identifying children who are under-immunized. The inpatient setting offers an opportunity to screen pediatric patients for immunization status. A survey was administered to nurses working on an inpatient pediatric unit to gauge nurse self-report of Cerner™ Electronic Health Record (EHR) use for immunization documentation, their perceptions regarding EHR ease of use for documenting pediatric immunization status, attitudes towards documenting immunization status, and perceived …

Strategies For Maximizing The Use Of Electronic Health Records Systems In Medical Clinics, Alexandra Nieves Rivera

Walden Dissertations and Doctoral Studies

Ineffective leadership can negatively impact the use of electronic health records (EHR) systems in medical clinics. Healthcare managers who fail to maximize the use of EHR systems are missing out on the opportunity to optimize the quality of medical care that their clinic provides. Grounded in complexity leadership theory, the purpose of this qualitative multiple-case study was to explore strategies healthcare managers use to maximize the use of EHRs systems. Participants comprised six healthcare managers who successfully implemented strategies to maximize the use of EHRs systems. Data were collected from semistructured interviews and publicly available information. Thematic analysis was used …

Standardizing Handoff Report In A Medsurg Telemetry Floor, Brandon Tyler Thompson

Master's Projects and Capstones

Problem: Hospital A’s 9^th floor telemetry units lacked a standardized method of handoff and required investigation. Current practices were evaluated, and an intervention was designed based on weak communication areas. Context: Using a 5 P’s assessment the key stakeholders included unit nurses, the nursing director, nurse educators, and unit nurse managers, and the patients were medsurg telemetry patients. The process included handoff in care and the pattern evaluated was methods of reporting with the purpose of providing high quality evidence-based patient centered care. A SWOT analysis revealed strong teamwork, interdisciplinary collaboration, and proficiency in health record technologies as strengths …

Feasibility Of Using Electronic Health Records For Cascade Monitoring And Cost Estimates In Implementation Science Studies In The Adolescent Trials Network For Hiv/Aids Interventions, Tyra Dark, Kit N. Simpson, Sitaji Gurung, Amy L. Pennar, Marshall Chew, Sylvie Naar

Publications and Research

Background:One of the most difficult areas in the fight against HIV/AIDS is reaching out to youth aged 13 to 24 years. The proportion of youth living with HIV/AIDS on antiretroviral therapy (ART) and who are virally undetectable is low, highlighting significant challenges for reaching the Joint United Nations Program on HIV targets.

Objective:This study aimed to assess the feasibility of obtaining key clinical indicators and monitoring treatment, viral suppression, and retention components of the youth HIV treatment cascade in Adolescent Trials Network for HIV/AIDS Interventions clinics using electronic health record (EHR) downloads and to provide baseline characteristics for the study …

Medical Factors Associated With Caregiver Intention To Vaccinate Their Children Against Covid-19, Thao-Ly Phan, Paul T Enlow, Michael King, Amanda M Lewis, Anne E Kazak, Jonathan M Miller

Department of Medicine Faculty Papers

Objective: To describe medical factors that are associated with caregiver intention to vaccinate their children against COVID-19.

Methods: We conducted a cross-sectional study of families receiving primary care in a mid-Atlantic pediatric healthcare system, linking caregiver-reported data from a survey completed March 19 to April 16, 2021 to comprehensive data from the child's EHR.

Results: 513 families were included (28% Black, 16% Hispanic, 44% public insurance, 21% rural, child age range 0-21 years). 44% of caregivers intended to vaccinate their children against COVID-19, while 41% were not sure and 15% would not. After adjusting for socio-demographics, the only medical factors …

A Qualitative Analysis Of The Impact Of Electronic Health Records (Ehr) On Healthcare Quality And Safety: Clinicians’ Lived Experiences, Soumya Upadhyay, Han-Fen Hu

Healthcare Administration & Policy Faculty Publications

Purpose: There have been mixed findings of clinicians’ perceptions of Electronic Health Record (EHR). This study aims to explore the lived experiences of clinicians, to assess the role of EHR in improving the quality and safety of healthcare.

Basic Procedures: A qualitative study design was used. We collected the opinions from different groups of clinicians (physicians, hospitalists, nurse practitioners, nurses, and patient safety officers) using semi-structured interviews. Organizations represented were trauma hospitals, academic medical centers, medical clinics, home health centers, and small hospitals.

Main findings: Our study found clinicians’ ambivalent assessments toward EHR, which confirms extant literature. …

Innovative Use Of Ehr To Support Admission Screening For Emerging Pathogens, Patricia Dumonceaux Msn, Rn, Cic, Phn, Carolyn Harlander-Zimny, Elizabeth Kiffmeyer, Ellen Simonson, Tamara Welle

Nursing Posters

• CentraCare hospitals were the first in Minnesota to identify a patient with Candida auris (C. auris), an emerging pathogen.
• 2018 Centers for Disease Control and Prevention (CDC) and state health department recommended adoption of enhanced admission screening process to allow for early identification of patients at risk of being colonized with C. auris/Carbapenem-Resistant Organisms (CROs).
• C. auris, a fungus, and CROs, comprised of organisms from the Enterobacteriaceae family resistant to carbapenems, are emerging multidrug resistant pathogens. Emphasis on identification and early isolation of at-risk patients decreases risk of transmission.

Physician’S Resistance To Ehr Post Successful Organizational Adoption: Dual Factors Investigative Study, Sawsan Abdullah Altammar

CGU Theses & Dissertations

The introduction of Electronic Medical Records (EMR) has drastically improved the quality of health care, streamlined the processing of its tasks, and enhanced the retention of patient data for the hospitals of today. This research is a response to a call for an investigation of the reasons or factors that could affect health care workers’ decision to use or to resist software once it has been implemented. Physicians form the focus of this study because previous research demonstrates that physicians are an important user group of EMR. Physicians’ attitudes about using and their resistance to correlate with the attitudes of …

The Impact Of Electronic Health Records Meaningful Use On Patient Safety And Satisfaction, Paulette Brown

Walden Dissertations and Doctoral Studies

AbstractThe widespread adoption of electronic health records (EHRs) is encouraged because of their potential to improve the quality of care provided. It was unknown to what extent the meaningful use of EHRs would impact patient safety and satisfaction in general and specialty hospitals. The researcher’s purpose for this quantitative correlational research was to examine the impact of meaningful EHR use of EHRs on patient safety and satisfaction outcomes in general and specialty hospitals in Philadelphia (PA). The constructs of the institutional theory guided the study. The hypotheses that guided the study included (a) Meaningful EHR use positively influences patient satisfaction …

Implementation Of Cervical Cancer Screening Protocol (Ccsp): A Quality Improvement Project, Emilee Lenhart Hawk

Doctor of Nursing Practice (DNP) Manuscripts

Abstract

Background and significance: Cervical cancer is the fourth most commonly occurring cancer in women and the eighth most commonly occurring cancer overall (WCRF, 2020). Papanicolaou (Pap) testing is the primary screening for cervical cancer. In the past 40 years the number of cases and deaths from cervical cancer has decreased significantly, resulting from cervical cancer screenings (CDC, 2021). Healthy People 2030 reports to increase the proportion of females ages 21-65 who receive a cervical cancer screening based on the most recent guidelines. The 2030 target is 84.3%. Human papillomavirus (HPV) is a virus that is transmitted through sexual contact …

Use Of Electronic Health Records To Manage Tobacco Screening And Treatment In Rural Primary Care, Jean A. Talbot Phd, Erica C. Ziller Phd, Carly Milkowski Mph

Mental Health / Substance Use Disorders

Researchers at the Maine Rural Health Research Center, University of Southern Maine examined whether the use of electronic health records by rural primary care physicians facilitates their use of best practices in addressing tobacco dependence. The study used the National Ambulatory Medicare Care Survey (2012-2015) to explore how rurality and use of tobacco-related electronic health record functions were related to smoking status documentation and cessation treatment at adult primary care visits. Rural-urban comparisons were also examined.

The authors conclude that rural primary care physicians were at least as successful as their urban counterparts in leveraging electronic health records to enhance …

Effectiveness Of Ehr-Depression Screening Among Adult Diabetics In An Urban Primary Care Clinic, Filipina C. Schnabel Md, Mph, Msn, Fnp-Bc, Danielle Aldridge Msn, Fnp-C, Laura Reed Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Background Diabetes mellitus (DM) and depression are important comorbid conditions that can lead to more serious health outcomes. The American Diabetes Association (ADA) supports routine screening for depression as part of standard diabetes management. The PHQ2 and PHQ9 questionnaires are good diagnostic screening tools used for major depressive disorders in Type 2 diabetes mellitus (DM2). This quality improvement study aims to compare the rate of depression screening, treatment, and referral to behavioral health in adult patients with DM2 pre and post-integration of depression screening tools into the electronic health record (EHR).

Methods We conducted a retrospective chart review on patients …

Impact Of Health It On Practice Of Medicine, Deepti Singh

USF Tampa Graduate Theses and Dissertations

This dissertation focuses on three key facets of health IT impact on the practice of medicine: (1) Clinical impact on practitioner outcomes through malpractice claims, (2) Socio-economic impact on patient outcomes through the clinical treatment of social determinants of health (SDOH), and (3) Organizational impact on Long-Term Post-Acute Care (LTPAC) Facilities. The first dissertation essay (Chapter 1) investigates the impact of Health IT on the nature and severity of malpractice claims reported in Florida from 2009-2016. The essay empirically examines the treatment effect of federal initiatives, specifically the Meaningful Use program, on medical practitioners enrolled in the Medicare program and …

Physicians And Their Patience: Redefining Healthcare Relationships Through Readability Optimization, Rachel V. Ball

Honors Undergraduate Theses

The present study takes legibility research and extends it to the medical setting. Internal Medicine Physicians from UCF developed six passages of medical text detailing a History of Present Illness (HPI) Report from an emergency department as well as comprehension questions for the purpose of our study. In our study, we first presented non-medical passages and comprehension questions in six common fonts to identify participants' individual fastest and slowest fonts. We then gave participants medical passages in both their best and worst fonts while measuring reading speed and comprehension. This study was delivered to a population of Amazon Mechanical Turk …

Perceptions And Experiences Of Adopting A Technology Based Intervention For Alcohol Screening And Referral To Treatment In Primary Care, Sonya L. Lachance

Doctoral Dissertations

Alcohol abuse is a significant concern in the United States. Today in the U.S., 15.1 million adults ages 18 and older, have been identified as having an alcohol use disorder. Alcohol abuse and binge drinking are highest amongst college students. More than 58.0 percent of college students admit to regular binge drinking or heavy alcohol use every month. Left unaddressed, this leads to negative health consequences later in life. The United States Preventive Services Task Force states that there is strong evidence that screening patients in primary care can reduce alcohol use disorder. Though screening, brief intervention, and referral to …

In-Basket Teamwork: Divide The Work And Multiply The Success The Registered Nurse Role In Ambulatory Clinic Ehr In-Basket Management, James Smoot

Master's Projects and Capstones

Electronic Health Record (EHR) in-basket results (e.g., lab results, pathology reports, etc.) must be reviewed and acted upon in a timely manner by clinical staff in order to provide safe and effective care to ambulatory patients. Delays in reading results are significant contributors to medical errors. A large backlog of in-basket results that have never been appropriately filed is both a safety concern and a symptom of other clinical workflow issues. EHRs have shifted a greater proportion of administrative and triage roles onto providers, contributing to provider burnout. This paper synthesizes some of the best evidenced-based practices available for the …

Optimizing The Impact Of Quality Healthcare Improvements Within A Federally Qualified Health Clinic (Fqhc), Felicia Keys, Ladonna Phillips, Lashundra Speights

Doctoral Projects

This doctoral project’s purpose was geared toward strengthening quality healthcare outcomes documentation by constructing an updated policy and procedure manual specific to quality measures identified above, identifying attitudes and barriers to documenting, and assessing administration willingness to change. The project included a retrospective chart review of three populations and seven healthcare topics. Each diagnosis was researched utilizing specific ICD-10 (see Appendix A). A focus group/Pre-Implementation Questionnaire was administered to a panel of experts consisting of three nurse practitioners with one to nine years of experience employed at the FQHC. Afterward, a focus group was held to discuss barriers and attitudes …

Technical Standards For Bioinformatics And Medical Informatics, Jorge L. Contreras, Adrian Thorogood

Utah Law Faculty Scholarship

With a few exceptions, the biomedical industry, and the informatics field in particular, have not been affected by the standards litigation that has plagued the ICT sector. But with the increasing adoption of standards by informatics researchers and vendors, the issues faced by ICT standards groups will become increasingly relevant. This chapter summarizes general legal issues associated with standards development, then surveys standardization efforts in the informatics space and reviews the policies and procedures adopted by SDOs operating in the informatics area. It concludes with recommendations regarding prudent policy adoption by SDOs developing standards for informatics applications.

Electronic Health Records And Health Information Exchange And Their Impact On International Healthcare System Efficiency, David Pfaehler

Honors Theses

The 19th century epidemiological transition in healthcare caused a major shift in physician focus from curing one-time, deadly illness to managing chronic disease. Now, even the most advanced international healthcare systems must find a way to increase their efficiency in order to compensate for heightened strains on medical systems and swelling costs of healthcare delivery. Fortunately, recent technological innovation and, chiefly, the growth of Electronic Health Records (EHRs) provide a potential solution to this looming threat. EHRs are digital charts with the potential to store and share patient health data among providers to offer the most informed, streamlined care available. …

Qt Monitoring In The Icu: A Benchmark Project, Jeffrey S. Woodward

MSN Capstone Projects

In adult Intensive Care Unit (ICU) patients, does QT/QTc monitoring compared to no QT/QTc monitoring affect mortality or ventricular tachyarrhythmia rates during their ICU stay? Not monitoring changes in the QT interval can lead to poor outcomes since mortality rates are higher in patients with arrhythmias (Uvelin, Pejakovic, & Mijatovic, 2017). Approximately 300,000 sudden cardiac deaths occur in the United States each year with an estimated 15,000 because of a lethal ventricular tachyarrhythmia rhythm called Torsades de Pointes (TdP) that occurs when a QT interval is prolonged (Dave, Bessette, & Setnik, 2017). Some risk factors for developing prolonged QT intervals …

Complexities Of Data, Tasks And Workflows In Health It Management, Gaurav Jetley

USF Tampa Graduate Theses and Dissertations

This dissertation focuses on three key aspects in health IT management: (1) Complexities in the collection of health data in electronic health record (EHR) systems and the use of EHR data in research, (2) Complexities of collaboration between physicians and AI for improving healthcare delivery, and (3) Complexities of workflows and collaborations between healthcare organization (HCO) staff during the delivery of care. The first dissertation essay (Chapter 1) examines the key data quality issues that arise in recorded health information in EHR systems, provides quality thresholds that the data needs to meet for mitigating errors and increasing reproducibility of downstream …

Academic Electronic Health Record Implementation: Tips For Success, Patricia K. Ravert, Kristen Whipple, Stacie Hunsaker

Faculty Publications

Many nursing programs use simulation experiences to augment or replace clinical experiences. Use of an electronic health record (EHR) in the educational setting extends the realism. A task force reviewed EHR programs, selected an EHR, and created an implementation plan with successful rollout over 2 years.

Physicians’ Perceptions Of Facilitators And Barriers In Electronic Health Record Education, Alice Keene Martin

Walden Dissertations and Doctoral Studies

A significant focus in health care is quality documentation to lower patient safety risks. The local problem at a healthcare organization in the northeastern United States is that some physicians are falling short with quality documentation of patient care in athenaNet, a cloud-based electronic health record (EHR). This qualitative case study was conducted to explore physicians' perceptions of the facilitators and barriers that impact the educational process for quality documentation in EHRs. Attention also focused on identifying physicians' recommendations for enhancing the educational process for quality documentation. Knowles’ adult learning theory served as the conceptual framework. Purposeful sampling was used …

Modulation Of Medical Condition Likelihood By Patient History Similarity, Jonathan Turner, Dympna O'Sullivan, Jon Bird

Articles

Introduction: We describe an analysis that modulates the simple population prevalence derived likelihood of a particular condition occurring in an individual by matching the individual with other individuals with similar clinical histories and determining the prevalence of the condition within the matched group.

Methods: We have taken clinical event codes and dates from anonymised longitudinal primary care records for 25,979 patients with 749,053 recorded clinical events. Using a nearest neighbour approach, for each patient, the likelihood of a condition occurring was adjusted from the population prevalence to the prevalence of the condition within those patients with the closest …