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 …

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 …

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 …

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 …

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 …

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 …

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. …

Seven Steps To Successful Change: How A Large Academic Medical Center Prepared Patients For Organizational Change, Brian Carlson, Madison Agee, Terrell Smith, Paul Sternberg Jr, Jason Morgan

Patient Experience Journal

Vanderbilt University Medical Center (VUMC) launched a new electronic health record (EHR) in a “big bang” implementation that saw the new software go live across multiple hospitals, clinics and geographic locations in a single morning. The organization rightly focused most of its energy on preparing its nearly 25,000 employees for the impacts of the transition, but it also considered the effects that would be felt by its patients and families. Survey data indicate that patient satisfaction scores demonstrably dip before, during and after an EHR implementation, and take approximately a year to recover. A team at DMC employed a seven-step …

Combining Human Factors And Data Science Methods To Evaluate The Use Of Free Text Communication Orders In Electronic Health Records, Swaminathan Kandaswamy

Doctoral Dissertations

Medication errors are a leading cause of death in the United States. Electronic Health Records (EHR) along with Computerized Provider Order Entry (CPOE) are considered promising ways to reduce these errors. However, EHR systems have not eliminated medication errors. Moreover, in some cases they have facilitated errors due to issues such as poor usability and negative effects on clinical workflows. The use of unexpected free text within a CPOE system can serve as a marker that the system does not adequately support clinical workflow. Prior studies have looked at the use of free text within medication orders, but the inclusion …

The Use Of Clinical Decision Support To Improve Nursing Practice, Kathleen Klimpel

Dissertations

Healthcare information technology is solidly entrenched in most acute care hospitals but the need to demonstrate its positive impact on patient outcomes persists. Clinical decision support (CDS) is an informatics tool that is highly customizable to promote patient improvement activities. Despite its high potential, studies have had mixed results regarding the impact of CDS and it has not been widely studied in the realm of nursing practice. One aim of this dissertation was to analyze the concept of CDS in order to inform the examination of the relationships between CDS implementation and nursing interventions. The determining factors of nurses use …

Primary Care Practices’ Progress Of Using Electronic Health Information Exchange (Hie), Susan M. Heyde

Applied Research Projects

Now that EHRs are purportedly fully implemented in the healthcare industry, it is important to evaluate the electronic Health Information Exchange (HIE) between primary care facilities, laboratories, hospitals, specialists, regional coops, and public health authorities.

Meaningful Use Stage 3 implementation is to begin this year, 2018. Complementing this implementation, the Medicare Access and CHIP Reauthorization Act, MACRA, was signed into law on April 16, 2015. MACRA removes eligible clinicians from EHR Incentive Programs that were previously established by the HITECH Act. MACRA also creates the Quality Payment Program that the CMS will use for Medicare and Medicaid reimbursement to primary …

The Importance Of Clinical Documentation Improvement, Amanda Shanty Baksh

Applied Research Projects

The world of technology in the twenty first century is forever expanding. In the healthcare field, patient data has transformed from paper charts into electronic health records. Electronic health records allow for organized patient information however, an enormous amount of information becomes available. Sometimes the massive amount of information is not always needed but important detail the medical chart is looked for by insurance companies for reimbursement. There is a special department in hospitals called the Clinical Documentation Improvement specialists who are made up of experienced medical coders, registered nurses, mid-level practitioners such as nurse practitioner’s s or physician’s assistants …

Proposal Defense: Improving Patient Portal Adoption In Primary Care, Melissa Wagner

Doctoral Projects

Introduction: Stage three of Meaningful Use (MU) is currently underway and is focused on promoting patient portal use. If the electronic medical record patient portal use is less than 25%, primary care providers face reductions in value-based reimbursements. National adoption rates from portal use remain under 27% with some providers averaging well below the needed 25%. The following practice question is proposed, “In a low-income urban adult clinic, how does an interactive electronic education intervention compared to no education intervention affect patient portal adoption rates?”

Objectives: The purpose of this project is to identify whether an electronic patient educational video …

The Use Of Electronic Health Records Data For Public Health: A Snapshot Of Current Practices In Nebraska’S Local Health Departments, Kushal Karan

Capstone Experience

Background: Public health issues are constantly changing and require local health departments (LHDs) to continually evolve in their approaches to address these issues. Advancements in health information technology (HIT), such as electronic health records (EHRs), play an important role in the collection of data that can be used to improve population health.

Objective: The purpose of this project was to assess the current use of electronic health records data by Nebraska’s local health departments and identify the data or tools they are using to address the health needs of the populations they serve.

Methods: In this study, a Mixed-Methods approach …

Does The Electronic Health Record Improve The Timeliness Review And Notification Of Medical Laboratory And X-Ray Test Results?, Ruby Estes

Applied Research Projects

The medical community struggles with timeliness issues throughout the different healthcare environments in many areas of patient care. The demands of meeting patient care needs is great everywhere. One area that can lead to extreme adverse outcomes and affects patient safety is failure to review and follow-up on medical test results timely. In addition the lack of timely follow-up and treatment can lead to medico-legal implications for all healthcare professionals involved in the patients care. Some timeliness issues have been attributed to understaffed healthcare institutions, lack of trained staff, and in many instances inefficient and insufficient processes. This is an …

Adoption Rate Of A Certified Ehr At Medical Practices With Five Or Fewer Physicians, Nelda Onwualiaobu

Applied Research Projects

The adoption rate of a certified electronic health record (EHR) for small medical practices have been the subject of discussion because prior research shows that larger medical practices have a higher rate of adoption than small medical practices. The major reason for this disparity has been the cost of adoption and implementation as many small practices are not financially equipped to shoulder this burden. The purpose of this research was to determine the adoption rate of a certified EHR for medical practices with five or fewer physicians. Through a google search and filtering the results of the search, the office …

Ehr Quality Documentation Research Thesis, Ashley Danielle Holmes

Applied Research Projects

This research proposal contains and introduction to my proposed research, background of the issue at hand, purpose of the research, significance of the research, research questions that I will be asking, definition of terms, limitations that I may be facing, literature review, SWOT Analysis, and Work Flow diagram on literature review. Also discussed are my proposed research methodology, research design, population sample, data collection procedures, as well as a table of survey variables that I propose to include. This proposal will go over why documentation quality and quantity is so important and the history behind why we are facing a …

The Public Health Information Technology Maturity Index: An Approach To Evaluating The Adoption And Use Of Public Health Information Technology, Kenyon Crowley, Robert S. Gold, Sruthi Bandi, Ritu Agarwal

Frontiers in Public Health Services and Systems Research

Background: Public health information technology (PHIT) has the potential to improve the effective and efficient use of information in achieving public health objectives. Information technology maturity models have been extensively used in other domains to guide information technology assessment and planning, but an information technology maturity model tailored for public health departments has heretofore been unavailable.

Purpose: The purpose of this study was to develop a Public Health Information Technology Maturity Index.

Methods: An extensive literature review and content analysis was conducted of information system adoption, use, and maturity in general and in the public health systems and services research …

Development & Integration Of Fhir With Open-Source Emr & Relational Databases, Timothy Van Wagner

Dissertations, Master's Theses and Master's Reports

This project looks into the development and implementation of an open source EHR software, using a FHIR interface to the system for data exchange. The EMR system used was OpenEMR, which is an open source EMR system that uses MySQL as the database backend combined with Apache and PHP to provide a user interface. The FHIR interface uses HAPI-FHIR which is an open source framework and libraries available for JAVA. Using JAVA, a RESTful API is created in order to respond to requests, and to also receive FHIR messages using the information stored in the two SQL databases, OpenEMR database …

Measuring Quality Of Health Care In Type Ii Diabetes Mellitus Patients Using Certified Electronic Health Records, Tracey A. Hines

Applied Research Projects

Great strides have been made in health care over the past six years after the implementation of the policy known as meaningful use by the Center of Medicare and Medicaid Services. Health care subsidies and monetary incentive programs were created for eligible professionals and critical area hospitals to encourage the use of certified electronic health records in an effort to improve quality care of all acute and chronically ill patients, as well as provide routine examinations for healthy individuals.

Patients diagnosed with type II diabetes mellitus were studied using a certified electronic health record system for compliance in physician ordered …

The Impact Of Ehr Usability Issues On The Perceived Efficiency Of Non-Clinical Hospital-Based Ehr Users, Natasha Ocean

Applied Research Projects

A survey-based study of the impact of the EHR systems usability issues on the perceived efficiency of work among non-clinical users in the hospital settings was performed June 20th to July 24th 2015. There were 160 valid responses. The results were processed in SPSS (IBM statistical application) and I determined the usability dimensions with the greatest impact on efficiency, for all EHRs and for the major EHRs (Meditech, Epic and Cerner). Helpfulness was the most frequent problem for users of all EHRs.

The survey is experimental and cross-sectional. The format was 20 Likert-type questions, along with screening and demographic questions. …

Emr Training Tactics: A Case Study Of Clinical Staff Training Experiences, Needs And Perceptions, Victoria Leaann Miller

Graduate Theses and Dissertations

Electronic medical record systems have become essential for giving patient care at health care institutions. The purpose of this study was to explore the training provided to staff at the University of Arkansas for Medical Sciences Northwest Family Medical Center in an effort to identify participant training experiences, needs, and perceptions. This study included qualitative, case study research. There were fourteen participants in the study. A focus group interview was conducted with eight administrative and training participants. Interviews and observations were conducted with six staff members.

The literature review of this study discussed educational theories including andragogy and training techniques. …

The Detrimental Pitfalls Of Provider Documentation, Rosalind Crook-Duckett

Applied Research Projects

Electronic Health Records hold many benefits and clearly is a cut above maintain-ing paper records. Although, over the years we have learned that there are potential drawbacks that come with having an electronic health record. This review on EHR’s, is what could be, considered detrimental pitfalls of provider documentation (copying and pasting) and how this may affect the safety and quality of the physician documentation and patient care.

Managing Copy And Paste Functionality In The Electronic Health Record, Tricia Urquhart-Jones

Applied Research Projects

The increased adoption of Electronic Health Records (EHR) has identified a significant need to develop tools to help providers maximize time spent documenting in the EHR. Copy and paste functionality, also known as carrying forward, cut and paste, and cloning, is one of many tools that can help providers save time and has been around longer than computers. A survey of thirteen Health Information Management (HIM) professionals responsible for HIMS functions within an acute care hospital in North Carolina was conducted. The survey response rate was 53%. The data gathered in this research study will add to HIM body of …

Electronic Health Records: Cure-All Or Chronic Condition?, Chris Kimble

Chris Kimble

Computer-based information systems feature in almost every aspect of our lives, and yet most of us receive handwritten prescriptions when we visit our doctors and rely on paper-based medical records in our healthcare. Although electronic health record (EHR) systems have long been promoted as a cost-effective and efficient alternative to this situation, clear-cut evidence of their success has not been forthcoming. An examination of some of the underlying problems that prevent EHR systems from delivering the benefits that their proponents tout identifies four broad objectives - reducing cost, reducing errors, improving coordination and improving adherence to standards - and shows …

Electronic Health Record Documentation: Is It An Accurate Indicator Of Quality Of Care For Mechanically Ventilated Patients?, Joetta Powell

Applied Research Projects

Background: Ventilator associated pneumonia is one of the leading hospital acquired infections associated with increased mortality and lengths of stay in mechanically ventilated patients.

Hypothesis: It is hypothesized that the introduction of chlorhexidine gluconate will show reduction in the incidences of ventilator associated pneumonia and a greater reduction with tooth brushing vs oral swabbing. It is also hypothesized that the electronic health record will provide more evidence of quality of care than an external EHR sources.

Methods: The non-randomized, non-sampled population included 98 patient records that met the inclusion criteria. The external tool, Automated Vent Bundle tool provided information as …

Meaningful Use – Is It Worth It?, Karen Perry Callahan

Applied Research Projects

The world of medicine has long been an ever changing environment. The advancements and progress in both knowledge and techniques has made patient care and treatment an increasingly successful endeavor. Physicians are often eager to embrace any new technology in the medical field that allows them to better care for their patients. The problem with new medical technology is that unless this technology can be shared or related to others, it is somewhat useless.

The medical profession has been somewhat reluctant to come to terms with the use of computer technology and its many benefits. Generally embedded in the use …

Recognizing Patient Safety Importance Through Instrument Validation On Physicians' Assessment Of An Ehr, Cherie Notebloom, Kathryn Dempsey Cooper

Interdisciplinary Informatics Faculty Proceedings & Presentations

Patient safety and high quality patient care are critical concerns for healthcare providers. The Institute of Medicine report suggests medical errors account for up to 98,000 patient deaths each year. Therefore, the US healthcare system is looking to information technology applications as one means of making patient care safer. This paper compares the psychometric properties of the Electronic Health Record Nurse Satisfaction instrument (based on the Health Information Technology Research-based Evaluation Framework) to our study that employed the same instrument but measured clinical physicians' opinions of an EHR to determine if the instrument could be used across domains of users. …