Health Information Technology Commons^™

Impact Of Covid-19 Lockdown On Patient-Provider Electronic Communications, Michael A Hansen, Rebecca Chen, Jacqueline Hirth, James Langabeer, Roger Zoorob

Faculty, Staff and Students Publications

BACKGROUND: SARS CoV-2 virus (COVID-19) impacted the practice of healthcare in the United States, with technology being used to facilitate access to care and reduce iatrogenic spread. Since then, patient message volume to primary care providers has increased. However, the volume and trend of electronic communications after lockdown remain poorly described in the literature.

METHODS: All incoming inbox items (telephone calls, refill requests, and electronic messages) sent to providers from patients amongst four primary care clinics were collected. Inbox item rates were calculated as a ratio of items per patient encountered each week. Trends in inbox rates were assessed during …

Enhancing Clinical Relevance Of Pretrained Language Models Through Integration Of External Knowledge: Case Study On Cardiovascular Diagnosis From Electronic Health Records, Qiuhao Lu, Andrew Wen, Thien Nguyen, Hongfang Liu

Faculty, Staff and Student Publications

Background: Despite their growing use in health care, pretrained language models (PLMs) often lack clinical relevance due to insufficient domain expertise and poor interpretability. A key strategy to overcome these challenges is integrating external knowledge into PLMs, enhancing their adaptability and clinical usefulness. Current biomedical knowledge graphs like UMLS (Unified Medical Language System), SNOMED CT (Systematized Medical Nomenclature for Medicine-Clinical Terminology), and HPO (Human Phenotype Ontology), while comprehensive, fail to effectively connect general biomedical knowledge with physician insights. There is an equally important need for a model that integrates diverse knowledge in a way that is both unified and compartmentalized. …

Academic Detailing As A Health Information Technology Implementation Method: Supporting The Design And Implementation Of An Emergency Department-Based Clinical Decision Support Tool To Prevent Future Falls, Hanna J Barton, Apoorva Maru, Margaret A Leaf, Daniel J Hekman, Douglas A Wiegmann, Manish N Shah, Brian W Patterson

Faculty, Staff and Student Publications

BACKGROUND: Clinical decision support (CDS) tools that incorporate machine learning-derived content have the potential to transform clinical care by augmenting clinicians' expertise. To realize this potential, such tools must be designed to fit the dynamic work systems of the clinicians who use them. We propose the use of academic detailing-personal visits to clinicians by an expert in a specific health IT tool-as a method for both ensuring the correct understanding of that tool and its evidence base and identifying factors influencing the tool's implementation.

OBJECTIVE: This study aimed to assess academic detailing as a method for simultaneously ensuring the correct …

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 …

Leveraging The Electronic Health Record To Implement Emergency Department Delirium Screening, Anita N Chary, Elise Brickhouse, Beatrice Torres, Ilianna Santangelo, Christopher R Carpenter, Shan W Liu, Kyler M Godwin, Aanand D Naik, Hardeep Singh, Maura Kennedy

Faculty, Staff and Students Publications

OBJECTIVE: The aim of this study is to understand how emergency departments (EDs) use health information technology (HIT), and specifically the electronic health record (EHR), to support implementation of delirium screening.

METHODS: We conducted semi-structured interviews with 23 ED clinician-administrators, representing 20 EDs, about how they used HIT resources to implement delirium screening. Interviews focused on challenges participants experienced when implementing ED delirium screening and EHR-based strategies they used to overcome them. We coded interview transcripts using dimensions from the Singh and Sittig sociotechnical model, which addresses use of HIT in complex adaptive health care systems. Subsequently, we analyzed data …

Nudging Health Care Providers' Adoption Of Clinical Decision Support: Protocol For The User-Centered Development Of A Behavioral Economics-Inspired Electronic Health Record Tool, Safiya Richardson, Katherine Dauber-Decker, Jeffrey Solomon, Sundas Khan, Douglas Barnaby, John Chelico, Michael Qiu, Yan Liu, Devin Mann, Renee Pekmezaris, Thomas Mcginn, Michael Diefenbach

Faculty, Staff and Students Publications

BACKGROUND: The improvements in care resulting from clinical decision support (CDS) have been significantly limited by consistently low health care provider adoption. Health care provider attitudes toward CDS, specifically psychological and behavioral barriers, are not typically addressed during any stage of CDS development, although they represent an important barrier to adoption. Emerging evidence has shown the surprising power of using insights from the field of behavioral economics to address psychological and behavioral barriers. Nudges are formal applications of behavioral economics, defined as positive reinforcement and indirect suggestions that have a nonforced effect on decision-making.

OBJECTIVE: Our goal is to employ …

Low Rates Of Structured Advance Care Planning Documentation In Electronic Health Records: Results Of A Single-Center Observational Study, Adela Wu, Robert J Huang, Gabriela Ruiz Colón, Chris Zembrzuski, Chirag B Patel

Faculty, Staff and Student Publications

BACKGROUND: Proper advance care planning (ACP) documentation both improves patient care and is increasingly seen as a marker of high quality by governmental payers. The transition of most medical documentation to electronic health records (EHR) allows for ACP documents to be rapidly disseminated across diverse ambulatory practice settings. At the same time, the complexity and heterogeneity of the EHR, as well as the multiple potential storage locations for documentation, may lead to confusion and inaccessibility. There has been movement to promote structured ACP (S-ACP) documentation within the EHR.

METHODS: We performed a retrospective cohort study at a single, large university …

Usability And Technology Acceptance Of An Electronic Child Abuse Screening Tool In A Pediatric Emergency Department, Angela Hayes

Translational Projects (Open Access)

Up to half of all child physical abuse victims with major abuse injuries seen in hospitals had sentinel injuries assessed by medical providers. Universal screening for child abuse and neglect in the emergency department can potentially increase detection at lower levels of injury. However, we must consider usability for the electronic health record embedded child abuse and neglect-screening tool to be most effective. The user most likely to interact with the screening tool is the bedside nurse. The interface of the initial screening tool and the process of inputting information must be perceived as useful, usable, and satisfying to the …

Sexual Health Assessment Is Vital To Whole Health Models Of Care, Alex Uzdavines, Drew A Helmer, Juliette F Spelman, Kristin M Mattocks, Amanda M Johnson, John F Chardos, Kristine E Lynch, Michael R Kauth

Center for Medical Ethics and Health Policy Staff Publications

Sexual health is the state of well-being regarding sexuality. Sexual health is highly valued and associated with overall health. Overall health and well-being are more than the absence of disease or dysfunction. Health care systems adopting whole health models of care need to incorporate a holistic assessment of sexual health. This includes assessing patients' sexual orientation and gender identity (SOGI). If health systems, including but not limited to the Veterans Health Administration (VHA), incorporate sexual health into whole health they could enhance preventive care, promote healthy sexual functioning, and optimize overall health and well-being. Assessing sexual health can give providers …

Can Variables From The Electronic Health Record Identify Delirium At Bedside?, Ariba Khan, Kayla Heslin, Michelle Simpson, Michael L. Malone

Journal of Patient-Centered Research and Reviews

Delirium, a common and serious disorder in older hospitalized patients, remains underrecognized. While several delirium predictive models have been developed, only a handful have focused on electronic health record (EHR) data. This prospective cohort study of older inpatients (≥ 65 years old) aimed to determine if variables within our health system’s EHR could be used to identify delirium among hospitalized patients at the bedside. Trained researchers screened daily for delirium using the 3-minute diagnostic Confusion Assessment Method (3D-CAM). Patient demographic and clinical variables were extracted from the EHR. Among 408 participants, mean age was 75 years, 60.8% were female, and …

Tobacco Use Screening And Cessation Counseling In Primary Care, Jacob A. Heil

DNP Projects

Abstract

BACKGROUND: Primary care providers (PCPs) are poised across healthcare settings to reduce the leading cause of preventable morbidity and mortality, cigarette smoking. However, their patients may not be screened for tobacco use and miss cessation counseling, thus increasing tobacco-related diseases, and incurring costs to healthcare payers.

PURPOSE: This project seeks to identify the documentation process in a new electronic health record (EHR), communicate efficacy barriers, administer an educational intervention regarding the new process for PCPs, and measure its impact on performance of tobacco use screening and cessation counseling.

METHODS: This project was a quasi-experimental, single center, pre- and post-interventional …

Enhancing Healthcare Quality In Hospitals Through Electronic Health Records: A Systematic Review, Peter Gatiti, Eunice Ndirangu, Joseph Mwangi, Arnold Mwanzu, Terry Ramadhani

Libraries

Background: The evolution of information technology has continued to put pressure on healthcare systems to switch from manual to electronic systems. The electronic health record is a leading information technology system that has drawn considerable interest from governments and private health facilities. However, EHR implementation has proved to be a problematic endeavor, especially in developing countries.

Objective: This review sought to determine the influence of EHR implementation on healthcare quality in hospitals and identifying applicable lessons for EHR implementers in hospital settings.

Methods: Relevant literature was searched in the identified databases, including Scopus, PubMed, CINAHL, PsycInfo, and …

Can Caregivers Trust Information Technology In The Care Of Their Patients? A Systematic Review, Alice Noblin, Barbara Hewitt, Murad Moqbel, Scott Sittig, Lakesha Kinnerson, Vera Rulon

Information Systems Faculty Publications

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that healthcare providers allow patients to engage in their healthcare by allowing access to their health records. Often patients need informal caregivers including family members or others to help them with their care. This paper explores whether trust is a key factor for informal caregivers’ decision to use health information technologies (HIT) including electronic health records (EHR), patient portals, mobile apps, or other devices to care for their patient. Six reviewers conducted a comprehensive search of four literature databases using terms that pertained to a caregiver and trust to …

Qualitative Comparative Case Study Exploring The Interpersonal And Intrapersonal Conflicts Experienced By Nurses While Utilizing Ehr-Electronic Health Record Technology, Patricia Alejandra Casas

Department of Conflict Resolution Studies Theses and Dissertations

Nurses are the largest group of health information technology system users. As the nurses are the focal point of patient care because they interact with multiple areas under the healthcare realm and manage multiple components of patient care, the use of EHR technology is likely to have an impact on their careers and healthcare delivery outcomes. Conflicts experienced during EHR use or adoption have been researched; however, despite these studies, understanding nurses’ experiences of conflicts remain underexplored; in particular, there have been no research studies that have differentiated between interpersonal and intrapersonal conflicts experienced. The general problem addressed in this …

Technology And Workflow Recommendations To Improve Use Of Guideline Directed Medical Therapy For Heart Failure With Reduced Ejection Fraction., Roy Robertson Md, Ryan Ahmed, Tammy Toscos Phd, Victor P. Cornet Ms, Shauna Wagner, Sarah Colletta, Carly Daley, Michael Mirro Md

Health Services and Informatics Research

BACKGROUND: Optimal use of Guideline Directed Medical Therapy (GDMT) is the cornerstone of reducing mortality and morbidity in heart failure patients with reduced ejection fraction (HFrEF). Interventions targeted at increasing GDMT use are necessary to improve outcomes. Integration of a pharmacist in specialty clinics may improve GDMT use; However, the potential benefit may be underrealized due to constraints in technology use and workflow.

PROJECT INTENT: To understand existing processes and explore workflow optimization opportunities to enhance use of GDMT prescription for patients with HFrEF.

METHODOLOGY: Teams of 2 researchers performed contextual inquiry4 during in-situ, 2-hour observations with 5 physicians, 3 …

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. …

Nurses' Perceptions Of The Impact Of The Electronic Health Record On Clinical Decision-Making, Angela Dizon Garcia

Nursing | Senior Theses

This study explored the impact of electronic health record (EHR) use on registered nurses’ critical thinking, decision-making, and quality of care for hospitalized patients. Based on literature review, the researcher maintained a consistent definition of critical thinking and decision-making and how the use of the EHR affects these two complex yet significant processes. A descriptive survey design to assessed registered nurses’ attitudes and perceptions of how the EHR influences their clinical decision-making when caring for patients in an acute care setting. It found that nurses are aware that the EHR is beneficial, yet they often feel that electronically charting can …

The Population Health Outcomes And Information Exchange (Phoenix) Program - A Transformative Approach To Reduce The Burden Of Chronic Disease, Steven J. Korzeniewski, Carla Bezold, Jason T. Carbone, Shooshan Danagoulian, Bethany Foster, Dawn Misra, Maher M. El-Masri, Dongxiao Zhu, Robert Welch, Lauren Meloche, Alex B. Hill, Phillip Levy

Urban Studies and Planning Faculty Research Publications

This concept article introduces a transformative vision to reduce the population burden of chronic disease by focusing on data integration, analytics, implementation and community engagement. Known as PHOENIX (The Population Health OutcomEs aNd Information EXchange), the approach leverages a state level health information exchange and multiple other resources to facilitate the integration of clinical and social determinants of health data with a goal of achieving true population health monitoring and management. After reviewing historical context, we describe how multilevel and multimodal data can be used to facilitate core public health services, before discussing the controversies and challenges that lie ahead.

Discrepancies In Written Versus Calculated Durations In Opioid Prescriptions: Pre-Post Study., Benjamin H. Slovis, John Kairys, Bracken Babula, Melanie Girondo, Cara Martino, Lindsey M. Roke, Jeffrey Riggio

Department of Medicine Faculty Papers

BACKGROUND: The United States is in the midst of an opioid epidemic. Long-term use of opioid medications is associated with an increased risk of dependence. The US Centers for Disease Control and Prevention makes specific recommendations regarding opioid prescribing, including that prescription quantities should not exceed the intended duration of treatment.

OBJECTIVE: The purpose of this study was to determine if opioid prescription quantities written at our institution exceed intended duration of treatment and whether enhancements to our electronic health record system improved any discrepancies.

METHODS: We examined the opioid prescriptions written at our institution for a 22-month period. We …

Medication Adherence For Atrial Fibrillation Patients: Triangulating Measures From A Smart Pill Bottle, E-Prescribing Software, And Patient Communication Through The Electronic Health Record, Tammy Toscos Phd, Michelle Drouin, Jessica Pater, Mindy Flanagan, Shauna Wagner, Amanda Coupe, Ryan Ahmed, Michael Mirro Md

Health Services and Informatics Research

Objective: Our primary objectives were to examine adherence rates across two technologies (e-prescribing software and smart pill bottle) with cross-validation from alert-triggered messaging within the patient electronic health record (EHR) portal and to explore the benefits and challenges faced by atrial fibrillation (AF) patients in using a smart pill bottle.

Materials and Methods: We triangulated the rate of oral anticoagulant medication adherence among 160 AF patients over 6 months using an EHR in combination with data from the AdhereTechVC Wireless Smart Pill Bottle and SurescriptsVC . In addition, we collected qualitative feedback on patients’ Smart Pill Bottle usage …

Preventive Primary Care Screening Patterns After Provider Ehr Adoption For Michigan Medicaid Adults, William D. Corser 9183470, Zhiying You, John Hazewinkel

Michigan Journal of Public Health

Introduction

It remains largely unknown how use of electronic health records (EHR) impacts ordering of preventive/screening services (PSS). These analyses examined the influence of confirmed Medicaid provider EHR adoption on primary care ordering rates of five major PSS. Sample was comprised of 10,149 continuously enrolled Michigan Medicaid adults linked to 6,587 providers.

Methods

The authors obtained complete office-based billing claims data from the Michigan Medicaid Data Warehouse for adults with 29 or more months of continuous state Medicaid coverage. PSS claims data were linked to patients’ Medicaid-assigned providers who either had, or had not, EHR-attested during the 60-month analytic window. …

Optimizing Clinical Processes Using The Electronic Health Record To Improve Patient Outcomes In Primary Care, Alex Jubril

Doctoral Projects

Background: The EHR has been used to leverage clinical processes for the improvement of patient outcomes. The average users of EHR limit its uses to the minimum level required to complete the daily tasks needed, regardless of the existence of features within the EHR that are readily available to optimize clinical processes for efficiency and effectiveness.

Objectives: The objective of this project was to improve the documentation in a nurse-managed health clinic related to the patient-centered medical home (PCMH) core criteria through enhancing the EHR to foster the quality improvement metrics and reporting.

Methods: This was a quality improvement project …

Developing Clinical Judgment Through The Implementation Of Information And Communication Technology, Such As The Electronic Healthcare Record (Ehr), Sherri Carter

Nursing Theses and Capstone Projects

Graduate nurses are expected to enter a technology-rich workforce with an understanding of the electronic health record (EHR) and how it is used to guide patient care. Limited access to EHRs in clinical settings may result in students entering professional practice with limited ability to understand the full potential of the EHR. Over a seven-week term, students enrolled in the Patient-Centered Care I course, during the 2018 Spring I term, participated in high-fidelity simulation and seminar activities that included an educational electronic healthcare record (EEHR). These activities were integrated into the course to guide students when making clinical decisions regarding …

Asthma Control Screening Using The Electronic Health Record, Accursia A. Baldassano, Jonathon Mack

Doctor of Nursing Practice Final Manuscripts

ABSTRACT

Experts in asthma care globally recommend screening for asthma control in all patients with asthma through the use of an evidence-based tool. This project embedded the Asthma Control Test (ACT) in the electronic health record to determine if screening for control would change compared to standard care.

Methods

An electronic template of the ACT was embedded in the electronic health record system for a community faith-based family medicine clinic. All patients 12 years and older with a previous diagnosis of asthma were included in this project. These patients were screened for asthma control using the template at every appointment. …

Impact Of Electronic Health Records On Patient Outcomes, Lilian Ndifon, Jude E. Edwards, Leila Halawi

Publications

With the passing of the HITECH Act, EHRs have come into prominence and sharper focus, due to efforts by the government to push for a national adoption of EHRs into our healthcare system. This push for a national adoption of EHRs is based on the premise that it will help improve the quality delivery of health care services and reduce costs. However, this push for a “national adoption” has experienced mixed results. This study was designed to assess the impact of EHRs post-2009, the year of the HITECH Act, to review some of the key contributing factors to this mixed …

An Automated Model Using Electronic Health Record Data To Identify Delirium Among Hospitalized Older Adults: A Pilot Project, Ariba Khan, Maharaj Singh, Hina Singh, Ayesha Maria, Michelle Simpson

Journal of Patient-Centered Research and Reviews

Background: Delirium is a serious change in mental status with adverse outcomes, but remains underrecognized. The electronic health record (EHR) may assist in the identification of delirium.

Purpose: This study was performed to generate an automated delirium identification model using data from the EHR among hospitalized older adults.

Methods: Inpatients 65 years and older were included in this cross-sectional study. The researchers used “confusion assessment method” as the gold standard to identify delirium. Four categories of variables were obtained from the EHR on the day of and the day prior to researcher assessment: 1) hypoactive delirium (any one of the …

Prognostic Indices For Hospitalized Older Adults: A Meta-Analysis And Systematic Review, Ariba Khan, Ayesha Maria, James Hocker, Maharaj Singh, Michelle Simpson

Journal of Patient-Centered Research and Reviews

Background: A prognostication predictive model incorporated into the electronic health record (EHR) may be useful in assisting the health care team in accurately predicting mortality and may be used in appropriately allocating palliative care services.

Purpose: To systematically review and summarize current medical literature regarding the factors predictive of mortality in an inpatient population above 65 years of age.

Methods: Nondisease-specific prognostication indices that predict 1-year mortality in an inpatient population of adults over age 65 were included. We excluded studies that estimated intensive care unit, disease-specific or in-hospital mortality. A MEDLINE, CINAHL, Ovid and Cochrane literature search of English-language …

Improving Antibiotic Resistant Infection Transmission Situational Awareness In Enclosed Facilities With A Novel Interface Design For Tactical Biosurveillance, Ann L. Fruhling, Devika Ramachandran

Interdisciplinary Informatics Faculty Proceedings & Presentations

The implementation of the Electronic Health Record to substantially improve the practice of medicine has not fully reached its projected potential partly due to many barriers to its adoption. There is growing evidence that one of the reasons for the delay in the adoption of EHR has been due to the negative impact of current EHRs on the clinician-patient interaction, clinician workflow and communications. This research studies the usability of the Electronic Health Record for clinicians involved in cardiac care by evaluating various clinician-patient interaction workflows. The aim of the study is to identify inefficiencies by examining the similarities and …

Examining Faith Community Nurses’ Perception And Utilization Of Electronic Health Records, Carole N. Mattingly, M. Eve Main

International Journal of Faith Community Nursing

Abstract

The purpose of this study is to identify current faith community nurse documentation practices, explore factors impacting intention to adopt electronic health records, and identify perceived barriers and benefits to electronic health record use among faith community nurses practicing in the Midwest. The technology acceptance model is used to examine impact of perceived usefulness and perceived ease of use of electronic health records on intention to adopt.

This study is a quantitative exploratory research study utilizing a cross-sectional researcher-developed 39-item questionnaire. Surveys were distributed by mail and e-mail to faith community nurses practicing in South-Central Indiana and Western Kentucky. …