Health Information Technology Commons^™

Electronic Health Record Alerts To Improve Lipid Lowering After A Recent Myocardial Infarction, Dean G. Karalis, Benjamin Richter, Scott Hessen, Patrick Moeller, Laney K. Jones

Division of Cardiology Faculty Papers

BACKGROUND: This observational, quality initiative evaluated the impact of changing from a passive (dismissible) to an active (nondismissible without action) electronic health record alert on guideline-recommended lipid-lowering therapy (LLT) prescriptions in patients with recent myocardial infarction at risk for secondary events.

METHODS: We sequentially recruited a retrospective passive-alert (February 2018-July 2019; n=733) and a prospective active-alert (August 2020-January 2022; n=587) cohort of patients who triggered an alert to intensify LLT or order a low-density lipoprotein-cholesterol (LDL-C) test if they had a recent myocardial infarction (within 12 months) and elevated (≥70 mg/dL) or missing LDL-C. Prescribed LLTs and cumulative percentages of …

Nudging Implementation Of Low Tidal Volume Ventilation: A Stepped Wedge, Cluster Randomized Trial, Meeta Prasad Kerlin, Michael O. Harhay, Fan Li, Dylan S. Small, Yingying Lu, Wei Wang, Barry D. Fuchs, Mark E. Mikkelsen, Teresa Tran, Aerielle Belk, Jasmine A. Silvestri, Tamar Klaiman, Stefania Scott, Elizabeth Levy, Michael W. Sjoding, Rachel Kohn, Karsten J. Roberts, Rinad S. Beidas, Scott D. Halpern

College of Health Professions Faculty Papers

BACKGROUND: "Nudges" embedded in the electronic health record (EHR) facilitate desired decisions while preserving autonomy and may provide a scalable strategy to overcome the common implementation barrier of lack of knowledge about a best practice. We sought to test whether EHR-based nudges targeting two intensive care unit (ICU) clinician groups would safely increase evidence-based use of low tidal volume ventilation.

METHODS: We performed a stepped-wedge, cluster randomized, hybrid type 3 effectiveness-implementation trial in 12 ICUs from February 2021 to May 2023 to test three nudges targeting clinicians responsible for order entry and respiratory therapists responsible for operationalizing orders and documentation. …

Electronic Health Records In Non-Hospital Settings Of Developing Economies: A Systematic Review On Enablers And Barriers, Bejie Rodriguez, Joenelyn Kaye Demoral, Jan Jacob Carpio, Alan Napoleon Gultia, Gloria Shiela Coyoca, Cecilio Garciano, Lemuel Clark Velasco

Institute of Philippine Culture (IPC)

In recent years, rapid advancements in Information and Communications Technology (ICT) have greatly transformed the healthcare landscape by streamlining health data management and providing decision-makers with secure and convenient access to health records. In developing economies, limited resources hinder healthcare access. Implementing EHRs in non-hospital settings is essential for enhancing healthcare quality and accessibility. While existing literature supports EHR use, further research is needed to pinpoint specific barriers and enablers. Using PRISMA guidelines, 18 relevant articles were systematically analyzed with the Human, Organization, and Technology Fit (HOT-fit) framework to examine these factors in non-hospital settings within developing economies. This study …

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. …

Data Driven Trade-Off Analysis For Cybersecurity, Goskel Kucukkaya, Murat Ozer, Murat Balci, Emrah Ugurlu

Engineering Management & Systems Engineering Faculty Publications

Trade-off analysis, a specialization of systems engineering, addresses design criteria like security, cost, performance, and compliance. Monte Carlo simulations are commonly employed to generate impact scenarios for trade-off analysis combined with solution alternatives that accommodate industry-specific considerations and uncertainties. In the cyber domain, this paper proposes a methodology for data-driven trade-off analysis in cybersecurity, leveraging industry reports as primary data sources using confidentiality, integrity, and availability as trade-off analysis objectives. Distribution functions are derived to manage and model uncertainties for various industries. The approach given in this study aims to facilitate informed choices and to enhance cybersecurity decision making and …

Infusing Machine Learning And Computational Linguistics Into Clinical Notes, Funke V. Alabi, Onyeka Omose, Omotomilola Jegede

Mathematics & Statistics Faculty Publications

Entering free-form text notes into Electronic Health Records (EHR) systems takes a lot of time from clinicians. A large portion of this paper work is viewed as a burden, which cuts into the amount of time doctors spend with patients and increases the risk of burnout. We will see how machine learning and computational linguistics can be infused in the processing of taking clinical notes. We are presenting a new language modeling task that predicts the content of notes conditioned on historical data from a patient's medical record, such as patient demographics, lab results, medications, and previous notes, with the …

Ode To My Emr, Kelly T. Clouse

HCA Healthcare Journal of Medicine

Our EMRs should empower us, but unfortunately, they often bully and frustrate us. This poem is an expression of my frustration and disappointment with my own EMR. Creating it allowed me to channel my frustration and disappointment.

Development Of A Computable Phenotype Using Electronic Health Records For Venous Thromboembolism In Medical Inpatients: The Medical Inpatient Thrombosis And Hemostasis Study, Ryan M Thomas, Katherine Wilkinson, Insu Koh, Ang Li, Janine S A Warren, Nicholas S Roetker, Nicholas L Smith, Chris E Holmes, Timothy B Plante, Allen B Repp, Mary Cushman, Neil A Zakai

Faculty, Staff and Students Publications

BACKGROUND: Accurate and efficient methods to identify venous thromboembolism (VTE) events in hospitalized people are needed to support large-scale studies. Validated computable phenotypes using a specific combination of discrete, searchable elements in electronic health records to identify VTE and distinguish between hospital-acquired (HA)-VTE and present-on-admission (POA)-VTE would greatly facilitate the study of VTE, obviating the need for chart review.

OBJECTIVES: To develop and validate computable phenotypes for POA- and HA-VTE in adults hospitalized for medical reasons.

METHODS: The population included admissions to medical services from 2010 to 2019 at an academic medical center. POA-VTE was defined as VTE diagnosed within …

An Analysis Of The Effects Of Certified Electronic Health Records On Organizations And Patients., Picandra Elzie

Electronic Theses and Dissertations

The growing technological advancement of electronic health records can become an issue with quality and electronic patient information exchange if hospitals do not adhere to federal guidelines. It is recommended that hospitals utilize certified electronic health records (EHRs) to receive financial incentives. This certification is supposedly also associated with the quality of the EHR itself. The certification process is criticized for allowing EHR vendors to meet a set of limited functions known in advance. EHRs can affect healthcare quality and electronic health information exchange. This dissertation explored what is known about the effects of certified EHRs on length of stay …

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 …

Patient Experience Of The Electronic Health Record (Ehr) In A Maternity Unit In Ireland, Joye Mckernan, Paul Corcoran Dr, Richard A. Greene Professor

Patient Experience Journal

The introduction of the Electronic Health Records (EHRs) for maternity services in Ireland provided an opportunity to examine patient satisfaction and to examine what patients require from an Electronic Health Record. The implementation of the EHR in Ireland started in 2016, and at present, four of the 19 maternity units are digital. Patients at antenatal booking visits in an Irish maternity unit were invited to participate in the project. The invite was taken up by 201 women. The survey took 10-15 minutes to complete. The survey was conducted nine months following the implementation of the MN-CMS. The survey was anonymous …

Leveraging Clinical Digitized Data To Understand Temporal Characteristics And Outcomes Of Acute Myocardial Infarctions At A Tertiary Care Medical Centre In Pakistan From 1988-2018 - Methods And Results, Zainab Samad, Ali Aahil Noorali, Awais Farhad, Safia Awan, Nada Qaiser Qureshi, Mushyada Ali, Laiba Masood, Ghurfan Adnan, Zulfiqar Ahmed Bhutta, Javed Tai

Section of Cardiology

Background and objective: Few data exist on trends in acute myocardial infarction (AMI) patterns spanning recent epidemiological shifts in low middle-income countries (LMICs). To understand temporal disease patterns of AMI characteristics and outcomes between 1988-2018, we used digitized legacy clinical data at a large tertiary care centre in Pakistan.
Methods: We reviewed digital health information capture systems maintained across the Aga Khan University Hospital and obtained structured elements to create a master dataset. We included index admissions of patients >18 years that were discharged between January 1, 1988, and December 31, 2018, with a primary discharge diagnosis of AMI (using …

The Mission System: An Electronic Health Record For Medical Treatment In Guatemala, Tawniece M. Curry

Dissertations

Abstract

Problem: The introduction of an electronic health record (EHR) system has become an essential component in monitoring and tracking patient information in most developed countries but are difficult to implement in underdeveloped countries. Guatemala is a country with poor health care and limited resources for patient tracking and monitoring. An organization in Guatemala, Nursing Heart Inc. (NHI), provides care to over 40 underserved rural communities but lacks the ability to monitor and track patient information. In order for NHI to properly monitor and evaluate their programs and track patients’ continuity of care, the introduction of an EHR system is …

The Contribution Of Ethical Governance Of Artificial Intelligence & Machine Learning In Healthcare, Tina Nguyen

Electronic Theses and Dissertations

With the Internet Age and technology progressively advancing every year, the usage of Artificial Intelligence (AI) along with Machine Learning (ML) algorithms has only increased since its introduction to society. Specifically, in the healthcare field, AI/ML has proven to its end-users how beneficial its assistance has been. However, despite its effectiveness and efficiencies, AI/ML has also been under scrutiny due to its unethical outcomes. As a result of this, two polarizing views are typically debated when discussing AI/ML. One side believes that AI/ML usage should continue regardless of its unsureness, while the other side argues that this technology is too …

Examining The Impact Of Design Features Of Electronic Health Records Patient Portals On The Usability And Information Communication For Shared Decision Making, Rong Yin

All Dissertations

The use of the Electronic Health Records (EHR) patient portal has been shown to be effective in generating positive outcomes in patients’ healthcare, improving patient engagement and patient-provider communication. Government legislation also required proof of its meaningful use among patients by healthcare providers. Typical patient portals also include features such as health information and patient education materials. However, little research has examined the specific use of patient portals related to individuals with specific diseases such as inflammatory bowel diseases (IBDs). IBDs are life-long, not curable, chronic diseases that can impact the whole population. Individuals with IBDs may have higher needs …

Initial Steps For Integrating Academic Electronic Health Records Into Clinical Curricula Of Physical And Occupational Therapy In The United States: A Survey-Based Observational Study, Stephen C. Burrows, Lola Halperin, Eric C. Nemec, Wendy Romney

Healthcare Informatics Faculty Publications

Training programs must be designed to prepare physical and occupational therapy students for using Electronic Health Records (EHR) and interprofessional collaboration. This report aims to describe physical and occupational therapy students' perceptions of integrating Academic EHR in their Problem-Based Learning (PBL) curricula in the College of Health Professions, Sacred Heart University, Fairfield, Connecticut, the United States. A paper-based case approach to PBL was adapted by creating patient cases in an Academic EHR (AEHR). Students were asked to complete chart reviews and review provider notes to enhance their learning. An online survey was conducted to determine their perceptions of using AEHR …

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 …

Research And Data Mining During The Covid-19 Pandemic, Hale Z. Toklu, Rakesh Prashad

HCA Healthcare Journal of Medicine

With the recent advances in information and technology systems, most developed countries have invested in building advanced systems for the management of electronic medical records. If the infrastructure of these systems are well designed, they both serve as an information resource for routine patient care and also serve as the primary backbone for medical research. This evidence became clear during the recent coronavirus pandemic, which has been a worldwide challenge since the beginning of 2020. Rapid spread of SARS–CoV-2 infections all over the world has resulted in tremendous health, economic and social ramifications, including social distancing, travel restrictions and closing …

Understanding Subscription-Based Automated Electronic Notification Usage In Hospitals: A Qualitative Study, William J.K. Vervilles, Benjamin Slovis, Md, Ma, Jeffrey Riggio, Md

Phase 1

Introduction: The potential exists for patient harm when clinicians do not respond to clinical results in a timely manner. Much of the research on asynchronous electronic notifications (pager, cellphone or wearable devices) comes from home-grown electronic health records (EHR). Little is known about factors influencing notifications from vendor-based EHRs and the effect of subscription-based notifications, where providers select which results for notification. This study investigates what factors influence a clinician’s decision to order result notifications, the perceived role of these notifications in the clinical setting, and ways to improve notifications in a vendor-based EHR.

Methods: We queried the EHR to …

Electronic Health Records: All That They’Re Chalked Up To Be?, Mac Williams, Meghan Gannon, Phd

Phase 1

Introduction. The United States faces a challenge: how to improve access to healthcare with an aging physician workforce. An aging baby boomer population prompts higher medical demands, further heightening this challenge. Although measures to increase the longevity of practice for older physicians could help address this challenge, the federal government has lacked to create such policy.

Methods. This study looked at the role of electronic health records and the American Recovery and Reinvestment Act in the ability of primary care physicians to continue practice through in-depth qualitative interviews. A total of N=5 interviews were conducted in-person and remotely using a …

A Rule-Based Data Quality Assessment System In Electronic Health Records, Zhan Wang

Theses and Dissertations

Measuring and managing data quality in healthcare has remained largely uncharted territory. Rule-based data quality assessment in healthcare was explored through compilation of 63,397 data quality rules. This work applied a design science framework to design, demonstrate and test a scalable framework with which data quality rules can be managed, executed, and used in healthcare facilities for data quality assessment and monitoring. Rules were acquired by multiple methods including iterative design meetings with stakeholders. The system was validated using a mixed methods approach. System function was validated through iterative testing to assure that the system was working properly. Rule performance …

Using Clinical Decision Support Within The Electronic Health Record To Reduce Incorrect Prescribing For Acute Sinusitis, Regina Ginzburg, Justin J. Conway, Eve Waltermaurer, Wendy Song, Samantha P. Jellinek-Cohen

Journal of Patient-Centered Research and Reviews

Purpose: Acute sinusitis has viral etiology in more than 90% of cases, but antibiotics are prescribed for more than 80% of adults in the United States. While applications of computer-assisted guidelines have been found effective in reducing inaccurate prescribing for acute respiratory infections, there is a paucity of research focused specifically on the utilization of electronic best practice alerts (BPA) in improving treatment for acute sinusitis.

Methods: This observational cohort study examined prescribing behavior for sinusitis at a single Federally Qualified Health Center 1 year prior and during the first year of implementation of a BPA in the electronic health …

Patient-Centered Outcomes Measurement: Does It Require Information From Patients?, Leif I. Solberg, Stephen E. Asche, John Butler, David Carrell, Christine K. Norton, Jeffrey G. Jarvik, Rebecca Smith-Bindman, Juliana O. Tillema, Robin R. Whitebird, Ann M. Werner, Jeanette Y. Ziegenfuss

Journal of Patient-Centered Research and Reviews

Purpose: Since collecting outcome measure data from patients can be expensive, time-consuming, and subject to memory and nonresponse bias, we sought to learn whether outcomes important to patients can be obtained from data in the electronic health record (EHR) or health insurance claims.

Methods: We previously identified 21 outcomes rated important by patients who had advanced imaging tests for back or abdominal pain. Telephone surveys about experiencing those outcomes 1 year after their test from 321 people consenting to use of their medical record and claims data were compared with audits of the participants’ EHR progress notes over the time …

Awareness And Use Of Electronic Health Records In Entry-Level Occupational Therapy And Occupational Therapy Assistant Curricula, Louis F. Dmytryk, Tina M. Deangelis

The Open Journal of Occupational Therapy

The Accreditation Council for Occupational Therapy Education (ACOTE) requires programs to instruct entry-level occupational therapy (OT) and occupational therapy assistant (OTA) students in technology that may include electronic documentation systems, distance communication, virtual environments, and telehealth (standard B1.8). At this time, there are no publications describing if and how electronic health record (EHR) instruction is implemented in entry-level OT and OTA programs. The purpose of this study is to investigate awareness and use of EHRs in entry-level OT and OTA curricula. Respondents from 76 nationally accredited entry-level programs (two OT doctoral, 24 OT masters, two OT combined bachelors/masters, and 48 …

How Barriers To Using The Electronic Health Record Effects Behavioral Healthcare, Jennifer Woodard

Applied Research Projects

The healthcare scene is rapidly changing due to the introduction of the electronic health record (EHR) and advances in technology. This means more patient data is readily available for use and gives physicians and patients’ faster access to that data. With the passing of recent legislature such as the Health Information Technology for Economic and Clinical Health Act and the American Recovery and Reinvestment Act of 2009, resulting in the rapid adoption of electronic health records due to incentive payment programs. With this comes the push for use of the electronic health record to prepare for Meaningful Use and improved …

Using Electronic Health Record Data To Improve Community Health Assessment, Brian E. Dixon, Jian "Frank" Zou, Karen F. Comer, Marc Rosenman, Jennifer L. Craig, P Gibson

Frontiers in Public Health Services and Systems Research

Background: Community health assessments assist health departments in identifying health needs as well as disparities, and they enable linking of needs with available interventions. Electronic health record (EHR) systems possess growing volumes of clinical and administrative data, making them a valuable source of data for ongoing community health assessment.

Purpose: To produce population health indicators using data from EHR systems that could be combined and visually displayed alongside social determinants data, and to provide data sets at geographic levels smaller than a county.

Methods: Data from multiple EHR systems used by major health systems covering >90% of the population in …

Linking Emr To Virtual Care Of Psychiatric Patients In The Acute Care Setting, Howard Louis Beatty Jr.

MUSC Theses and Dissertations

The purpose of this study is to test if the implementation of the Tele-Psychiatric Consultation Process (built within the FirstNet (Cerner/EMR) application, which pulls the patient’s current EMR encounter from multiple facility locations to a different physical facility location for consultation) provided increased quality by decreasing in total length of stay. The coordination of virtual care consultations allows for inter-practice data exchange for multi-provider clinical decision support. Documentation of medications and treatment regimens, which may be unfamiliar to the acute care provider, are provided through virtual tele-psychiatric consultations. An eTracking queue within FirstNet was built in-house by Carolinas Healthcare System …

Electronic Health Records In The Academic World, Madeline Leapaldt

Williams Honors College, Honors Research Projects

Health or medical records are the backbone of the healthcare industry. They allow professions to practice patient-centered, interdisciplinary care. Electronic Health Records help accelerate the care process and allow for a smoother patient experience. However, many healthcare professionals have not used an Electronic Health Record prior to employment or internships. This can be detrimental to the process and slow down the entire team. Research shows that teaching Electronic Health Records in an academic setting allows students to safely explore the system and become comfortable with using technology for healthcare purposes. There are specific requirements that have been shown to aid …

Data Governance In Electronic Health Records: A Systematic Review, Rawan Adel Alsharida

Theses and Dissertations

Data governance as a discipline is applicable to encompass in any organization. For this thesis, the focus of our research setting is the data governance in electronic health records (EHR). This thesis presents a literature survey by analyzing 87 articles through over ten years period (from January 2004 – December 2014) related to EHRs. We found our articles written in English language from database MEDLINE that have indexing journals in all fields of medicine and related topics. For several years EHRs have been developed by different providers and researchers, who in turn, put patients’ health in danger. IBM data governance …

Electronic Health Record Optimization For Cardiac Care, Lisa A. Grabenbauer

Theses & Dissertations

Electronic health record (EHR) systems have been studied for over 30 years, and despite the benefits of information technology in other knowledge domains, progress has been slow in healthcare. A growing body of evidence suggests that dissatisfaction with EHR systems was not simply due to resistance to adoption of new technology but also due to real concerns about the adverse impact of EHRs on the delivery of patient care. Solutions for EHR improvement require an approach that combines an understanding of technology adoption with the complexity of the social and technical elements of the US healthcare system. Several studies are …