Ambulatory physicians' electronic health record self-efficacy.
Ontology highlight
ABSTRACT:
SUBMITTER: Hellems MA
PROVIDER: S-EPMC8423415 | biostudies-literature | 2021 Jul
REPOSITORIES: biostudies-literature
Publications
Ambulatory physicians' electronic health record self-efficacy.
JAMIA open 20210104 3
Ambulatory providers were administered an EHR skills self-assessment survey to assess their confidence in learning about and using the electronic health record (EHR). Seventy-one providers participated. Only 35% of respondents felt that they had strong EHR skills, 92% felt confident that they could learn new skills, and 90% felt they could improve with practice. Forty-five percent of faculty physicians felt confident that they could use the EHR in a time-efficient manner and 52% felt could keep ...[more]
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| S-EPMC10285567 | biostudies-literature
Project description:BackgroundMultiple policy initiatives encourage more cautious prescribing of opioids in light of their risks. Electronic health record (EHR) redesign can influence prescriber choices, but some redesigns add to workload.ObjectiveTo estimate the effect of an EHR prescribing redesign on both opioid prescribing choices and keystrokes.DesignQuality improvement quasi-experiment, analyzed as interrupted time series.ParticipantsAdult patients of an academic multispecialty practice and a federally qualified health center (FQHC) who received new prescriptions for short-acting opioids, and their providers.InterventionIn the redesign, new prescriptions of short-acting opioids defaulted to the CDC-recommended minimum for opioid-naïve patients, with no alerts or hard stops, such that 9 keystrokes were required for a guideline-concordant prescription and 24 for a non-concordant prescription.Main measuresProportion of guideline-concordant prescriptions, defined as new prescriptions with a 3-day supply or less, calculated per 2-week period. Number of mouse clicks and keystrokes needed to place prescriptions.Key resultsAcross the 2 sites, 22,113 patients received a new short-acting opioid prescription from 821 providers. Before the intervention, both settings showed secular trends toward smaller-quantity prescriptions. At the academic practice, the intervention was associated with an immediate increase in guideline-concordant prescriptions from an average of 12% to 31% of all prescriptions. At the FQHC, about 44% of prescriptions were concordant at the time of the intervention, which was not associated with an additional significant increase. However, total keystrokes needed to place the concordant prescriptions decreased 62.7% from 3552 in the 6 months before the intervention to 1323 in the 6 months afterwards.ConclusionsAutocompleting prescription forms with guideline-recommended values was associated with a large increase in guideline concordance in an organization where baseline concordance was low, but not in an organization where it was already high. The redesign markedly reduced the number of keystrokes needed to place orders, with important implications for EHR-related stress.Trial registrationwww.ClinicalTrials.gov protocol 1710018646.
| S-EPMC7878599 | biostudies-literature
Project description:OBJECTIVE: To describe small area variation in ambulatory electronic health record (EHR) adoption and assess evidence of a "digital divide" in whether adoption is lagging in traditionally underserved communities. DATA SOURCES: Survey data on U.S. ambulatory health care sites (261,973 sites representing 716,160 providers) collected by SK&A Information Services in 2011. STUDY DESIGN: We examined cross-sectional variation in two measures of local area EHR adoption: share of providers at sites using an EHR with e-prescribing functionality; and predicted probability of EHR adoption for the average site. Local areas were defined as Public Use Microdata Areas (n = 2,068). Using multivariate regression, we examined the association between adoption and three area characteristics: high concentration of minority population; high concentration of low-income population; and metropolitan status. PRINCIPAL FINDINGS: EHR adoption varied significantly across local areas, ranging from 8 to 88 percent with a median of 41 percent. Adoption was lower in large metropolitan areas; areas with high concentration of minority population in the Northeast and West; and areas with high concentration of low-income population in the Midwest. CONCLUSIONS: Our 2011 estimates suggest there was substantial room for increased EHR adoption across the United States, including some underserved areas with relatively low EHR adoption rates. Further research should monitor policy initiatives in these areas and examine sources of heterogeneity in low- and high-adoption communities.
| S-EPMC3876400 | biostudies-other
Project description:ObjectivesEmergency medicine (EM) physicians commonly track the progress of former patients to learn about their clinical outcome. While some studies have described the behavior, little is known about the specific information sought during tracking. The objective of this study was to determine how often EM physicians track patients and the motivations, strategies, and barriers to tracking.MethodsIn June 2019 we surveyed EM physicians practicing at six hospitals. We defined patient tracking as viewing the chart of a patient who was no longer under the physician's care or contacting the patient or the patient's subsequent providers to learn about the patient's progress. The survey asked respondents how often they track patients, by what mechanisms, and for what reasons. The survey also asked what information physicians sought when tracking and what barriers to tracking exist.ResultsOf the 156 EM physicians invited to respond, 111 completed the survey (72% response rate). Of those, 109 (98%) reported tracking their patients, and residents reported tracking a higher percentage of patients than attendings. Reasons for tracking included an unusual or complex case (98%), uncertain diagnosis (89%), and concern about a potential error (48%). Most respondents (86%) said that knowledge gained from patient tracking changed their subsequent practice patterns, and almost all respondents (98%) strongly agreed or agreed that tracking helps physicians avoid future mistakes. The most commonly sought information types during tracking were the hospital discharge summary or emergency department note from the index visit, test results since the index visit, and new diagnoses added since the index visit. Physicians cited time limitations and difficulty accessing information as the leading barriers to tracking.ConclusionsPatient tracking is nearly ubiquitous among surveyed EM physicians, who find it valuable for learning and patient safety.
| S-EPMC8923647 | biostudies-literature
Project description:ImportanceElectronic health record (EHR) work has been associated with decreased physician well-being. Understanding the association between EHR usability and physician satisfaction and burnout, and whether team and technology strategies moderate this association, is critical to informing efforts to address EHR-associated physician burnout.ObjectivesTo measure family physician satisfaction with their EHR and EHR usability across functions and evaluate the association of EHR usability with satisfaction and burnout, as well as the moderating association of 4 team and technology EHR efficiency strategies.Design, setting, and participantsThis study uses data from a cross-sectional survey conducted from December 12, 2021, to October 17, 2022, of all family physicians seeking American Board of Family Medicine recertification in 2022.ExposurePhysicians perceived EHR usability across 6 domains, as well as adoption of 4 EHR efficiency strategies: scribes, support from other staff, templated text, and voice recognition or transcription.Main outcomes and measuresPhysician EHR satisfaction and frequency of experiencing burnout measured with a single survey item ("I feel burned out from my work"), with answers ranging from "never" to "every day."ResultsOf the 2067 physicians (1246 [60.3%] younger than 50 years; 1051 men [50.9%]; and 1729 [86.0%] practicing in an urban area) who responded to the survey, 562 (27.2%) were very satisfied and 775 (37.5%) were somewhat satisfied, while 346 (16.7%) were somewhat dissatisfied and 198 (9.6%) were very dissatisfied with their EHR. Readability of information had the highest usability, with 543 physicians (26.3%) rating it as excellent, while usefulness of alerts had the lowest usability, with 262 physicians (12.7%) rating it as excellent. In multivariable models, good or excellent usability for entering data (β = 0.09 [95% CI, 0.05-0.14]; P < .001), alignment with workflow processes (β = 0.11 [95% CI, 0.06-0.16]; P < .001), ease of finding information (β = 0.14 [95% CI, 0.09-0.19]; P < .001), and usefulness of alerts (β = 0.11 [95% CI, 0.06-0.16]; P < .001) were associated with physicians being very satisfied with their EHR. In addition, being very satisfied with the EHR was associated with reduced frequency of burnout (β = -0.64 [95% CI, -1.06 to -0.22]; P < .001). In moderation analysis, only physicians with highly usable EHRs saw improvements in satisfaction from adopting efficiency strategies.Conclusions and relevanceIn this survey study of physician EHR usability and satisfaction, approximately one-fourth of family physicians reported being very satisfied with their EHR, while another one-fourth reported being somewhat or very dissatisfied, a concerning finding amplified by the inverse association between EHR satisfaction and burnout. Electronic health record-based alerts had the lowest reported usability, suggesting EHR vendors should focus their efforts on improving alerts. Electronic health record efficiency strategies were broadly adopted, but only physicians with highly usable EHRs realized gains in EHR satisfaction from using these strategies, suggesting that EHR burden-reduction interventions are likely to have heterogenous associations across physicians with different EHRs.
| S-EPMC11362862 | biostudies-literature
Project description:ObjectiveElectronic health records (EHR) hold great promise for managing patient information in ways that improve healthcare delivery. Physicians differ, however, in their use of this health information technology (IT), and these differences are not well understood. The authors study the differences in individual physicians' EHR use patterns and identify perceptions of uncertainty as an important new variable in understanding EHR use.DesignQualitative study using semi-structured interviews and direct observation of physicians (n=28) working in a multispecialty outpatient care organization.MeasurementsWe identified physicians' perceptions of uncertainty as an important variable in understanding differences in EHR use patterns. Drawing on theories from the medical and organizational literatures, we identified three categories of perceptions of uncertainty: reduction, absorption, and hybrid. We used an existing model of EHR use to categorize physician EHR use patterns as high, medium, and low based on degree of feature use, level of EHR-enabled communication, and frequency that EHR use patterns change.ResultsPhysicians' perceptions of uncertainty were distinctly associated with their EHR use patterns. Uncertainty reductionists tended to exhibit high levels of EHR use, uncertainty absorbers tended to exhibit low levels of EHR use, and physicians demonstrating both perspectives of uncertainty (hybrids) tended to exhibit medium levels of EHR use.ConclusionsWe find evidence linking physicians' perceptions of uncertainty with EHR use patterns. Study findings have implications for health IT research, practice, and policy, particularly in terms of impacting health IT design and implementation efforts in ways that consider differences in physicians' perceptions of uncertainty.
| S-EPMC3912724 | biostudies-literature
Project description:BackgroundThere is interest in leveraging the electronic medical records (EMRs) to improve knowledge and understanding of patients' characteristics and outcomes of patients with ambulatory heart failure (HF). However, the diagnostic performance of International Classification of Diseases (ICD) -10 diagnosis codes from the EMRs for patients with HF and with reduced or preserved ejection fraction (HFrEF or HFpEF) in the ambulatory setting are unknown.MethodsWe examined a cohort of patients aged ≥ 18 with at least 1 outpatient encounter for HF between January 2016 and June 2018 and an echocardiogram conducted within 180 days of the outpatient encounter for HF. We defined HFrEF encounters as those with ICD-10 codes of I50.2x (systolic heart failure); and we defined HFpEF encounters as those with ICD-10 codes of I50.3x (diastolic heart failure). The referent definitions of HFrEF and HFpEF were based on echocardiograms conducted within 180 days of the ambulatory encounter for HF RESULTS: We examined 68,952 encounters of 14,796 unique patients with HF. The diagnostic performance parameters for HFrEF (based on ICD-10 I50.2x only) depended on LVEF cutoff, with a sensitivity ranging from 68%-72%, specificity 63%-68%, positive predictive value 47%-63%, and negative predictive value 73%-84%. The diagnostic performance parameters for HFpEF depended on left ventricular ejection fraction cut-off, with sensitivity ranging from 34%-39%, specificity 92%-94%, positive predictive value 86%-93%, and negative predictive value 39%-54%.ConclusionsICD-10 coding abstracted from the EMR for HFrEF vs HFpEF in the ambulatory setting had suboptimal diagnostic performance and, thus, should not be used alone to examine HFrEF and HFpEF in the ambulatory setting.
| S-EPMC8918045 | biostudies-literature
Project description: Not available
| S-EPMC11897832 | biostudies-literature
Project description:Background and study aims
The Federal Ministry of Education and Research (BMBF) has funded the development of a patient controlled “Personal Electronic Health Record” (PEPA) as part of their current INFOPAT project. PEPA allows for the exchange of medical data between all interested groups, including the patients thenselves. A PEPA contains medical reports and findings including, for example, x-rays, CT scans and MRIs. The patients can safeguard their information and access all content. The aim of this study is to test the PEPA-prototype for cancer patients being treated at the National Center for Tumor Diseases (NCT) in Heidelberg.
Who can participate?
Adult colorectal cancer patients being treated at the National Center for Tumor Diseases (NCT) in Heidelberg.
What does the study involve?
There are two part to this study. The first part involves focus groups, in which a group of people are asked their opinion and attitudes towards, for example, an idea, product or service. Here, focus groups are set up that involve the patients, doctors and other health professionals to discuss current problems with the coordination of care offered to cancer patients, as well as discuss what people want to get from using PEPA (i.e. user requirements). The PEPA-prototype is then developed taking into account the conclusions from the focus groups. In the second part of the study, patients are encouraged to use the PEPA-prototype to prepare and follow up meetings with their physicians.
| 2424890 | ecrin-mdr-crc
Project description:BackgroundSubstantial research has been performed about the impact of computerized physician order entry on medication safety in the inpatient setting; however, relatively little has been done in ambulatory care, where most medications are prescribed.ObjectiveTo outline the development and piloting process of the Ambulatory Electronic Health Record (EHR) Evaluation Tool and to report the quantitative and qualitative results from the pilot.MethodsThe Ambulatory EHR Evaluation Tool closely mirrors the inpatient version of the tool, which is administered by The Leapfrog Group. The tool was piloted with seven clinics in the United States, each using a different EHR. The tool consists of a medication safety test and a medication reconciliation module. For the medication test, clinics entered test patients and associated test orders into their EHR and recorded any decision support they received. An overall percentage score of unsafe orders detected, and order category scores were provided to clinics. For the medication reconciliation module, clinics demonstrated how their EHR electronically detected discrepancies between two medication lists.ResultsFor the medication safety test, the clinics correctly alerted on 54.6% of unsafe medication orders. Clinics scored highest in the drug allergy (100%) and drug-drug interaction (89.3%) categories. Lower scoring categories included drug age (39.3%) and therapeutic duplication (39.3%). None of the clinics alerted for the drug laboratory or drug monitoring orders. In the medication reconciliation module, three (42.8%) clinics had an EHR-based medication reconciliation function; however, only one of those clinics could demonstrate it during the pilot.ConclusionClinics struggled in areas of advanced decision support such as drug age, drug laboratory, and drub monitoring. Most clinics did not have an EHR-based medication reconciliation function and this process was dependent on accessing patients' medication lists. Wider use of this tool could improve outpatient medication safety and can inform vendors about areas of improvement.
| S-EPMC7929716 | biostudies-literature