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Search results for "Electronic Health Records"

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Perspectives on Safety > Interview

In Conversation With… Bernardo Perea-Pérez, MD, DDS, PhD

Patient Safety in Dentistry, July/August 2016

Dr. Perea-Pérez is Director of the Spanish Observatory for Dental Patient Safety. We spoke with him about patient safety in dentistry.

Journal Article > Study

Workarounds and test results follow-up in electronic health record–based primary care.

Menon S, Murphy DR, Singh H, Meyer AND, Sittig DF. Appl Clin Inform. 2016;7:543-559.

Implementation of the electronic health record has led to providers engaging in workarounds to circumvent system limitations. This survey found that nearly half of providers at Veterans Affairs medical centers use workarounds when managing test results in the electronic health record. The authors suggest that results management should be improved in future electronic health records and work systems to enhance efficiency and care coordination.

Journal Article > Study

Clinical benefits of electronic health record use: national findings.

King J, Patel V, Jamoom EW, Furukawa MF. Health Serv Res. 2014;49:392-404.

This survey of more than 1700 physicians in ambulatory practice found generally positive perceptions of electronic health records (EHRs), with approximately 80% reporting that EHRs enhanced the overall quality of care for patients. Respondents also noted safety benefits, with two-thirds reporting that the EHR alerted them to a potential medication error.

Journal Article > Study

A typology of electronic health record workarounds in small-to-medium size primary care practices.

Friedman A, Crosson JC, Howard J, et al. J Am Med Inform Assoc. 2014;21:e78-e83.

This ethnographic study used direct observation to characterize how users of an electronic health record compensated for perceived system deficiencies.

Journal Article > Study

Electronic health record-based triggers to detect potential delays in cancer diagnosis.

Murphy DR, Laxmisan A, Reis BA, et al. BMJ Qual Saf. 2014;23:8-16.

Delayed diagnoses in cancer may commonly be caused by cognitive errors or logistical breakdowns. These delays can lead to poor patient outcomes and are a frequent cause of malpractice lawsuits in the ambulatory setting. In this study, four electronic triggers were developed to detect patients at risk for delayed diagnosis of prostate and colorectal cancers. The algorithm identified patients with elevated prostate-specific antigen levels, positive fecal occult blood tests, iron-deficiency anemia, or bright red blood per rectum, but automatically excluded those that already received appropriate care or had known terminal illnesses. The positive predictive values for each these triggers were between 58% and 70%, providing a reasonably accurate report of patients that truly lacked appropriate follow-up. The American Medical Association has identified better follow-up of abnormal test results as a key area for improving patient safety in the ambulatory setting.

Journal Article > Commentary

Getting moving on patient safety—harnessing electronic data for safer care.

Jha AK, Classen DC. N Engl J Med 2011;365:1756-1758.

Describing weaknesses in current safety measurement tools, this perspective suggests that legislation requiring use of electronic medical records can improve safety in health care.

Journal Article > Study

What stands in the way of technology-mediated patient safety improvements? A study of facilitators and barriers to physicians' use of electronic health records.

Holden RJ. J Patient Saf. 2011;7:193-203.

This qualitative study identifies user, system, organizational, and environmental factors that help and hinder uptake of electronic health records.

Journal Article > Study

Electronic health record-based surveillance of diagnostic errors in primary care.

Singh H, Giardina TD, Forjuoh SN, et al. BMJ Qual Saf. 2012;22:93-100.

Diagnostic errors are one of the most common types of preventable errors in ambulatory care, according to data from closed malpractice claims. Difficulty in identifying missed and delayed diagnoses has hampered progress in addressing diagnostic errors. In this case-control study, investigators assessed two triggers for identifying possible cases of diagnostic error within an electronic health record. These triggers were refined from a prior study by the same investigators. The trigger methodology was reasonably accurate in identifying likely diagnostic errors, although the study was limited by poor interrater reliability between physician reviewers on whether an error occurred. Nevertheless, this study demonstrates the potential of screening approaches within electronic medical records for identifying and categorizing possible diagnostic errors.

Journal Article > Study

Development of a tool within the electronic medical record to facilitate medication reconciliation after hospital discharge.

Schnipper JL, Liang CL, Hamann C, et al. J Am Med Inform Assoc. 2011;18:309-313.

Efforts to prevent medication-related adverse events after hospital discharge have largely focused on medication reconciliation at the time of discharge. This study reports on the early experience with a medication reconciliation tool for use by primary care physicians after discharge. Although initial uptake was low, the study reports on many lessons learned through initial implementation.

Newspaper/Magazine Article

Panel set to study safety of electronic patient data.

Freudenheim M. New York Times. December 13, 2010:3B.

This article reports on a committee created by the Institute of Medicine to analyze the potential impact of electronic medical records (EMR) on costs and quality of care.

Journal Article > Study

Improving medication safety in primary care using electronic health records.

Nemeth LS, Wessell AM. J Patient Saf. 2010;6:238-243.

This study used a theoretical model for primary care practice improvement to identify strategies to address medication safety. Key solutions focused on medication reconciliation, prevention of medication errors in selected patients, and customizing electronic health record decision support tools for dosing, drug interactions, and monitoring.

Cases & Commentaries

Reconciling Records

  • Web M&M

Hardeep Singh, MD, MPH; Dean F. Sittig, PhD; Maureen Layden, MD, MPH; November 2010

At two different hospitals, patients were instructed to continue home medications, even though their medication lists had errors that could have led to significant adverse consequences.

Journal Article > Study

The incidence and cost of unexpected hospital use after scheduled outpatient endoscopy.

Leffler DA, Kheraj R, Garud S, et al. Arch Intern Med. 2010;170:1752-1757.

An automated surveillance system within an existing electronic medical record detected many more post-procedural adverse events than standard voluntary reporting.

Journal Article > Commentary

The electronic medical record in dermatology.

Grosshandler JA, Tulbert B, Kaufmann MD, Bhatia A, Brodell RT. Arch Dermatol. 2010;146:1031-1036.

This commentary discusses the costs, risks, and benefits of implementing electronic medical records (EMRs) in dermatology practice.

Journal Article > Study

Beliefs of ambulatory care physicians about accuracy of patient medication records and technology-enhanced solutions to improve accuracy.

Weeks DL, Corbett CF, Stream G. J Healthc Qual. 2010;32:12-21.

This survey of primary care physicians revealed strong support for technological solutions to improve medication reconciliation in ambulatory care.

Journal Article > Commentary

Reducing diagnostic error through medical home-based primary care reform.

Singh H, Graber M. JAMA. 2010;304:463-464.

This commentary discusses how the patient-centered medical home could improve safety and reduce diagnostic errors.

Journal Article > Study

The management of test results in primary care: does an electronic medical record make a difference?

Elder NC, McEwen TR, Flach J, Gallimore J, Pallerla H. Fam Med. 2010;42:327-333.

Electronic health records (EHRs) hold great promise for improving patient safety, but remain underutilized, especially in ambulatory care settings. Failure to appropriately follow up on abnormal test results is a common ambulatory care safety problem, and has been implicated in malpractice lawsuits arising from missed or delayed diagnoses. In this study conducted at eight family medicine clinics, those with an EHR documented clinician and patient notification of abnormal test results and clear follow-up plans more often than those with paper charts. However, even in clinics using EHRs, more than one-third of abnormal results had no follow-up plan documented. This finding corroborates prior research that clinician notification alone does not ensure timely and complete follow-up of test results.

Journal Article > Study

Notification of abnormal lab test results in an electronic medical record: do any safety concerns remain?

  • Classic

Singh H, Thomas EJ, Sittig DF, et al. Am J Med. 2010;123:238-244.

Unreliable test result management systems are a common problem in ambulatory care, and failure (or inability) to promptly follow up abnormal test results may lead to diagnostic errors and other safety problems. Automated alerts within electronic health records should minimize such problems. However, this study conducted in Veterans Affairs clinics found that 1 in 10 alerts for abnormal laboratory test results went unread by providers, and a large proportion of those patients did not receive timely clinical follow-up. The investigators found similar results when analyzing follow-up of alerts for abnormal imaging results. "Alert fatigue" is one possible explanation for these findings.

Journal Article > Study

The relationship between physician practice characteristics and physician adoption of electronic health records.

Bramble JD, Galt KA, Siracuse MV, et al. Health Care Manage Rev. 2010;35:55-64.

In this survey of physicians in Nebraska and South Dakota, those who adopted electronic health records were more likely to be younger and working in group practices.

Journal Article > Commentary

Unintended errors with EHR-based result management: a case series.

Yackel TR, Embi PJ. J Am Med Inform Assoc. 2010;17:104-107.

The authors identify errors that may occur with electronic test result systems and describe improvement strategies to address such failures.

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