Search results for "Electronic Health Records"

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

Electronic medical records (EMRs) are generally perceived to improve patient safety, and prior reviews have found that EMR implementation is associated with improvement in some measures of safety and quality. This study of EMR implementation in a large primary care medical group found a positive association between implementation of a new EMR and safety culture, with sustained improvement in Safety Attitudes Questionnaire scores over a 3-year period following implementation. Interestingly, the perceived improvement in safety culture was smallest in the first year of use of the new EMR; a prior study found that 1 year of experience was necessary before primary care physicians felt a new EMR improved safety and quality.

A multimodal quality improvement project based in a shared electronic medical record resulted in a decrease in potential adverse drug events in 20 primary care practices.

In this cross-sectional study, patients with multiple comorbidities were less likely to receive treatment for depression if their physician used an electronic medical record.

Medication reconciliation was initially established as a National Patient Safety Goal (NPSG) in 2005. However, difficulty establishing and implementing effective medication reconciliation approaches led to The Joint Commission suspending evaluation of this NPSG in 2009 and eventually eliminating it as a separate NPSG in 2011. This report from a large health care system provides a detailed template for integrating medication reconciliation into clinician workflow in the outpatient setting. Through a combination of leadership engagement, rapid cycle quality improvement projects, and financial incentives, the organization achieved consistent and sustained improvement in documentation of medication reconciliation for pediatric patients over a 5-year period. As medication reconciliation has been less studied in the ambulatory care setting, this study provides a useful window into the barriers inherent in changing outpatient clinician workflow and the steps this organization took to minimize unintended consequences of the intervention.

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.

Diagnostic errors are a known threat to patient safety, and measuring their prevalence is challenging, particularly outside pathology and radiology settings. Past studies have highlighted classification systems and related prevention strategies, including the adoption of checklists. This study explored the use of a situational awareness (SA) framework to understand diagnostic errors in a primary care setting. Investigators interviewed providers involved in a diagnostic error and revealed that one level of SA was lacking (e.g., information perception, information comprehension, forecasting future events, and choosing appropriate action based on the first three levels). The authors found that applying the SA framework to analyze such errors provided deeper insight into the provider–work system interaction, which included important interface with the electronic health record. A past AHRQ WebM&M perspective and interview discussed diagnostic errors in medicine.

Achieving medication reconciliation continues to present significant challenges, despite existing guidelines and its demonstrated impact on patient safety. Electronic health records (EHRs) and related tools have long been touted as solutions to bolster reconciliation safety. This study evaluated whether an EHR shared between outpatient and inpatient providers could reduce suspected medication discrepancies. Although errors were reduced, significant discrepancies persisted among various forms of reconciliation, including differences between what was in the record and what patients actually reported taking. Problems included outdated or incomplete medication information, incorrect information provided by patients, or mismatched information between the different sources. The authors argue that EHRs, as an added information vehicle, may help reduce reconciliation errors, but they caution that EHRs are only a tool (and not in themselves a solution) for safer reconciliation. A past AHRQ WebM&M commentary discussed whose job it is to assure safe medication reconciliation.

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.

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.

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

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.

Less than 20% of ambulatory practices in the United States utilize electronic health records (EHRs). Uptake has been limited by cost issues and concern about the impact of EHRs on clinician workflow. This survey evaluated clinicians' perceptions of a newly implemented electronic medical record in three primary care clinics. Although initially clinicians felt that the EHR resulted in longer patient visits and increased the time spent documenting, by 1 year after implementation, clinicians felt that the EHR improved their ability to follow up on test results and communicate with other providers, and contributed to higher quality care overall. Importantly, these perceived advantages emerged only after 1 full year of using the new system.

This cross-sectional study found that outpatient practices' use of an electronic health record (EHR) was not associated with higher quality care. The authors posit several reasons for this finding, including the possibility that EHRs were not implemented as fully as at benchmark institutions, or lacked decision support.

In this study, patients had access to a web-based electronic health record that allowed them to view their medication list and report inaccuracies. However, medication lists were found to be equally inaccurate for users and nonusers of the system.

The authors discuss why general practitioners' adoption of electronic health records is more prevalent in the United Kingdom than the United States and identify features that might encourage adoption in the US.

This survey found that by 2012, 72% of ambulatory-based physicians in the United States had implemented some form of electronic health record and 40% were using computerized provider order entry. These figures represent a substantial increase over the past several years.

Despite large volumes of data generated in primary care settings, this literature review noted a paucity of data that is routinely used to measure adverse events.

Failure to adequately follow up on test results is a known problem after hospital discharge, in primary care settings, and within computerized systems. This study reviewed more than 5400 patient medical records from 19 community-based and 4 academic primary care practices and discovered a 7.1% rate of failure to inform (or document informing). Interestingly, investigators found that partial electronic health records (EHRs), with a mix of paper and electronic systems, were associated with higher failure rates than those practices without an EHR or with a complete EHR. Variations in failure rates among practices, ranging from 0% to 26%, suggest that best practices can make a significant difference. A past AHRQ WebM&M commentary discussed the impact of delayed notification for a test result following hospital discharge.

Introduction of an electronic discharge summary was associated with more timely communication with outpatient physicians and improved communication of potential patient safety problems, such as test results that were pending at the time of discharge.