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Search results for "Information Professionals"

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Journal Article > Study

Assessing the potential adoption and usefulness of concurrent, action-oriented, electronic adverse drug event triggers designed for the outpatient setting.

Mull HJ, Rosen AK, Shimada SL, et al. EGEMS (Wash DC). 2015;3:1116.

Trigger tools have been shown to be an efficient way to screen for adverse events. This AHRQ-funded study assessed the usefulness of different adverse drug event triggers in the outpatient setting. Five of the triggers performed reasonably well for either detecting harm or leading to a change in care plan.

Journal Article > Study

Best practices: an electronic drug alert program to improve safety in an accountable care environment.

Griesbach S, Lustig A, Malsin L, Carley B, Westrich KD, Dubois RW. J Manag Care Spec Pharm. 2015;21:330-336.

This study of a quality improvement initiative found that automated screening of prescribing data uncovered many potential adverse drug events. Prescribers were notified about these safety concerns, and almost 80% of these potential adverse drug events were resolved through prescription changes. The extent of patient harm which occurred or was averted was not reported. This work suggests that real-time data from electronic prescribing could be harnessed to improve patient safety, as others have suggested.

Journal Article > Study

The impact of a diagnostic decision support system on the consultation: perceptions of GPs and patients.

Porat T, Delaney B, Kostopoulou O. BMC Med Inform Decis Mak. 2017;17:79.

The recent National Academy of Medicine report on improving diagnosis cited the need for enhanced clinical decision support. This pre–post study used a simulation approach (standardized patients) to compare visits with and without use of a diagnostic clinical decision aid embedded in the electronic health record. The patients' visit satisfaction ratings did not differ in the visits with and without the decision support, although more patients in the decision support group noted that physicians focused more on the computer than the patient. The physicians reported high overall satisfaction with the decision tool, but they noted that it required inputting more clinical documentation during the visit, resulting in more time directed at the electronic health record. The authors conclude that the clinical decision support tool interface should be improved in order to facilitate adoption of real-time diagnostic support.

Journal Article > Commentary

Identifying and analyzing diagnostic paths: a new approach for studying diagnostic practices.

Rao G, Epner P, Bauer V, Solomonides A, Newman-Toker DE. Diagnosis. 2017;4:67-72.

This commentary explores diagnosis of common conditions in primary care and highlights approaches for studying the process, such as practice variation and patterning. The authors suggest big data as a method to mine electronic medical records to identify the information needed to inform improvement.

Journal Article > Study

A national survey assessing the number of records allowed open in electronic health records at hospitals and ambulatory sites.

Adelman JS, Berger MA, Rai A, et al. J Am Med Inform Assoc. 2017 Apr 17; [Epub ahead of print].

Wrong-patient errors can occur during computerized provider order entry, particularly if ordering clinicians have more than one patient record open. Experts have recommended that health systems allow only a single patient record to be open at a time to prevent these errors. This national survey of electronic health record leaders examined whether health systems permit records for multiple patients to be open simultaneously for electronic ordering and documentation. Nearly 200 health systems responded to the survey, and respondents described widely differing practices. Among health systems where clinicians could open multiple patient records at a time, the common justification was to support efficiency. A significant proportion did impose a restriction of working on one patient record at a time, and a smaller group limited clinicians to working with two open patient records only. These results suggest that further study of the optimal number of open patient records is needed to balance safety and efficiency in completing electronic health record work.

Journal Article > Study

Diagnostic accuracy of GPs when using an early-intervention decision support system: a high-fidelity simulation.

  • Classic

Kostopoulou O, Porat T, Corrigan D, Mahmoud S, Delaney BC. Br J Gen Pract. 2017;67:e201-e208.

Improving diagnosis in outpatient care is a patient safety priority. This simulation study evaluated the process of diagnosis in the primary care setting. Investigators contrasted physicians' diagnostic accuracy conducting a primary care visit in their usual manner versus using a clinical decision support tool. Each visit employed a standardized patient (an actor reporting symptoms consistent with a given diagnosis) and the visits with and without decision support were matched for complexity. The tool improved diagnostic accuracy significantly: 68% of visits using decision support reached the correct diagnosis versus 59% of usual care visits. The duration of visits and number of subspecialty consultations did not change with or without decision support. Physician participants rated the usability of the decision support tool favorably overall. These data suggest that decision support can be feasibly integrated into primary care to improve diagnostic accuracy.

Journal Article > Study

Electronic detection of delayed test result follow-up in patients with hypothyroidism.

Meyer AND, Murphy DR, Al-Mutairi A, et al. J Gen Intern Med. 2017;32:753-759.

Trigger tools facilitate identification of adverse events. In this retrospective medical record review study, investigators found that an automated trigger successfully identified delayed follow-up of laboratory thyroid testing among patients with hypothyroidism, with a positive predictive value of 60%. The authors suggest that this trigger approach could be used to detect and ameliorate follow-up delays in real time.

Journal Article > Study

Screening for medication errors using an outlier detection system.

Schiff GD, Volk LA, Volodarskaya M, et al. J Am Med Inform Assoc. 2017;24:281-287.

Medication errors continue to occur despite implementation of computerized provider order entry and clinical decision support systems. This study sought to assess whether medication error alerts might have a greater impact on mitigating such errors if they were generated based on outlier detection screening. Researchers analyzed data from the electronic health records of 747,985 outpatients to identify outliers that might indicate a medication error. They then chose 300 charts from the 15,693 resulting alerts. The charts were reviewed using a coding system to evaluate the utility of the alerts generated. About 75% of the chart-reviewed alerts created by the screening system identified possible medication errors. The authors suggest that using this type of outlier detection screening to generate alerts might improve existing clinical decision support systems' ability to mitigate medication errors. A prior WebM&M commentary discussed an incident involving an electronic prescribing error.

Journal Article > Review

The challenges of electronic health records and diabetes electronic prescribing: implications for safety net care for diverse populations.

Ratanawongsa N, Chan LLS, Fouts MM, Murphy EJ. J Diabetes Res. 2017;2017:8983237.

Diabetes medications are known to be high risk for adverse drug events. This case study reviews several patient safety measures for electronic prescribing for diabetes in outpatient care. Researchers describe an adverse drug event involving electronic prescribing of insulin and detail how the incident could have been prevented. Electronic prescribing is not currently standardized and may require using a trade name for medications, which may lead to prescribing errors. Adoption of the medication naming conventions put forth by the National Library of Medicine's RxNorm would prevent this vulnerability. Similarly, standardizing electronic prescribing orders for high-risk medications like insulin may reduce the risk of erroneously choosing a long-acting instead of short-acting insulin formulation, which can have life-threatening consequences. The authors advocate for using Universal Medication Schedule instructions and providing language-concordant labels to patients to support safe medication self-administration. They suggest that real-time, bidirectional communication between prescribers and pharmacists may improve safe prescribing. The authors conclude that recommended safety practices are not uniformly implemented in clinical practice and advocate for implementation research to ensure medication safety for outpatients with diabetes.

Perspectives on Safety > Interview

In Conversation With… Andrew Bindman, MD

New Leaders in Safety and Quality, November 2016

Dr. Bindman, an expert in health policy in underserved populations, was appointed as director of the Agency for Healthcare Research and Quality (AHRQ) in May 2016. We spoke with him about his new role at AHRQ.

Perspectives on Safety > Interview

In Conversation With… Reed V. Tuckson, MD

Telemedicine and Patient Safety, September 2016

Dr. Tuckson is President of the American Telemedicine Association. We spoke with him about telemedicine and patient safety.

Book/Report

Report on the Safe Use of Pick Lists in Ambulatory Care Settings.

Rizk S, Oguntebi G, Graber ML, Johnston D. Research Triangle Park, NC: RTI International; 2016.

Standard term selection tools—like pick lists or drop-down menus—in information technology can create opportunities for user error due to human factors. This publication explores how mistakes such as selecting the wrong drug from an ordering pick list can occur in the ambulatory environment. The report includes recommendations and resources to help enhance medication safety when using these tools.

Perspectives on Safety > Perspective

Telemedicine and Patient Safety

with commentary by Stephen Agboola, MD, MPH, and Joseph Kvedar, MD, Telemedicine and Patient Safety, September 2016

This piece explores benefits and safety concerns associated with the increased adoption of telemedicine services.

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

Ambulatory computerized prescribing and preventable adverse drug events.

Overhage JM, Gandhi TK, Hope C, et al. J Patient Saf. 2016;12:69-74.

Adverse drug events (ADEs) are a common source of patient harm in the ambulatory setting. A substantial proportion of ADEs are caused by preventable errors in medication prescribing or monitoring. The introduction of computerized provider order entry (CPOE) has been shown to reduce the rate of medical errors in the inpatient setting. This before–after study examined rates of ADEs in primary care practices that implemented a CPOE system in Boston and Indianapolis. At baseline, the potential ADE rate was more than seven-fold greater in Indianapolis compared to Boston. Following CPOE implementation, this rate decreased by 56% in Indianapolis but increased by 104% in Boston, and there was no change overall in preventable ADEs. A recent PSNet annual perspective reviewed the relationship and current evidence linking CPOE and patient safety.

Journal Article > Study

Choice, transparency, coordination, and quality among direct-to-consumer telemedicine websites and apps treating skin disease.

Resneck JS Jr, Abrouk M, Steuer M, et al. JAMA Dermatol. 2016;152:768-775.

Telemedicine is being more widely used in order to increase access to care. A relatively new aspect of telemedicine is direct-to-consumer telemedicine, including teledermatology. Using secret shoppers who submitted photographs and clinical information to teledermatology sites, this study found poor diagnostic accuracy and failure to elicit important information. Other studies have also raised concerns about the diagnostic accuracy of virtual clinical visits.

Journal Article > Study

Missing clinical and behavioral health data in a large electronic health record (EHR) system.

Madden JM, Lakoma MD, Rusinak D, Lu CY, Soumerai SB. J Am Med Inform Assoc. 2016;23:1143-1149.

Electronic health records (EHRs) were promoted as a patient safety improvement strategy, but their promise has not been fully realized. Comparing data from an EHR to information from insurance claims, this study found that EHRs inadequately capture mental health care, including inpatient and outpatient visits, medications, and specialty care. This information gap carries significant risk to patients and suggests a need for improved care integration and EHR interoperability.

Journal Article > Study

Variation in quality of urgent health care provided during commercial virtual visits.

Schoenfeld AJ, Davies JM, Marafino BJ, et al. JAMA Intern Med. 2016;176:635-642.

There seems to be an increasing patient demand for immediately accessible virtual medical visits via the Internet. Although provision of this service has proliferated, little is known about the quality of care delivered by these models. This audit study used trained standardized patients—"secret shoppers"— to present common acute illnesses to the eight most popular commercial virtual visit websites. Physicians correctly named diagnoses in 77% of the visits, but key management decisions complied with guidelines in only about half of cases. The quality of care provided varied widely across websites. Virtual visit physicians frequently prescribed antibiotics inappropriately, though this is also true in traditional clinic settings. Conversely, physicians generally did not order additional testing, even when it would be recommended by guidelines, such as in ankle pain cases with specific concerning signs. These findings call for further study to understand these emerging models of care delivery and specific opportunities to improve quality and safety in these settings.

Journal Article > Study

Analysis of prescribers' notes in electronic prescriptions in ambulatory practice.

  • Classic

Dhavle AA, Yang Y, Rupp MT, Singh H, Ward-Charlerie S, Ruiz J. JAMA Intern Med. 2016;176:463-470.

Many ambulatory practices have recently introduced electronic prescribing, which has the potential to improve medication safety. In this large cross-sectional study, researchers analyzed more than 26,000 electronic prescriptions that included free-text notes sent to community pharmacies. Two-thirds of free-text notes contained inappropriate content, despite the availability of a standard data field. Nearly 1 in 5 of these notes included conflicting administration instructions from the designated structured field, creating an important source of potential medication errors. In addition, approximately 5% of notes contained irrelevant information, which may distract or confuse pharmacy staff. The authors outline recommended solutions based on the information most commonly included in prescription free-text notes.

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