Search results for "Information Professionals"

The Patient Centered Medical Home (PCMH) concept reorganizes primary care services to ensure that team-based, coordinated, system-oriented, and accessible care is provided to patients in their homes. This Web site offers resources to support the application of systems principles in PCMHs and engage primary care clinicians, practices, and patients in achieving safety goals.

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.

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.

Adverse events after hospital discharge are common. Prior research demonstrates that communication and information transfer between inpatient providers and primary care physicians (PCPs) may be lacking, raising patient safety concerns. This study described how applying Lean methodology, enhancing frontline provider engagement, and redesigning workflow processes within the electronic health record led to improved communication with PCPs around the time of hospital discharge. Through these interventions, the pediatric medical service was able to increase verbal communication with PCPs at discharge to 80%, and they sustained this for a 7-month period. Discharge communication with PCPs across other services improved as well. A previous PSNet perspective discussed the challenges associated with care transitions and suggested opportunities for improvement.

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.

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.

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.

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.

Presenting to his new primary physician's office for his first visit, a man was checked in under the record of an existing patient with the exact same name and age. The mistake wasn't noticed until the established patient received the new patient's test results by email.

This retrospective study of abnormal laboratory test orders and results in primary care uncovered multiple vulnerabilities, similar to prior studies. The authors describe a conceptual model to comprehensively address the safety of laboratory testing and results management in primary care, a useful step for future interventions.

Prescribing errors are a serious source of patient harm in primary care. This cross-sectional study in the United Kingdom found wide variation in the prevalence of potentially hazardous prescribing ranging from nearly zero to 10%, and for inadequate medication monitoring ranging from 10% to 42% between practices.

This observational study of 11 community practices that had integrated behavioral health and primary care describes the challenges related to electronic health records that do not specifically support integrated care delivery functions. There were issues with documentation, tracking, communication, and coordination of care, requiring practices to develop workarounds such as double data entry, scanning and uploading documents, or using separate tracking systems.

Ineffective implementation of health information technology (IT) can result in workarounds and other workflow changes that disrupt care delivery. This report examines how health IT implementation can affect clinician and staff workload in the ambulatory care environment, including increase interruptions and multitasking, and recommends workload considerations to enable staff to adapt to changes in practice.

This cross-sectional study of patient records found that linked primary and secondary care data provides a more robust surveillance of medication safety. Older patients and those prescribed multiple medications were at highest risk for prescribing hazards.

In this Greek study, providing early support (consisting of possible diagnoses for clinicians to consider) to primary care physicians improved their diagnostic accuracy on computerized vignettes. This finding matches a previous study that used the same methodology for primary care physicians in the United Kingdom, suggesting the intervention may have broad applicability.

This survey-based study of primary care providers revealed a lack of standardization for the tracking, receiving, and reporting of laboratory results. Even practices with integrated electronic medical records reported the need for a back-up tracking system to ensure important test results are not lost.

This article describes an intervention that trained health coaches to use mobile technology to assess the health status of recently discharged Medicare patients, first during an in-home visit 48 hours after leaving the hospital and then with weekly phone calls over a 3-week period. The program resulted in decreased readmission rates and significant cost savings.

Most research on computerized provider order entry (CPOE) has focused on its role in preventing medication errors. This modeling study sought to determine the cost-effectiveness of CPOE in the ambulatory setting. The authors used prior data on changes in adverse drug event rates both before and after implementation of electronic prescribing to estimate the benefit of CPOE for outpatient medication safety. Exploring four simulations varying in practice sizes and characteristics, they found that CPOE was cost-effective and associated with fewer medication errors. These data support further implementation of electronic prescribing, despite concerns about introducing new errors with health information technology. A previous AHRQ WebM&M perspective discusses how to design safer CPOE systems.

Exploring the impact of electronic prescribing in ambulatory care, this review describes benefits such as decreased rates of medication errors, cost savings, and improved patient adherence. The author also identifies challenges to implementation, including concerns about cost, privacy, and poorly designed systems.

One major safety advantage of computerized provider order entry (CPOE) systems lies in their ability to prevent adverse drug events due to prescribing errors. In the outpatient setting, use of electronic prescriptions is growing thanks to studies demonstrating that e-prescribing reduces medication errors. However, as with CPOE in general, increasing use of e-prescribing is leading to greater recognition of new types of errors associated with this new technology. This study analyzed the frequency of unintended discrepancies in e-prescriptions from three primary care clinics by comparing the prescription information in the prescribing physician's note with the order entered into the e-prescribing system and the medication ultimately dispensed by the pharmacy. The investigators found that errors occurred at each stage of the process, with a small but significant rate of discrepancies between both physician notes and e-prescriptions and between e-prescriptions and the medication dispensed. These errors often occurred when providers entered free-text instructions into the e-prescribing system, as found in prior research. The potential safety benefits and hazards of e-prescribing are discussed in detail in an AHRQ WebM&M commentary.