Alice M. Noblin

EHR Implementation in a New Clinic: A Case Study of Clinician Perceptions

Driven by the Health Information Technology for Economic and Clinical Health (HITECH) Act large numbers of physicians and hospitals are now implementing electronic health records (EHR) with the general expectation that such systems will improve the quality, safety and efficiency of health care services. Studies of conversions from paper to electronic records paint a mixed picture with healthcare providers pleased with some aspects of their EHRs but dissatisfied with others. These prior studies focused on conversions from paper to electronic records. Many provider impressions, therefore, may have been influenced by reactions to the process of being required to change well established patterns. In order to help separate such reactions from true evaluations of the efficacy of the EHR, we decided to survey the providers in a new health center. To insure that the information gathered was not merely anecdotal, we used a well-established format starting with a semi-structured interview which facilitates analysis and recognition of major themes. We included questions around several important areas including workflow, communication, patient satisfaction, productivity, documentation, and quality of care. Ten main themes emerged: impeding patient flow, hindering communication in office, improving communication after the visit, improving tracking of patient care, spending less time with patients, requiring more training, wanting more features, diminishing productivity, appreciating benefits of templates, and enhancing internal communication. The need for better training appeared to be of especially high importance as it impacted several of the other themes. We believe that our study helps validate the similar concerns expressed in studies of transitions from paper to electronic record systems. Our method may be generally useful to other clinics because it facilitates timely recognition of themes, both positive and negative, that clinicians and clinic managers would want to know at an early stage. Prompt knowledge of such developing themes may help to accentuate the positive aspects of the EHR and to prevent negative themes from developing into serious problems that might be considered serious unintended consequences of EHR usage.

Use of electronic health record documentation by healthcare workers in an acute care hospital system.

EXECUTIVE SUMMARY Acute care clinicians spend significant time documenting patient care information in electronic health records (EHRs). The documentation is required for many reasons, the most important being to ensure continuity of care. This study examined what information is used by clinicians, how this information is used for patient care, and the amount of time clinicians perceive they review and document information in the EHR. A survey administered at a large, multisite healthcare system was used to gather this information. Findings show that diagnostic results and physician documents are viewed more often than documentation by nurses and ancillary caregivers. Most clinicians use the information in the EHR to understand the patients overall condition, make clinical decisions, and communicate with other caregivers. The majority of respondents reported they spend 1 to 2 hours per day reviewing information and 2 to 4 hours documenting in the EHR. Bedside nurses spend 4 hours per day documenting, with much of this time spent completing detailed forms seldom viewed by others. Various flow sheets and forms within the EHR are rarely viewed. Organizations should provide ongoing education and awareness training for hospital clinical staff on available forms and best practices for effective and efficient documentation. New forms and input fields should be added sparingly and in collaboration with informatics staff and clinical team members to determine the most useful information when developing documentation systems.

Intention to use a personal health record: a theoretical analysis using the technology acceptance model

Physicians who have an electronic health record in their office may have the option to provide their patients with a personal health record. Research was undertaken to determine if a patient population would indeed use a personal health record if the physician(s) made it available in the future. The technology acceptance model was used to evaluate both perceived usefulness and perceived ease of use (technology barriers). Although the perceived usefulness of a personal health record was a significant determining factor related to intention to adopt, technology barriers were indirectly related to intention to adopt as well. Technology barriers can be addressed by providing office staff for hands-on training as well as assistance with interpretation of medical information. Longitudinal research is needed to determine if the technology barriers decline over time and usefulness of the information promotes increased demand.

Privacy policy analysis for health information networks and regional health information organizations.

Regional Health Information Organizations (RHIOs) are forming in response to President George W. Bushs 2004 mandate that medical information be made available electronically to facilitate continuity of care. Privacy concerns are a deterrent to widespread acceptance of RHIOs. The Health Information Portability and Accountability Act of 1996 provides some guidelines for privacy protection. However, most states have stricter guidelines, causing difficulty when RHIOs form across these jurisdictions. This article compares several RHIOs including their privacy policies where available. In addition, studies were reviewed considering privacy concerns of people in the United States and elsewhere. Surveys reveal that Americans are concerned about the privacy of their personal health information and ultimately feel it is the role of the government to provide protection. The purpose of this article is to look at the privacy issues and recommend a policy that may help to resolve some of the concerns of both providers and patients. Policy research and action are needed to move the National Health Information Network toward reality. Efforts to provide consistency in privacy laws are a necessary early step to facilitate the construction and maintenance of RHIOs and the National Health Information Network.

Utilizing Telemedicine Techniques to Confront Rural Mental Health Care Challenges: The Progression Towards a Technological Health Ecosystem

Due to the unique population characteristics of Rural America, the diagnosis and treatment of medical conditions is a challenge. This is especially true when specialists are needed, in particular for mental health care including psychiatry. Provision of care often falls to primary care providers, who may fail to recognize symptoms or misdiagnose a condition. In addition, a stigma is often attached to mental health issues and precludes many people from seeking treatment, particularly due to embarrassment and perceived confidentiality issues. This paper will describe the rural population and mental health issues faced by patients and providers. Challenges will be explored from a systems theory viewpoint, as well as from community development perspectives. Solutions will be offered ranging from the broad theoretical perspective including policy options, and specific solutions for practitioners in various settings. Of particular focus is telemedicine in the form of telepsychiatry. This option is mentioned throughout this paper in terms of current usage in specific settings as well as provider and patient acceptance of the technology.

The use of governance tools in promotion of health care information technology adoption by physicians.

Electronic health records are important technology for health care with promises of streamlining and improving care. However, physicians have been slow to adopt the technology usually because of financial constraints. Third-party payers, including Medicare and Medicaid, are coming forward with solutions and funding. While payers have the most to gain in terms of cost savings, they have been slow to provide a solution to the financial dilemmas posed by the new technology. This article details some governance tools that are frequently used to alleviate the financial concerns. Grants, loans, and tax expenditures are some of the options available to physicians to purchase electronic health records and other types of health care information technology.

Electronic health record project initiation and early planning in a community health center.

Community health centers exist to help their constituents become proactive in addressing their own health care needs and to improve the overall well-being of the community. However, they pose a different set of challenges when implementing an electronic health record system. This article applies 2 project management principles, initiation and early planning, to the electronic health record implementation in a community health center. Issues such as planning, financial considerations, and quality improvement are discussed.

Exploring physical therapists' perceptions of mobile application usage utilizing the FITT framework.

ABSTRACT Primary Objective: The use of mobile apps in clinical settings is becoming a widely accepted tool for many healthcare professionals. Physical therapists (PTs) have been underresearched in this area, leaving little information regarding the challenges in using mobile apps in the PT environment. The FITT framework provides a theoretical underpinning for this investigation. Research Design and Methods: A survey was developed based on the FITT framework and research questions. Licensed PTs in attendance at the FPTA conference were asked to complete the survey. A descriptive analysis was conducted for the study and demographic variables. A factor analysis was performed to determine the appropriateness of the FITT framework. Main Outcome and Results: The individual-technology dimension showed the best fit to the framework, with the weakest fit being the individual-task dimension. The majority of PTs surveyed do not currently use apps in their professional practice nor do they feel that their organizational leadership endorses app usage. Conclusions: The integration of mobile apps into physical therapy practice can improve the standard of care. Additional apps and marketing of these apps could elevate use of this technology. However, leadership support with the necessary resources for app usage will be key to improved overall FITT.

Impact of Health Literacy on Senior Citizen Engagement in Health Care IT Usage

Objective: Patient engagement in health care information technology (IT) is required for government reimbursement programs. This research surveyed one older adult group to determine their willingness to use health information from a variety of sources. Health literacy was also measured using the Newest Vital Sign (NVS) and eHealth Literacy Scale (eHEALS) tools. Method: Regression models determined engagement in health care IT usage and impact of literacy levels based on survey data collected from the group. Results: Although most participants have adequate literacy, they are not more likely to use health care IT than those with limited literacy scores. Knowledge of how to use the Internet to answer questions about health was statistically associated with IT usage. Discussion: Health care IT usage is important for healthy aging. The ability of older adults to understand information provided to them can impact population health including medication usage and other important factors.

Adverse Events Among Patients With Diabetes and Ambulatory Practice Characteristics: Evidence From a Nationally Representative Survey

Medications are the most common treatment modality for diabetes; however, medications may lead to inadvertent injury. Reducing adverse events in patients with diabetes is an important health care goal. Using pooled data from the 2011-2013 National Ambulatory Medical Care Survey, this cross-sectional, observational study explored univariate associations between patient safety for patients with diabetes as measured by adverse events and practice characteristics, including health information technology capabilities. This study found that the overall rate of adverse events among adults with diabetes is 7%, inclusive of injury, poisoning, or adverse effect of medical/surgical care or medicinal drug. We find evidence that e-prescribing, seeing a primary care provider, and being an established patient are associated with less adverse events.