Thomas Reese

The Pharmacist and the EHR

The adoption of electronic health records (EHRs) across the United States has impacted the methods by which health care professionals care for their patients. It is not always recognized, however, that pharmacists also actively use advanced functionality within the EHR. As critical members of the health care team, pharmacists utilize many different features of the EHR. The literature focuses on 3 main roles: documentation, medication reconciliation, and patient evaluation and monitoring. As health information technology proliferates, it is imperative that pharmacists’ workflow and information needs are met within the EHR to optimize medication therapy quality, team communication, and patient outcomes.

Interactive Visual Displays for Interpreting the Results of Clinical Trials: Formative Evaluation With Case Vignettes

Background At the point of care, evidence from randomized controlled trials (RCTs) is underutilized in helping clinicians meet their information needs. Objective To design interactive visual displays to help clinicians interpret and compare the results of relevant RCTs for the management of a specific patient, and to conduct a formative evaluation with physicians comparing interactive visual versus narrative displays. Methods We followed a user-centered and iterative design process succeeded by development of information display prototypes as a Web-based application. We then used a within-subjects design with 20 participants (8 attendings and 12 residents) to evaluate the usability and problem-solving impact of the information displays. We compared subjects’ perceptions of the interactive visual displays versus narrative abstracts. Results The resulting interactive visual displays present RCT results side-by-side according to the Population, Intervention, Comparison, and Outcome (PICO) framework. Study participants completed 19 usability tasks in 3 to 11 seconds with a success rate of 78% to 100%. Participants favored the interactive visual displays over narrative abstracts according to perceived efficiency, effectiveness, effort, user experience and preference (all P values <.001). Conclusions When interpreting and applying RCT findings to case vignettes, physicians preferred interactive graphical and PICO-framework-based information displays that enable direct comparison of the results from multiple RCTs compared to the traditional narrative and study-centered format. Future studies should investigate the use of interactive visual displays to support clinical decision making in care settings and their effect on clinician and patient outcomes.

Clinical and Economic Outcomes of Ranolazine Versus Conventional Antianginals Users Among Veterans With Chronic Stable Angina Pectoris

Real-world outcomes in patients with chronic stable angina treated with ranolazine and other antianginal medications as second- or third-line therapy are limited. In a historical cohort study of veterans with chronic stable angina, we compared time with coronary revascularization procedures, hospitalizations, and 1-year healthcare costs between new-users of ranolazine versus conventional antianginals (i.e., calcium channel blockers, β blockers, or long-acting nitrates) as second- or third-line. Weighted regression models calculated adjusted hazard ratios (HR) at up to 8-year follow-up, and adjusted incremental costs in the first year. Weighted groups comprised 4,699 ranolazine users and 31,815 conventional antianginal users. Percutaneous coronary intervention (PCI) occurred more often in ranolazine users compared with conventional antianginal users (HR 1.16; 95% confidence intervals [CI] 1.08 to 1.25, p <0.001), and coronary artery bypass grafting occurred less often (HR 0.82; 95% CI 0.68 to 1.00, p <0.046). All-cause and atrial fibrillation (AF) hospitalizations were less common with ranolazine users compared with conventional users (all-cause: HR 0.94; 95% CI 0.90 to 0.99, p <0.010; AF:HR 0.74; 95% CI 0.67 to 0.82, p <0.001), and acute coronary syndrome was more common (HR 1.13; 95% CI 1.00 to 1.27, p <0.042). Adjusted 1-year costs were

Trend Displays to Support Critical Care: A Systematic Review

24,517 in ranolazine users and

1152: DISPLAY FEATURES THAT IMPROVE INTERPRETATION OF CRITICAL CARE INFORMATION

24,798 in conventional users (difference,

1148: GRAPHICAL DISPLAY OF PATIENT INFORMATION IMPROVES OUTCOMES IN CRITICAL CARE

-280; 95% CI

Patient information organization in the intensive care setting: expert knowledge elicitation with card sorting methods

-1,742 to

The Impact of Healthcare-Associated Methicillin-Resistant Staphylococcus aureus Infections on Postdischarge Health Care Costs and Utilization across Multiple Health Care Systems

1,181, p = 0.71). In conclusion, ranolazine users had lower rates of coronary artery bypass grafting and all-cause and AF hospitalizations, but higher rates of percutaneous coronary intervention and hospitalizations due to acute coronary syndrome compared with conventional antianginal users. Healthcare costs were similar between ranolazine and conventional antianginal users.

Structured Information Displays for the Comparison of Clinical Trials

An important aspect of designing information displays to support monitoring and decision-making in critical care is the representation of change of patient data over time. We systematically reviewed articles to identify novel alternatives to tabular and single variable plots of values over time to convey information about change in multiple related variables. Following screening of 5,119 articles, 28 met our inclusion criteria. They described 26 unique displays evaluated in 31 experiments. Methods for representing change varied widely. We classified these methods as enhanced graphical displays (enhanced plots of quantitative data over time), other displays (novel object and metaphoric displays), small multiples displays (multiple co-presented small graphic displays), and simple change indicator displays. Overall, findings support the value of an explicit display of trend information using many different approaches. Few studies directly compared different methods for displaying trend information in ways that would support broader conclusions about which approaches may be preferred for specific applications. The studies suggest that, for displaying patient data trends, it is feasible to develop electronic displays that will outperform both historical paper-based flowcharts and current electronic health record (EHR)-based tabular approaches. There is evidence to suggest that even minor improvements to current approaches such as the automatic presentation of simple line plots of trends on EHRs or the addition of simple graphical indicators of trend direction on patient monitors could lead to clinically meaningful improvements in diagnostic accuracy and efficiency.