Recent articles from PubMed about the EHR

Are there patient disparities when electronic health records are adopted?

J Health Care Poor Underserved. 2009 May;20(2):473-88

Using nationally representative samples of visits from the 2005-2006 National Ambulatory Medical Care Surveys and the National Hospital Ambulatory Medical Care Surveys (N=39,343), this study examines whether electronic health record (EHR) systems have been adopted by primary care physicians or providers (PCPs) for poor minority patients at the same rate as by the PCPs for wealthier non-minority patients. Although we found that electronic health record adoption rates varied primarily by type of practice of the PCP, we also found that uninsured Black and Hispanic or Latino patients, as well as Hispanic or Latino Medicaid patients were less likely to have PCPs using EHRs, compared with privately-insured White patients, after controlling for PCPs' practice type and location, as well as patient characteristics. This finding reflects a mixture of high and low EHR adopters among PCPs for poor minority patients.
PMID: 19395843 [PubMed - in process]

Evaluation of a Physician Informatics Tool to Improve Patient Handoffs.

J Am Med Inform Assoc. 2009 Apr 23;
Authors: Flanagan ME, Patterson ES, Frankel RM, Doebbeling BN

OBJECTIVE To facilitate patient handoffs between physicians, the computerized Patient Handoff Tool (PHT) extracts information from the electronic health record to populate a form that is printed and given to the cross-cover physician. OBJECTIVES were to: 1) evaluate the rate at which data elements of interest were extracted from the electronic health record into the PHT, 2) assess the frequency for needing information beyond that contained in the PHT and where obtained, 3) assess physician's perceptions of the PHT, 4) identify opportunities for improvement. DESIGN Observational study. MEASUREMENTS This multimethod study included content coding of PHT forms, end of shift surveys of cross-cover resident physicians, and semi-structured interviews to identify opportunities for improvement. Thirty-five of 42 internal medicine resident physicians participated. Measures included: 1264 PHT forms coded for type of information, 63 end-of-shift surveys of cross-cover residents (residents could participate 2 times), and 18 semi-structured interviews. RESULTS For objective 1, patient identifiers and medications were reliably extracted (>98%). Other types of information--allergies and code status--were more variable (<50%).>The Relationship between Electronic Health Record Use and Quality of Care over Time.

J Am Med Inform Assoc. 2009 Apr 23;
Authors: Zhou L, Soran CS, Jenter CA, Volk LA, Orav EJ, Bates DW, Simon SR

OBJECTIVE Electronic health records (EHRs) have the potential to advance the quality of care, but recent studies have shown mixed results. We undertook the present study to examine the extent of EHR usage and how the quality of care delivered in ambulatory care practices varied according to duration of EHR availability. METHODS We linked two data sources: a statewide survey of physicians' adoption and use of EHR and claims data reflecting quality of care as indicated by physicians' performance on widely used quality measures. Using four years of measurement, we combined 18 quality measures into 6 clinical condition categories. While the survey of physicians was cross-sectional, respondents indicated the year in which they adopted EHR. In an analysis accounting for duration of EHR use, we examined the relationship between EHR adoption and quality of care. RESULTS The percent of physicians reporting adoption of EHR and availability of EHR core functions more than doubled between 2000 and 2005. Among EHR users in 2005, the average duration of EHR use was 4.8 years. For all 6 clinical conditions, there was no difference in performance between EHR users and non-users. In addition, for these 6 clinical conditions, there was no consistent pattern between length of time using an EHR and physicians' performance on quality measures in both bivariate and multivariate analyses. CONCLUSION In this cross-sectional study, we found no association between duration of using an EHR and performance with respect to quality of care, although power was limited. Intensifying the use of key EHR features, such as clinical decision support, may be needed to realize quality improvement from EHRs. Future studies should examine the relationship between the extent to which physicians use key EHR functions and their performance on quality measures over time.
PMID: 19390094 [PubMed - as supplied by publisher]

Financial performance of primary care physician practices prior to electronic health record implementation.

Proc (Bayl Univ Med Cent). 2009 Apr;22(2):112-8
Authors: Fleming NS, Becker ER, Culler S, Cheng D, McCorkle R, Ballard DJ

While electronic health records (EHRs) are being widely implemented across the nation, few empirical data are currently available regarding their potential impact on financial performance and resource use. HealthTexas Provider Network is implementing a networkwide EHR, providing a unique opportunity to describe and evaluate fiscal effects. We conducted a retrospective, longitudinal observational study of financial performance related to inputs and income- and productivity-related outputs for the 33 primary care practices (July 2002-April 2006). Models for each outcome were constructed to test for a linear trend over time, adjusted for practice characteristics. F tests based on these models were used to determine the effect of each adjustor and to determine existence of a trend in each outcome. The observed staff per physician full-time equivalent (FTE) (3.6) was similar to staffing ratios reported for other primary care-only practices, while observation of 4692 work relative value units per physician FTE annually was higher than reported nationally. Significant monthly trends were identified for three of the outcome measures. During the pre-EHR baseline period, staffing ratios were equivalent to and physician productivity greater than reports available for these measures nationally or in other settings. Identification of time trends in three measures will allow these to be accounted for in the model used to evaluate the financial performance impact of EHR implementation.
PMID: 19381309 [PubMed - in process]

Managing terminology assets in electronic health records.

Stud Health Technol Inform. 2009;143:507-12
Authors: Abrams K, Schneider S, Scichilone R

Electronic Health Record (EHR)systems rely on standard terminologies and classification systems that require both Information Technology (IT) and Information Management (IM) skills. Convergence of perspectives is necessary for effective terminology asset management including evaluation for use, maintenance and intersection with software applications. Multiple terminologies are necessary for patient care communication and data capture within EHRs and other information management tasks. Terminology asset management encompasses workflow and operational context as well as IT specifications and software application run time requirements. This paper identifies the tasks, skills and collaboration of IM and IT approaches for terminology asset management.
PMID: 19380984 [PubMed - in process]

Strategies to Increase Familiarization and Acceptance of Electronic Health Records among Health Professionals and Consumers.

Stud Health Technol Inform. 2009;143:419-25
Authors: Burdyny C, Findlater S, Caron MP, Ajaz M

There are many reasons an organization may choose to implement electronic health records. The challenge is to acknowledge the benefits and deficiencies of the electronic health record, to understand the driving forces for implementation and the barriers to it, and to effect change in the workplace and consumer behaviour. Indeed, one challenge is the determination of the organizational stance with regard to these factors. If all of these factors are seriously considered and the risks to implementation measured, a successful implementation should ensue.
PMID: 19380971 [PubMed - in process]