How is the electronic health record being used? Use of EHR data to assess physician-level variability in technology use

Background

Studies of the effects of electronic health records (EHRs) have had mixed findings, which may be attributable to unmeasured confounders such as individual variability in use of EHR features.

Objective

To capture physician-level variations in use of EHR features, associations with other predictors, and usage intensity over time.

Methods

Retrospective cohort study of primary care providers eligible for meaningful use at a network of federally qualified health centers, using commercial EHR data from January 2010 through June 2013, a period during which the organization was preparing for and in the early stages of meaningful use.

Results

Data were analyzed for 112 physicians and nurse practitioners, consisting of 430 803 encounters with 99 649 patients. EHR usage metrics were developed to capture how providers accessed and added to patient data (eg, problem list updates), used clinical decision support (eg, responses to alerts), communicated (eg, printing after-visit summaries), and used panel management options (eg, viewed panel reports). Provider-level variability was high: for example, the annual average proportion of encounters with problem lists updated ranged from 5% to 60% per provider. Some metrics were associated with provider, patient, or encounter characteristics. For example, problem list updates were more likely for new patients than established ones, and alert acceptance was negatively correlated with alert frequency.

Conclusions

Providers using the same EHR developed personalized patterns of use of EHR features. We conclude that physician-level usage of EHR features may be a valuable additional predictor in research on the effects of EHRs on healthcare quality and costs.     

Are physicians' perceptions of healthcare quality and practice satisfaction affected by errors associated with electronic health record use?

Background

Electronic health record (EHR) adoption is a national priority in the USA, and well-designed EHRs have the potential to improve quality and safety. However, physicians are reluctant to implement EHRs due to financial constraints, usability concerns, and apprehension about unintended consequences, including the introduction of medical errors related to EHR use. The goal of this study was to characterize and describe physicians'' attitudes towards three consequences of EHR implementation: (1) the potential for EHRs to introduce new errors; (2) improvements in healthcare quality; and (3) changes in overall physician satisfaction.

Methods

Using data from a 2007 statewide survey of Massachusetts physicians, we conducted multivariate regression analysis to examine relationships between practice characteristics, perceptions of EHR-related errors, perceptions of healthcare quality, and overall physician satisfaction.

Results

30% of physicians agreed that EHRs create new opportunities for error, but only 2% believed their EHR has created more errors than it prevented. With respect to perceptions of quality, there was no significant association between perceptions of EHR-associated errors and perceptions of EHR-associated changes in healthcare quality. Finally, physicians who believed that EHRs created new opportunities for error were less likely be satisfied with their practice situation (adjusted OR 0.49, p=0.001).

Conclusions

Almost one third of physicians perceived that EHRs create new opportunities for error. This perception was associated with lower levels of physician satisfaction.     

Preference of physicians’ gender among male and female primary health care clinic attendees in a university hospital in Saudi Arabia

Objectives:

To assess gender preference concerning different healthcare specialties, and investigate reasons behind gender preferences among male and female attendees at the primary healthcare (PHC), King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia.

Methods:

In this cross-sectional study, a sample of 150 males and 150 females, 18 years and above were randomly selected. The 2 proportion sample size equation was used to estimate the suitable sample size for our study. An Arabic translated specially-designed, self-administered questionnaire were distributed at the waiting area of the PHC. It covered personal data, preference of physicians’ gender for 24 different specialties, reasons behind choosing a specific gender, and physicians’ characteristics, if gender does not matter to them. A previous pilot study was carried out to assess reliability of the questionnaire.

Results:

The results are statistically significant for most of the specialties (p=0.001). Male physicians were preferred by both genders for surgical specialties (such as, 50% of males and 39% of females in General Surgery), as people believe they are more knowledgeable. For medicine, women preferred to be examined by the same gender (54% in Internal Medicine), whereas men mostly had no gender preference (55% in Internal Medicine). When it comes to obstetric and gynecologic care, both genders (67% males and 85% females) preferred a female physician, stating embarrassment as the main reason for the choice.

Conclusion:

Attendees appeared to have gender preference regarding their physician in some specialties. However, the most in demand physician’s character is the years of experience. Results of this study may influence future physicians in choosing their specialty. We recommend collecting the overall population preference, and broaden the scope of the search, as this may reveal interestingly results.     

General practitioners’ challenges and strategies in dealing with Internet-related health anxieties—results of a qualitative study among primary care physicians in Germany

Wiener Medizinische Wochenschrift - Time and again, it is discussed that in medical practices, the number of patients who develop health anxieties due to extensive health information searches on...     

Blue Button use by patients to access and share health record information using the Department of Veterans Affairs’ online patient portal

Objective

The Blue Button feature of online patient portals promotes patient engagement by allowing patients to easily download their personal health information. This study examines the adoption and use of the Blue Button feature in the Department of Veterans Affairs’ (VA) personal health record portal, My HealtheVet.

Materials and methods

An online survey presented to a 4% random sample of My HealtheVet users between March and May 2012. Questions were designed to determine characteristics associated with Blue Button use, perceived value of use, and how Veterans with non-VA providers use the Blue Button to share information with their non-VA providers.

Results

Of the survey participants (N=18 398), 33% were current Blue Button users. The most highly endorsed benefit was that it helped patients understand their health history better because all the information was in one place (73%). Twenty-one percent of Blue Button users with a non-VA provider shared their VA health information, and 87% reported that the non-VA provider found the information somewhat or very helpful. Veterans’ self-rated computer ability was the strongest factor contributing to both Blue Button use and to sharing information with non-VA providers. When comparing Blue Button users and non-users, barriers to adoption were low awareness of the feature and difficulty using the Blue Button.

Conclusions

This study contributes to the understanding of early Blue Button adoption and use of this feature for patient-initiated sharing of health information. Educational efforts are needed to raise awareness of the Blue Button and to address usability issues that hinder adoption.     

Research and applications: Primary care practitioners’ views on test result management in EHR-enabled health systems: a national survey

Context

Failure to notify patients of test results is common even when electronic health records (EHRs) are used to report results to practitioners. We sought to understand the broad range of social and technical factors that affect test result management in an integrated EHR-based health system.

Methods

Between June and November 2010, we conducted a cross-sectional, web-based survey of all primary care practitioners (PCPs) within the Department of Veterans Affairs nationwide. Survey development was guided by a socio-technical model describing multiple inter-related dimensions of EHR use.

Findings

Of 5001 PCPs invited, 2590 (51.8%) responded. 55.5% believed that the EHRs did not have convenient features for notifying patients of test results. Over a third (37.9%) reported having staff support needed for notifying patients of test results. Many relied on the patient''s next visit to notify them for normal (46.1%) and abnormal results (20.1%). Only 45.7% reported receiving adequate training on using the EHR notification system and 35.1% reported having an assigned contact for technical assistance with the EHR; most received help from colleagues (60.4%). A majority (85.6%) stayed after hours or came in on weekends to address notifications; less than a third reported receiving protected time (30.1%). PCPs strongly endorsed several new features to improve test result management, including better tracking and visualization of result notifications.

Conclusions

Despite an advanced EHR, both social and technical challenges exist in ensuring notification of test results to practitioners and patients. Current EHR technology requires significant improvement in order to avoid similar challenges elsewhere.     

Transmission and postexposure management of bloodborne virus infections in the health care setting: Where are we now?

THERE HAS BEEN CONSIDERABLE DEBATE ABOUT THE NEED for mandatory serologic testing of individuals who are the source of bloodborne pathogen exposures in health care and other occupational settings. The transmission of hepatitis B (HBV), hepatitis C (HCV) and HIV between patients and health care workers (HCWs) is related to the frequency of exposures capable of allowing transmission, the prevalence of disease in the source populations, the risk of transmission given exposure to an infected source and the effectiveness of postexposure management. Transmission of HBV from patients to HCWs has been substantially reduced by vaccination and universal precautions. The transmission of HCV and HIV to HCWs does occur, although postexposure prophylaxis (PEP) is available to reduce the risk of HIV transmission. Transmission of bloodborne pathogens from infected HCWs to patients has also been documented. Policy-making concerning the mandatory postexposure testing of patients who may be the source of infection must weigh the relative infrequency of patients' refusals to be tested and the consequences for PEP recommendations with the ethical and legal considerations of bypassing informed consent and mandating testing. Mandatory postexposure testing of HCWs who are the source of infection will have a limited impact on reducing transmission because of the lack of recognition and reporting of exposures. Comprehensive approaches have been recommended to reduce the risk of transmission of bloodborne virus infections.     

E-Licensing of Radiation Applications (eLORA) in Armed Forces Hospitals: ‘Nuts and Bolts’

As per current statutory requirement, licence for operation of all medical radiation facilities (diagnostic radiology/radiotherapy/nuclear medicine) in India has to be obtained using the e-Licensing of Radiation Applications (acronym as ‘eLORA’) platform which is a web-based application on Atomic Energy Regulatory Board (AERB) website. This article is envisaged as a procedural guide for all medical administrators and radiologists in service institutions processing eLORA. Specific focus has been placed on practical methods to deal with inherent procedural hurdles unique to armed forces institutions, based on first-hand experience gained in successful eLORA processing at a tertiary care hospital.     

‘I mean I expect that it’s pretty safe’: Perceptions of food trust in pregnancy – implications for primary health care practice

Background

Pregnancy is a time in which food choice is of particular importance. Trust in the food supply and those who regulate it is receiving greater acknowledgement because of the influence of trust on food choice. No prior investigation into pregnant women and food trust has been conducted.

Aims

This paper identifies factors that determine the nature and extent of pregnant women’s trust in food; sources of information which influence pregnant women’s food choices; and how trust impacts on pregnant women’s food choices.

Method

In-depth interviews were conducted with 13 pregnant women; nine were pregnant with their first child and four were in their second or subsequent pregnancy.

Results

Food choices of pregnant women were predominantly influenced by nutrition and perceived quality of food. Risktaking behaviour, such as the consumption of foods considered high risk during pregnancy, was common amongst participants. The sample was characterised by a dependence on expert information, limited reflexivity in relation to food safety, and contradictory practice such as risk-taking behaviours in regard to high risk foods were observed.

Conclusion

Further research is needed to confirm findings in this study. Research into consumption of high-risk foods and the information received from healthcare providers would be useful in creating a clearer understanding of whether provision of information is sufficient in communicating risks and promoting a healthy pregnancy.     

Discovery of fifth serotype of dengue virus (DENV-5): A new public health dilemma in dengue?control

Dengue fever is a re-emerging public health problem with two-fifths of the world population being at risk of infection. Till now, dengue fever was believed to be caused by four different serotypes. The fifth variant DENV-5 has been isolated in October 2013. This serotype follows the sylvatic cycle unlike the other four serotypes which follow the human cycle. The likely cause of emergence of the new serotype could be genetic recombination, natural selection and genetic bottlenecks. There is no indication of the presence of DENV-5 in India. Recent clinical trials with the promising Chimerivax tetravalent vaccine suffered a setback. Discovery of DENV-5 and more such sylvatic strains in future may further impede the Dengue Vaccine Initiative. Integrated Vector Management holds the key to sustainable dengue control. Further epidemiological and ecological studies are needed to detect additional sylvatic dengue strains.     

HSP_(60), HSP_(70) in the Pathogenesis of Kawasaki Disease:Implication and Action

ThepathogenesisofKawasakidisease(KD)hasnotbeenfullyclarified.Itsclinicalmanifestationsandepidemicfeaturessuggestthatitmaybeassociatedwithinfectionbutsuchhypothesishasnotbeensupportedbylaboratoryorexperimentalevidences.Atpresent,thediagnosisofthediseaseismainlybasedonsymptomsandphysicalsigns.Theaimofthestudyistoexploretheroleofheatshockprotein--60(HSP,,),HSP,,inthepathogenesisofKD.1MATERIALSANDMETHODS1'1ExperimentalGroups1.1.1KDGroupKDgroupconsistedof14cases,amongthem12weremalesa…     

Bioequiwalence of clavulanate Potassium and Amoxicillin(1:7) dispersible tablets in healthy volunteers

Clavulanate Potassium( CL S) and Amoxicillin( AMC) ( 1 :7) dispersible tablets,twice daily,isindicated for short term treatment of bacterial in-fections at several sites when amoxicillin resistantβ— lactamase producing strainsare suspected as thecause.Resistance to many antibiotics is caused bybacterial enzymes which destroy the antibiotic be-fore it can act on the pathogen.The ClavulanatePotassium in the compound can circumventthis de-fense mechanism by blocking theβ- lactamase en-zyme…     

Fuzheng Huayu Capsule (扶正化瘀胶囊) in the treatment of liver fibrosis: Clinical evidence and mechanism of action

Liverfibrosisrepresentsthewoundhealingresponsetoliverinjuryfromawidevarietyofetiologies.Remarkableprogresseshavebeenshowninthefieldofliverfibrosisinarangeofareasinthepastyears.Inparticular,thereversibilityofliverfibrosishasbeenwelldocumentedinbothpatientsandanimalmodels.GreatprogresseshavebeenmadeinthetreatmentofliverfibrosiswithChinesemedicine.ThisreviewsummarizestheeffectsofFuzhengHuayuCapsule(扶正化瘀胶囊,FZHYC)intreatingliverfibrosisandinflammationinducedbychronichepatitisBinclinicaltrialsandthemechanismofactionofFZHYCinreversingliverfibrosisinvivoandinvitroexperiments.     

Levels of osteoprotegerin (OPG) and receptor activator for nuclear factor kappa B ligand (RANKL) in serum: Are they of any help?

Wiener Medizinische Wochenschrift - The coupling of bone formation and resorption is mediated through the OPG/RANK/RANKL system. OPG and RANKL are mainly produced by osteoblasts but also a variety...     

Kuanxiong Aerosol(宽胸气雾剂)in Treatment of Angina Pectoris:A Literature Review and Network Pharmacology

Angina pectoris (AP) is the most common symptom of cardiovascular diseases, which seriously affects the quality of life in cardiovascular patients. Kuanxiong (KX) Aerosol (宽胸气雾剂), a compound preparation that consists of 5 traditional Chinese medicines: Herba Asari, Rhizoma Alpiniae Officinarum, Lignum Santali Albi, Fructus Piperis Longi, and Borneolum, has been used in the treatment of AP for many years, exhibiting a significant curative effect and less side-effect. For the convenience and comprehensive understanding of KX Aerosol, this review systematically summarizes evidence on KX Aerosol in the treatment of AP including the pharmacological effects of its composition, clinical research, animal experiments, and network pharmacology prediction. Meanwhile, we highlight the research limitation of KX Aerosol at present. This review may guide the clinical application of KX Aerosol and further provide a reference for the research of AP.     

Effect of San’ao Decoction (三拗汤) on the airway inflammation and hyperresponsiveness in a murine model of lipopolysaccharide-enhanced asthma

Objective  

San’ao Decoction (三拗汤, SAD), as a representative Chinese medicine (CM) formula, was chosen to evaluate the effect of airway inflammation and hyperresponsiveness on the lipopolysaccharide (LPS) enhanced asthma model.