Looking Behind the Curtain: Identifying Factors Contributing to Changes on Care Outcomes During a Large Commercial EHR Implementation.

Objective: To identify factors contributing to changes on quality, productivity, and safety outcomes during a large commercial electronic health record (EHR) implementation and to guide future research.

Methods: We conducted a mixed-methods study assessing the impact of a commercial EHR implementation. The method consisted of a quantitative longitudinal evaluation followed by qualitative semi-structured, in-depth interviews with clinical employees from the same implementation.

Comprehensive methodology to monitor longitudinal change patterns during EHR implementations: a case study at a large health care delivery network.

Objective: To test a systematic methodology to monitor longitudinal change patterns on quality, productivity, and safety outcomes during a large-scale commercial Electronic Health Record (EHR) implementation.

Materials And Methods: Our method combines an interrupted time-series design with control sites and 41 consensus outcomes including quality (11 measures), productivity (20 measures), and safety (10 measures). The intervention consisted of a phased commercial EHR implementation at a large health care delivery network.

Development and classification of a robust inventory of near real-time outcome measurements for assessing information technology interventions in health care.

Objective: To develop and classify an inventory of near real-time outcome measures for assessing information technology (IT) interventions in health care and assess their relevance as perceived by experts in the field.

Materials And Methods: To verify the robustness and coverage of a previously published inventory of measures and taxonomy, we conducted semi-structured interviews with clinical and administrative leaders from a large care delivery system to collect suggestions of outcome measures that can be calculated with data available in electronic format for near real-time monitoring of EHR implementations. We combined these measures with the most commonly reported in the literature.

Health information technology adoption: Understanding research protocols and outcome measurements for IT interventions in health care.

Objective: To classify and characterize the variables commonly used to measure the impact of Information Technology (IT) adoption in health care, as well as settings and IT interventions tested, and to guide future research.

Materials And Methods: We conducted a descriptive study screening a sample of 236 studies from a previous systematic review to identify outcome measures used and the availability of data to calculate these measures. We also developed a taxonomy of commonly used measures and explored setting characteristics and IT interventions.

Problem list completeness in electronic health records: A multi-site study and assessment of success factors.

Objective: To assess problem list completeness using an objective measure across a range of sites, and to identify success factors for problem list completeness.

Methods: We conducted a retrospective analysis of electronic health record data and interviews at ten healthcare organizations within the United States, United Kingdom, and Argentina who use a variety of electronic health record systems: four self-developed and six commercial. At each site, we assessed the proportion of patients who have diabetes recorded on their problem list out of all patients with a hemoglobin A1c elevation>=7.

Problem management module: an innovative system to improve problem list workflow.

Electronic problem lists are essential to modern health record systems, with a primary goal to serve as the repository of a patient's current health issues. Additionally, coded problems can be used to drive downstream activities such as decision support, evidence-based medicine, billing, and cohort generation for research. Meaningful Use also requires use of a coded problem list.

Impacts of EHR Certification and Meaningful Use Implementation on an Integrated Delivery Network.

Three years ago Intermountain Healthcare made the decision to participate in the Medicare and Medicaid Electronic Heath Record (EHR) Incentive Program which required that hospitals and providers use a certified EHR in a meaningful way. At that time, the barriers to enhance our home grown system, and change clinician workflows were numerous and large. This paper describes the time and effort required to enhance our legacy systems in order to pass certification, including filling 47 gaps in (EHR) functionality.

Progress and challenge in meeting meaningful use at an integrated delivery network.

Intermountain Healthcare hospitals and providers are eligible for approximately $95 million in incentives from the Health Information Technology for Economic and Clinical Health Act (HITECH), which requires that hospitals and providers use a certified electronic health record (EHR) in a meaningful way. This paper describes the our progress in readying legacy systems for certification, including measuring, and filling gaps in (EHR) functionality. Also addressed are some of the challenges and successes in meeting meaningful use.

Assessing readiness for meeting meaningful use: identifying electronic health record functionality and measuring levels of adoption.

With the passage, in 2009, of the Health Information Technology for Economic and Clinical Health Act (HITECH),part of the American Recovery and Reinvestment Act (ARRA), over 19 Billion dollars was targeted for healthcare information technology (HIT) projects to accelerate the adoption of electronic Health Records (EHR)s. Intermountain Healthcare facilities and providers are eligible for approximately $93 million in incentives from HITECH, if we use a "certified EHR" in a "meaningful way". This paper describes the current state of our EHR functions and EHR adoption compared to those required by the HITECH act.

The use of antenatal magnesium sulfate for neuroprotection for infants born prematurely.

Cerebral palsy occurs in three to four infants per 1000 live births. Preterm birth prior to 34 weeks' gestation is a major risk factor. Five randomized controlled trials of antenatal magnesium sulfate (MgSO(4)) found a trend of reduced risk of cerebral palsy and mortality in preterm infants.

Measuring use of electronic health record functionality using system audit information.

Meaningful and efficient methods for measuring Electronic Health Record (EHR) adoption and functional usage patterns have recently become important for hospitals, clinics, and health care networks in the United State due to recent government initiatives to increase EHR use. To date, surveys have been the method of choice to measure EHR adoption. This paper describes another method for measuring EHR adoption which capitalizes on audit logs, which are often common components of modern EHRs.

Cervicoisthmic cerclage: transabdominal vs transvaginal approach.

Objective: We sought to compare the outcomes of cervicoisthmic (CI) cerclage using traditional transabdominal (TA) approach vs the lesser used transvaginal (TV) approach.

Study Design: We conducted a retrospective cohort study of women who underwent placement of a CI cerclage.

Results: Before CI placement, the abdominal group had a total of 100 pregnancies that continued beyond the first trimester and had 27 (27%) surviving infants.

The role of antibiotics in the prevention of preterm birth.

THERE ARE MULTIPLE USES FOR ANTIBIOTICS DURING PREGNANCY: treatment of intercurrent bacterial infections such as urinary or respiratory tract infections, maternal treatment to prevent fetal or neonatal disease, prophylactic treatment for surgical procedures, and treatment of puerperal infections. This report will summarize the current recommendations for the use of antibiotics specifically to reduce the risk of preterm birth.

Physician use of outpatient electronic health records to improve care.

We applied a model of usage categories of electronic health records for outpatient physicians to a large population of physicians, using an established electronic health record. This model categorizes physician users according to how extensively they adopt the various capabilities of electronic health records. We identified representative indicators from usage statistics for outpatient physician use of the HELP-2 outpatient electronic medical record, in use at Intermountain Healthcare.

Use of ambulatory physician group clinical information by hospital-based users within an integrated delivery network.

At Intermountain Healthcare, as part of a broad information system transition plan, a proposal was made to replace the integrated ambulatory EHR, used by 550 physicians, with a new stand alone EHR. The notion leading to the proposal was that ambulatory data was infrequently accessed outside of the ambulatory setting. To test this notion, retrospective analysis was done to determine the number of ambulatory patient events accessed by hospital based users.

Physician use of electronic medical records: issues and successes with direct data entry and physician productivity.

At Intermountain Health Care, we evaluated whether physicians in an ambulatory setting will voluntarily choose to enter data directly into an electronic health record (EHR). In this paper we describe the benefits of an EHR, as they exist in the current IHC application and the ways in which we have sought to minimize obstacles to physician data entry. Currently, of 472 IHC employed physicians, 321 (68%) routinely enter some data directly into the EHR without coercion.

Building a comprehensive clinical information system from components. The approach at Intermountain Health Care.

Objectives: To discuss the advantages and disadvantages of an interfaced approach to clinical information systems architecture.

Methods: After many years of internally building almost all components of a hospital clinical information system (HELP) at Intermountain Health Care, we changed our architectural approach as we chose to encompass ambulatory as well as acute care. We now seek to interface applications from a variety of sources (including some that we build ourselves) to a clinical data repository that contains a longitudinal electronic patient record.

Using natural language processing to analyze physician modifications to data entry templates.

Efficient data entry by clinicians remains a significant challenge for electronic medical records. Current approaches have largely focused on either structured data entry, which can be limiting in expressive power, or free-text entry, which restricts the use of the data for automated decision support. Text-based templates are a semi-structured data entry method that has been used to assist physicians in manually entering clinical notes, by allowing them to edit predefined example notes.

Does epidural analgesia cause dystocia?

Study Objective: To analyze the effects of epidural analgesia for labor when dystocia occurs.

Design: Retrospective cohort study.

Setting: Academic health center.

Relationship between pregnancy-induced hypertension and placenta previa: a population-based study.

Objective: Our purpose was to investigate, in a large population-based cohort, the hypothesis that the risk of pregnancy-induced hypertension is lower among pregnancies complicated by placenta previa compared with pregnancies occurring in women with fundally implanted placentas.

Study Design: Data for this retrospective cohort study were derived from the computerized Atlee perinatal database of the Reproductive Care Program, Nova Scotia, Canada. Women who were delivered in the province between 1980 and 1993 were included in the study.