EHR Conversion on the PreOp Care: A Pre-Post Workflow Comparison.

The impact of EHRs conversion on clinicians' daily work is crucial to evaluate the success of the intervention for Hospitals and to yield valuable insights into quality improvement. To assess the impact of different EHR systems on the preoperative nursing workflow, we used a structured framework combining quantitative time and motion study and qualitative cognitive analysis to characterize, visualize and explain the differences before and after an EHR conversion. The results showed that the EHR conversion brought a significant decrease in the patient case time and a reduced percentage of time using EHR.

In Search of Vital Signs: A Comparative Study of EHR Documentation.

Vital sign documentation is an essential part of perioperative workflow. Health information technology can introduce complexity into all facets of documentation and burden clinicians with high cognitive load. The Mayo Clinic enterprise is in the process of documenting current EHR-mediated workflow prior to a system-wide EHR conversion.

Multi-Method Study of Electronic Health Records Workflows.

EHRs transform work practices in ways that enhance or impede the quality of care. There is a need for in-depth analysis of EHR workflows, particularly in complex clinical environments. We investigated EHR-basedpre-operative workflows by combining findings from 18 interviews, 7 days of observations, and process mining of EHR interactions from 31 personnel caring for 375 patients at one tertiary referral center.

Evidence-based Health Informatics Frameworks for Applied Use.

Health Informatics frameworks have been created surrounding the implementation, optimization, adoption, use and evaluation of health information technology including electronic health record systems and medical devices. In this contribution, established health informatics frameworks are presented. Important considerations for each framework are its purpose, component parts, rigor of development, the level of testing and validation its undergone, and its limitations.

Patients' Experiences Using a Brief Screening Tool for Medication-Related Problems in a Community Pharmacy Setting.

Objectives: The objective of this study was to explore patient perceptions and the practical implication of using a brief 9-item scale to screen for medication-related problems in community pharmacies.

Methods: Semistructured, audio-recorded, telephonic interviews were conducted with 40 patients who completed the scale and reviewed its results with their pharmacist. Audio recordings were transcribed verbatim and analyzed using qualitative methods to identify themes.

A Multidimensional Data Warehouse for Community Health Centers.

Community health centers (CHCs) play a pivotal role in healthcare delivery to vulnerable populations, but have not yet benefited from a data warehouse that can support improvements in clinical and financial outcomes across the practice. We have developed a multidimensional clinic data warehouse (CDW) by working with 7 CHCs across the state of Indiana and integrating their operational, financial and electronic patient records to support ongoing delivery of care. We describe in detail the rationale for the project, the data architecture employed, the content of the data warehouse, along with a description of the challenges experienced and strategies used in the development of this repository that may help other researchers, managers and leaders in health informatics.

Utility of a brief screening tool for medication-related problems.

Background: Medication therapy management (MTM) services position pharmacists to prevent, detect, and resolve medication-related problems (MRPs.) However, selecting patients for MTM who are most at risk for MRPs is a challenge. Using self-administered scales that are practical for use in clinical practice are one approach.

Patient-centered appointment scheduling using agent-based simulation.

Enhanced access and continuity are key components of patient-centered care. Existing studies show that several interventions such as providing same day appointments, walk-in services, after-hours care, and group appointments, have been used to redesign the healthcare systems for improved access to primary care. However, an intervention focusing on a single component of care delivery (i.

OpenMRS, a global medical records system collaborative: factors influencing successful implementation.

OpenMRS is an open-source, robust electronic health record (EHR) platform that is supported by a large global network and used in over forty countries. We explored what factors lead to successful implementation of OpenMRS in resource constrained settings. Data sources included in-person and telephone key informant interviews, focus groups and responses to an electronic survey from 10 sites in 7 countries.

An operational citywide electronic infection control network: results from the first year.

The prevalence of drug resistant bacteria such as Methicillin-resistant Staphylococcus aureus (MRSA) continues to increase nationwide. Infection control is a regional problem, particularly in urban settings, requiring a coordinated effort. To enable coordinated infection control efforts, we created a citywide electronic notification system to prospectively track and share information regarding all known patients with MRSA.

An evaluation of the Veterans Health Administration's clinical reminders system: a national survey of generalists.

Background: The Veterans Health Administration (VHA) is a leader in developing computerized clinical reminders (CCRs). Primary care physicians' (PCPs) evaluation of VHA CCRs could influence their future development and use within and outside the VHA.

Objective: Survey PCPs about usefulness and usability of VHA CCRs.

Information technology to support improved care for chronic illness.

Background: In populations with chronic illness, outcomes improve with the use of care models that integrate clinical information, evidence-based treatments, and proactive management of care. Health information technology is believed to be critical for efficient implementation of these chronic care models. Health care organizations have implemented information technologies, such as electronic medical records, to varying degrees.

Connecting the dots: creation of an electronic regional infection control network.

The prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococci (VRE) continues to increase dramatically worldwide. Successful programs to reduce infection rates of resistant organisms require regional or national compliance with strict infection control measures and feedback on implementation and reduced rates. We partnered with local infection control professionals (ICPs) and leveraged our existing electronic network to create a comprehensive city-wide network to track and uniformly respond to patients admitted with a history of MRSA or VRE.