Changing patient care orders from paper to computerized provider order entry-based process.

The purpose of this study was to describe the extent of change in patient care orders primarily for six diagnoses, procedures, or conditions in a not-for-profit Midwestern rural referral hospital. A descriptive method was used to analyze changes in the order sets over time for chest pain with acute myocardial infarction, degenerative osteoarthritis with hip joint replacement and degenerative osteoarthritis with knee joint replacement procedures, coronary artery bypass graft procedures, congestive heart failure, and pneumonia. Ten items about service-specific order sets were abstracted during pre- and post-EHR implementation and a year later.

Longitudinal study of symptom control and quality of life indicators with patients receiving community-based case management services.

A longitudinal study examined seven outcomes of chronically ill patients receiving community-based case management services. A repeated-measures analysis showed that these patients reported greater satisfaction with quality of life and personal well-being and controlled their symptoms better, but declined in self-care activities of daily living and in self-care instrumental activities of daily living.

Evaluating clinical decision support rules as an intervention in clinician workflows with technology.

The implementation of electronic health records in rural settings generated new challenges beyond those seen in urban hospitals. The preparation, implementation, and sustaining of clinical decision support rules require extensive attention to standards, content design, support resources, expert knowledge, and more. A formative evaluation was used to present progress and evolution of clinical decision support rule implementation and use within clinician workflows for application in an electronic health record.

Impact of health information technology on detection of potential adverse drug events at the ordering stage.

Purpose: The impact of implementing commercially available health care information technologies at hospitals in a large health system on the identification of potential adverse drug events (ADEs) at the medication ordering stage was studied.

Methods: All hospitals in the health system had implemented a clinical decision-support system (CDSS) consisting of a centralized clinical data repository, interfaces for reports, a results reviewer, and a package of ADE alert rules. Additional technology including computerized provider order entry (CPOE), an advanced CDSS, and evidence-based order sets was implemented in nine hospitals.

Infusing clinical decision support interventions into electronic health records.

Electronic medical records and health records provide a variety of clinical decision support interventions to guide or support the clinical user. These interventions are design features to guide users in next steps, offer useful evidence-based knowledge, or provide patient information relevant to a decision.

Terminology use in electronic health records: basic principles.

Electronic health records (EHRs) are a cost-saving and environmentally friendly means for documenting patient care and improving patient safety, quality, and evidence-based practice. Standardized clinical classification systems and terminologies are essential ingredients of the EHR. Their selection must be driven by a clear understanding of requirements for their use and application.

Nurses exchanging information: understanding electronic health record standards and interoperability.

The complexity in adopting health information technology (IT) standards is not from lack of standards. Rather, there are a vast number of standards that overlap and some that are missing. The objective of this article is to provide nurses with an understanding of the importance of the National Health IT Agenda and be empowered to influence the processes to ensure nursing is represented.

Structured terminologies in clinical information systems: implementation through collaboration.

The structure and content of the dialog with a clinical end-user is a critical aspect of clinical information system use, data capture and retrieval, and efficient and effective health care. This dialog is driven ultimately by embedded structures and processes that: a) provide functional models of clinical expression in support of professional practice, and b) determine how structured terminologies ought to populate these models. Based on diverse practical experience, this study identifies challenges to implementing structured clinical terminologies, categorizing them by both stakeholder group and application area.

Transformation of Emergency Department processes of care with EHR, CPOE, and ER event tracking systems.

Mercy Medical Center, North Iowa implemented electronic health records (EHR), computerised provider order entry (CPOE) and event tracking systems in the emergency department (ED) as part of hospital-wide implementation of clinical information systems. This case study examines the changes in outcomes and processes in the ED following implementation. Although the system was designed to enhance efficiency, there was a significant increase in the mean length of stay (about 17 minutes, or 15%) in the ED after implementation.

Redesigning care processes using an electronic health record: a system's experience.

Background: Implementation of health information technology (HIT) has encountered many difficulties and produced mixed outcomes. Yet Trinity Health, a major integrated delivery system, successfully leveraged implementation of a systemwide electronic health record (EHR) to promote process redesign and continuous quality improvement.

Implementing A Systemwide Ehr: After several years of planning, two waves of EHR implementation were launched, in 2001 and 2003.

Redesigning care delivery through health IT implementation. Exploring Trinity Health's IT model.

Trinity Health is a large multihospital healthcare system that developed a system-wide information technology strategy and implementation model. This study looks at how that system-wide strategy and implementation model, called Project Genesis, was used at Mercy Medical Center-North Iowa, a Trinity Health rural referral hospital, and how the care delivery system was redesigned using an electronic health record. This study was funded in part by a grant (UC1 HS15196; Rural Iowa Redesign of Care Delivery with EHR Functions) from the Agency for Healthcare Research and Quality to implement an integrated EHR system in the hospital and two clinics and assess its impact on patient safety, quality of care and organizational culture.

Expert clinical rules automate steps in delivering evidence-based care in the electronic health record.

A working framework is presented for interdisciplinary professionals for designing, building, and evaluating clinical decision support rules (expert rules) within the electronic health record. The working framework outlines the key workflow processes for eight health system organizations for selecting, designing, building, activating, and evaluating rules. In preparation, an interdisciplinary team selected expert rules for their organizations.