Foraging for Information in the EHR: The Search for Adherence Related Information by Mental Health Clinicians.

In this project we sought to qualitatively describe clinician's search for information related to the complex construct of adherence. Nineteen think aloud observations and semi-structured interviews were conducted with mental health providers as they prepared for a patient visit. The transcripts were coded according to constructs from information foraging theory (information goal, patch, scent, enrichment, and opportunity cost).

Decisions about Renal Replacement Therapy in Patients with Advanced Kidney Disease in the US Department of Veterans Affairs, 2000-2011.

Background And Objectives: It is not known what proportion of United States patients with advanced CKD go on to receive RRT. In other developed countries, receipt of RRT is highly age dependent and the exception rather than the rule at older ages.

Design, Setting, Participants, & Measurements: We conducted a retrospective study of a national cohort of 28,568 adults who were receiving care within the US Department of Veteran Affairs and had a sustained eGFR <15 ml/min per 1.

The Feasibility of Using Large-Scale Text Mining to Detect Adverse Childhood Experiences in a VA-Treated Population.

Free text in electronic health records resists large-scale analysis. Text records facts of interest not found in encoded data, and text mining enables their retrieval and quantification. The U.

Computerized provider documentation: findings and implications of a multisite study of clinicians and administrators.

Objective: Clinical documentation is central to the medical record and so to a range of healthcare and business processes. As electronic health record adoption expands, computerized provider documentation (CPD) is increasingly the primary means of capturing clinical documentation. Previous CPD studies have focused on particular stakeholder groups and sites, often limiting their scope and conclusions.

Initial Steps toward Validating and Measuring the Quality of Computerized Provider Documentation.

Background: Concerns exist about the quality of electronic health care documentation. Prior studies have focused on physicians. This investigation studied document quality perceptions of practitioners (including physicians), nurses and administrative staff.

An exploration of the impact of computerized patient documentation on clinical collaboration.

Purpose: The purpose of this study was to explore the experience of experienced users of computerized patient documentation for the purpose of collaboration and coordination. A secondary analysis of qualitative data using Clark's theoretical framework of communication was conducted with the goal of bringing research findings into design.

Methods: Physicians, nurses and administrative staff volunteered to participate in focus groups at 4 VA sites.

Nursing documentation usage analysis.

This project investigated the use of electronic patient documentation in the work context of VA nurses, guided by cognitive work analysis methodology. Prominent themes in nursing workflow and documentation usage identifed in previous research were summarized and presented in detail to a focus group of practicing nurses. The group validated a need for integrated access to order, prescription and document information.

Copying and pasting of examinations within the electronic medical record.

Electronic patient records often include text that has been copied and pasted from other records. A type of copying that involves the highest risk for confusion, medical error, and medico-legal harm is the copying of the clinical examination. We studied this phenomenon using an automated text categorization algorithm to detect copied exams in a set of 167,076 VA records.

Are electronic medical records trustworthy? Observations on copying, pasting and duplication.

As routine use of on-line progress notes in US Department of Veterans Affairs facilities grew rapidly in the past decade, health information managers and clinicians began to notice that authors sometimes copied text from old notes into new notes. Other sources of duplication were document templates that inserted boilerplate text or patient data into notes. Word-processing and templates aided the transition to electronic notes, but enabled author copying and sometimes led to lengthy, hard-to-read records stuffed with data already available on-line.