Electronic Health Record Transition Considerations.

After an initial phase of electronic health record (EHR) solutions for both independent practices and larger health care organizations, we are now entering a period in which transitioning between EHRs is becoming more common. Many of the decisions and implementation processes for an EHR transition are similar to those encountered during the transition from paper records to an EHR. Detailed project planning and management are essential to keep the effort on track and within budget to a successful conclusion.

Clinical decision support of therapeutic drug monitoring of phenytoin: measured versus adjusted phenytoin plasma concentrations.

Background: Therapeutic drug monitoring of phenytoin by measurement of plasma concentrations is often employed to optimize clinical efficacy while avoiding adverse effects. This is most commonly accomplished by measurement of total phenytoin plasma concentrations. However, total phenytoin levels can be misleading in patients with factors such as low plasma albumin that alter the free (unbound) concentrations of phenytoin.

Computerized detection of adverse drug reactions in the medical intensive care unit.

Objective: Clinical event monitors are a type of active medication monitoring system that can use signals to alert clinicians to possible adverse drug reactions. The primary goal was to evaluate the positive predictive values of select signals used to automate the detection of ADRs in the medical intensive care unit.

Method: This is a prospective, case series of adult patients in the medical intensive care unit during a six-week period who had one of five signals presents: an elevated blood urea nitrogen, vancomycin, or quinidine concentration, or a low sodium or glucose concentration.

Analysis of a failed clinical decision support system for management of congestive heart failure.

In order to increase compliance with The Joint Commission's Congestive Heart Failure Core Measures, a rule based clinical decision support system (CDSS) was developed and deployed at a community hospital in our health system. We evaluated the performance of the CDSS in identifying patients with primary congestive heart failure (CHF)and identified problems encountered with its introduction. Performance of the CDSS was compared against a manual review of records of patients with diagnosis of primary CHF.

Negative CPOE attitudes correlate with diminished power in the workplace.

Power changes have been identified as a frequent and unintended consequence of the implementation of computerized physician order entry (CPOE). However, no previous study has described the degree or direction of power change, or even confirmed that such a relationship exists. Using a validated, standardized instrument for measuring personal power, we collected data from 276 healthcare workers in two different hospitals before and after implementation of CPOE.

Development of an instrument for measuring clinicians' power perceptions in the workplace.

We report on the development of an instrument to measure clinicians' perceptions of their personal power in the workplace in relation to resistance to computerized physician order entry (CPOE). The instrument is based on French and Raven's six bases of social power and uses a semantic differential methodology. A measurement study was conducted to determine the reliability and validity of the survey.

Stroke-related knowledge and health behaviors among poststroke patients in inpatient rehabilitation.

Objective: To measure stroke knowledge and prestroke personal health behaviors of stroke patients undergoing inpatient rehabilitation and their caregivers.

Design: Prospective cohort.

Setting: Academic rehabilitation hospital.