Electronic clinical decision support for management of depression in primary care: a prospective cohort study.

Objective: To assess the utility of an electronic clinical decision support tool for management of depression in primary care.

Method: This prospective study was conducted in a national network of ambulatory practices over a 1-year period (October 2007-October 2008). A clinical decision support tool was embedded into the electronic health record of 19 primary care practices with 119 providers.

Impact of EHR-based clinical decision support on adherence to guidelines for patients on NSAIDs: a randomized controlled trial.

Purpose: Electronic health records (EHRs) with clinical decision support hold promise for improving quality of care, but their impact on management of chronic conditions has been mixed. This study examined the impact of EHR-based clinical decision support on adherence to guidelines for reducing gastrointestinal complications in primary care patients on nonsteroidal anti-inflammatory drugs (NSAIDs).

Methods: This randomized controlled trial was conducted in a national network of primary care offices using an EHR and focused on patients taking traditional NSAIDs who had factors associated with a high risk for gastrointestinal complications (a history of peptic ulcer disease; concomitant use of anticoagulants, anti-platelet medications [including aspirin], or corticosteroids; or an age of 75 years or older).

An electronic medical record-based intervention to improve quality of care for gastro-esophageal reflux disease (GERD) and atypical presentations of GERD.

Background: Gastro-esophageal reflux disease (GERD) is common in primary care but is often underdiagnosed and untreated. GERD can also present with atypical symptoms like chronic cough and asthma, and physicians may be unaware of this presentation. We aimed to implement and evaluate an intervention to improve diagnosis and treatment for GERD and atypical GERD in primary care.

Impact of decision support in electronic medical records on lipid management in primary care.

Electronic decision-support tools may help to improve management of hyperlipidemia and other chronic diseases. This study examined the impact of lipid management tools integrated into an electronic medical record (EMR) in primary care practices. This randomized controlled trial was conducted in a national network of physicians who use an outpatient EMR.

Management of depression in ambulatory care for patients with medical co-morbidities: a study from a national Electronic Health Record (EHR) network.

Objective: Since co-morbid depression can complicate medical conditions such as cardiovascular disease and cancer, physicians may treat depression more aggressively in patients with these conditions. This study compared antidepressant medication use in persons with and without medical co-morbidities.

Methods: This cross-sectional study was conducted in a national network of outpatient electronic medical record users.

Using NLP to extract concepts from chief complaints.

The NLM's MMTx natural language processing (NLP) engine was used to extract concepts from chief complaints entered into an ambulatory electronic medical record (EMR). Of the over 600,000 strings submitted to the process, approximately 25% were assigned at least one concept, with a rate of 2% for incorrect assignments.

Clinical terminology support for a national ambulatory practice outcomes research network.

The Medical Quality Improvement Consortium (MQIC) is a nationwide collaboration of 74 healthcare delivery systems, consisting of 3755 clinicians, who contribute de-identified clinical data from the same commercial electronic medical record (EMR) for quality reporting, outcomes research and clinical research in public health and practice benchmarking. Despite the existence of a common, centrally-managed, shared terminology for core concepts (medications, problem lists, observation names), a substantial "back-end" information management process is required to ensure terminology and data harmonization for creating multi-facility clinically-acceptable queries and comparable results. We describe the information architecture created to support terminology harmonization across this data-sharing consortium and discuss the implications for large scale data sharing envisioned by proponents for the national adoption of ambulatory EMR systems.

Accelerating Biopharmaceutical Development in the Decade of Health Information Technology: Applications of EHRs for outcomes research and clinical trials recruitment.

Electronic health records hold vast potential for streamlining patient recruitment for clinical trials and improving outcomes research.

The use of SNOMED CT simplifies querying of a clinical data warehouse.

The usefulness of digital clinical information is limited by difficulty in accessing that information. Information in electronic medical records (EMR) must be entered and stored at the appropriate level of granularity for individual patient care. However, benefits such as outcomes research and decision support require aggregation to clinical data -- "heart disease" as opposed to "S/P MI 1997" for example.