Racism and Electronic Health Records (EHRs): Perspectives for research and practice.

Informatics researchers and practitioners have started exploring racism related to the implementation and use of electronic health records (EHRs). While this work has begun to expose structural racism which is a fundamental driver of racial and ethnic disparities, there is a lack of inclusion of concepts of racism in this work. This perspective provides a classification of racism at 3 levels-individual, organizational, and structural-and offers recommendations for future research, practice, and policy.

Physicians' Perceptions of and Satisfaction With Artificial Intelligence in Cancer Treatment: A Clinical Decision Support System Experience and Implications for Low-Middle-Income Countries.

As technology continues to improve, health care systems have the opportunity to use a variety of innovative tools for decision-making, including artificial intelligence (AI) applications. However, there has been little research on the feasibility and efficacy of integrating AI systems into real-world clinical practice, especially from the perspectives of clinicians who use such tools. In this paper, we review physicians' perceptions of and satisfaction with an AI tool, Watson for Oncology, which is used for the treatment of cancer.

Implementation of enhanced recovery protocols reduces opioid use in pediatric laparoscopic Heller myotomy surgery.

Background: Enhanced recovery protocols (ERPs) are effective means of standardizing and improving the quality of surgical care in adults. Our purpose was to retrospectively compare outcomes before and after implementation of ERPs in children undergoing laparoscopic Heller myotomy for achalasia.

Methods: A pediatric-specific ERP was used for children undergoing laparoscopic Heller myotomy starting July 2017 at two pediatric surgery centers within a single metropolitan healthcare system.

A Quality Improvement Intervention Leveraging a Safety Net Model for Surveillance Colonoscopy Completion.

Systems to address follow-up testing of clinically positive surveillance colonoscopy results are lacking. The impact of an ambulatory safety net (ASN) intervention on rates of colonoscopy completion was assessed. The ASN team identified patients using an electronic registry, conducted patient outreach, coordinated care, and tracked colonoscopy completion.

Improving Quality of Care in Rheumatoid Arthritis Through Mobile Patient-Reported Outcome Measurement: Focus Group Study.

Background: Patient-reported outcomes (PROs) for chronic disease management can be integrated into the routine workflow by leveraging mobile technology.

Objective: The objective of our study was to describe the process of our quality improvement (QI) efforts using tablets for PRO collection in a busy, academic rheumatology practice to support a treat-to-target (TTT) approach for rheumatoid arthritis (RA) management.

Methods: Our QI team designed a process for routine collection of PROs for RA patients at the Arthritis Center, employing information technology and an electronic medical record (EMR) system.

Safety of the Zoster Vaccine Recombinant Adjuvanted in Rheumatoid Arthritis and Other Systemic Rheumatic Disease Patients: A Single Center's Experience With 400 Patients.

Objective: Patients with rheumatoid arthritis (RA) and other systemic rheumatic diseases (SRDs) are at increased risk of developing herpes zoster (HZ). Zoster recombinant adjuvanted (ZRA) is a recombinant vaccine approved by the Food and Drug Administration in 2018. Concern has been raised that the ZRA may trigger disease flares in rheumatology patients who are immunocompromised.

Ambulatory Safety Nets to Reduce Missed and Delayed Diagnoses of Cancer.

Background: An ambulatory safety net (ASN) is an innovative organizational intervention for addressing patient safety related to missed and delayed diagnoses of abnormal test results. ASNs consist of a set of tools, reports and registries, and associated work flows to create a high-reliability system for abnormal test result management.

Methods: Two ASNs implemented at an academic medical center are described, one focusing on colon cancer and the other on lung cancer.

Alert-based computerized decision support for high-risk hospitalized patients with atrial fibrillation not prescribed anticoagulation: a randomized, controlled trial (AF-ALERT).

Aims: Despite widely available risk stratification tools, safe and effective anticoagulant options, and guideline recommendations, anticoagulation for stroke prevention in atrial fibrillation (AF) is underprescribed. We created and evaluated an alert-based computerized decision support (CDS) strategy to increase anticoagulation prescription in hospitalized AF patients at high risk for stroke.

Methods And Results: We enrolled 458 patients (CHA2DS2-VASc score ≥1) with AF who were not prescribed anticoagulant therapy and were hospitalized at Brigham and Women's Hospital.

Who adopts a patient portal?: An application of the diffusion of innovation model.

Background: Patient portals have emerged as an important tool through which patients can access online health information and engage in their health care. However, we know little about how patients perceive portals and whether patient perceptions might influence portal adoption.

Objective: Apply the diffusion of innovation (DOI) theory to assess perceptions of adopters and non-adopters of a patient portal.

Physician Beliefs about the Meaningful Use of the Electronic Health Record: A Follow-Up Study.

Background There is continuing interest in how physicians are responding to the meaningful use of the electronic health record (EHR) incentive program. However, little research has been done on physician beliefs about the meaningful use of the EHR. Objective This study aims to conduct a follow-up study of physician beliefs about the meaningful use of the EHR.

Awareness and Use of the After-Visit Summary Through a Patient Portal: Evaluation of Patient Characteristics and an Application of the Theory of Planned Behavior.

Background: Patient portals are being used to provide a clinical summary of the office visit or the after-visit summary (AVS) to patients. There has been relatively little research on the characteristics of patients who access the AVS through a patient portal and their beliefs about the AVS.

Objective: The aim was to (1) assess the characteristics of patients who are aware of and access the AVS through a patient portal and (2) apply the Theory of Planned Behavior (TPB) to predict behavioral intention of patients toward accessing the AVS provided through a patient portal.

Assessing information system readiness for mitigating malpractice risk through simulation: results of a multi-site study.

Objective: To develop and test an instrument for assessing a healthcare organization's ability to mitigate malpractice risk through clinical decision support (CDS).

Materials And Methods: Based on a previously collected malpractice data set, we identified common types of CDS and the number and cost of malpractice cases that might have been prevented through this CDS. We then designed clinical vignettes and questions that test an organization's CDS capabilities through simulation.

A mobile app for securely capturing and transferring clinical images to the electronic health record: description and preliminary usability study.

Background: Photographs are important tools to record, track, and communicate clinical findings. Mobile devices with high-resolution cameras are now ubiquitous, giving clinicians the opportunity to capture and share images from the bedside. However, secure and efficient ways to manage and share digital images are lacking.

Patient perceptions of a personal health record: a test of the diffusion of innovation model.

Background: Personal health records (PHRs) have emerged as an important tool with which patients can electronically communicate with their doctors and doctor's offices. However, there is a lack of theoretical and empirical research on how patients perceive the PHR and the differences in perceptions between users and non-users of the PHR.

Objective: To apply a theoretical model, the diffusion of innovation model, to the study of PHRs and conduct an exploratory empirical study on the applicability of the model to the study of perceptions of PHRs.

The digital divide in adoption and use of a personal health record.

Background: Personal health records (PHRs) offer the potential to improve the patient experience and the quality of patient care. However, the "digital divide," the population-level gap in Internet and computer access, may prevent certain groups from accessing the PHR.

Methods: We conducted a cross-sectional analysis of a PHR within a northeastern health system.

"Under the radar": nurse practitioner prescribers and pharmaceutical industry promotions.

Objective: To assess nurse practitioners' interactions with pharmaceutical industry promotional activities and their perception of information reliability and self-reported prescribing behaviors.

Study Design: Self-administered online survey.

Methods: A nationally randomized sample of nurse practitioner prescribers was surveyed.

Physicians' decisions to prescribe antidepressant therapy in older patients with depression in a US managed care plan.

Background: Published studies indicate that depression in older adults is severely under-recognized and under-treated.

Objective: To characterize primary-care physicians' decisions to prescribe antidepressants to older patients with depression.

Methods: Electronic medical record (EMR) notes from office visits of older patients (aged ≥65 years), treated in a central Massachusetts multi-specialty medical group practice, were screened every 2 weeks between August 2007 and July 2008 for mention of depression.

Adherence to inhaled corticosteroid use and local adverse events in persistent asthma.

Objectives: To measure adherence to inhaled corticosteroid (ICS) therapy using prescription claims and a patient survey, to identify local adverse events (LAEs) from the patient perspective and from medical records, and to evaluate the association between LAEs and adherence to ICS therapy.

Study Design: Survey administration and claims-based and medical record-abstracted data.

Methods: Patients aged 6 to 64 years with persistent asthma (defined using an established algorithm) and at least 2 ICS prescriptions were selected from a claims database (1999-2006) of a central Massachusetts medical group practice.

Patient decision to initiate therapy for osteoporosis: the influence of knowledge and beliefs.

Background: There are effective treatments to prevent osteoporotic fractures, but these treatments are underutilized.

Objective: To evaluate the influence of patient characteristics, perceptions, knowledge and beliefs about osteoporosis on the decision to initiate osteoporotic treatment.

Participants: We identified female members of a managed care plan who had a dual energy x-ray absorptiometry (DXA) bone density test and fulfilled World Health Organization criteria for osteoporosis.

Short-term economic impact of body weight change among patients with type 2 diabetes treated with antidiabetic agents: analysis using claims, laboratory, and medical record data.

Background: Obesity is highly prevalent among patients with type 2 diabetes. Unfortunately, weight gain may also be a consequence of some antidiabetic medications. Although clinical benefits of weight loss have been established, the economic consequence of weight change among patients with type 2 diabetes is unclear.

A survey-based assessment of the prevalence and severity of chronic hand dermatitis in a managed care organization.

Although studies conducted outside of the United States have found a 7% to 12% prevalence of chronic hand dermatitis, no US general population-based estimates have been reported. The objective of this study was to quantify the prevalence of chronic hand dermatitis in a US managed care organization population. A 13-item self-assessment questionnaire was developed and validated, with 85% sensitivity and 95% specificity.

Identifying unrecognized peripheral arterial disease among asymptomatic patients in the primary care setting.

National initiatives to enhance recognition of the detrimental impact of peripheral arterial disease on the health of adult Americans have been advocated. The objective of this study was to evaluate a strategy for identifying patients with unrecognized peripheral arterial disease from among persons without known atherosclerotic disease in the primary care setting. A cross-sectional design was used.

Impact of chronic hand dermatitis on quality of life, work productivity, activity impairment, and medical costs.

Background: The impact of chronic hand dermatitis (ChHD) on patient-reported outcomes and economic costs has not been assessed in a US population.

Objective: We sought to evaluate the quality of life, work productivity, activity impairment, and health care costs of patients with ChHD versus those without ChHD.

Methods: A 13-item self-assessment questionnaire to identify ChHD was developed and validated.