Time Requirements for Electronic Health Record Use in an Academic Ophthalmology Center.

Importance: Electronic health record (EHR) systems have transformed the practice of medicine. However, physicians have raised concerns that EHR time requirements have negatively affected their productivity. Meanwhile, evolving approaches toward physician reimbursement will require additional documentation to measure quality and cost of care.

Clinical decisions support malfunctions in a commercial electronic health record.

Objectives: Determine if clinical decision support (CDS) malfunctions occur in a commercial electronic health record (EHR) system, characterize their pathways and describe methods of detection.

Methods: We retrospectively examined the firing rate for 226 alert type CDS rules for detection of anomalies using both expert visualization and statistical process control (SPC) methods over a five year period. Candidate anomalies were investigated and validated.

Transitioning From Volume to Value: One Academic Medical Center's Approach to Improving Population Health.

Problem: The U.S. health care system is undergoing a major transformation.

Clinic Workflow Simulations using Secondary EHR Data.

Clinicians today face increased patient loads, decreased reimbursements and potential negative productivity impacts of using electronic health records (EHR), but have little guidance on how to improve clinic efficiency. Discrete event simulation models are powerful tools for evaluating clinical workflow and improving efficiency, particularly when they are built from secondary EHR timing data. The purpose of this study is to demonstrate that these simulation models can be used for resource allocation decision making as well as for evaluating novel scheduling strategies in outpatient ophthalmology clinics.

Perspectives and Uses of the Electronic Health Record Among US Pediatricians: A National Survey.

Little is known about how existing electronic health records (EHRs) influence the practice of pediatric medicine. A total of 808 pediatricians participated in a survey about workflows using the EHR. The EHR was the most commonly used source of initial patient information.

Early experiences of accredited clinical informatics fellowships.

Since the launch of the clinical informatics subspecialty for physicians in 2013, over 1100 physicians have used the practice and education pathways to become board-certified in clinical informatics. Starting in 2018, only physicians who have completed a 2-year clinical informatics fellowship program accredited by the Accreditation Council on Graduate Medical Education will be eligible to take the board exam. The purpose of this viewpoint piece is to describe the collective experience of the first four programs accredited by the Accreditation Council on Graduate Medical Education and to share lessons learned in developing new fellowship programs in this novel medical subspecialty.

Clinical Decision Support Reduces Overuse of Red Blood Cell Transfusions: Interrupted Time Series Analysis.

Background: Red blood cell transfusion is the most common procedure in hospitalized patients in the US. Growing evidence suggests that a sizeable percentage of these transfusions are inappropriate, putting patients at significant risk and increasing costs to the health care system.

Methods: We performed a retrospective quasi-experimental study from November 2008 until November 2014 in a 576-bed tertiary care hospital.

Variability in Electronic Health Record Usage and Perceptions among Specialty vs. Primary Care Physicians.

Despite federal incentives for adoption of electronic health records (EHRs), surveys have shown that EHR use is less common among specialty physicians than generalists. Concerns have been raised that current-generation EHR systems are inadequate to meet the unique information gathering needs of specialists. This study sought to identify whether information gathering needs and EHR usage patterns are different between specialists and generalists, and if so, to characterize their precise nature.

Impact of an electronic health record operating room management system in ophthalmology on documentation time, surgical volume, and staffing.

Importance: Although electronic health record (EHR) systems have potential benefits, such as improved safety and quality of care, most ophthalmology practices in the United States have not adopted these systems. Concerns persist regarding potential negative impacts on clinical workflow. In particular, the impact of EHR operating room (OR) management systems on clinical efficiency in the ophthalmic surgery setting is unknown.

Time-motion analysis of clinical nursing documentation during implementation of an electronic operating room management system for ophthalmic surgery.

Efficiency and quality of documentation are critical in surgical settings because operating rooms are a major source of revenue, and because adverse events may have enormous consequences. Electronic health records (EHRs) have potential to impact surgical volume, quality, and documentation time. Ophthalmology is an ideal domain to examine these issues because procedures are high-throughput and demand efficient documentation.

Evaluation of electronic health record implementation in ophthalmology at an academic medical center (an American Ophthalmological Society thesis).

Purpose: To evaluate three measures related to electronic health record (EHR) implementation: clinical volume, time requirements, and nature of clinical documentation. Comparison is made to baseline paper documentation.

Methods: An academic ophthalmology department implemented an EHR in 2006.

Electronic health record systems in ophthalmology: impact on clinical documentation.

Objective: To evaluate quantitative and qualitative differences in documentation of the ophthalmic examination between paper and electronic health record (EHR) systems.

Design: Comparative case series.

Participants: One hundred fifty consecutive pairs of matched paper and EHR notes, documented by 3 attending ophthalmologist providers.

Fixed-wing medical transport crashes: characteristics associated with fatal outcomes.

Introduction: Previous studies within the aeromedical literature have looked at factors associated with fatal outcomes in helicopter medical transport, but no analysis has been conducted on fixed-wing aeromedical flights. The purpose of this study was to look at fatality rates in fixed-wing aeromedical transport and compare them with general aviation and helicopter aeromedical flights.

Methods: This study looked at factors associated with fatal outcomes in fixed-wing aeromedical flights, using the National Transportation Safety Board Aviation Accident Incident Database from 1984 to 2009.

Unintended errors with EHR-based result management: a case series.

Test result management is an integral aspect of quality clinical care and a crucial part of the ambulatory medicine workflow. Correct and timely communication of results to a provider is the necessary first step in ambulatory result management and has been identified as a weakness in many paper-based systems. While electronic health records (EHRs) hold promise for improving the reliability of result management, the complexities involved make this a challenging task.