Browsing by Subject "Electronic Health Record"

Now showing 1 - 4 of 4
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    Effect of a Computer-Based Decision Support Intervention on Autism Spectrum Disorder Screening in Pediatric Primary Care Clinics: A Cluster Randomized Clinical Trial
    (JAMA Network, 2019-12-02) Downs, Stephen M.; Bauer, Nerissa S.; Saha, Chandan; Ofner, Susan; Carroll, Aaron E.; Pediatrics, School of Medicine
    Importance: Universal early screening for autism spectrum disorder (ASD) is recommended but not routinely performed. Objective: To determine whether computer-automated screening and clinical decision support can improve ASD screening rates in pediatric primary care practices. Design, Setting, and Participants: This cluster randomized clinical trial, conducted between November 16, 2010, and November 21, 2012, compared ASD screening rates among a random sample of 274 children aged 18 to 24 months in urban pediatric clinics of an inner-city county hospital system with or without an ASD screening module built into an existing decision support software system. Statistical analyses were conducted from February 6, 2017, to June 1, 2018. Interventions: Four clinics were matched in pairs based on patient volume and race/ethnicity, then randomized within pairs. Decision support with the Child Health Improvement Through Computer Automation system (CHICA) was integrated with workflow and with the electronic health record in intervention clinics. Main Outcomes and Measures: The main outcome was screening rates among children aged 18 to 24 months. Because the intervention was discontinued among children aged 18 months at the request of the participating clinics, only results for those aged 24 months were collected and analyzed. Rates of positive screening results, clinicians' response rates to screening results in the computer system, and new cases of ASD identified were also measured. Main results were controlled for race/ethnicity and intracluster correlation. Results: Two clinics were randomized to receive the intervention, and 2 served as controls. Records from 274 children (101 girls, 162 boys, and 11 missing information on sex; age range, 23-30 months) were reviewed (138 in the intervention clinics and 136 in the control clinics). Of 263 children, 242 (92.0%) were enrolled in Medicaid, 138 (52.5%) were African American, and 96 (36.5%) were Hispanic. Screening rates in the intervention clinics increased from 0% (95% CI, 0%-5.5%) at baseline to 68.4% (13 of 19) (95% CI, 43.4%-87.4%) in 6 months and to 100% (18 of 18) (95% CI, 81.5%-100%) in 24 months. Control clinics had no significant increase in screening rates (baseline, 7 of 64 children [10.9%]; 6-24 months after the intervention, 11 of 72 children [15.3%]; P = .46). Screening results were positive for 265 of 980 children (27.0%) screened by CHICA during the study period. Among the 265 patients with positive screening results, physicians indicated any response in CHICA in 151 (57.0%). Two children in the intervention group received a new diagnosis of ASD within the time frame of the study. Conclusions and Relevance: The findings suggest that computer automation, when integrated with clinical workflow and the electronic health record, increases screening of children for ASD, but follow-up by physicians is still flawed. Automation of the subsequent workup is still needed.
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    Qualitative study of system-level factors related to genomic implementation
    (Springer Nature, 2019-07) Zebrowski, Alexis M.; Ellis, Darcy E.; Barg, Frances K.; Sperber, Nina R.; Bernhardt, Barbara A.; Denny, Joshua C.; Dexter, Paul R.; Ginsburg, Geoffrey S.; Horowitz, Carol R.; Johnson, Julie A.; Levy, Mia A.; Orlando, Lori A.; Pollin, Toni I.; Skaar, Todd C.; Kimmel, Stephen E.; Medicine, School of Medicine
    PURPOSE: Research on genomic medicine integration has focused on applications at the individual level, with less attention paid to implementation within clinical settings. Therefore, we conducted a qualitative study using the Consolidated Framework for Implementation Research (CFIR) to identify system-level factors that played a role in implementation of genomic medicine within Implementing GeNomics In PracTicE (IGNITE) Network projects. METHODS: Up to four study personnel, including principal investigators and study coordinators from each of six IGNITE projects, were interviewed using a semistructured interview guide that asked interviewees to describe study site(s), progress at each site, and factors facilitating or impeding project implementation. Interviews were coded following CFIR inner-setting constructs. RESULTS: Key barriers included (1) limitations in integrating genomic data and clinical decision support tools into electronic health records, (2) physician reluctance toward genomic research participation and clinical implementation due to a limited evidence base, (3) inadequate reimbursement for genomic medicine, (4) communication among and between investigators and clinicians, and (5) lack of clinical and leadership engagement. CONCLUSION: Implementation of genomic medicine is hindered by several system-level barriers to both research and practice. Addressing these barriers may serve as important facilitators for studying and implementing genomics in practice.
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    Student perceptions of a teaching electronic medical record in Health Administration education
    (2022) Taylor, Heather L.; Brumitt, Gary; Harle, Christopher A.; Johnston, Ann; Williams, Karmen; Vest, Joshua R.
    Given the ubiquity of electronic health records (EHR), health administrators should be formally trained on the use and evaluation of EHR data for common operational tasks and managerial decision-making. A teaching electronic medical record (tEMR) is a fully operational electronic medical record that uses de-identified electronic patient data and provides a framework for students to familiarize themselves with the data, features, and functionality of an EHR. Although purported to be of value in health administration programs, specific benefits of using a tEMR in health administration education is unknown. We sought to examine Master of Health Administration (MHA) students' perceptions of the use, challenges, and benefits of a tEMR. We analyzed qualitative data collected from a focus group session with students who were exposed to the tEMR during a semester MHA course. We also administered pre- and post-survey questions on students' self-efficacy and perceptions of the ease of use, usefulness, and intention to use health care data analysis in their future jobs. We found several MHA students valued their exposure to the tEMR, as this provided them a realistic environment to explore de-identified patient data. Scores for students' perceived ease of using healthcare data analysis in their future job significantly increased following use of the tEMR (pre-test score M=3.31, SD=0.21; post-test score M=3.71, SD=0.18; p=0.01). Student exposure and use of a tEMR may positively affect perceptions of using EHR data for strategic and managerial tasks typical of health administrators.
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    Towards a More Patient-Centered Approach to Medication Safety
    (SAGE Publications, 2018-06) Lee, Joy L.; Dy, Sydney M.; Gurses, Ayse P.; Kim, Julia M.; Suarez-Cuervo, Catalina; Berger, Zackary D.; Brown, Rachel; Xiao, Yan; Medicine, School of Medicine