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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 732 Research Studies DisplayedBouchelle Z, Menko SG, Yazdani M
Parent perspectives on documentation and sharing of health-related social needs data.
This survey aimed to examine parents of pediatric patients’ preferences regarding how health-related social needs (HRSN) screening program data are documented and shared. The authors conducted semi-structured interviews with parents of hospitalized children participating in an HRSN screening program at a quaternary care children's hospital. Interviews were then coded to identify emergent themes. A total of 20 parents were interviewed with all being female, 55% identifying as Black or African American and 20% identifying as Hispanic or Latino. Parents expressed comfort with electronic health record documentation of HRSN data and the use of ICD-10 Revision Z codes as long as this information was used to provide families with meaningful support. Most parents viewed social workers and medical teams as being the most appropriate recipients of the data, with few parents feeling comfortable with HRSN data being shared with payors. Parents wanted transparency around HRSN data sharing, with many expressing concerns that documentation and sharing of HRSN data could lead to unwanted or unsafe disclosures or result in child welfare referrals.
AHRQ-funded; HS028555.
Citation: Bouchelle Z, Menko SG, Yazdani M .
Parent perspectives on documentation and sharing of health-related social needs data.
Hosp Pediatr 2024 Apr; 14(4):308-16. doi: 10.1542/hpeds.2023-007478..
Keywords: Children/Adolescents, Screening, Electronic Health Records (EHRs), Health Information Technology (HIT)
Wu J, Yuan CT, Moyal-Smith R
Electronic health record-supported implementation of an evidence-based pathway for perioperative surgical care.
This study examines the role of electronic health records (EHRs) in implementing enhanced recovery pathways (ERPs) for perioperative surgical care. Interviews with informaticians and clinicians from eight US hospitals revealed three thematic clusters: "EHR difficulties," "EHR enablers," and "EHR barriers." Researchers concluded that high performers and improvers successfully integrated ERPs into EHRs with dedicated multidisciplinary teams, while others faced challenges. Early involvement of informatics expertise benefited ERP implementation and sustainability.
AHRQ-funded; 2332015000201.
Citation: Wu J, Yuan CT, Moyal-Smith R .
Electronic health record-supported implementation of an evidence-based pathway for perioperative surgical care.
J Am Med Inform Assoc 2024 Feb 16; 31(3):591-99. doi: 10.1093/jamia/ocad237.
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Surgery, Evidence-Based Practice, Hospitals
Geary CR, Hook M, Popejoy L
Ambulatory care coordination data gathering and use.
The purpose of this study was to identify information gathered and used to support care coordination in ambulatory settings. Survey respondents, most of whom were nurses, provided demographic information and their practice patterns, including use of electronic health records. Most described at least a partial use of electronic health records, but two respondents described paper documentation systems. The authors concluded that the responses demonstrated significant heterogeneity in ambulatory care coordination data usage, but noted that additional research is needed to identify common data elements to support knowledge development in the context of a learning health system.
AHRQ-funded; HS028000.
Citation: Geary CR, Hook M, Popejoy L .
Ambulatory care coordination data gathering and use.
Comput Inform Nurs 2024 Jan; 42(1):63-70. doi: 10.1097/cin.0000000000001069.
Keywords: Care Coordination, Ambulatory Care and Surgery, Electronic Health Records (EHRs), Health Information Technology (HIT)
Frimpong JA, Liu X, Liu L
AHRQ Author: Liu L
Adoption of electronic health record among substance use disorder treatment programs: nationwide cross-sectional survey study.
The purpose of this study was to explore the adoption of electronic health record (EHR) systems in substance use disorder (SUD) programs, with an emphasis on changes in adoption from 2014 to 2017, and identify organizational-level variables related with EHR adoption. The researchers utilized data from the 2014 and 2017 National Drug Abuse Treatment System Surveys, and analyzed 1,027 SUD programs. The study found the adoption of EHR increased significantly from 57.6% in 2014 to 69.2% in 2017. Nearly one-third of SUD programs had not yet adopted an EHR system by 2017. The researchers identified a significant increase in technology use and ownership by a parent company and a decrease in the percentage of uninsured patients in 2017 compared to 2014. Further analysis revealed significant differences by adoption status for three main barriers to adoption: 1. Costs of start-up, 2. Ongoing financial costs, and 3. Privacy or security concerns. Programs that used computerized scheduling and billing systems had a greater likelihood of adopting EHR. Ownership type, such as private nonprofit and public, or interest in taking part in a patient-centered medical home were related with a greater likelihood to adopt EHR. Overall, SUD programs were more likely to adopt an EHR system in 2017 compared to 2014.
AHRQ-authored.
Citation: Frimpong JA, Liu X, Liu L .
Adoption of electronic health record among substance use disorder treatment programs: nationwide cross-sectional survey study.
J Med Internet Res 2023 Dec 14; 25:e45238. doi: 10.2196/45238..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Substance Abuse, Behavioral Health
Lopez K, Li H, Lipkin-Moore Z
Deep learning prediction of hospital readmissions for asthma and COPD.
The purpose of this observational study was to identify Electronic Health Record (EHR) features of severe asthma and COPD exacerbations and assess the performance of four machine learning (ML) and one deep learning (DL) model in predicting readmissions using EHR data. The study included 31, 2017 patients hospitalized with asthma and COPD exacerbations. The study found that Black and Hispanic patients had a greater likelihood of readmission for asthma. Patients with COPD readmissions included a high percentage of Blacks and Hispanics. To identify patients at high risk of readmission, index hospitalization data of a subset of 2,682 patients, 777 with asthma and 1,905 with COPD, was analyzed with four ML models, and one DL model. The researchers discovered that multilayer perceptron, the DL method, had the best sensitivity and specificity compared to the four ML methods implemented in the same dataset.
AHRQ-funded; HS027626.
Citation: Lopez K, Li H, Lipkin-Moore Z .
Deep learning prediction of hospital readmissions for asthma and COPD.
Respir Res 2023 Dec 13; 24(1):311. doi: 10.1186/s12931-023-02628-7..
Keywords: Asthma, Respiratory Conditions, Hospital Readmissions, Electronic Health Records (EHRs), Health Information Technology (HIT)
Dullabh P, Heaney-Huls KK, Chiao AB
Implementation and evaluation of an electronic health record-integrated app for postpartum monitoring of hypertensive disorders of pregnancy using patient-contributed data collection.
This paper describes a pilot intervention of a smartphone app for postpartum monitoring of hypertensive disorders of pregnancy (HDP) that integrates patient-contributed data into electronic health records (EHRs) to support monitoring and clinical decision-making. Results from the pilot evaluation highlighted the resources needed when implementing the app, challenges for integrating an app into the EHR, and the usability and utility of the HDP monitoring app for patient and clinician users. Key observations of the implementation team included the importance of a local clinical champion, more robust patient involvement and support for the remote patient monitoring program, an impetus for EHR developers to adopt data integration standards, and a need to expand the capabilities of the standards to support interventions using patient-contributed data.
AHRQ-funded; 233201500023I.
Citation: Dullabh P, Heaney-Huls KK, Chiao AB .
Implementation and evaluation of an electronic health record-integrated app for postpartum monitoring of hypertensive disorders of pregnancy using patient-contributed data collection.
JAMIA Open 2023 Dec; 6(4):ooad098. doi: 10.1093/jamiaopen/ooad098..
Keywords: Electronic Health Records (EHRs), Maternal Care, Blood Pressure, Telehealth, Health Information Technology (HIT), Women
Hua Y, Wang L, Nguyen V
A deep learning approach for transgender and gender diverse patient identification in electronic health records.
The research described in this article used transgender and gender diverse (TGD) populations as a case study to build an accurate patient gender identity predictive, deep learning model; the goal was to address challenges in identifying relevant patient-level information from electronic health record (EHR) data. Participants were adult patients in a large healthcare system in Boston, MA. The deep learning model significantly outperformed rule-based algorithms. The researchers concluded that future work should evaluate additional diverse data sources for more generalizable algorithms.
AHRQ-funded; HS028916.
Citation: Hua Y, Wang L, Nguyen V .
A deep learning approach for transgender and gender diverse patient identification in electronic health records.
J Biomed Inform 2023 Nov; 147:104507. doi: 10.1016/j.jbi.2023.104507..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Vulnerable Populations
Kukhareva PV, Li H, Caverly TJ
Implementation of lung cancer screening in primary care and pulmonary clinics: pragmatic clinical trial of electronic health record-integrated everyday shared decision-making tool and clinician-facing prompts.
The authors conducted pre- and post-intervention analysis in primary care and pulmonary clinics to explore whether clinician-facing electronic health record (EHR) prompts and an EHR-integrated shared decision-making (SDM) tool designed to support incorporation of SDM into primary care could improve low-dose computer tomography scan imaging ordering and completion. Subjects were patients who met US Preventive Services Task Force criteria for lung cancer screening (LCS). The results indicated that EHR prompts and the EHR-integrated SDM tool were promising approaches to improving LCS in the primary care setting. The authors noted that further research is warranted.
AHRQ-funded; HS026198; HS028791.
Citation: Kukhareva PV, Li H, Caverly TJ .
Implementation of lung cancer screening in primary care and pulmonary clinics: pragmatic clinical trial of electronic health record-integrated everyday shared decision-making tool and clinician-facing prompts.
Chest 2023 Nov; 164(5):1325-38. doi: 10.1016/j.chest.2023.04.040..
Keywords: Cancer: Lung Cancer, Cancer, Screening, Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Shared Decision Making
Ranusch A, Lin YJ, Dorsch MP
Role of individual clinician authority in the implementation of informatics tools for population-based medication management: qualitative semistructured interview study.
The objective of this study was to examine how individual authority of clinical pharmacists and anticoagulation nurses is affected by the implementation success of an electronic health record (EHR) direct oral anticoagulant (DOAC) Dashboard for safe DOAC medication prescribing. Researchers conducted semistructured interviews with pharmacists and nurses after the implementation of the EHR DOAC Dashboard at three clinical sites. Results showed that a high level of individual clinician authority was associated with high levels of key facilitators for effective use of the DOAC Dashboard; conversely, a lack of individual authority was associated with key barriers to effective use. The researchers concluded that increased individual clinician authority is a necessary antecedent to the effective implementation of an EHR DOAC Population Management Dashboard.
AHRQ-funded; HS026874.
Citation: Ranusch A, Lin YJ, Dorsch MP .
Role of individual clinician authority in the implementation of informatics tools for population-based medication management: qualitative semistructured interview study.
JMIR Hum Factors 2023 Oct 24; 10:e49025. doi: 10.2196/49025..
Keywords: Medication, Provider: Pharmacist, Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Nurse, Blood Thinners
Ahmed N, Sanghavi K, Mathur S
Patient portal use: persistent disparities from pre- to post-onset of the COVID-19 pandemic.
This study examined patient portal usage from pre- to post-onset of the COVID-19 pandemic to determine what impact the pandemic had on portal usage by patient sub-populations. The authors included a total of 153,628 unique patients. They assessed patient portal usage from pre-onset (March 2019-February 2020) to post-onset of the COVID-19 pandemic (March 2020-February 2021). They examined usage by patient sub-populations (age, sex, race, ethnicity), comorbid conditions, and health insurance type. Differences were seen in specific patient portal actions. Increases were seen in immunization views (0.43) and health record views (0.43) from post-onset compared to pre-onset. A decrease was noted in prescription renewal (medication) views (-0.07) from pre- to post-onset There was a decrease in both immunization views and health record views among Black patients (-0.07) in comparison to White patients, but an increase in prescription renewal (medication) views (0.07) amongst Black patients compared to White patients.
AHRQ-funded; HS026298.
Citation: Ahmed N, Sanghavi K, Mathur S .
Patient portal use: persistent disparities from pre- to post-onset of the COVID-19 pandemic.
Int J Med Inform 2023 Oct; 178:105204. doi: 10.1016/j.ijmedinf.2023.105204..
Keywords: COVID-19, Disparities, Electronic Health Records (EHRs), Health Information Technology (HIT)
Hendrix N, Bazemore A, Holmgren AJ
AHRQ Author: Eden AR
Variation in family physicians' experiences across different electronic health record platforms: a descriptive study.
This AHRQ-authored study analyzed variation in reported usability and satisfaction of family physicians across different electronic health records (EHRs). Participants included 3358 ABFM-certified family physicians who use an EHR with at least 50 total responding physicians. These physicians were given an Internet-based survey between December 2021 and October 2022. The EHR systems analyzed included: Epic, athenahealth, Practice Fusion, Allscripts, Cerner, Greenway, and eClinical Works. The EHRs with the most satisfaction included athenahealth or Epic, while physicians using Allscripts, Cerner, or Greenway were the least likely to be very satisfied. There was a great variation in satisfaction due to EHR-specific factors: this overall influence explained 48% of variation in the probability of being very satisfied with Epic, 46% with eClinical Works, 14% with athenahealth, and 49% with Cerner.
AHRQ-authored.
Citation: Hendrix N, Bazemore A, Holmgren AJ .
Variation in family physicians' experiences across different electronic health record platforms: a descriptive study.
J Gen Intern Med 2023 Oct; 38(13):2980-87. doi: 10.1007/s11606-023-08169-5..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Physician
Magoc T, Allen KS, McDonnell C
Generalizability and portability of natural language processing system to extract individual social risk factors.
The purpose of this study was to validate the portability and generalizability of a Natural Language Processing (NLP) method to extract individual social factors from clinical notes. More than 6 million notes were processed at the receiving site by the NLP model. The study found that approximately 13,000 and 19,000 were categorized as positive for financial insecurity and housing instability, respectively. The NLP model reflected excellent performance on the validation dataset with all measures over 0.87 for both social factors.
AHRQ-funded; HS028636.
Citation: Magoc T, Allen KS, McDonnell C .
Generalizability and portability of natural language processing system to extract individual social risk factors.
Int J Med Inform 2023 Sep; 177:105115. doi: 10.1016/j.ijmedinf.2023.105115..
Keywords: Social Determinants of Health, Electronic Health Records (EHRs), Health Information Technology (HIT)
Mehta S, Lyles CR, Rubinsky AD
Social determinants of health documentation in structured and unstructured clinical data of patients with diabetes: comparative analysis.
It is not clear how accurately Electronic health records (HER) data reflect patients' lived experience of social determinants of health (SDOH). The process of manually reviewing clinical notes to retrieve SDOH information is not feasible. The purpose of this study was to apply two tools, PatientExploreR and Electronic Medical Record Search Engine (EMERSE), to identify SDOH mappings for structured and unstructured patient data. The researchers included 4,283 adult patients receiving primary care for diabetes at UCSF. The study results revealed that SDOH may be more significant in the lives of patients with diabetes than is evident from structured data recorded on EHRs. When researchers applied EMERSE NLP rules, additional information was uncovered from patient clinical notes on problems related to social connections isolation, employment, financial insecurity, housing insecurity, food insecurity, education, and stress.
AHRQ-funded; HS026383.
Citation: Mehta S, Lyles CR, Rubinsky AD .
Social determinants of health documentation in structured and unstructured clinical data of patients with diabetes: comparative analysis.
JMIR Med Inform 2023 Aug 22; 11:e46159. doi: 10.2196/46159..
Keywords: Social Determinants of Health, Diabetes, Chronic Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT)
Allende-Richter S, Benitez AD, Ramirez M
A patient portal intervention to promote adolescent and young adult self-management skills.
This study’s objective was to examine whether a patient portal educational intervention is acceptable and can improve adolescent and young adult (AYA) self-management skills toward transition readiness to adult care. The authors conducted a single site feasibility study using a mixed research method consisting of 1) a patient portal one-on-one educational intervention with pre- and postsurveys adapted from the Transition Readiness Assessment Questionnaire to assess participant self-management skills and portal user activity; 2) a portal user experience that was assessed through semistructured interviews until thematic saturation was reached. Study participants were 13 to 25 years old and received care at an academic-affiliated community pediatric clinic, of whom 78 (60%) completed the pre- and post-surveys. Following the educational intervention, they observed an increase in participants self-reporting knowing how to access their protected health information and in the proportion of participants self-reporting to strongly agree to know their medication. They also observed an increase in portal user access at 3 weeks. The median number of logins was 2 per participant.
AHRQ-funded; HS000063.
Citation: Allende-Richter S, Benitez AD, Ramirez M .
A patient portal intervention to promote adolescent and young adult self-management skills.
Acad Pediatr 2023 Aug; 23(6):1252-58. doi: 10.1016/j.acap.2023.02.003..
Keywords: Children/Adolescents, Young Adults, Patient Self-Management, Electronic Health Records (EHRs), Health Information Technology (HIT)
Fuery MA, Kadhim B, Samsky MD
Electronic health record embedded strategies for improving care of patients with heart failure.
This article reviews recent findings from randomized clinical trials examining the impact of electronic health record (HER) alerts (called nudges) on quality of care for heart failure patients. These clinical trials demonstrated that some EHR alerts can improve care for heart failure patients. The trials described utilized default options, involved clinicians in the alert design process, provided actionable recommendations, and aimed to minimize disruptions to typical workflow.
AHRQ-funded; HS027626.
Citation: Fuery MA, Kadhim B, Samsky MD .
Electronic health record embedded strategies for improving care of patients with heart failure.
Curr Heart Fail Rep 2023 Aug; 20(4):280-86. doi: 10.1007/s11897-023-00614-0..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Heart Disease and Health, Cardiovascular Conditions, Chronic Conditions
Sparling JL, France D, Abraham J
Handoff Effectiveness Research in periOperative environments (HERO) Design Studio: a conference report.
This conference report reviewed the historical background which led to the Handoff Effectiveness Research in periOperative environments (HERO) Design Studio. The objectives of the HERO Design Studio were to examine the existing literature base, create a national research agenda, and build the research infrastructure necessary to address critical evidence gaps in perioperative handoff quality and safety. The authors described how they prepared for the research conference and synthesized the conference’s results. They also recommended future directions regarding perioperative handoff improvement.
AHRQ-funded; HS027769.
Citation: Sparling JL, France D, Abraham J .
Handoff Effectiveness Research in periOperative environments (HERO) Design Studio: a conference report.
Jt Comm J Qual Patient Saf 2023 Aug; 49(8):422-30. doi: 10.1016/j.jcjq.2023.02.004..
Keywords: Health Information Technology (HIT), Workflow, Transitions of Care, Electronic Health Records (EHRs), Evidence-Based Practice
Kalenderian E, Bangar S, Yansane A
Identifying contributing factors associated with dental adverse events through a pragmatic electronic health record-based root cause analysis.
This study’s objective was to analyze harmful dental adverse events (AEs) to assess potential contributing factors. Harmful AEs were defined as those that resulted in temporary moderate to severe harm, required hospitalization, or resulted in permanent moderate to severe harm. The authors classified potential contributing factors according to (1) who was involved (person), (2) what were they doing (tasks), (3) what tools/technologies were they using (tools/technologies), (4) where did the event take place (environment), (5) what organizational conditions contributed to the event? (organization), (6) patient (including parents), and (7) professional-professional collaboration. A second review was conducted by a blinded panel of dental experts to confirm the presence of an AE. A total of 59 cases at 2 dental institutions had 1 or more harmful AEs. The most common harmful AE was pain (27.1%) followed by nerve injury (16.9%), hard tissue injury (15.2%), and soft tissue injury (15.2%). The most common contribution factor was the care provider (training, supervision, and fatigue at 31.5%) followed by patient ((noncompliance, unsafe practices at home, low health literacy, 17.1%), and professional-professional collaboration (15.3%).
AHRQ-funded; HS027268.
Citation: Kalenderian E, Bangar S, Yansane A .
Identifying contributing factors associated with dental adverse events through a pragmatic electronic health record-based root cause analysis.
J Patient Saf 2023 Aug 1; 19(5):305-12. doi: 10.1097/pts.0000000000001122..
Keywords: Dental and Oral Health, Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Patient Safety
Liberman AL, Wang Z, Zhu Y
Optimizing measurement of misdiagnosis-related harms using Symptom-Disease Pair Analysis of Diagnostic Error (SPADE): comparison groups to maximize SPADE validity.
The purpose of this paper was to clarify features of the Symptom-Disease Pair Analysis of Diagnostic Error (SPADE) approach to accurately measure diagnostic errors to assure that researchers utilize this method to yield valid results, as well as improve the validity of SPADE and related approaches to quantify diagnostic error in medicine. The researchers describe four types of comparators (intra-group and inter-group), detailing the reason for selecting one over the other and conclusions that can be drawn from these comparative analyses.
AHRQ-funded; HS027614.
Citation: Liberman AL, Wang Z, Zhu Y .
Optimizing measurement of misdiagnosis-related harms using Symptom-Disease Pair Analysis of Diagnostic Error (SPADE): comparison groups to maximize SPADE validity.
Diagnosis 2023 Aug 1; 10(3):225-34. doi: 10.1515/dx-2022-0130..
Keywords: Diagnostic Safety and Quality, Medical Errors, Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Sparling JL, Hong Mershon B, Abraham J
Perioperative handoff enhancement opportunities through technology and artificial intelligence: a narrative review.
This narrative review synthesized prior research on electronic tools for perioperative handoffs, limitations of current tools and barriers to their implementation, and use of AI and machine learning in perioperative care. Results showed that several efforts have incorporated electronic tools to improve perioperative handoffs, but were limited by imprecision in selecting handoff elements. AI and machine learning use and integration into handoff workflows were not yet being studied. Existing technology such as mobile applications, barcode scanners, and radio-frequency identification tags to advance perioperative safety were similarly not applied to handoffs.
AHRQ-funded; HS027769.
Citation: Sparling JL, Hong Mershon B, Abraham J .
Perioperative handoff enhancement opportunities through technology and artificial intelligence: a narrative review.
Jt Comm J Qual Patient Saf 2023 Aug; 49(8):410-21. doi: 10.1016/j.jcjq.2023.03.009..
Keywords: Health Information Technology (HIT), Workflow, Transitions of Care, Electronic Health Records (EHRs), Evidence-Based Practice
Ahmed N, Brown J, Parau C
Bridging the digital health divide: characterizing patient portal users and nonusers in the U.S.
The purpose of this study was to 1) review variations in demographics between patient portal users and nonusers; and 2) review variations in health literacy, patient self-efficacy, and technology utilization and attitudes between patient portal users and nonusers. The researchers collected data from Amazon Mechanical Turk (MTurk) workers between December 2021 and January 2022. 489 Participants completed an online survey with questions on their attitudes about media and technology, attitudes about their health, their access to technology, health literacy, patient self-efficacy, and patient portal use. The study results indicated qualitative differences between users and nonusers of patient portals as related to type of neighborhood, income, education, disability status, comorbidity, type of insurance, and the presence or absence of primary care providers. Quantitative results supported the qualitative results, revealing that participants with insurance, a primary care provider, or a disability or comorbid condition had a greater likelihood of having a patient portal account.
AHRQ-funded; HS026298.
Citation: Ahmed N, Brown J, Parau C .
Bridging the digital health divide: characterizing patient portal users and nonusers in the U.S.
Med Care 2023 Jul; 61(7):448-55. doi: 10.1097/mlr.0000000000001869..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Health Literacy
Garber A, Garabedian P, Wu L
Developing, pilot testing, and refining requirements for 3 EHR-integrated interventions to improve diagnostic safety in acute care: a user-centered approach.
This study’s objective was to describe a user-centered approach to develop, pilot test, and refine requirements for 3 electronic health record (EHR)-integrated interventions that target key diagnostic process failures in hospitalized patients. The interventions to be developed were a Diagnostic Safety Column (DSC) within an EHR-integrated dashboard to identify at-risk patients; a Diagnostic Time-Out (DTO) for clinicians to reassess the working diagnosis; and a Patient Diagnosis Questionnaire (PDQ) to gather patient concerns about the diagnostic process. After initial refinement from an analysis, final requirements were created for 10 test cases predicted by the DSC, 18 clinician DTO participants, and 39 PDQ responses including the following: DSC configurable parameters (variables, weights) to adjust baseline risk estimates in real-time based on new clinical data collected during hospitalization; more concise DTO wording and flexibility for clinicians to conduct the DTO with or without the patient present; and integration of PDQ responses into the DSC to ensure closed-looped communication with clinicians. An analysis of focus groups confirmed that tight integration of the interventions with the EHR would be necessary to prompt clinicians to reconsider the working diagnosis in cases with elevated diagnostic error (DE) risk or uncertainty. Potential implementation barriers identified included alert fatigue and distrust of the risk algorithm (DSC); time constraints, redundancies, and concerns about disclosing uncertainty to patients (DTO); and patient disagreement with the care team's diagnosis (PDQ).
AHRQ-funded; HS026613.
Citation: Garber A, Garabedian P, Wu L .
Developing, pilot testing, and refining requirements for 3 EHR-integrated interventions to improve diagnostic safety in acute care: a user-centered approach.
JAMIA Open 2023 Jul; 6(2):ooad031. doi: 10.1093/jamiaopen/ooad031..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Diagnostic Safety and Quality, Patient Safety
Linfield GH, Patel S, Ko HJ
Evaluating the comparability of patient-level social risk data extracted from electronic health records: a systematic scoping review.
This study’s objective was to evaluate how and from where social risk data are extracted from electronic health records (EHRs) for research purposes, and how observed differences may impact study generalizability. A systematic scoping review was conducted of peer-reviewed literature that used patient-level EHR data to assess 1 ± 6 social risk domains: housing, transportation, food, utilities, safety, social support/isolation. The authors found 111 of 9022 identified articles met inclusion criteria. By domain, martial/partner status was most often included, predominantly defined by marital partner status, and extracted from structured sociodemographic data. Structured housing data was extracted most from billing codes and screening tools. Across domains, data were predominantly sourced from structured fields (n = 89/111) versus unstructured free text (n = 32/111).
AHRQ-funded; HS026383.
Citation: Linfield GH, Patel S, Ko HJ .
Evaluating the comparability of patient-level social risk data extracted from electronic health records: a systematic scoping review.
Health Informatics J 2023 Jul-Sep; 29(3):14604582231200300. doi: 10.1177/14604582231200300..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Social Determinants of Health, Risk
Corby S, Ash JS, Florig ST
How providers can optimize effective and Safe Scribe use: a qualitative study.
Providers have begun hiring scribed to address the increase in after-hours and weekend work for providers due to the use of electronic health records. New patient safety risks could be created from the lack of scribe industry standards and the broad variation in how providers and scribes work together. The aim of this secondary analysis study of qualitative data was to describe how providers can optimize the use of scribes safely and effectively. Subject matter experts, providers, informaticians, medical scribes, medical assistants, administrators, social scientists, medical students, and qualitative researchers were included. The study results revealed 3 themes: 1) communication aspects, 2) teamwork efforts, and 3) provider characteristics. Each theme included relevant activities so providers can utilize scribes safely and with a standardized methodology.
AHRQ-funded; HS025141.
Citation: Corby S, Ash JS, Florig ST .
How providers can optimize effective and Safe Scribe use: a qualitative study.
J Gen Intern Med 2023 Jul; 38(9):2052-58. doi: 10.1007/s11606-022-07942-2..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Health Personnel
Narindrarangkura P, Alafaireet PE, Khan U
Predicting suicide attempts among people with diabetes using a large multicenter electronic health records dataset.
This study’s goal was to determine the risk factors for suicidal behaviors of people with diabetes as they have a higher risk than the general population. The authors investigated risk factors and predicted suicide attempts in people with diabetes using the Least Absolute Shrinkage and Selection Operator (LASSO) regression. They used data from Cerner Real-World Data™ and included over 3 million diabetes patients in the study. They analyzed gender-, diabetes-type, and depression-specific LASSO regression models. The study included 7764 subjects diagnosed with suicide attempts with an average age of 45. They found risk factors for suicide attempts in diabetes patients, such as being an American Indian or Alaska Native, atypical agents, benzodiazepines, and antihistamines. Amyotrophy had a negative coefficient for suicide attempts with males with diabetes but had a positive coefficient for females. Using MAOI had a negative coefficient for suicide attempts in T1DM patients. Patients less than 20 years of age had a positive coefficient for suicide in depressed and non-depressed patients with diabetes.
AHRQ-funded; HS028032.
Citation: Narindrarangkura P, Alafaireet PE, Khan U .
Predicting suicide attempts among people with diabetes using a large multicenter electronic health records dataset.
Int J Psychiatry Med 2023 Jul; 58(4):302-24. doi: 10.1177/00912174231162477..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Behavioral Health, Diabetes, Chronic Conditions
Apathy NC, Rotenstein L, Bates DW NC, Rotenstein L, Bates DW
Documentation dynamics: note composition, burden, and physician efficiency.
This study’s objective was to analyze how physician clinical note length and composition relate to electronic health record (EHR)-based measures of burden and efficiency that have been tied to burnout. This cross-sectional study examined EHR metadata capturing physician-level measures from 203,728 US-based ambulatory physicians using the Epic Systems EHR between September 2020 and May 2021. The authors calculated physician-level averages for four measures of interest and assigned physicians to overall note length deciles and note composition deciles from six sources, including templated text, manual text, and copy/paste text. They found that physicians in the top decile of note length demonstrated greater burden and lower efficiency than physicians in the median decile level, spending 39% more time in the EHR after hours and closing 5.6 percentage points fewer visits on the same day. Copy/paste use demonstrated a similar dose/response relationship, with top-decile copy/paste users closing 6.8 percentage points fewer visits on the same day and spending more time in the EHR after hours and on days off. Templated text such as Epic’s SmartTools demonstrated a non-linear relationship with burden and efficiency, with very low and very high levels of use associated with increased EHR burden and decreased efficiency.
AHRQ-funded; HS026116.
Citation: Apathy NC, Rotenstein L, Bates DW NC, Rotenstein L, Bates DW .
Documentation dynamics: note composition, burden, and physician efficiency.
Health Serv Res 2023 Jun; 58(3):674-85. doi: 10.1111/1475-6773.14097..
Keywords: Provider: Physician, Burnout, Electronic Health Records (EHRs), Health Information Technology (HIT)