Author Interviews, Cost of Health Care, Duke, Electronic Records, JAMA / 21.02.2018

MedicalResearch.com Interview with: Barak Richman JD, PhD Bartlett Professor of Law and Business Administration Duke University  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The US not only has the highest health care costs in the world, we have the highest administrative costs in the world. If we can reduce non-value added costs like the ones we document, we can make substantial changes in the affordability of health care without having to resort to more draconian policy solutions. Our paper finds that administrative costs remain high, even after the adoption of electronic health records.  Billing costs, for example, constituted 25.2% of professional revenue for ED departments and 14.5% of revenue for primary care visits.  The other numbers are captured below. (more…)
Author Interviews, Electronic Records, Emergency Care / 09.02.2018

MedicalResearch.com Interview with: Shannon Toohey, MD, MAEd Associate Residency Director, Emergency Medicine Assistant Clinical Professor, Emergency Medicine University of California, Irvine Editor-in-Chief Journal of Education and Teaching in Emergency Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Electronic prescriptions (e-prescriptions) are now the predominant form of prescription used in the US. Concern has been raised that this form of prescription may be more difficult for emergency department (ED) patients to utilize than traditional printed prescriptions, given the unplanned nature of most ED visits at all times of day. While there are disincentives for physicians who choose not to use them, many emergency physicians are still concerned that it could decrease compliance in their patients. This study evaluated prescription compliance in insured patients at a single center. In our studied population, we found that patients were as equally likely to fill paper and e-Prescriptions. (more…)
Author Interviews, Electronic Records, Technology / 08.02.2018

MedicalResearch.com Interview with: http://www.timicoin.io/Will Lowe, Timicoin CEO Mr. Lower discusses the first cryptocurrency blockchain mobile platform for storing medical records that can be safely accessed from anywhere. MedicalResearch.com: What is the background for this announcement? Would you briefly explain what is meant by blockchain technology? How does it allow for more efficient storage and transmittal of encrypted medical records? Response: We do not store the data on any cloud storage to avoid any threat to data security and server overhead for data processing as well as to avoid temporary potential data unavailability. When a certain kind of data is queried by the consumer, our cloud engine first passes on the query to each of the providers (our gateway applications that are running on their node) and see if there are enough query results, it shows a sample to the consumer and if consumer decides to pay, it creates a Blockchain channel between the providers and the consumer that queried the data and all the provider nodes propagate the queried data onto that channel. So a common trust is built between the nodes and the consumer on that Blockchain channel and the shared query stays there as the trust builder. Then the consumer can anytime access the data needed from that blockchain channel. (more…)
Author Interviews, Dermatology, Electronic Records / 29.01.2018

MedicalResearch.com Interview with: “Computer” by FullCodePress is licensed under CC BY 2.0Matilda W. Nicholas, MD, PhD Duke Dermatology Durham, North Carolina MedicalResearch.com: What is the background for this study? Response: I have found many physicians overwhelmed by the electronic messaging feature in Electronic Health Record systems (EHRs). I found there was very little published about this phenomenon, particularly for specialists. So, we set out to take a look at the volume and effect these systems have.  MedicalResearch.com: What are the main findings?  Response: We found that, on average, clinicians receive 3.24 messages per patient visit, for an average of about 50 messages per full day of clinic. The number of messages also correlated with poor reported work life balance for dermatologists. (more…)
ASCO, Author Interviews, Cancer Research, Electronic Records, University Texas / 29.10.2017

MedicalResearch.com Interview with: Dr. Ali Haider, MBBS MD Assistant Professor, Department of Palliative Care and Rehabilitation Medicine Division of Cancer Medicine The University of Texas MD Anderson Cancer Center Houston, TX  MedicalResearch.com: What is the background for this study? Response: Patients with chronic and serious illnesses such as cancer often experience high physical and psychosocial symptoms. Recent studies have reported association of physicians' examination room computer use with less face to face interactions and eye contact. It's important for the clinicians to look for certain physical cues to better understand the well being of their patients. Therefore we conducted this randomized clinical trial to understand patients perception of physicians compassion, communication skills and professionalism with and without the use of examination room computer. (more…)
Author Interviews, Electronic Records, Heart Disease, JAMA / 06.09.2017

MedicalResearch.com Interview with: Rohan Khera MD Division of Cardiology University of Texas Southwestern Medical Center Texas  MedicalResearch.com: What is the background for this study? What are the main findings? Response: An increasing number of studies have used administrative claims (or billing) data to study in-hospital cardiac arrest with the goal of understanding differences in incidence and outcomes at hospitals that are not part of quality improvement initiatives like the American Heart Association’s Get With The Guidelines-Resuscitation (AHA’s GWTG-Resuscitation). These studies have important implications for health policies and determining targets for interventions for improving the care of patients with this cardiac arrest, where only in 1 in 5 patient survive the hospitalization. Therefore, in our study, we evaluated the validity of such an approach. We used data from 56,678 patients in AHA’s GWTG-Resuscitation with a confirmed in-hospital cardiac arrest, which were linked to Medicare claims data. We found: (1)  While most prior studies have used a diagnosis or procedure code alone to identify cases of in-hospital cardiac arrest, we found that the majority of confirmed cases in a national registry (AHA’s GWTG-Resuscitation) would not be captured using either administrative data strategy. (2)  Survival rates using administrative data to identify cases from the same reference population varied markedly and were 52% higher (28.4% vs. 18.7%) when using diagnosis codes alone to identify in-hospital cardiac arrest. (3)  There was large hospital variation in documenting diagnosis or procedure codes for patients with in-hospital cardiac arrest, which would have consequences for using administrative data to examine hospital-level variation in cardiac arrest incidence or survival, or conducting single-center studies to validate this administrative approach. (more…)
Author Interviews, Electronic Records, General Medicine / 28.07.2017

MedicalResearch.com Interview with: Macda Gerard M.D. Candidate | Class of 2021 Wayne State University School of Medicine MedicalResearch.com: What is the background for this study? Response: As electronic health records proliferate, patients are increasingly asking for their health information but little is known about how patients use that information or whether they encounter errors in their records. This comes at a time when we’re learning that understanding the patient and family experience, especially what is most valued in exchanges between doctors and patients is important and has many benefits. To learn more, we developed a formal mechanism for patients to provide feedback on what they like about accessing the information in their health records and to inform their clinical team about things like inaccuracies and perceived errors. So that’s the gap we tried to fill. The patient feedback tool is linked to the visit note in the electronic health record (EHR), and it’s part of a quality improvement initiative aimed at improving safety and learning what motivates patients to engage with their health information on the patient portal. Over the 12-month pilot period, 260 patients and care partners provided feedback using the OpenNotes patient feedback tool. Nearly all respondents found the tool to be valuable and about 70 percent provided additional information regarding what they liked about their notes and the feedback process. (more…)
Author Interviews, Electronic Records, JAMA, UCSF / 05.07.2017

MedicalResearch.com Interview with: Neda Ratanawongsa, MD, MPH Associate Chief Health Informatics Officer for Ambulatory Services, San Francisco Health Network Associate Professor, Division of General Internal Medicine UCSF Center for Vulnerable Populations Physician, Richard H. Fine People's Clinic (RHPC) Zuckerberg San Francisco General Hospital San Francisco, CA 94110 MedicalResearch.com: What is the background for this study? What are the main findings? Response: U.S. federal incentives allowed many safety net healthcare systems to afford fully functional electronic health record systems (EHRs). Although EHRs can help clinicians provide care to vulnerable populations, clinicians may struggle with managing the EHR workload, particularly in resource-limited settings. In addition, clinicians’ use of EHRs during clinic visits may affect how they communicate with patients. There are two forms of EHR use during clinic visits.  Clinicians can multitask, for example, by ordering laboratory tests while chatting with a patient about baseball.  However, like distracted driving, using EHRs while talking with increases risks – in this case, the risk of errors in patient-provider communication or in the EHR task. Alternatively, clinicians can use EHRs in complete silence, which may be appropriate for high-risk tasks like prescribing insulin. However, silence during visits has been associated with lower patient satisfaction and less patient-centered communication. So we studied how primary and specialty care clinicians used EHRs during visits with English- and Spanish-speaking patients in a safety net system with an EHR certified for Centers for Medicare & Medicaid Services meaningful use incentive programs. We found that multitasking EHR use was more common than silent EHR use (median of 30.5% vs. 4.6% of visit time). Focused patient-clinician talk comprised one-third of visit time. We also examined the transitions into and out of silent EHR use. Sometimes clinicians explicitly stated a need to focus on the EHR, but at times, clinicians drifted into silence without warning. Patients played a role in breaking silent EHR use, either by introducing small talk or by bringing up their health concerns. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Electronic Records, Infections / 21.05.2017

MedicalResearch.com Interview with: Faheem Guirgis MD Assistant Professor of Emergency Medicine Department of Emergency Medicine Division of Research UF Health Jacksonville MedicalResearch.com: What is the background for this study? What are the main findings? Response: Sepsis is quite prevalent among hospitals and the incidence is increasing. It is a life-threatening disease that can lead to poor outcomes if patients are not recognized and treated promptly. We recognized that our institution needed a strategic approach to the problem of sepsis, therefore the Sepsis Committee was created with the goal of creating a comprehensive sepsis program. We developed a system for sepsis recognition and rapid care delivery that would work in any area of the hospital. We found that we reduced overall mortality from sepsis, the number of patients requiring mechanical ventilation, intensive care unit length and overall hospital length of stay, and the charges to the patient by approximately $7000 per patient. (more…)
Author Interviews, Education, Electronic Records, JAMA, Johns Hopkins / 06.04.2017

MedicalResearch.com Interview with: Ge Bai, PhD, CPA Assistant Professor The Johns Hopkins Carey Business School Washington, DC 20036 MedicalResearch.com: What is the background for this study? What are the main findings? Response: We examined the hospital data breaches between 2009 and 2016 and found that larger hospitals and hospitals that have a major teaching mission have a higher risk of data breaches. (more…)
Author Interviews, Clots - Coagulation, Electronic Records, JAMA, NYU, Surgical Research / 23.03.2017

MedicalResearch.com Interview with: Zachary Borabm, Research fellow Hansjörg Wyss Department of Plastic Surgery NYU Langone Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Recent studies have shown that health care providers perform poorly in risk stratifying their patients for venous thromboembolism (VTE) which leads to inadequate VTE prophylaxis delivery, especially in surgical patients. Computerized Clinical Decision Support Systems (CCDSSs) are programs integrated into an electronic health record that have the power to aid health care providers. Using a meta-analysis study technique we were able to pool data from 11 studies, including 156,366 patients that either had CCDSSs intervention or routine care without CCDSSs. Our main outcome measures were the rate of prophylaxis for VTE and the rate of actual VTE events. We found that CCDSSs increased the rate of VTE prophylaxis (odds ratio 2.35, p<0.001) and decreased the risk of VTE events (risk ratio 0.78, p<0.001). (more…)
Author Interviews, Electronic Records / 17.03.2017

MedicalResearch.com Interview with: Neil Smiley CEO of Loopback Analytics MedicalResearch.com: What is the background for Loopback Analytics? What are the problems Loopback Analytics is attempting to mitigate? Response: Loopback Analytics (Loopback) is a Software-as-a-Service company that provides event-driven population health management. Founded in 2009, Loopback integrates and manages diverse data sources to support predictive analytics and intervention solutions to address health reform reimbursement challenges with the goal of achieving the Triple Aim – better care, better health and lower costs. Loopback enabled intervention solutions address key challenges associated with value-based care, such as reducing avoidable hospitalizations, high emergency department utilization, medication adherence and optimization of post-acute care networks. (more…)
AHRQ, Author Interviews, Electronic Records, Outcomes & Safety / 08.03.2017

MedicalResearch.com Interview with: Michael Furukawa, Ph.D. Senior Economist Agency for Healthcare Research and Quality  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Despite some progress, patient safety remains a serious concern in U.S. health care delivery, particularly in acute care hospitals. In part to support safety improvement, the Health Information Technology for Economic and Clinical Health (HITECH) Act promoted widespread adoption and use of certified electronic health record technology. To meet Meaningful Use (MU) requirements in the law, hospitals are required to adopt specific capabilities, such as computerized physician order entry, which are expected to reduce errors and promote safer care. We found that, after the HITECH Act was made law, the occurrence of in-hospital adverse drug events (ADEs) declined significantly from 2010 to 2013, a decline of 19%. Hospital adoption of medication-related MU capabilities was associated with 11% lower odds of ADEs occurring, but the effects did not vary by the number of years of experience with these capabilities. Interoperability capability was associated with 19% lower odds of adverse drug events occurring. Greater exposure to MU capabilities explained about one-fifth of the observed reduction in ADEs. (more…)
Author Interviews, Electronic Records, Opiods, Pain Research / 07.03.2017

MedicalResearch.com Interview with: Michelle S. Keller, MPH, PhD Candidate Health Policy and Management Cedars-Sinai Los Angeles CA 90048 MedicalResearch.com: What is the background for this new funding award? Response: Research shows that treating and managing chronic pain is tough, and it can be hard for patients and their physicians to be on the same page. Chronic pain touches so many facets of people’s lives—relationships, mental health, sleep, work—that treating it in a 15-minute visit can lead to a lot of frustration and disappointment. Our hope is that by arming patients and clinicians with evidence-based tools, we can help foster a better dialogue about what is ultimately important to patients, how to achieve fully functional lives while managing chronic pain. We’re testing two different types of communication tools: electronic health record alerts pointing physicians to guidelines when they write opioid prescriptions and patient portal-based tools that can help patients prepare for visits and become active, engaged partners in their care. (more…)
Author Interviews, Electronic Records, Mental Health Research / 04.03.2017

MedicalResearch.com Interview with: Steven K. Dobscha, M.D. Professor, Department of Psychiatry, OHSU Director, VAPORHCS Center to Improve Veteran Involvement in Care Oregon Health & Science University MedicalResearch.com: What is the background for this study?  Response: Several health care systems across the United States now offer patients online access to all of their clinical notes (sometimes referred to as progress notes) through electronic health record portals; this type of access has been referred to as OpenNotes (see www.opennotes.org for more information on the national OpenNotes initiative). Veterans have been able to use OpenNotes in the Veterans Health Care (VHA) system since 2013. However, some individuals have expressed concern that online access to clinical notes related to mental health could cause some patient harms. We are conducting a VA-funded research project with several objectives: 1) to examine benefits and unintended negative consequences of OpenNotes use as perceived by veterans receiving VHA mental health care and by VHA mental health clinicians, and 2) to develop and evaluate brief web-based courses designed to help veterans and clinicians use OpenNotes in ways that optimize Veteran-clinician collaboration and minimize unintended consequences. (more…)
Annals Internal Medicine, Author Interviews, Education, Electronic Records / 30.01.2017

MedicalResearch.com Interview with: Dresse Nathalie Wenger Cheffe de clinique FMH médecine interne Département de Médecine Interne CHUV - Lausanne  MedicalResearch.com: What is the background for this study? Response: The structure of a residents’ working day dramatically changed during the last decades (limitation of working hours per week, wide implementation of electronic medical records (EMR), and growing volume of clinical data and administrative tasks), especially in internal medicine with increasing complexity of patients. Electronic Medical Records (EMR) have some positive effects but negative effects have been also described ie more time writing notes, more administrative works, and less time for communication between physicians and patients. Few time motion studies have been published about the resident's working day in Internal Medicine: the impact of the computer, and what really do the residents do during their work, especially the time spent with the patient versus the computer, as now the EMRs are widely implemented. Previous studies have been mostly performed in the US, so we decided to conduct one observational and objective study in Europe. (more…)
Author Interviews, Brain Injury, Cost of Health Care, CT Scanning, Electronic Records, Emergency Care, Kaiser Permanente / 25.01.2017

MedicalResearch.com Interview with: Adam L. Sharp MD MS Research Scientist/Emergency Physician Kaiser Permanente Southern California Kaiser Permanente Research Department of Research & Evaluation Pasadena, CA 91101 MedicalResearch.com: What is the background for this study? Response: Millions of head computed tomography (CT) scans are ordered annually in U.S. emergency Departments (EDs), but the extent of avoidable imaging is poorly defined. Ensuring appropriate use is important to ensure patient outcomes and limited resources are optimized. A large number of stake holders have highlighted the need to reduce “unnecessary” CT scanning as part of their recommendations for the Choosing Wisely campaign. However, despite calls for improved stewardship, the extent of avoidable CT use among adults with minor trauma in community EDs is not known. The Canadian CT Head Rule (CCHR) is perhaps the most studied of many validated decision instruments designed to assist providers in evaluating patients with minor head trauma. This study aims to describe the scope of overuse of CT imaging by ED providers in cases where application of the CCHR could have avoided imaging. Secondarily, we sought to describe the extent to which avoidable CTs, if averted, would have resulted in “missed” intracranial hemorrhages requiring a neurosurgical intervention. (more…)
Author Interviews, Electronic Records, Endocrinology, Thyroid, Thyroid Disease / 25.01.2017

MedicalResearch.com Interview with: Ilya Likhterov, MD Assistant Professor, Otolaryngology Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? What are the main findings? Response: As our understanding of thyroid cancer improves, the way these patients are diagnosed and treated is changing. It is difficult for clinicians to incorporate every individual scientific study into their practice. These studies are numerous and the results can be conflicting. To address this difficulty, organizations such as the American Thyroid Association (ATA) create summary recommendations that account for the latest research and translate it into a format that is easily usable for physicians. Such clinical practice guidelines are available not just for thyroid cancer care, but in many other fields. The difficulty however, is how to ensure that clinicians have access to the guidelines and incorporate the recommendations into their practice. There are a number of barriers to actually using the guidelines in practice, and we attempt to identify strategies on how to overcome these. (more…)
Author Interviews, Electronic Records, Genetic Research, Heart Disease, Lipids, Science / 25.12.2016

MedicalResearch.com Interview with: Michael F. Murray MD Geisinger Health System Danville, PA 17822 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The DiscovEHR cohort was formed as a result of a research collaboration between Geisinger Health System and Regeneron Pharmaceuticals. There are over 50,000 patient participants in the cohort who have volunteered to have their de-identified genomic sequence data linked to their de-identified EHR data for research purposes. We report in this paper findings around the identification of 229 individuals (1:256) with pathogenic or likely pathogenic variants in one of the three genes (LDLR, APOB, PCSK9) associated with Familial Hypercholesterolemia (FH). The study found that these individuals are unlikely to carry a diagnosis of FH and are at risk for early coronary artery disease. (more…)
Author Interviews, Dermatology, Electronic Records, JAMA, Outcomes & Safety, Surgical Research / 08.12.2016

MedicalResearch.com Interview with: Sophia Akhiyat M.D. Candidate, Class of 2017 The George Washington University School of Medicine and Health Sciences METEOR Fellowship MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our study was inspired by one of Choudhry et al,1 in which patients' preferences for skin biopsy result disclosure was surveyed at melanoma clinics affiliated with several academic institutions. We sought to broaden participant inclusion criteria by evaluating patients' preferences at a general dermatology clinic at an academic center. Our findings support that the highest ranked patient-preferred method for receiving skin biopsy results was through an online portal. Patients also reported that the most important factors when selecting a modality for communication were the amount of information given and time available to discuss results. We also observed a relationship between a younger patient age range and online portal experience as well as a preference for biopsy notification via online portal. 1Choudhry A, Hong J, Chong K, et al. Patients' Preferences for Biopsy Result Notification in an Era of Electronic Messaging Methods. JAMA Dermatol. 2015;151(5):513-521. (more…)
Author Interviews, Electronic Records, Geriatrics, Pharmacology / 29.11.2016

MedicalResearch.com Interview with: Jashvant Poeran MD PhD Assistant Professor Dept. of Population Health Science & Policy Icahn School of Medicine at Mount Sinai New York, NY MedicalResearch.com: What is the background for this study? Response: Falls are an important patient safety issue among elderly patients and may lead to extended hospitalization and patient harm. Particularly important in elderly patients are high risk drugs such as sleep medications which are known to increase fall risk and should be dosed lower in elderly patients. In this study we looked at patients aged 65 years or older who fell during hospitalization. We found that in 62%, patients had been given at least one high risk medication that was linked to fall risk, within 24 hours before their fall. Interestingly, we found that also a substantial proportion of these medications were given at doses higher than generally recommended for elderly patients. (more…)
Author Interviews, Diabetes, Electronic Records / 04.11.2016

MedicalResearch.com Interview with: Lee Kallenbach, PhD, MPH Principal Investigator Practice Fusion MedicalResearch.com: What is the background for this study? Response: Clinical inertia, or the tendency for patients and providers to continue using the same course of treatment even when clinical markers may suggest that treatment intensification is necessary, is an ongoing factor that can contribute to inadequate diabetes care. This is especially true when the treatment intensification may involve a switch from an oral medication to an injectable medication. It is less challenging for a patient to take a pill than it is to give themselves a shot. Even with all the new diabetes treatments available, clinical inertia is still common among patients with uncontrolled type 2 diabetes (T2D). To further understand the extent of clinical inertia among patients with T2D, the study assessed treatment intensification patterns and associated demographic and clinical characteristics for patients with uncontrolled T2D who were already taking two or more oral anti-diabetes medications. The study consisted of a retrospective observational analysis leveraging data from Practice Fusion’s de-identified clinical database, which includes more than 38 million records, representing 6.7 percent of all practices across the United States.1 Using a cohort of 25,365 de-identified records, we studied the care given by providers in independent practices to patients in need of intensifying their antidiabetic therapy for managing T2D. To our knowledge, this is one of the largest real world evidence (RWE) studies of T2D that has leveraged a de-identified clinical database from an electronic health record (EHR) platform. (more…)
Author Interviews, Beth Israel Deaconess, Electronic Records, HIV / 31.10.2016

MedicalResearch.com Interview with: Douglas Krakower, MD Infectious Disease Division Beth Israel Deaconess Medical Center Boston, MA, MedicalResearch.com: What is the background for this study? What are the main findings? Response: There are 45,000 new HIV infections in the US annually, so effective HIV prevention strategies are needed. HIV pre-exposure prophylaxis (PrEP), whereby a person who is HIV-uninfected uses an HIV treatment medication on a daily basis to protect themselves from becoming infected with HIV, is over 90% effective when taken with high adherence. The Centers for Disease Control and Prevention estimates that there are 1.2 million Americans who are likely to benefit from using PrEP. However, only 80,000 persons have been prescribed PrEP. One of the barriers to implementing PrEP is that clinicians face challenges with identifying persons who are most likely to benefit from PrEP, given infrequent sexual health history assessments during routine clinical care. We thus sought to develop an automated algorithm that uses structured data from electronic health records (EHRs) to identify patients who are most likely to benefit from using PrEP. Our methods included extracting potentially relevant EHR data for patients with incident HIV and without HIV from nearly a decade of EHR data from a large ambulatory practice in Massachusetts. We then used machine learning algorithms to predict HIV infection in those with incident HIV and those without HIV. We found that some algorithms could offer clinically useful predictive power to identify persons who were more likely to become infected with HIV as compared to controls. When we applied these algorithms to the general population and identified a subset of about 1% of the population with risk scores above an inflection point in the total distribution of risk scores; these persons may be appropriate for HIV testing and/or discussions about PrEP. (more…)
Author Interviews, Electronic Records, JAMA, NYU, Technology / 07.10.2016

MedicalResearch.com Interview with: Saul Blecker, MD, MHS Department of Population Health New York University Langone School of Medicine, New York, NY 10016 [email protected] MedicalResearch.com: What is the background for this study? What are the main findings? Response: The identification of conditions or diseases in the electronic health record (EHR) is critical in clinical practice, for quality improvement, and for clinical interventions. Today, a disease such as heart failure is typically identified in real-time using a “problem list”, i.e., a list of conditions for each patient that is maintained by his or her providers, or using simple rules drawn from structured data. In this study, we examined the comparative benefit of using more sophisticated approaches for identifying hospitalized patients with heart failure. (more…)
Author Interviews, Blood Pressure - Hypertension, Electronic Records, Heart Disease, Primary Care / 18.08.2016

MedicalResearch.com Interview with: Tom Marshall, PhD, MRCGP, FFPH Professor of public health and primary care Institute of Applied Health Research University of Birmingham Edgbaston, Birmingham MedicalResearch.com: What is the background for this study? What are the main findings? Response: Shortly before the Health Checks programme began, a programme of targeted case finding was set up in Sandwell in the West Midlands. In general practices in the area a programme nurse searched electronic medical records to identify untreated patients at high risk of cardiovascular disease. The nurse then invited high risk patients for assessment in the practice and those who needed treatment were referred to their GP for further action. This was implemented in stages across 26 general practices, allowing it to be evaluated as a stepped wedge randomised controlled trial. The programme was successful, resulting in a 15.5% increase in the number of untreated high risk patients started on either antihypertensives or statins. (more…)
Author Interviews, Brigham & Women's - Harvard, Electronic Records, JAMA, Outcomes & Safety / 04.08.2016

MedicalResearch.com Interview with: Stephanie Mueller, MD MPH FHM Division of General Medicine Brigham and Women's Hospital Boston, MA 02120 MedicalResearch.com: What is the background for this study?  Response: Failures in communication among healthcare personnel are known threats to patient safety, and occur all too commonly during times of care transition, such as when patient care responsibility is transferred from one provider to another (i.e., handoff). Such failures in communication put patients at risk for adverse outcomes. (more…)
Author Interviews, Electronic Records, JAMA, Primary Care / 16.03.2016

MedicalResearch.com Interview with: Daniel R. Murphy MD MBA Assistant Professor - Interim Director of GIM at Baylor Clinic Department of Medicine Health Svc Research & General Internal Medicine Baylor College of Medicine Houston, TX, US MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Murphy: Electronic health records (EHRs) have enabled a large number of messages to be transmitted to physicians each day, including new types of messages that were not present in the pre-EHR era. Lack of support and policies to assist physicians with this workload creates opportunities for important information, such as abnormal tests results, to be missed among the vast amount of other information. We found that primary care physicians (PCPs) at three clinics using commercial EHRs received an average of 77 messages per day, of which only about 20% were test results. Specialists received an average of 29 total messages per day. Extrapolating time needed to process these messages from prior work suggests that PCPs would require an average of 67 minutes per day to process these messages. (more…)
Author Interviews, Compliance, Electronic Records, Kaiser Permanente, Technology / 12.02.2016

MedicalResearch.com Interview with: Shayna L. Henry, PhD Postdoctoral Research Fellow Department of Research & Evaluation Kaiser Permanente Southern California Medical Research: What is the background for this study? What are the main findings? Dr. Henry: In this study, we analyzed the electronic health records of 838,638 Kaiser Permanente members in Southern California. We decided to conduct this study because Kaiser Permanente always strives to advance standards of excellence for care, and even with all the outreach resources available to health care providers and staff, gaps in preventive care still arise. It can be hard to get patients engaged in managing their preventive care, because there are so many tasks for them to keep track of – many of which don’t happen on a very regular basis. Online patient portals have been very useful at helping patients get more engaged in their care, but patients still have to make the first move, and put all the pieces together. Our tool, the Online Personal Action Plan (oPAP), puts our members’ health status and preventive and chronic care tasks in a single dashboard, and alerts them via email to their upcoming care needs, prompting them to log in, view their upcoming health care tasks such as annual vaccinations, tests and blood draws for chronic conditions, and routine cancer screenings, and make the necessary medical appointments to close those gaps in care. We wanted to better understand if having access to the oPAP tools was associated with a higher likelihood of taking care of those outstanding health care tasks in a timely manner. We found that members who used oPAP were more likely to get a mammogram, Pap smear, receive colorectal cancer screenings, and more likely to complete HbA1c testing for diabetes within 90 days of their coming due compared to members who were not registered on our patient portal.   (more…)
AHRQ, Author Interviews, Electronic Records, Outcomes & Safety / 11.02.2016

MedicalResearch.com Interview with: Mr. Noel Eldridge Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality Medical Research: What is the background for this study? What are the main findings? Mr. Eldridge: We used existing data on adverse events from the Medicare Patient Safety Monitoring System, which AHRQ, CMS, and Qualidigm have been analyzing for years, and focused on the question as to whether rates of the adverse event measures were higher or lower in patients whose charts indicated that they had been treated with a full electronic health record (EHR) or a partial EHR during their inpatient stay. The main finding was that the adverse event rates were lower in the full EHR patients. We saw three different diagnosis groups of patients (cardiovascular, pneumonia, and major surgery), and looked at combined rates for all adverse event types, as well as for four combined subtypes separately: hospital-acquired infections, adverse drug events, post-procedural events, and falls and pressure ulcers combined. Not all of our findings were what people unfamiliar with our measures would have expected. (more…)
Author Interviews, Education, Electronic Records, JAMA / 08.12.2015

MedicalResearch.com Interview with: David Ouyang MD Department of Internal Medicine Stanford University School of Medicine Stanford, California Medical Research: What is the background for this study? What are the main findings? Dr. Ouyang: In American teaching hospitals, trainee resident physicians are an integral part of the medical team in performing procedures, writing notes, and coordinating care. As more care is being facilitated by electronic medical record (EMR) systems, we are just now finally able to understand how much residents work and how residents spend their time. In our study, we examined the types and timing of electronic actions performed on the EMR system by residents and found that residents spend about a third (36%) of their day in front of the computer and frequently perform many simultaneous tasks across the charts of multiple patients. Additionally, residents often do work long hours, with a median of 69.2 hours per week when on the inpatient medicine service. (more…)