Author Interviews, Brigham & Women's - Harvard, Electronic Records, JAMA, Pediatrics, Primary Care / 09.07.2021

MedicalResearch.com Interview with: Lisa Rotenstein, MD, MBA Assistant Medical Director Population Health and Faculty Wellbeing Department of Medicine Brigham and Women's Hospital MedicalResearch.com: What is the background for this study? Response: Our previous work in JAMA Internal Medicine demonstrated significant differences in time spent on the electronic health record (EHR) by specialty, and specifically showed that primary care clinicians spent significantly more total and after-hours time on the EHR than surgical and medical specialty counterparts. Primary care clinicians spent twice as long as surgical colleagues on notes, and received more than twice as many messages from team-mates, five times as many patient messages, and fifteen times as many prescription messages each day. Given these findings, the heavy administrative burden placed on primary care clinicians, and previous data about burnout among primary care clinicians, we wanted to better understand differences in time spent on the EHR among the different types of primary care clinicians. (more…)
Education, Electronic Records, Nursing / 10.03.2021

medical-technology-nursingFor many years now, professional nursing has held a unique place in the American health care system. Nurses make up one of the largest health care professions in the U.S. with more than 3.1 million nurses working in diverse fields and settings. Although most nurses work in health care settings like hospitals, a nurse’s expertise expands well beyond the hospital walls. Working on their own and alongside other healthcare professionals, nurses promote the health of families, individuals, and communities. Nurses have always played an important role in healthcare settings. However, their role has changed a lot over the years. In the past, nurses had extraordinarily little formal medical training. In fact, nurses learned the medical skills they needed from their mothers or other women in the nursing profession. Today, the nursing profession has changed for the better. Not only are there extensive training programs available for nurses, but this role now comes with a level of prestige that was not there before. And this is not the only thing that has altered. Technology has also played a huge role in changing this profession for the better. Keep reading below to find out about the history of nursing and how technology has changed the role of nursing. For those seeking additional assistance or support in navigating the complexities of nursing education or academic tasks, exploring resources from reputable nursing paper writing services can offer valuable expertise and assistance in achieving success in the field.

How Nursing Has Changed Over Time

Time has done a lot for many career paths. However, the nursing profession has seen more changes than most. Here are some of the ways the nursing profession has changed over time: Training – in the past, nurses were not required to have any formal education. However, nowadays nurses are no longer able to care for patients without passing the correct certification first. Setting – many years ago, nurses would take care of people in their homes or on the battlefield. Although some nurses still care for patients in their homes, nowadays, most nurses work in a hospital setting. Responsibilities – nursing responsibilities have come a long way from the early days when they used to look a lot like a household chore list. The change in responsibilities for nurses stems from several changes in the profession, including the changing views of women, more comprehensive training, and the growing demand for medical professionals. Culture – in the 20th century, nursing culture was known as being mainly made up of females who had a small amount of medical knowledge. While nursing culture has not changed completely, it has changed a lot over the years. In fact, research suggests that more men than ever are choosing to train in this profession. Patient care – patient care is more important than ever before. The advancements in technology have created an environment that makes patient care more helpful and efficient for patients. These advancements have altered almost every industry in the U.S. and the medical field is no different. (more…)
Abuse and Neglect, Electronic Records, Yale / 15.11.2019

MedicalResearch.com Interview with: Edward R. Melnick, MD, MHS Assistant Professor of Emergency Medicine Program Director, Yale-VA Clinical Informatics Fellowship Program Principal Investigator, EMBED Trial Network Yale School of Medicine New Haven, CT 06519  MedicalResearch.com: What is the background for this study? Response: We know that physicians are frustrated with their EHRs and that EHRs are a driver of burnout. This is the first study to measure these issues nationally. We included a standardized metric of technology from other industries (System Usability Scale, SUS; range 0-100) on the AMA’s 2017 physician burnout survey. This metric has been used in >1300 other studies so we can compare where the EHR’s usability is to other everyday technologies. We are also able to measure the relationship between physicians’ perception of their EHR’s usability and the likelihood they are burned out. (more…)
Author Interviews, Electronic Records, JAMA, Outcomes & Safety / 06.11.2018

MedicalResearch.com Interview with: "Portable Information station, nurse, computer, hand wipes, 9th floor, Virginia Mason Hospital, Seattle, Washington, USA" by Wonderlane is licensed under CC BY 2.0Timothy Ryan PhD This work was performed while Dr. Ryan was at Precera Biosciences, 393 Nichol Mill Lane Frankluin, Tennessee  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The study design is quite simple.  We measured medication concentrations in patients, then compared empirically detected medications with prescribed medications in each patient’s medical record.  We used this information to estimate how many prescribed medications patients had actually taken and how often they took medications that were not in their medical record.  The later comparison is a particularly novel measure of the number and types of medications taken by patients unbeknownst to healthcare providers who use the medical record as a guide to patient care. Further, the test was performed in blood and not urine, so we could obtain an estimate of how often patients were in range for medications that they did take – at least for medications where the therapeutic range for blood concentrations are well established. In sum, we found that patients do not take all of their medications, the medical records are not an accurate indicator of the medications that patients ingest, and that even when taken as prescribed, medications are often out of therapeutic range.  The majority of out-of-range medications were present at subtherapeutic levels.  (more…)
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, 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, 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, Education, Electronic Records, PLoS, UCSF / 17.07.2015

Dr. Courtney Lyles Ph.D. Assistant Professor UCSF School of MedicineMedicalResearch.com Interview with: Dr. Courtney Lyles Ph.D. Assistant Professor UCSF School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Lyles: In our commentary (http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001852), we describe the Meaningful Use program sponsored by the federal government to incentivize healthcare systems to implement electronic health records (EHRs).  This Meaningful Use program also includes financial incentives for healthcare systems who can get substantial proportions of their patient population to access their electronic health records – that is, by logging into an online patient portal website to view medical information like lab results or immunization lists or to perform a healthcare task like requesting a medication refill or messaging their provider.  Because there are billions of dollars at stake in this program for EHR implementation, there is a lot of attention on this issue right now.  Many thought leaders are discussing how we can transform healthcare by digitizing medical information and connecting with patients in their everyday life outside of office or hospital visits.  Portals are key to a lot of changes we might make in healthcare delivery in an attempt to increase convenience and satisfaction for patients.  Perhaps most importantly, these online portal websites are also one of the first health technologies that will be relatively uniformly distributed across healthcare settings, from private doctor’s offices to public clinics/hospitals serving vulnerable patient populations. However, our main message is that we in the medical and healthcare fields should be paying more attention to how patients are able to understand and use the information provided through portal websites.  There is a lot of evidence that patients who have lower education/income, are from racial/ethnic minority groups, or have limited health literacy are significantly less likely to use the existing portal websites.  There is also evidence that portal websites are not extremely usable or accessible, which is an additional barrier for those with communication barriers like lower literacy or limited English proficiency.  Therefore, we don’t want widespread EHR implementation to result in only the most well-resourced individuals gaining the potential benefits of portal access. (more…)
Author Interviews, Electronic Records / 21.02.2015

Rally HealthMedicalResearch.com Interview with: Brian Dolan Chief Strategy and Partner Integration Officer Rally Health MedicalResearch.com Editor’s note: On February 3, 2015, Rally Health launched a New HIPPA compliant Digital Engagement platform that gives consumers the support and tools they need to better manage their health and well-being. Brian Dolan, the Chief Strategy and Partner Integration Officer at Rally Health, was kind enough to answer questions regarding the new health care interface for the readers of MedicalResearch.com. MedicalResearch: What is the background or vision for the Rally Health digital engagement platform? Mr. Dolan: We designed the platform to give consumers the support and tools they need to better manage their health and well-being. Rally leverages the power of personal health data, social networking, and gamification to encourage consumers to take control of their health. Rally’s proven behavior-changing technology encourages consumers to manage their own health by inspiring sustained action and offering intrinsic and extrinsic value-based incentives for engagement. Members can also meet other Rally users for ongoing support and encouragement. With the right balance of social and digital connectivity, Rally Health creates a modern consumer experience that makes getting healthy personal, relevant and fun. (more…)
AHRQ, Author Interviews, Electronic Records, Urinary Tract Infections / 26.08.2014

Craig A Umscheid, MD, MSCE, FACP Assistant Professor of Medicine and Epidemiology Director, Center for Evidence-based Practice Medical Director, Clinical Decision Support Chair, Department of Medicine Quality Committee Senior Associate Director, ECRI-Penn AHRQ Evidence-based Practice Center University of Pennsylvania, Philadelphia, PA 19104MedicalResearch.com Interview with: Craig A Umscheid, MD, MSCE, FACP Assistant Professor of Medicine and Epidemiology Director, Center for Evidence-based Practice Medical Director, Clinical Decision Support Chair, Department of Medicine Quality Committee Senior Associate Director, ECRI-Penn AHRQ Evidence-based Practice Center University of Pennsylvania, Philadelphia, PA 19104 Medical Research: What are the main findings of the study? Dr. Umscheid: We found that targeted automated alerts in electronic health records significantly reduce urinary tract infections in hospital patients with urinary catheters. In addition, when the design of the alert was simplified, the rate of improvement dramatically increased. Approximately 75 percent of urinary tract infections acquired in the hospital are associated with a urinary catheter, which is a tube inserted into the bladder through the urethra to drain urine.  According to the Centers for Disease Control and Prevention, 15 to 25 percent of hospitalized patients receive urinary catheters during their hospital stay. As many as 70 percent of urinary tract infections in these patients may be preventable using infection control measures such as removing no longer needed catheters resulting in up to 380,000 fewer infections and 9,000 fewer deaths each year. Our study has two crucial, applicable findings.  First, electronic alerts do result in fewer catheter-associated urinary tract infections. Second, the design of the alerts is very important. By making the alert quicker and easier to use, we saw a dramatic increase in the number of catheters removed in patients who no longer needed them. Fewer catheters means fewer infections, fewer days in the hospital, and even, fewer deaths. Not to mention the dollars saved by the health system in general. In the first phase of the study, two percent of urinary catheters were removed after an initial “off-the-shelf” electronic alert was triggered (the stock alert was part of the standard software package for the electronic health record). Hoping to improve on this result in a second phase of the study, we developed and used a simplified alert based on national guidelines for removing urinary catheters that we previously published with the CDC. Following introduction of the simplified alert, the proportion of catheter removals increased more than seven-fold to 15 percent. The study also found that catheter associated urinary tract infections decreased from an initial rate of .84 per 1,000 patient days to .70 per 1,000 patient-days following implementation of the first alert and .50 per 1,000 patient days following implementation of the simplified alert. Among other improvements, the simplified alert required two mouse clicks to submit a remove-urinary-catheter order compared to seven mouse clicks required by the original alert. The study was conducted among 222,475 inpatient admissions in the three hospitals of the University of Pennsylvania Health System between March 2009 and May 2012. In patients’ electronic health records, physicians were prompted to specify the reason (among ten options) for inserting a urinary catheter. On the basis of the reason selected, they were subsequently alerted to reassess the need for the catheter if it had not been removed within the recommended time period based on the reason chosen. (more…)
Author Interviews, Baylor College of Medicine Houston, Electronic Records / 21.06.2014

Dr. Hardeep Singh MD, MPH Chief the Health Policy, Quality & Informatics Program Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety Michael E. DeBakey VA Medical Center in Houston, Texas Associate professor at Baylor College of MedicineMedicalResearch.com Interview with: Dr. Hardeep Singh MD, MPH Chief the Health Policy, Quality & Informatics Program Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety Michael E. DeBakey VA Medical Center in Houston, Texas Associate professor at Baylor College of Medicine MedicalResearch: What are the main findings of the study? Dr. Singh: EHRs use can prompt new patient safety concerns, and many of these problems are complex and difficult to detect. We sought to better understand the nature of these patient safety concerns and reviewed 100 closed investigations involving 344 technology-related incidents arising between 2009 and 2013 at the Department of Veterans Affairs (VA). We evaluated safety concerns related to technology itself as well as human and operational factors such as user behaviors, clinical workflow demands, and organizational policies and procedures involving technology. Three quarters of the investigations involved unsafe technology while the remainder involved unsafe use of technology. Most (70%) investigations identified a mix of 2 or more technical and/or non-technical underlying factors. The most common types of safety concerns were related to the display of information in the EHR; software upgrades or modifications; and transmission of data between different components of the EHR system. (more…)
Author Interviews, BMJ, Electronic Records / 08.06.2014

Dr David A Hanauer MD MS Department of Pediatrics University of Michigan Medical School Ann Arbor, MIMedicalResearch.com Interview with: Dr David A Hanauer MD MS Department of Pediatrics University of Michigan Medical School Ann Arbor, MI   MedicalResearch: What are the main findings of the study? Dr. Hanauer: In this study we analyzed requests made by patients who wanted to make changes to their medical record. The goal was to develop an understanding of what the main reasons were for making a request to change the medical record, and what types of information they wanted changed. One of the main findings was that about half of all requests were ultimately approved.  This suggests that patients reviewing their records can detect errors and have them corrected, which could ultimately lead to a more accurate record for a patient. In essence, giving patients the opportunity to further participate in their care by allowing them to review their record can lead to the identification and correction of errors or omissions. (more…)
Author Interviews, BMJ, Cost of Health Care, Electronic Records / 13.02.2014

Dr Sarah Slight, School of Medicine Pharmacy and Health, Wolfson Research Institute University of Durham, United Kingdom.MedicalResearch.com Interview with; Dr Sarah Slight, School of Medicine Pharmacy and Health, Wolfson Research Institute University of Durham, United Kingdom. MedicalResearch.com: What are the main findings of the study? Dr. Slight: Our study identified four main cost categories associated with the implementation of EHR systems, namely: infrastructure (e.g., hardware and software), personnel (e.g., project management and training teams), estates / facilities (e.g., furniture and fittings), and other (e.g., consumables and training materials). Many factors were felt to impact on these costs, with different hospitals choosing varying amounts and types of infrastructure, diverse training approaches for staff, and different software applications to integrate with the new system. (more…)
Annals Internal Medicine, Author Interviews, Electronic Records / 10.01.2014

Robert S. Rudin, Ph.D. Associate Policy Researcher RAND Corporation 20 Park Plaza, Suite 920 Boston, MA 02116MedicalResearch.com Interview with: Robert S. Rudin, Ph.D. Associate Policy Researcher RAND Corporation Boston, MA 02116 MedicalResearch.com: What are the main findings of the study? Dr. Rudin: We found that most published health IT implementation studies report positive effects on quality, safety, and efficiency. Most evaluations focus on clinical decision support and computerized provider order entry. However, not all studies report equally positive results, and differences in context and implementation are one likely reason for these varying results, yet details of context and implementation are rarely reported in these studies. (more…)