Author Interviews, Duke, Electronic Records, Health Care Systems, JAMA / 20.04.2021

MedicalResearch.com Interview with: Eugenia McPeek Hinz MD MS FAMIA Associate CMIO - DHTS Duke University Health System MedicalResearch.com: What is the background for this study? Response: Clinician burnout rates have hovered around 50% for much of the past decade.  Burnout is a significant concern in healthcare for its effects on care givers and associated downstream adverse implications on patient care for quality and safety. The ubiquitous presence of Electronic Health Records (EHR) along with the increased clerical components and after hours use has been a significant concern for contributing to provider burnout.  (more…)
Author Interviews, Electronic Records, Race/Ethnic Diversity, Social Issues / 22.09.2020

MedicalResearch.com Interview with: Hailey Miller, PhD, RN Postdoctoral Associate Duke University School of Nursing Stephen P. Juraschek, MD PhD Beth Israel Deaconess Medical Center MedicalResearch.com: What is the background for this study?   Response: Digital tools, such as the electronic medical record (EMR), are increasingly utilized to identify and recruit participants for clinical trials. These strategies offer a strong opportunity to increase recruitment yields, however, our previous work has demonstrated that patient portal users are disproportionately White, and therefore utilizing these strategies may contribute to the under-representation of Black Americans in clinical research. This study examined multiple recruitment strategies, including EMR-based strategies and other non-EMR strategies, such as community mailing, Facebook advertisement and newspaper advertisement, to understand if recruitment strategies influenced the demographic composition of trial participants. Given our previous finding that patient portal users are disproportionately White, one of our EMR-based strategies included postal mailing to individuals without a patient portal. (more…)
Author Interviews / 13.05.2020

MedicalResearch.com Interview with: Celine Latulipe PhD Associate Professor University of Manitoba MedicalResearch.com: What is the background for this study? What are the main findings? Response: We wanted to find out how many hospitals offer proxy accounts for caregivers of adult patients. Most patient portal systems allow proxy accounts for parents of pediatric patients, so we know the underlying systems support the creation of proxy accounts. When we were starting this research, the two big healthcare systems where I was located did NOT offer such proxy accounts for caregivers of adult patients, and a staff person at one of those hospitals suggested adult patients share their passwords with their caregiver, if the caregiver needed access to the portal. As a computer scientist, I am well aware of the security and privacy risks associated with password sharing, and I was appalled by this advice. So we did this survey across the US and we found that 45% of the staff contacted in our study gave similar password sharing advice. This is hugely problematic. Caregivers using a patient's password means the caregiver can see everything in the medical record, including things the patient might not want the caregiver to know, such as past diagnoses of stigmatized illnesses, substance abuse or reproductive health decisions. Also, because password re-use is common across systems, a caregiver with a patient's portal password may now have access to the patient's online banking. (more…)
Author Interviews, Compliance, Electronic Records, JAMA, University of Pennsylvania / 05.03.2020

MedicalResearch.com Interview with: Alexander C. Fanaroff, MD, MHS Assistant Professor of Medicine, Division of Cardiovascular Medicine University of Pennsylvania MedicalResearch.com: What is the background for this study? Response: This is a secondary analysis of the ARTEMIS, a cluster randomized trial of copayment assistance for P2Y12 inhibitors in patients that had myocardial infarction. One of the primary endpoints of ARTEMIS was persistence with P2Y12 inhibitors: Did the patient continue to take a P2Y12 inhibitor over the entire 1 year following MI? In ARTEMIS, we captured persistence data in two ways, patient report and pharmacy fill records. What we did in this study was to look at the agreement between persistence as measured by these two methods. (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…)
Allergies, Author Interviews, Electronic Records / 13.11.2019

MedicalResearch.com Interview with: Sonam Sani MD Allergy & Immunology Fellow NYU Winthrop Hospital MedicalResearch.com: What is the background for this study? Response: Penicillin allergy label removal is becoming more common. Studies have shown that while 10% of the general population report an allergy to penicillin, after testing only 1% truly have an allergy. Allergists have the ability to evaluate patient’s for penicillin allergy by performing skin tests and oral challenges. However, even when people test negative for penicillin allergy, they still face barriers to having the label removed. We are noting more and more that despite having negative testing, upon further encounters, our patients still have their penicillin allergy label. (more…)
Annals Internal Medicine, Author Interviews, Electronic Records / 24.09.2019

MedicalResearch.com Interview with: John (Xuefeng) Jiang PhD Professor and Plante Moran Faculty Fellow Eli Broad College of Business Accounting & Information Systems Michigan State University East Lansing, MI MedicalResearch.com: How did you get interested in this issue? Response: This is the third project of our data breach trilogy. We first examined which healthcare providers (focusing on hospitals) more likely suffer from a data breach. We documented large hospitals, despite their resources, are more likely to experience a data breach. Some hospitals experienced multiple incidents (https://jamanetwork.altmetric.com/details/18464149). The findings made us wonder what happened? Besides size, what other factors contribute to data breaches? Based on detailed event descriptions, we documented the circumstances under which each data breach occurred (https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2715158). We found more than half of data breaches could be attributed to healthcare providers’ internal mistakes or negligence (e.g., forgot to encrypt laptop computers, used cc instead of bcc in emailing patients, didn’t revoke former employees’ login credentials after employment terminated) rather than external forces (e.g., hacking). We also found mobile devices (e.g. laptop computers, usb drives) are associated with most data breaches than paper records or network servers. Our results suggest if healthcare providers strengthen their internal control and limit the use of mobile device might be effective ways to reduce data breach risks.  (more…)
Author Interviews, Electronic Records / 02.07.2019

MedicalResearch.com Interview with: Ming Tai-Seale, PhD, MPH Professor Department of Family Medicine and Public Health University of California San Diego School of Medicine  MedicalResearch.com: What is the background for this study? Response: The electronic health record (EHR) potentially creates a 24/7 work environment for physicians. Its impact on physicians’ wellness has become a challenge for most health care delivery organizations. Understanding the relationships between physicians’ well-being and “desktop medicine”1 work in the EHR and work environment is critical if burnout is to be addressed more effectively. (more…)
Author Interviews, Electronic Records, JAMA, Pediatrics, Primary Care / 07.05.2019

MedicalResearch.com Interview with: Cari McCarty, PhD Research Professor, UW Investigator, Seattle Children’s Research Institute  MedicalResearch.com: What is the background for this study? Response: Adolescence is a time when teens begin to take charge of their health, but it is also a time when they can be prone to health risk behaviors, such as insufficient physical activity, poor sleep, and substance use. We were interested in whether using an electronic health risk screening tool in primary care settings could improve healthcare and health for adolescents.  The tool was designed to provide screening as well as motivational feedback directly to adolescents, in addition to clinical decision support for the healthcare clinician.  We conducted a trial with 300 adolescent patients where one group received the screening tool prior to their health checkup, and the other group received usual care. (more…)
Author Interviews, Electronic Records / 06.12.2018

MedicalResearch.com Interview with: Rebekah L Gardner MD Associate Professor of Medicine Warren Alpert Medical School Brown University Providence, Rhode Island MedicalResearch.com: What is the background for this study? What are the main findings? Response: Burnout profoundly affects physicians, their patients, and the health care system.The role of technology in physician burnout, specifically health information technology (HIT), is not as well characterized as some of the other factors. We sought to understand how stress related to HIT use predicts burnout among physicians. Our main findings are that 70% of electronic health record (EHR) users reported HIT-related stress, with the highest prevalence in primary care-oriented specialties. We found that experiencing HIT-related stress independently predicted burnout in these physicians, even accounting for other characteristics like age, gender, and practice type. In particular, those with time pressures for documentation or those doing excessive “work after work” on their EHR at home had approximately twice the odds of burnout compared to physicians without these challenges. We found that physicians in different specialties had different rates of stress and burnout. (more…)
Author Interviews, Cost of Health Care, JAMA, Kaiser Permanente, Primary Care / 17.09.2018

MedicalResearch.com Interview with: Richard W. Grant MD MPH Research Scientist III, Kaiser Permanente Division of Resarch Adjunct Associate Professor, UCSF Dept Biostatistics & Epidemiology Director, Kaiser Permanente Delivery Science Fellowship Program Co-Director, NIDDK Diabetes Translational Research post-doctoral training program MedicalResearch.com: What is the background for this study? Response: Primary care in the United States is in a state of crisis, with fewer trainees entering the field and more current primary care doctors leaving due to professional burnout. Changes in the practice of primary care, including the many burdens related to EHR documentation, has been identified as a major source of physician burnout. There are ongoing efforts to reduce physician burnout by improving the work environment. One innovation has been the use of medical scribes in the exam room who are trained to enter narrative notes based on the patient-provider interview. To date, there have only been a handful of small studies that have looked at the impact of medical scribes on the provider’s experience of providing care. (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, 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, 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, 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…)
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…)
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, 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, 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, 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…)
Author Interviews, Electronic Records / 24.09.2015

MedicalResearch.com Interview with: Lara Varpio, PhD Associate Professor, Department of Medicine Acting Associate Director, Graduate Programs in Health Professions Education Uniformed Services University of the Health Sciences Bethesda MD and Dr. Judy Rashotte PhD Director Nursing Research and Knowledge Translation Consultant   Ottawa Canada Medical Research: What is the background for this study? Drs. Varpio and Rashotte: Electronic health records (EHRs) are being adopted in healthcare centers around the world. The patient record is intricately implicated in care processes, clinical reasoning activities, and in collaborative work. As part of a larger study aimed at understanding how EHRs impact health professionals’ interprofessional collaborative practice (ICP), we explored how changing from a paper chart to an EHR can impact clinical reasoning. Medical Research: What are the main findings? Drs. Varpio and Rashotte: Our research demonstrated how different parts of the patient record (i.e. communication genres / artefacts) are part of the contextual factors that influence clinical reasoning and ICP. A key finding of our study is that building the patient’s story is an essential part of clinical reasoning activities. Making and understanding data interconnections is facilitated when clinicians are actively engaged in assembling isolated data bits into contextually-derived, comprehensive, and comprehensible ensembles. Building the patient’s story is facilitated through the use of a chronologically-organized textual narrative (i.e. free-text notations) structure and structures that promote visual bundles of clinical data. The use of an EHR can problematize clinicians’ ability to build the patient’s story and to disseminate it with other members of the care team when data interconnections are fragmented. Fragmentation happens when narrative spaces are dispersed and/or character-limited, and when data displays are not chronologically organized in visual assemblies. The constraint of chronologically and contextually isolated data inhibits clinicians’ ability to read the why and how interpretations of clinical activities from other team members. When an EHR splinters narrative reports, there is a loss of shared interprofessional understanding of the patient’s story, and time efficient care delivery can be compromised. (more…)
Author Interviews, Electronic Records, Outcomes & Safety, Surgical Research, UCSD / 09.11.2014

MedicalResearch.com Interview with: Jamie Anderson MD MPH Department of Surgery University of California, San Diego Medical Research: What is the background for this study? What are the main findings? Dr. Anderson: Risk adjustment is an important component of outcomes and quality analysis in surgical healthcare. To compare two hospitals fairly, you must take into account the “risk profile” of their patients. For example, a hospital operating on predominately very sick patients with multiple co-morbidities would be expected to have different outcomes to a hospital operating on relatively healthier patients with fewer co-morbidities. Somewhat counter-intuitively, it is possible that a hospital with a 10% mortality rate may be better than a hospital with 5% mortality rate when you adjust for the risk of the patient population. Currently, the “gold standard” database to evaluate surgical outcomes is the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), which includes a number of variables on each patient to perform risk adjustment. However, collecting these variables is costly and time consuming. There is also concern that risk adjusted benchmarking systems can be “gamed” because they include data elements that require subjective interpretation by hospital personnel. With the widespread adoption of electronic health records, the aim of this study was to determine whether a number of objective data elements already used for patient care could perform as well as a traditional, full risk adjustment model that includes other provider-assessed and provider-recorded data elements. We tested this hypothesis with an analysis of the NSQIP database from 2005-2010, comparing models that adjusted for all 66 pre-operative risk variables captured by NSQIP to models that only included 25 objective variables. These results suggest that rigorous risk adjusted surgical quality assessment can be performed relying solely on objective variables already captured in electronic health records. (more…)
Author Interviews, CMAJ, Diabetes, Electronic Records / 04.11.2014

Dr. Tim A. Holt PhD MRCP FRCGP NIHR Academic Clinical Lecturer University of Oxford Department of Primary Care Health Sciences Radcliffe Observatory Quarter Woodstock Road OxfordMedicalResearch.com Interview with: Dr. Tim A. Holt PhD MRCP FRCGP NIHR Academic Clinical Lecturer University of Oxford Department of Primary Care Health Sciences Radcliffe Observatory Quarter Woodstock Road Oxford Medical Research: What is the background for this study? Dr. Holt: Undiagnosed diabetes is a serious and very costly problem. Early diagnosis is important to reduce risk of long term complications. A structured approach to management at the practice level involves electronic diabetes registers, enabling audit of care, automated recall, and screen reminders. Such registers depend on the presence of an electronic code for diabetes in the record.  (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…)
Annals Internal Medicine, Author Interviews, Electronic Records, Outcomes & Safety / 05.06.2014

Lisa M. Kern, MD, MPH, FACP Associate Professor of Healthcare Policy and Research and of Medicine Associate Director for Research, Center for Healthcare Informatics and Policy Deputy Director, Health Information Technology Evaluation Collaborative Weill Cornell Medical College New York, NY 10065MedicalResearch.com Interview with: Lisa M. Kern, MD, MPH, FACP Associate Professor of Healthcare Policy and Research and of Medicine Associate Director for Research, Center for Healthcare Informatics and Policy Deputy Director, Health Information Technology Evaluation Collaborative Weill Cornell Medical College New York, NY 10065 MedicalResearch: What are the main findings of the study? Dr. Kern: We found that primary care physicians participating in Patient-Centered Medical Homes (PCMHs) improved their quality of care over time at a significantly higher rate than their non-PCMH peers. (more…)