Browsing by Subject "Electronic Health Records"

Now showing 1 - 8 of 8
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    Athletic Training Students' Academic Preparation in Healthcare Documentation
    (2015-05) Brugge, Amy
    Documentation is fundamental to all patient encounters across health professions, including athletic trainers. The athletic training education competencies delineate five competencies and one clinical integration proficiency specific to documentation knowledge, skills, and abilities. There is little research regarding athletic training students� preparation in performing patient documentation and suggestion that recent graduates and employers have identified the domain of healthcare administration as a perceived deficit in professional preparation. A descriptive study was undertaken to ascertain students� reports of their preparation in healthcare documentation in didactic, laboratory, and clinical education. The purpose of this study was to examine the ways in which final-year athletic training students report having received instruction, having rehearsed, and having been assessed on the documentation-related competencies in athletic training. An electronic survey was sent to final-year athletic training students across the United States currently enrolled in professional programs accredited by the Commission on Accreditation of Athletic Training Education (CAATE). A 16.9% response rate was obtained via 185 survey participants. These participants were from all ten districts of the National Athletic Trainers’ Association. Findings suggest that final-year students report appropriate levels of instruction, rehearsal, and assessment of their knowledge and skills in medical terminology and the security, privacy, and confidentiality of medical records, but that foundational knowledge in the use of procedural and diagnostic coding and performance of third party reimbursement activities may be lacking. Only 7% of final-year students reported having used their documentation to communicate with insurers and bill for services. Additionally, students enrolled in professional programs at the post-baccalaureate degree level reported the inclusion of academic electronic health records in didactic coursework at statistically significant greater level than their baccalaureate degree peers. Athletic training educators should consider the timing and placement of documentation-related competencies in program curricula in order to allow for adequate instruction, rehearsal reinforced through clinical education experiences, and appropriate assessment of documentation knowledge, skills, and abilities prior to graduation. The future of the athletic training profession is dependent upon a workforce that excels in documentation in order to support outcomes-based clinical research and successfully obtain payment for services rendered.
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    Chronic Kidney Disease: Evaluating Area Level Socioeconomic Characteristics, Individual Characteristics, and Patterns of Care by Census Tract in the Twin Cities Metro Area
    (2020-04) Ghazi, Lama
    Chronic kidney disease (CKD) is a major public health problem that affects 15% of the United States adult population. CKD is asymptomatic until advanced stages; therefore, diagnosis and treatment are usually delayed. CKD has been shown to be associated with low socioeconomic status (SES). Disadvantaged socioeconomic populations have a disproportionate burden of CKD and have contributed to the growing CKD epidemic. This dissertation characterizes the interplay between neighborhood characteristics and CKD using the Fairview Health Services electronic health record (EHR) database, a large health system in Minnesota that services the Twin Cities metro area and surrounding communities. For all manuscripts, we used census tracts as our geographical unit of analysis. Data for census tract was obtained from the American Community Survey 5-year data [2008-2012]. We linked each patients’ residence, obtained from their EHR data, to the appropriate census tract and tract characteristics. We defined a low and high SES tract as belonging to the first and fourth quartile, respectively of the distribution of each census tract SES measure in the metropolitan area. In the first manuscript, we evaluated whether adding neighborhood SES to current screening recommendations – patients with hypertension and/or diabetes - improves the sensitivity and/or specificity for detecting CKD. Overall, CKD was prevalent in 13% of our cohort (2008-2019). Additional screening of patients who live in low neighborhood SES improved our sensitivity but decreased our specificity to detect CKD compared to current screening recommendations. In the second manuscript, we examine: 1) if there is an independent association of neighborhood SES and individual insurance type with CKD prevalence and 2) association of neighborhood racial composition, a measure of racial segregation, with CKD prevalence. We observed that patients living in low vs. high SES neighborhood had higher CKD prevalence. Moreover, for patients <65 years being on Medicaid compared to other insurance was associated with higher CKD prevalence. We found no association between neighborhood racial composition (percent blacks in tracts) and CKD prevalence. The third manuscript explores whether neighborhood SES is associated with quality of care received by patients with CKD. Interestingly, we found that quality of care measures (prescribing appropriate medications, testing for proteinuria, or documenting CKD in patients’ charts) are not associated with neighborhood SES. However, overall adherence to CKD guidelines is low (for example, only 27% of patients with CKD had their proteinuria level evaluated). Overall, area SES contributes to CKD burden among patients seen at Fairview Health Services. In the future, health systems may want to consider a multifactorial approach, including neighborhood characteristics and a patient’s individual level SES, to improve detection and management of CKD.
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    Developing a Predictive Model for Hospital-Acquired Catheter-Associated Urinary Tract Infections Using Electronic Health Records and Nurse Staffing Data
    (2016-08) Park, Jung In
    There are a number of clinical guidelines and studies about hospital-acquired catheter-associated urinary tract infections (CAUTIs), but the rate of CAUTI occurrence is still rising. Hospitals are focusing on preventing hospital-acquired CAUTI, as the Centers for Medicare and Medicaid Services (CMS) does not provide payment for hospital-acquired infections anymore. There is a need to explore additional factors associated with hospital-acquired CAUTI and develop a predictive model to detect patients at high risk. This study developed a predictive model for hospital-acquired CAUTIs using electronic health records (EHRs) and nurse staffing data from multiple data sources. Research using large amounts of data could provide additional knowledge about hospital-acquired CAUTI. The first aim of the study was to create a quality, de-identified dataset combining multiple data sources for machine learning tasks. To address the first aim of the study, three datasets were combined into a single dataset. After integrating the datasets, data were cleaned and prepared for analysis. The second aim of the study was to develop and evaluate predictive models to find the best predictive model for hospital-acquired CAUTI. For the second aim of the study, three predictive models were created using the following data mining method: decision trees (DT), logistic regression (LR), and support vector machine (SVM). The models were evaluated and DT model was determined as the best predictive model for hospital-acquired CAUTI. The findings from this study have presented factors associated with hospital-acquired CAUTI. The study results demonstrated that female gender, old adult (≥56), Charlson comorbidity index score ≥ 3, longer length of stay, glucose lab result > 200 mg/dl, present of rationale for continued use of catheter, higher percent of direct care RNs with associate’s degree in nursing, less total nursing hours per patient day, and lower percent of direct care RNs with specialty nursing certification was related to CAUTI occurrence. Implications for future research include the use of different analytic software to investigate detailed results for LR model, adding more factors associated with CAUTI in modeling, using a larger sample with more patients with CAUTI, and patient outcomes research using nursing-sensitive indicators. This study has important implications for nursing practice. According to the study results, nurse specialty certification, nurse’s education at the baccalaureate level or higher, and more nursing hours per patient day were associated with better patient outcomes. Therefore, considerable efforts are needed to promote possession of nurse specialty certification and higher level of nursing education, as well as enough supply of nursing workforce.
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    Essays on Meaningful Use of Electronic Health Records in Physicians
    (2023-06) Zhou, Jiani
    Meaningful use of electronic health records (EHR), characterized by the use of certified EHR technology to enhance the safety, quality, and efficiency of care, plays a crucial role in optimizing EHR functionalities for facilitating care coordination and health information exchange. Despite the widespread adoption of EHR as a result of the EHR incentive program, a large proportion of physicians continue to struggle with meeting meaningful use criteria. While literature has extensively examined the facilitating conditions and barriers to EHR use, limited research has focused on social influence, a key construct in the technology acceptance model that determines physicians’ intention to use and behavior in utilizing technologies. Given significant fragmentation of the healthcare system, it is important to understand the role of meaningful use in the context of coordination and transitions of care. The lack of empirical evidence in this domain creates a knowledge gap regarding the effectiveness of the EHR incentive program and the meaningful use standards it established.This dissertation comprises three empirical studies that collectively contribute to the understanding of meaningful use of EHR in office-based physicians, providing insights into the challenges and benefits associated with meaningful use and its implementation. The first two chapters delve into the factors that influence physicians’ meaningful use practices. Specifically, the first chapter studies the association between physician relationships and meaningful use performance, and the second chapter seeks to understand whether switching to different EHR vendors hinders physicians’ achievement of meaningful use requirements. The third chapter shifts the focus towards the downstream impact of meaningful use, assessing its association with patient sharing between physicians. Chapter 1 estimates the association of physician network structure with physicians’ performance on meaningful use criteria in 2016. The analysis employs social network analysis techniques and data from the DocGraph HOP Teaming file to construct physician patient-sharing networks at the hospital referral regions level. We calculate a set of measures that characterize the centrality and density of physician networks. We focus on meaningful use criteria that were designed to enhance care efficiency and coordination between physicians. The findings indicate that physicians who were more connected with other physicians or occupied a central position within their networks tended to demonstrate better performance on electronic prescribing and patient electronic access criteria. In contrast, physicians situated within densely interconnected networks were more likely to exhibit poorer performance on these two criteria, suggesting that the isolated local networks may diminish physicians’ perceived usefulness of EHR. These findings contribute to the understanding of the variation in meaningful use across physicians and suggest that future interventions may leverage physician interaction relationships to promote the utilization of EHR functionalities for effective care coordination. Chapter 2 assesses the association of switching EHR vendors with physicians’ meaningful use between 2011 and 2016. We use a difference-in-differences study design to disentangle the heterogeneous effect of vendor switching over time and across physicians who switched vendors at different time points. The findings demonstrate a persistent negative impact of vendors switching on physicians’ meaningful use achievement. Notably, physicians in small practices were particularly vulnerable to the negative effect of vendor switching. These findings speak to the need for ongoing support during vendor switching period and the importance of interoperability across vendors to attain sustained, advanced use of EHR. Chapter 3 investigates the relationship between meaningful use and patient sharing between physicians in stage 2 of the incentive program that aimed to improve care coordination through enhanced exchange and reconciliation of health information. The requirements for health information exchange and patient electronic access may reduce the time and financial costs associated with seeking care from differential physicians, thereby diminishing physicians’ monopoly power and patient sharing with others. We construct a panel of physician pairs who shared patients between 2014 and 2016 and compare the change in the number of patients shared between physician pairs across three groups: neither physician, only one physician, and both physicians achieving meaningful use. We also analyze the moderating effects of physician type and market conditions. The findings indicate a positive association between joint meaningful use achievement and patient sharing, particularly in unaffiliated physicians. The moderating effect of market concentration level highlights the deterrent effect of competitive pressures on patient and information sharing between physicians. These findings supplement existing research on the realized benefits of meaningful use of EHR and highlight the necessity for customized incentives that address competition concerns to encourage patient and information sharing in competitive market environments.
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    Interview with Donald Connelly
    (2015-04-01) Connelly, Donald; Tobbell, Dominique
    Donald Connelly begins by discussing his educational background, including his early interest in biomedical computing. He describes his first years in the Department of Laboratory Medicine and Pathology including the state of computing in laboratories in the 1970s, the atmosphere of the Department, and his experiences as director of the Laboratory Data Division and acting director of the Outpatient Laboratory. Next, Dr. Connelly discusses his experiences as a Ph.D. student in the Division of Health Computer Sciences. He goes on to describe his early research developing ways to graphically display laboratory data to clinicians, and his subsequent research with Theodore Thompson, MD, to develop a clinical workstation for the University of Minnesota’s Neonatal Intensive Care Unit. He also describes his work developing an automated decision support system for blood bank personnel assessing requests for platelets. Dr. Connelly next discusses the courses he taught in the Division of Health Computer Sciences; the National Library of Medicine Training Grant programs; and the interdisciplinarity and interprofessionalism of health informatics. He reflects upon the leadership of Eugene Ackerman and Laël Gatewood, the challenges each faced due to the lack of strong institutional support for the Division of Health Computer Sciences, and the increased status of health informatics within the University following the establishment of the Clinical and Translational Science Institute. He also discusses his experiences directing the Division of Health Computer Sciences. Dr. Connelly briefly discusses the relationships between the Division of Health Computer Sciences and the Mayo Clinic, the Biomedical Library, and the Minnesota Department of Health. He next discusses work that he has done in the area of electronic health records. Dr. Connelly goes on to discuss the establishment of the Institute for Health Informatics; the directorship of Julie Jacko; and the establishment of the Master’s in Health Informatics. Finally, Dr. Connelly reflects on some of the major changes he has in health informatics observed over his career.
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    Patient Use of the Electronic Communication Portal in Management of Type 2
    (2015-06) Peremislov, Diana
    The high incidence and prevalence of Type 2 Diabetes require urgent attention to the management of this chronic disease. Previous studies present the advantages of e-communication via the patient portal to access Electronic Medical Records (EMR) by patients. The purpose of this study was to explore e-communication between patients with Type 2 Diabetes and their providers within the patient portal in one of the Midwest healthcare systems. The study employed a qualitative design, based on the use of content analysis methods. Conversation Theory served as the theoretical framework. A purposive, random sample of 90 charts of patients with Type 2 Diabetes in a Midwestern health system was subjected to a retrospective review of the e-communication within the patient portal. The sample consisted of patients between the ages of 50 and 70, the majority of whom were White, Non-Hispanic, English-speaking, and married. Patients were described as receiving good care, with the mean duration of Diabetes at 8.41 years. Patients were also relatively experienced in using the patient portal. The three main themes that emerged in the e-communication via patient portal were the Inform Theme, the Question Theme, and the Instruct/Request Theme. The Inform theme was the most frequently identified; the Instruct/Request Theme was mainly used in initiation of e-communication. The Question Theme was the least frequently observed of the three themes in e-message encounters. The fit with Conversation Theory revealed that most of the staff-initiated e-message encounters fit within the monolog type, while most of the patient-initiated e-message encounters fit within the dialogue type. Dialectic and construction types of conversation were very rare. Limitations of the study include the bias of the researcher, and lack of certain data in EMR. There is a need to develop standardized templates for Type 2 Diabetes e-communication via patient portal to capture complete data from the patients, and to promote diabetes education via patient portal using a construction type of conversation. Healthcare system guidelines should include information about the initiation and the use of e-communication via patient portal, and specifically target engaging patients who are not meeting desired diabetes care outcomes.
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    TRUST: Clinical Text Retrieval and Use towards Scientific Rigor and Transparent Process
    (2021-12) Fu, Sunyang
    Rapid proliferation and adoption of the electronic health record (EHR) has led to seamless integration of clinical research into practice, and has facilitated healthcare decision-making through enabling accurate and timely supply of health information. Leveraging this supply of information, the Institute of Medicine envisioned the concept of continuously Learning Health Systems (LHS) in 2007, with the aim of first deriving knowledge from routine care data and then translating such knowledge into evidence-based clinical practice. To achieve such a vision, it is critical to have a robust data and informatics infrastructure with the following properties: 1) high-throughput and real-time methods for data retrieval, extraction, and analysis, 2) transparent and reproducible processes to ensure scientific rigor in clinical research, and 3) implementable and generalizable scientific findings. There are many approaches to the derivation of knowledge from care data, one of which is through the use of chart review: a common, albeit manual, approach to practice-based knowledge discovery. Traditionally, chart review is performed by manually reviewing patient medical records. As a significant portion of clinical information is represented in textual format, this manual approach can be time-consuming and costly. With the implementation of EHRs, chart review can be automated by extracting data from structured fields systematically and leveraging natural language processing (NLP) techniques to extract information from text. Rigorous development and evaluation of NLP algorithms for a specific chart review task requires, however, data abstraction and annotation (i.e., the manual creation of a gold standard clinical corpus to evaluate the developed NLP algorithm). In EHR-based settings, there is, however, a lack of standard processes or best practices for creating such a corpus due to the heterogeneity of institutional EHR systems and process variation between single and multi-site research settings. Recent advancement in healthcare AI identifies the need for detailed data provenance for data used in the training and validation of AI models. Secondary use of EHR for clinical research leveraging AI technologies such as NLP therefore requires the documentation of the provenance information relating to the process used for the retrieval and organization of the raw data used as well as the extraction and annotation of training data. We thus define this process as clinical Text Retrieval and Use towards Scientific rigor and Transparent (TRUST) process. As EHR-based research becomes increasingly integrated into clinical care, it is important to have a systematic understanding of the TRUST process, its corresponding utilization when developing informatics tools and methods, as well as its overall impact on research reproducibility. In this work, we propose a multi-phase method to develop informatics frameworks and best practices to ensure reproducible TRUST processes for single and multi-site studies. In the following chapters, we propose: 1) a definition of reproducibility in the context of the secondary use of EHRs, 2) methods to assess various levels of data heterogeneity caused by differing EHR systems and inter-institutional variations, 3) approaches to examine the implication of data heterogeneity to reproducibility, 4) steps to develop frameworks, best practices, and reporting standards conforming to the TRUST process, and 5) an application of the TRUST process in a real-world case study.
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    Understanding clinician information demands and synthesis of clinical documents in electronic health record systems.
    (2012-06) Farri, Oladimeji Feyisetan
    Large quantities of redundant clinical data are usually transferred from one clinical document to another, making the review of such documents cognitively burdensome and potentially error-prone. Inadequate designs of electronic health record (EHR) clinical document user interfaces probably contribute to the difficulties clinicians experience while processing patient-specific information during time-constrained patient encounters. Furthermore, the continuous need for clinicians to review multiple EHR clinical documents during the typical out-patient visit increases the likelihood of overloading their working memory in the short duration available for complex cognitive activities related to patient care. In a collection of three studies incorporating fundamental principles in clinical informatics, cognitive psychology and human-computer interaction, the think-aloud protocol, combined with other qualitative and quantitative methodologies, was utilized to investigate cognitive processes associated with clinicians' synthesis of EHR clinical documents, the impact of time restrictions on these processes, and implementing a novel visualization tool to enhance processing of these documents during patient care. These studies serve to fill fundamental knowledge gaps in our understanding of how clinicians interact with EHR systems when using clinical documents and can help future EHR system user interface design for clinical documentation with the ultimate goal of improving patient care and clinician satisfaction with these systems.