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Hwang TS, Thomas M, Hribar M, Chen A, White E. The Impact of Documentation Workflow on the Accuracy of the Coded Diagnoses in the Electronic Health Record. OPHTHALMOLOGY SCIENCE 2024; 4:100409. [PMID: 38054107 PMCID: PMC10694743 DOI: 10.1016/j.xops.2023.100409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/15/2023] [Accepted: 09/29/2023] [Indexed: 12/07/2023]
Abstract
Objective To determine the impact of documentation workflow on the accuracy of coded diagnoses in electronic health records (EHRs). Design Cross-sectional study. Participants All patients who completed visits at the Casey Eye Institute Retina Division faculty clinic between April 7, 2022 and April 13, 2022. Main Outcome Measures Agreement between coded diagnoses and clinical notes. Methods We assessed the rate of agreement between the diagnoses in the clinical notes and the coded diagnosis in the EHR using manual review and examined the impact of the documentation workflow on the rate of agreement in an academic retina practice. Results In 202 visits by 8 physicians, 78% (range, 22%-100%) had an agreement between the coded diagnoses and the clinical notes. When physicians integrated the diagnosis code entry and note composition, the rate of agreement was 87.9% (range, 62%-100%). For those who entered the diagnosis codes separately from writing notes, the agreement was 44.4% (22%-50%, P < 0.0001). Conclusion The visit-specific agreement between the coded diagnosis and the progress note can vary widely by workflow. The workflow and EHR design may be an important part of understanding and improving the quality of EHR data. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Thomas S. Hwang
- Casey Eye Institute, Oregon Health and Science University, Portland, OR
| | - Merina Thomas
- Casey Eye Institute, Oregon Health and Science University, Portland, OR
| | - Michelle Hribar
- Casey Eye Institute, Oregon Health and Science University, Portland, OR
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR
| | - Aiyin Chen
- Casey Eye Institute, Oregon Health and Science University, Portland, OR
| | - Elizabeth White
- Casey Eye Institute, Oregon Health and Science University, Portland, OR
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Altman RL, Lin CT, Earnest M. Problem-oriented documentation: design and widespread adoption of a novel toolkit in a commercial electronic health record. JAMIA Open 2023; 6:ooad005. [PMID: 36751467 PMCID: PMC9897179 DOI: 10.1093/jamiaopen/ooad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/16/2022] [Accepted: 01/25/2023] [Indexed: 02/05/2023] Open
Abstract
Background Problem-oriented documentation is an accepted method of note construction which facilitates clinical thought processes. However, problem-oriented documentation is challenging to put into practice using commercially available electronic health record (EHR) systems. Objective Our goal was to create, iterate, and distribute a problem-oriented documentation toolkit within a commercial EHR that maximally supported clinicians' thinking, was intuitive to use, and produced clear documentation. Materials and Methods We used an iterative design process that stressed visual simplicity, data integration, a predictable interface, data reuse, and clinician efficiency. Creation of the problem-oriented documentation toolkit required the use of EHR-provided tools and custom programming. Results We developed a problem-oriented documentation interface with a 3-column view showing (1) a list of visit diagnoses, (2) the current overview and assessment and plan for a selected diagnosis, and (3) a list of medications, labs, data, and orders relevant to that diagnosis. We also created a series of macros to bring information collected through the interface into clinicians' notes. This toolkit was put into a live environment in February 2019. Over the first 9 months, the custom problem-oriented documentation toolkit was used in a total of 8385 discrete visits by 28 clinicians in 13 ambulatory departments. After 9 months, the go-live education and EHR optimization teams in our health system began promoting the toolkit to new and existing users of our EHR resulting in a significantly increased uptake by outpatient clinicians. In April 2022 alone, the toolkit was used in more than 92 000 ambulatory visits by 894 users in 271 departments across our health system. Conclusions As a health-system client of a commercial EHR, we developed and deployed a revised problem-oriented documentation toolkit that is used by clinicians more than 92 000 times a month. Key success elements include an emphasis on usability and an effective training effort.
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Affiliation(s)
- Richard L Altman
- Corresponding Author: Richard L. Altman, MD, Division of General Internal Medicine, University of Colorado School of Medicine, 8th Floor, Academic Office 1, Mailstop B180, 12631 E 17th Ave, Aurora, CO 80045, USA;
| | - Chen-Tan Lin
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mark Earnest
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Rossi L, Butler S, Coakley A, Flanagan J. Nursing knowledge captured in electronic health records. Int J Nurs Knowl 2023; 34:72-84. [PMID: 35570416 DOI: 10.1111/2047-3095.12365] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/26/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE The purpose of this study was to describe the extent to which nursing assessment data was present in the electronic health record and linked to NANDA-I, NIC, and NOC. METHODS This retrospective review used a descriptive approach to examine documentation in the electronic health records (EHR) of 10 hospitalized patients requiring cardiac surgery. A team of experts applied a Delphi consensus-building process to identify the supports and barriers for nursing documentation. FINDINGS Collection of the health history was organized using Gordon's Functional Health Pattern (FHP) Framework. Seventy-five fields were noted for the entry of nursing assessment data of which 65 focused on health history data and 30 documented physical findings and observations. There were no references to the defining characteristics or etiologies with any of the diagnostic labels used. Care plans included the nursing diagnoses, goals of care, and interventions, although there was a lack of clear alignment between the assessment, NANDA-I, NIC, and NOC and the care plan. Progress note documentation addressed significant events in the patient's clinical course; however, these were not nursing problem or diagnosis focused. Four expert reviewers arrived at consensus regarding the supports and challenges impacting nurses' ability to document data depicting nursing's contribution to care using a FHP and standardized nursing language in the EHR. CONCLUSIONS The EHR provides an opportunity to reflect nursing clinical judgment and make nursing care visible. These findings suggest there are challenges to capturing nurse focused data elements in the EHR. IMPLICATIONS FOR NURSING PRACTICE This work has important implications for clinicians, educators, and administrators alike. EHR systems must accurately capture nurses' contribution to patient care to plan for resource allocation and quality care delivery. Ultimately, the development of standardized data sources reflecting the outcomes of nursing care will expand the opportunities to advance nursing knowledge.
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Affiliation(s)
- Laura Rossi
- Simmons University Boston, Massachusetts, USA.,Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shawna Butler
- Massachusetts General Hospital, Boston, Massachusetts, USA.,University of Massachusetts, Boston, Massachusetts, USA
| | | | - Jane Flanagan
- Massachusetts General Hospital, Boston, Massachusetts, USA.,Boston College, Chestnut Hill, Massachusetts, USA
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4
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Lapão LV, Peyroteo M, Maia M, Seixas J, Gregório J, Mira da Silva M, Heleno B, Correia JC. Implementation of Digital Monitoring Services During the COVID-19 Pandemic for Patients With Chronic Diseases: Design Science Approach. J Med Internet Res 2021; 23:e24181. [PMID: 34313591 PMCID: PMC8396539 DOI: 10.2196/24181] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/14/2021] [Accepted: 07/02/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic is straining health systems and disrupting the delivery of health care services, in particular, for older adults and people with chronic conditions, who are particularly vulnerable to COVID-19 infection. OBJECTIVE The aim of this project was to support primary health care provision with a digital health platform that will allow primary care physicians and nurses to remotely manage the care of patients with chronic diseases or COVID-19 infections. METHODS For the rapid design and implementation of a digital platform to support primary health care services, we followed the Design Science implementation framework: (1) problem identification and motivation, (2) definition of the objectives aligned with goal-oriented care, (3) artefact design and development based on Scrum, (4) solution demonstration, (5) evaluation, and (6) communication. RESULTS The digital platform was developed for the specific objectives of the project and successfully piloted in 3 primary health care centers in the Lisbon Health Region. Health professionals (n=53) were able to remotely manage their first patients safely and thoroughly, with high degrees of satisfaction. CONCLUSIONS Although still in the first steps of implementation, its positive uptake, by both health care providers and patients, is a promising result. There were several limitations including the low number of participating health care units. Further research is planned to deploy the platform to many more primary health care centers and evaluate the impact on patient's health related outcomes.
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Affiliation(s)
- Luís Velez Lapão
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- Research and Development Unit in Mechanical and Industrial Engineering (UNIDEMI), NOVA School of Science and Technology, Universidade Nova de Lisboa, Caparica, Portugal
| | - Mariana Peyroteo
- Comprehensive Health Research Center, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- NOVA School of Science and Technology, Universidade Nova de Lisboa, Caparica, Portugal
| | - Melanie Maia
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
- NOVA School of Social Sciences and Humanities, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Jorge Seixas
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - João Gregório
- Research Center for Biosciences and Health Technologies, Universidade Lusófona de Humanidades e Tecnologias, Lisbon, Portugal
| | | | - Bruno Heleno
- Comprehensive Health Research Center, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Jorge César Correia
- Unit of Patient Education, Division of Endocrinology, Diabetology, Nutrition and Patient Education, Department of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Cillessen F, de Vries Robbé P, Bor H, Biermans M. Factors affecting the manual linking of clinical progress notes to problems in daily clinical practice: A retrospective quantitative analysis and cross sectional survey. Health Informatics J 2021; 27:14604582211007534. [PMID: 33840302 DOI: 10.1177/14604582211007534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This cross sectional study examines how patient characteristics, doctor characteristics, and doctors' education and attitudes affect the extent to which doctors link progress notes to clinical problems. The independent effects of patient characteristics on the linking of notes was examined with a mixed model logistic regression. The effects of doctor characteristics and doctors' education and attitudes on the link ratio was analyzed with univariate analysis of variance. A survey was used to obtain arguments and attitudes on linking notes. For "patient characteristics", the odds of linking increased with an increase in the number of problems or hospital days, decreased, with an increase in the number of involved doctors, medical specialties or the number of notes. For "doctor characteristics", the link ratio increased with more work experience. For "doctors' education and attitudes", the link ratio increased with more familiarity in linking notes and belief in the added value of problem oriented charting. "Overview" was the most cited reason for linking; "I don't know how" the most cited reason for not linking. There is a huge variation within and between all disciplines. Important arguments, for and against, are found. Recommendations for policymakers and medical leadership are given to maximize the benefits.
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Affiliation(s)
| | | | - Hans Bor
- Radboud university medical center, the Netherlands
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6
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Poulos J, Zhu L, Shah AD. Data gaps in electronic health record (EHR) systems: An audit of problem list completeness during the COVID-19 pandemic. Int J Med Inform 2021; 150:104452. [PMID: 33864979 DOI: 10.1016/j.ijmedinf.2021.104452] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 03/29/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the completeness of diagnosis recording in problem lists in a hospital electronic health record (EHR) system during the COVID-19 pandemic. DESIGN Retrospective chart review with manual review of free text electronic case notes. SETTING Major teaching hospital trust in London, one year after the launch of a comprehensive EHR system (Epic), during the first peak of the COVID-19 pandemic in the UK. PARTICIPANTS 516 patients with suspected or confirmed COVID-19. MAIN OUTCOME MEASURES Percentage of diagnoses already included in the structured problem list. RESULTS Prior to review, these patients had a combined total of 2841 diagnoses recorded in their EHR problem lists. 1722 additional diagnoses were identified, increasing the mean number of recorded problems per patient from 5.51 to 8.84. The overall percentage of diagnoses originally included in the problem list was 62.3% (2841 / 4563, 95% confidence interval 60.8%, 63.7%). CONCLUSIONS Diagnoses and other clinical information stored in a structured way in electronic health records is extremely useful for supporting clinical decisions, improving patient care and enabling better research. However, recording of medical diagnoses on the structured problem list for inpatients is incomplete, with almost 40% of important diagnoses mentioned only in the free text notes.
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Affiliation(s)
- Jordan Poulos
- UCL Medical School, University College London, Gower Street, London, WC1E 6BT, UK; EHRS Directorate, University College London Hospitals NHS Foundation Trust, 250 Euston Rd, London, NW1 2PG, UK
| | - Leilei Zhu
- EHRS Directorate, University College London Hospitals NHS Foundation Trust, 250 Euston Rd, London, NW1 2PG, UK; Clinical and Research Informatics Unit, UCL/UCLH NIHR Biomedical Research Centre, UCL Institute of Health Informatics, 222 Euston Road, London, NW1 2DA, UK
| | - Anoop D Shah
- Clinical and Research Informatics Unit, UCL/UCLH NIHR Biomedical Research Centre, UCL Institute of Health Informatics, 222 Euston Road, London, NW1 2DA, UK.
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7
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Liao N, Kasick R, Allen K, Bode R, Macias C, Lee J, Ramachandran S, Erdem G. Pediatric Inpatient Problem List Review and Accuracy Improvement. Hosp Pediatr 2020; 10:941-948. [PMID: 33051244 DOI: 10.1542/hpeds.2020-0059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES The problem list (PL) is a meaningful use-incentivized criterion for electronic health record documentation. Inconsistent use or inaccuracy of the PL can create communication gaps among providers, potentially leading to diagnostic delays and serious safety events. The objective of the study was to increase the rate of PL review by attending physicians for inpatients discharged from hospital pediatrics and infectious disease services from a baseline of 70% to 80% by June 2018 and to sustain the rate for 6 months. The secondary aim was to improve PL accuracy by decreasing the rate of duplicate codes and red code diagnoses that should resolve before discharge from a baseline of 12% and 11%, respectively, to 5% and sustaining the rate for 6 months. METHODS A quality improvement team used the Institute for Healthcare Improvement Model for Improvement. We tracked duplicate codes and red codes as surrogate markers of PL quality. Rates of PL review and PL quality were analyzed monthly via statistical process control charts (p-charts) with 3-σ control limits to identify special cause variation. RESULTS PL review improved from a baseline of 70% to 90%, and the change was sustained for 1 year. PL quality improved as duplicate codes at the time of discharge decreased from 12% to 6% and as red codes decreased from a baseline of 11% to 6%. CONCLUSIONS The PL is an important communication tool that is underused. By engaging and educating stakeholders, incentivizing compliance, standardizing PL management, leveraging electronic health record enhancements, and providing physician feedback, we improved PL meaningful use and quality.
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Affiliation(s)
- Nancy Liao
- Nationwide Children's Hospital, Columbus, Ohio; and .,The Ohio State University, Columbus, Ohio
| | - Rena Kasick
- Nationwide Children's Hospital, Columbus, Ohio; and.,The Ohio State University, Columbus, Ohio
| | - Karen Allen
- Nationwide Children's Hospital, Columbus, Ohio; and.,The Ohio State University, Columbus, Ohio
| | - Ryan Bode
- Nationwide Children's Hospital, Columbus, Ohio; and.,The Ohio State University, Columbus, Ohio
| | | | - Jennifer Lee
- Nationwide Children's Hospital, Columbus, Ohio; and
| | | | - Guliz Erdem
- Nationwide Children's Hospital, Columbus, Ohio; and.,The Ohio State University, Columbus, Ohio
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8
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Mangin D, Lawson J, Adamczyk K, Guenter D. Embedding "Smart" Disease Coding Within Routine Electronic Medical Record Workflow: Prospective Single-Arm Trial. JMIR Med Inform 2020; 8:e16764. [PMID: 32716304 PMCID: PMC7418012 DOI: 10.2196/16764] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/21/2020] [Accepted: 04/10/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Electronic medical record (EMR) chronic disease measurement can help direct primary care prevention and treatment strategies and plan health services resource management. Incomplete data and poor consistency of coded disease values within EMR problem lists are widespread issues that limit primary and secondary uses of these data. These issues were shared by the McMaster University Sentinel and Information Collaboration (MUSIC), a primary care practice-based research network (PBRN) located in Hamilton, Ontario, Canada. OBJECTIVE We sought to develop and evaluate the effectiveness of new EMR interface tools aimed at improving the quantity and the consistency of disease codes recorded within the disease registry across the MUSIC PBRN. METHODS We used a single-arm prospective trial design with preintervention and postintervention data analysis to assess the effect of the intervention on disease recording volume and quality. The MUSIC network holds data on over 75,080 patients, 37,212 currently rostered. There were 4 MUSIC network clinician champions involved in gap analysis of the disease coding process and in the iterative design of new interface tools. We leveraged terminology standards and factored EMR workflow and usability into a new interface solution that aimed to optimize code selection volume and quality while minimizing physician time burden. The intervention was integrated as part of usual clinical workflow during routine billing activities. RESULTS After implementation of the new interface (June 25, 2017), we assessed the disease registry codes at 3 and 6 months (intervention period) to compare their volume and quality to preintervention levels (baseline period). A total of 17,496 International Classification of Diseases, 9th Revision (ICD9) code values were recorded in the disease registry during the 11.5-year (2006 to mid-2017) baseline period. A large gain in disease recording occurred in the intervention period (8516/17,496, 48.67% over baseline), resulting in a total of 26,774 codes. The coding rate increased by a factor of 11.2, averaging 1419 codes per month over the baseline average rate of 127 codes per month. The proportion of preferred ICD9 codes increased by 17.03% in the intervention period (11,007/17,496, 62.91% vs 7417/9278, 79.94%; χ21=819.4; P<.001). A total of 45.03% (4178/9278) of disease codes were entered by way of the new screen prompt tools, with significant increases between quarters (Jul-Sep: 2507/6140, 40.83% vs Oct-Dec: 1671/3148, 53.08%; χ21=126.2; P<.001). CONCLUSIONS The introduction of clinician co-designed, workflow-embedded disease coding tools is a very effective solution to the issues of poor disease coding and quality in EMRs. The substantial effectiveness in a routine care environment demonstrates usability, and the intervention detail described here should be generalizable to any setting. Significant improvements in problem list coding within primary care EMRs can be realized with minimal disruption to routine clinical workflow.
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Affiliation(s)
- Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Jennifer Lawson
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Krzysztof Adamczyk
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Dale Guenter
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
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O'Donnell HC, Suresh S. Electronic Documentation in Pediatrics: The Rationale and Functionality Requirements. Pediatrics 2020; 146:0. [PMID: 32601127 DOI: 10.1542/peds.2020-1684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Clinical documentation has dramatically changed since the implementation and use of electronic health records and electronic provider documentation. The purpose of this report is to review these changes and promote the development of standards and best practices for electronic documentation for pediatric patients. In this report, we evaluate the unique aspects of clinical documentation for pediatric care, including specialized information needs and stakeholders specific to the care of children. Additionally, we explore new models of documentation, such as shared documentation, in which patients may be both authors and consumers, and among care teams while still maintaining the ability to clearly define care and services provided to patients in a given day or encounter. Finally, we describe alternative documentation techniques and newer technologies that could improve provider efficiency and the reuse of clinical data.
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Affiliation(s)
- Heather C O'Donnell
- Department of Pediatrics, Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York.,Pediatric Physicians' Organization at Children's Hospital, Boston Children's Hospital, Brookline, Massachusetts; and
| | - Srinivasan Suresh
- Divisions of Health Informatics and Emergency Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine and UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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Sutton JM, Ash SR, Al Makki A, Kalakeche R. A Daily Hospital Progress Note that Increases Physician Usability of the Electronic Health Record by Facilitating a Problem-Oriented Approach to the Patient and Reducing Physician Clerical Burden. Perm J 2019; 23:18-221. [PMID: 31314721 DOI: 10.7812/tpp/18-221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We suggest changes in the electronic health record (EHR) in hospitalized patients to increase EHR usability by optimizing the physician's ability to approach the patient in a problem-oriented fashion and by reducing physician data entry and chart navigation. The framework for these changes is a Physician's Daily Hospital Progress Note organized into 3 sections: Subjective, Objective, and a combined Assessment and Plan section, subdivided by problem titles. The EHR would consolidate information for each problem by: 1) juxtaposing to each problem title relevant medications, key durable results, and limitations; 2) entering in the running lists under Assessment and Plan the most relevant information for that day, including abbreviated versions of relevant reports; and 3) generating a flow sheet in a problem's progress note for any key results tracked daily. To reduce physician EHR navigation, the EHR would place in the Objective section abbreviated versions of notes of other physicians, nurses, and allied health professionals as well as recent orders. The physician would enter only the analysis and plan and new information not included in the EHR. The consolidation of information for each problem would facilitate physician communication at points of transition of care including generation of a problem-oriented discharge summary.
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Affiliation(s)
- James M Sutton
- Department of Nephrology, Indiana University Health, Lafayette
| | - Steven R Ash
- Department of Nephrology, Indiana University Health, Lafayette
| | - Akram Al Makki
- Department of Nephrology, Indiana University Health, Lafayette
| | - Rabih Kalakeche
- Department of Nephrology, Indiana University Health, Lafayette
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Boyd AD, Dunn Lopez K, Lugaresi C, Macieira T, Sousa V, Acharya S, Balasubramanian A, Roussi K, Keenan GM, Lussier YA, Li J'J, Burton M, Di Eugenio B. Physician nurse care: A new use of UMLS to measure professional contribution: Are we talking about the same patient a new graph matching algorithm? Int J Med Inform 2018; 113:63-71. [PMID: 29602435 PMCID: PMC5909845 DOI: 10.1016/j.ijmedinf.2018.02.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 12/22/2017] [Accepted: 02/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Physician and nurses have worked together for generations; however, their language and training are vastly different; comparing and contrasting their work and their joint impact on patient outcomes is difficult in light of this difference. At the same time, the EHR only includes the physician perspective via the physician-authored discharge summary, but not nurse documentation. Prior research in this area has focused on collaboration and the usage of similar terminology. OBJECTIVE The objective of the study is to gain insight into interprofessional care by developing a computational metric to identify similarities, related concepts and differences in physician and nurse work. METHODS 58 physician discharge summaries and the corresponding nurse plans of care were transformed into Unified Medical Language System (UMLS) Concept Unique Identifiers (CUIs). MedLEE, a Natural Language Processing (NLP) program, extracted "physician terms" from free-text physician summaries. The nursing plans of care were constructed using the HANDS© nursing documentation software. HANDS© utilizes structured terminologies: nursing diagnosis (NANDA-I), outcomes (NOC), and interventions (NIC) to create "nursing terms". The physician's and nurse's terms were compared using the UMLS network for relatedness, overlaying the physician and nurse terms for comparison. Our overarching goal is to provide insight into the care, by innovatively applying graph algorithms to the UMLS network. We reveal the relationships between the care provided by each professional that is specific to the patient level. RESULTS We found that only 26% of patients had synonyms (identical UMLS CUIs) between the two professions' documentation. On average, physicians' discharge summaries contain 27 terms and nurses' documentation, 18. Traversing the UMLS network, we found an average of 4 terms related (distance less than 2) between the professions, leaving most concepts as unrelated between nurse and physician care. CONCLUSION Our hypothesis that physician's and nurse's practice domains are markedly different is supported by the preliminary, quantitative evidence we found. Leveraging the UMLS network and graph traversal algorithms, allows us to compare and contrast nursing and physician care on a single patient, enabling a more complete picture of patient care. We can differentiate professional contributions to patient outcomes and related and divergent concepts by each profession.
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Affiliation(s)
- Andrew D Boyd
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W Taylor St., Chicago, IL 60612, United States.
| | - Karen Dunn Lopez
- Department of Health System Science, College of Nursing, University of Illinois at Chicago, 845 South Damen Ave, Chicago, IL 60612, United States
| | - Camillo Lugaresi
- Department of Computer Science, College of Engineering, University of Illinois at Chicago, 851 South Morgan Street, Chicago, IL 60607, United States
| | - Tamara Macieira
- Department of Health System Science, College of Nursing, University of Illinois at Chicago, 845 South Damen Ave, Chicago, IL 60612, United States
| | - Vanessa Sousa
- Department of Health System Science, College of Nursing, University of Illinois at Chicago, 845 South Damen Ave, Chicago, IL 60612, United States
| | - Sabita Acharya
- Department of Computer Science, College of Engineering, University of Illinois at Chicago, 851 South Morgan Street, Chicago, IL 60607, United States
| | - Abhinaya Balasubramanian
- Department of Computer Science, College of Engineering, University of Illinois at Chicago, 851 South Morgan Street, Chicago, IL 60607, United States
| | - Khawllah Roussi
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W Taylor St., Chicago, IL 60612, United States
| | - Gail M Keenan
- Department of Health Care Environments and Systems, College of Nursing, University of Florida, PO Box 100187, Gainesville, FL 32610, United States
| | - Yves A Lussier
- Department of Medicine, College of Medicine, University of Arizona, 1501 N. Campbell Dr, Tucson, AZ 85724, United States; The University of Arizona Health Sciences Center, 1295 North Martin Ave, Tucson, AZ 85721, United States
| | - Jianrong 'John' Li
- Department of Medicine, College of Medicine, University of Arizona, 1501 N. Campbell Dr, Tucson, AZ 85724, United States; The University of Arizona Health Sciences Center, 1295 North Martin Ave, Tucson, AZ 85721, United States
| | - Michel Burton
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W Taylor St., Chicago, IL 60612, United States
| | - Barbara Di Eugenio
- Department of Computer Science, College of Engineering, University of Illinois at Chicago, 851 South Morgan Street, Chicago, IL 60607, United States
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12
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Collins S, Klinkenberg-Ramirez S, Tsivkin K, Mar PL, Iskhakova D, Nandigam H, Samal L, Rocha RA. Next generation terminology infrastructure to support interprofessional care planning. J Biomed Inform 2017; 75:22-34. [DOI: 10.1016/j.jbi.2017.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 09/15/2017] [Accepted: 09/17/2017] [Indexed: 10/18/2022]
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