- Reconceptualizing the Electronic Health Record for a New Decade: A Caring Technology? [Journal Article]
- AAANS Adv Nurs Sci 2019 Jul 08
- Since the 2009 publication by Petrovskaya et al on, "Dilemmas, Tetralemmas, Reimagining the Electronic Health Record," and passage of the Health Information Technology for Economic Clinical Health (H…
Since the 2009 publication by Petrovskaya et al on, "Dilemmas, Tetralemmas, Reimagining the Electronic Health Record," and passage of the Health Information Technology for Economic Clinical Health (HITECH) Act, 96% of hospitals and 78% of providers have implemented the electronic health record. While many positive outcomes such as guidelines-based clinical decision support and patient portals have been realized, we explore recent issues in addition to those continuing problems identified by Petrovskaya et al that threaten patient safety and integrity of the profession. To address these challenges, we integrate polarity thinking with the tetralemma model discussed by Petrovskaya et al and propose application of a virtue ethics framework focused on cultivation of technomoral wisdom.
- Electronic Health Records and Use of Clinical Decision Support. [Review]
- CCCrit Care Nurs Clin North Am 2019; 31(2):125-131
- In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act was signed into law. Along with this initiative came the push for meaningful use of the electronic health reco…
In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act was signed into law. Along with this initiative came the push for meaningful use of the electronic health record. Clinicians, information technology professionals, and informaticists must partner to create evidence-based clinical decision support models to guide patient care using tools such as structured computerized physician order entry, order sets, templates, alerts, and reminders. Clinical decision support should be used to improve the quality of patient care and compliance with regulatory standards, while inherently following a provider's workflow.
- An Electronic Medical Record Training Conversion for Onboarding Inpatient Nurses. [Journal Article]
- CIComput Inform Nurs 2019 Mar 11
- In recent times, policies stemming from the American Recovery and Reinvestment Act of 2009 have served as a stimulus for healthcare organizations to adopt an electronic medical record. As a result, n…
In recent times, policies stemming from the American Recovery and Reinvestment Act of 2009 have served as a stimulus for healthcare organizations to adopt an electronic medical record. As a result, nurses are now more knowledgeable of and experienced with an electronic medical record. In August 2016, our facility converted from instructor-led training to electronic learning for inpatient nurse electronic medical record training, hoping to capitalize on previous experience with the clinical information system. However, a complete program evaluation of this transition had yet to be conducted. The purpose of this study was to evaluate electronic learning usability and the return on investment of an electronic medical record training conversion. Evaluations of electronic medical record electronic learning training were collected from 75 newly hired, inpatient nurses from November and December 2017, and compared to our instructor-led program. Results showed that users found it effective and were satisfied with this training method. The electronic learning had superior efficiency, reducing training time by ~50% compared to instructor-led training, while proving to yield effectiveness and satisfaction. The return on investment was $18 540, with a gain of 593.25 hours in nursing time during the study period of two months. These results support the organizational decision to convert to electronic learning, further supporting the conversion for other clinical roles.
- Trends in Use of Electronic Health Records in Pediatric Office Settings. [Journal Article]
- JPedJ Pediatr 2019; 206:164-171.e2
- CONCLUSIONS: Although the adoption of EHRs has increased, >80% of pediatricians are working with EHRs that lack optimal functionality and 41% of pediatricians are not using EHRs with even basic functionality. EHRs lacking pediatric functionality impact the health of children through increased medical errors, missed diagnoses, lack of adherence to guidelines, and reduced availability of child-specific information. The pediatric certification outlined in the 21st Century Cures Act may result in improved EHR products for pediatricians.
- The Impact of a Location-Sensing Electronic Health Record on Clinician Efficiency and Accuracy: A Pilot Simulation Study. [Journal Article]
- ACAppl Clin Inform 2018; 9(4):841-848
- CONCLUSIONS: This pilot demonstrated in simulation that an EHR equipped with real-time location services improved performance in locating patients and reduced error compared with an EHR without RTLS. Furthermore, RTLS decreased the number of mouse clicks required to access information. This study suggests EHRs equipped with real-time location services that automates patient location and other repetitive tasks may improve physician efficiency, and ultimately, patient safety.
- DNA vaccine priming for seasonal influenza vaccine in children and adolescents 6 to 17 years of age: A phase 1 randomized clinical trial. [Randomized Controlled Trial]
- PlosPLoS One 2018; 13(11):e0206837
- CONCLUSIONS: In this first pediatric DNA vaccine study conducted in the U.S., the DNA prime-IIV3 boost regimen was safe and well tolerated. In children, the 4 mg DNA-IIV3 regimen resulted in antibody responses comparable to the IIV3-IIV3 regimen.
- Health Information Exchange Use (1990-2015): A Systematic Review. [Journal Article]
- EEGEMS (Wash DC) 2017 Dec 07; 5(1):27
- CONCLUSIONS: Use of HIE in the United States is growing but is still limited. Opportunities remain for expansion. Characteristics of successful implementations may provide a path forward.
- Heeding humanity in an age of electronic health records: Heidegger, Levinas, and Healthcare. [Journal Article]
- NPNurs Philos 2018; 19(3):e12214
- The American Recovery and Reinvestment Act of 2009 (ARRA) required healthcare providers in the United States to adopt and demonstrate meaningful use of electronic health records (EHRs) by January 1, …
The American Recovery and Reinvestment Act of 2009 (ARRA) required healthcare providers in the United States to adopt and demonstrate meaningful use of electronic health records (EHRs) by January 1, 2014. In many ways, EHRs mark a notable improvement over paper medical records as they are more easily accessible and allow for electronic searching and sharing of medical history. However, as EHRs have become mandated by ARRA, many nurses now rely upon computers far more heavily during nurse-patient interactions, thereby decreasing the level of direct interpersonal communication between the two. There is evidence that eye contact between nurses and patients positively affects patient satisfaction. Above and beyond the issue of patient satisfaction is the more basic ethical issue of respecting the patient as a person. The author argues that the templates used in electronic health systems have the possibility of eroding the respect for humanity that is the hallmark of nurse-patient relationships, as signalled by the American Nurses Association's first principle in their Code of Ethics. Using concepts from philosophers Martin Heidegger and Emmanuel Levinas, the author provides guidance as to what an ethical interaction between nurse and patient should look like in an age of EHRs.
- Meaningful Use of Electronic Health Records for Quality Assessment and Review of Clinical Ethics Consultation. [Journal Article]
- JCJ Clin Ethics 2018; 29(1):52-61
- Evolving practice requires peer review of clinical ethics (CE) consultation for quality assessment and improvement. Many institutions have identified the chart note as the basis for this process, but…
Evolving practice requires peer review of clinical ethics (CE) consultation for quality assessment and improvement. Many institutions have identified the chart note as the basis for this process, but to our knowledge, electronic health record (EHR) systems are not necessarily designed to easily include CE consultation notes. This article provides a framework for the inclusion of CE consultation notes into the formal EHR, describing a developed system in the Epic EHR that allows for the elaborated electronic notation of the CE chart note. The implementation of the "meaningful use" criteria for EHR, mandated by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, requires that health professionals meet certain standards for quality, efficiency, and safety, all of which overlap with the goals of standardization, peer review, and quality improvement within CE consultation.
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- Nine years of comparative effectiveness research education and training: initiative supported by the PhRMA Foundation. [Journal Article]
- JCJ Comp Eff Res 2018; 7(2):167-175
- The term comparative effectiveness research (CER) took center stage with passage of the American Recovery and Reinvestment Act (2009). The companion US$1.1 billion in funding prompted the launch of i…
The term comparative effectiveness research (CER) took center stage with passage of the American Recovery and Reinvestment Act (2009). The companion US$1.1 billion in funding prompted the launch of initiatives to train the scientific workforce capable of conducting and using CER. Passage of the Patient Protection and Affordable Care Act (2010) focused these initiatives on patients, coining the term 'patient-centered outcomes research' (PCOR). Educational and training initiatives were soon launched. This report describes the initiative of the Pharmaceutical Research and Manufacturers Association of America (PhRMA) Foundation. Through provision of grant funding to six academic Centers of Excellence, to spearheading and sponsoring three national conferences, the PhRMA Foundation has made significant contributions to creation of the scientific workforce that conducts and uses CER/PCOR.