Electronic health records to facilitate clinical research

Electronic health records (EHRs) provide opportunities to enhance patient care, embed performance measures in clinical practice, and facilitate clinical research. Concerns have been raised about the increasing recruitment challenges in trials, burdensome and obtrusive data collection, and uncertain generalizability of the results. Leveraging electronic health records to counterbalance these trends is an area of intense interest. The initial applications of electronic health records, as the primary data source is envisioned for observational studies, embedded pragmatic or post-marketing registry-based randomized studies, or comparative effectiveness studies. Advancing this approach to randomized clinical trials, electronic health records may potentially be used to assess study feasibility, to facilitate patient recruitment, and streamline data collection at baseline and follow-up. Ensuring data security and privacy, overcoming the challenges associated with linking diverse systems and maintaining infrastructure for repeat use of high quality data, are some of the challenges associated with using electronic health records in clinical research. Collaboration between academia, industry, regulatory bodies, policy makers, patients, and electronic health record vendors is critical for the greater use of electronic health records in clinical research. This manuscript identifies the key steps required to advance the role of electronic health records in cardiovascular clinical research

Marshfield Clinic: Health Information Technology Paves the Way for Population Health Management

Highlights Fund-defined attributes of an ideal care delivery system and best practices, including an internal electronic health record, primary care teams, physician quality metrics and mentors, and standardized care processes for chronic care management

Leveraging electronic health records for clinical research

Electronic health records (EHRs) can be a major tool in the quest to decrease costs and timelines of clinical trial research, generate better evidence for clinical decision making, and advance health care. Over the past decade, EHRs have increasingly offered opportunities to speed up, streamline, and enhance clinical research. EHRs offer a wide range of possible uses in clinical trials, including assisting with prestudy feasibility assessment, patient recruitment, and data capture in care delivery. To fully appreciate these opportunities, health care stakeholders must come together to face critical challenges in leveraging EHR data, including data quality/completeness, information security, stakeholder engagement, and increasing the scale of research infrastructure and related governance. Leaders from academia, government, industry, and professional societies representing patient, provider, researcher, industry, and regulator perspectives convened the Leveraging EHR for Clinical Research Now! Think Tank in Washington, DC (February 18-19, 2016), to identify barriers to using EHRs in clinical research and to generate potential solutions. Think tank members identified a broad range of issues surrounding the use of EHRs in research and proposed a variety of solutions. Recognizing the challenges, the participants identified the urgent need to look more deeply at previous efforts to use these data, share lessons learned, and develop a multidisciplinary agenda for best practices for using EHRs in clinical research. We report the proceedings from this think tank meeting in the following paper

CDSSs for CVD Risk Management: An Integrative Review

Cardiovascular disease (CVD) is a preventable disease affecting almost half of adults in the United States (U.S.) and can have significant negative outcomes such as stroke and myocardial infarction, which can be fatal. Utilizing clinical decision support systems (CDSSs) in the primary care and community health setting can improve primary prevention of CVD by supporting evidence-based decision making at the point of care. This integrative review synthesizes the most up-to-date literature on the use of clinical decision support (CDS) tools to support guideline-based management of CVD risk. Using Whittemore and Knafl’s framework for integrative reviews, a systematic search of CINAHL, Cochrane, and Medline and ancestry search yielded 492 results; 17 articles were included in the final review after applying inclusion and exclusion criteria. Evidence-based CDSSs for CVD prevention improved guideline-based initiation and intensification of pharmacological treatment, increased frequency and accuracy of CVD risk screening, and facilitated shared decision-making discussions with patients about CVD risk; however, they were not effective in promoting smoking cessation and only sometimes effective in improving blood pressure (BP) control. This integrative review supports future evidence-based practice projects implementing CDSSs designed to improve guideline-based primary prevention of CVD as an, albeit partial, solution to improving prevention of CVD in the U.S. and globally

Cycles of Electronic Health Records Adaptation by Physicians: How Do The Positive and Negative Experience with the EHR System Affect Physicians\u27 EHR Adaptation Process?

The integration of EHR in IT infrastructures supporting organizations enable improved access and recording of patient data, enhanced ability to make improved decisions, improved quality and reduced errors in patient care. Despite these benefits, there are mixed results as to the use of EHR. The literature suggests that the reasons for the limited use relate to policy, financial and usability considerations, but it does not provide an understanding of reasons for physicians’ limited interaction and adaptation of EHR. Following an analysis of qualitative data, collected in a case study at a hospital using interviews, this research explains how physicians interact with EHR. The key contribution of this research is in explaining how physicians interact with EHR in terms of concepts that are grounded in the real world experiences of physicians. The model of positive and negative physician work cycles is introduced and discussed. Contributions to research and practice are presented

Cycles of Electronic Health Records Adaptation by Physicians: How Do the Positive and Negative Experiences with the EHR System Affect Physicians’ EHR Adaptation Process?

The integration of EHR in IT infrastructures supporting organizations enable improved access and recording of patient data, enhanced ability to make improved decisions, improved quality and reduced errors in patient care. Despite these benefits, there are mixed results as to the use of EHR. The literature suggests that the reasons for the limited use relate to policy, financial and usability considerations, but it does not provide an understanding of reasons for physicians’ limited interaction and adaptation of EHR. Following an analysis of qualitative data, collected in a case study at a hospital using interviews, this research explains how physicians interact with EHR. The key contribution of this research is in explaining how physicians interact with EHR in terms of concepts that are grounded in the real world experiences of physicians. The model of positive and negative physician work cycles is introduced and discussed. Contributions to research and practice are presented

Organizing for Higher Performance: Case Studies of Organized Delivery Systems

Offers lessons learned from healthcare delivery systems promoting the attributes of an ideal model as defined by the Fund: information continuity, care coordination and transitions, system accountability, teamwork, continuous innovation, and easy access

Challenges of Change:Technological Ease or Technological Upset?

The Electronic Health Record (EHR) has created new challenges for service providers and healthcare organizations. They need to remain competitive, improve the quality of care, and reduce costs while providing quality patient care. The development and implementation of new knowledge from individual current competencies will be an ongoing focus for healthcare organizations and healthcare providers who use the EHR technology. Twenty-eight physicians were interviewed for this report in order to understand their perceptions EHR technology in knowledge change or technology inspired unlearning, during service delivery. A model is proposed to better understand the changes needed in patient care delivery systems as specific actions, behaviors, and mental models require continual updating. Through this analysis, we developed the model, Service Delivery Unlearning Paradigm, to suggest how change influences collaboration, technological ease, and technological upset. Recommendations for future research and actions for practitioners are suggested