Building a Structured Field within Clinical Notes in a Migraine Practice: A Quality Improvement Project

Background: Documentation practices in an outpatient migraine clinic describe migraine and headache days (MHD) experienced per month in narrative form within an electronic health record (EHR). Narrative data is time consuming to use in clinic-based research (Meyers et al., 2018). The Model of Improvement’s Plan-Study-Do-Act (PDSA) and the Chronic Care Model (CCM) guided the methodology of this QI project aiming to 1). build a structured field (SF) within an EHR clinical note, and 2). to describe the characteristics of patients who self-record and track their migraine days compared to those who do not. This work includes the first PDSA cycle. Methods: A MHD SF for the EHR clinical note was developed based on the literature review, clinical practice guidelines and informaticists consultation. Migraine clinical patients were recruited and divided into two groups based on whether they kept a record of MHD in a diary or not. Participants completed a questionnaire assessing education level, income, and marital status. A chart review then quantified additional characteristics including age, sex, history of migraine medication use, MHD frequency and severity, age of migraine onset, and zip code. The documented migraine data will be input into the MHD SF once the SF is built. Results: The MHD SF is currently being built. A total of 52 patients have been enrolled for the feasibility portion of the project, 28 tracked MHDs and 24 did not. Migraine characteristics and demographic data were compared between the two groups. There were no statistically significant differences between the groups (p > 0.05) except for the number of preventives tried, which was higher in the documented MHD group (M = 8.89, SD = 5.32) compared to the group that did not keep a diary (M = 5.92, SD = 3.50), p=0.03. Conclusion: The COVID-19 pandemic delayed the construction of the MHD SF. Changes in clinic dynamics and patient access changed with COVID-19 which impacted the original feasibility portion of the work involving LVNs and patients. This QI project will improve therapy evaluation and facilitate clinic-based research. The PDSA and CCM provide the project practical and conceptual structure and supports the projects sustainability

E-Health Hazards: Provider Liability and Electronic Health Record Systems

In the foreseeable future, electronic health record (EHR) systems are likely to become a fixture in medical settings. The potential benefits of computerization could be substantial, but EHR systems also give rise to new liability risks for health care providers that have received little attention in the legal literature. This Article features a first of its kind, comprehensive analysis of the liability risks associated with use of this complex and important technology. In addition, it develops recommendations to address these liability concerns. Appropriate measures include federal regulations designed to ensure the quality and safety of EHR systems along with agency guidance and well crafted clinical practice guidelines for EHR system users. In formulating its recommendations, the Article proposes a novel, uniform process for developing authoritative clinical practice guidelines and explores how EHR technology itself can enable experts to gather evidence of best practices. The authors argue that without thoughtful interventions and sound guidance from government and medical organizations, this promising technology may encumber rather than support clinicians and may hinder rather than promote health outcome improvements

Performance Measures Using Electronic Health Records: Five Case Studies

Presents the experiences of five provider organizations in developing, testing, and implementing four types of electronic quality-of-care indicators based on EHR data. Discusses challenges, and compares results with those from traditional indicators

Iowa Board of Pharmacy News, September 2013

The Iowa Board of Pharmacy News is published by the Iowa Board of Pharmacy and the National Association of Boards of Pharmacy Foundation, Inc, to promote compliance of pharmacy and drug law

A Way Forward After Dobbs: Human Rights Advocacy and Self-Managed Abortion in the United States

Even in the era before Dobbs, wherein the Supreme Court repeatedly classified abortion as a fundamental right, the ability to have an abortion was inaccessible in many parts of the United States. The irony that a fundamental right was so difficult to exercise results from how Constitutional rights are understood, which left many open-ended avenues for states to bring restrictions. International Human Rights law, however, offers a more optimistic and accountable approach to steps forward in increasing abortion access—illustrating a need to bring a human rights-based approach home. Dobbs has eviscerated any concept of federal protections for abortion, severely worsening the situation. But, a lack of abortion rights was already a lived reality for many before Dobbs. In the wake of Dobbs, advocates must demand more of lawmakers by expanding the rhetoric and law surrounding abortion beyond our Roe-regime understanding. Moving forward, overturning Dobbs and going back to Roe is not good enough. This Note therefore calls attention to the shortcomings of the pre-Dobbs regime, lest they be lost in a sea of calls to codify Roe. In the meantime, this Note provides a framework for effective human rights advocacy in the abortion context. It also documents the benefits and shortcomings of self-managed abortion care, a practice that will remain relevant in Dobbs\u27 aftermath. Part I of this Note will first examine the evolution of United States case law and policy regarding abortion, noting the previous federal right and Dobbs\u27 elimination of such protections. Part II will explain the flaws of the previous negative rights regime under Roe and Casey that created access gaps, permitted harmful restrictions, and failed to hold states accountable. Part III will compare the United States\u27 pre-Dobbs approach to abortion protections to International Human Rights law and highlight the United States\u27 express failure to ratify international treaties and adopt the positive rights approach to abortion. Highlighting the difference between a fundamental right before Dobbs and a human right under International Human Rights law, this Part will use this comparison to point out additional flaws and gaps created by the negative rights approach. Finally, Part IV will explain and analyze how self-managed abortion presents a potential solution to the issues posed by federal legal doctrine. This Part will include an examination of various self-managed abortion efforts already underway, in light of human rights advocacy goals, and demonstrate the need for governmental accountability for solutions beyond what self-managed advocacy efforts may be able to achieve

An Analysis of the Work System Framework for Examining Information Exchange in a Healthcare Setting

Lack of communication is a leading root cause of sentinel events (any unanticipated event in a healthcare setting resulting in a patient’s death or serious physical or psychological injury and not related to the natural course of the patient\u27s illness). Deficits in communication of essential information when patients transfer between different healthcare services can cause interruptions in the continuity of care, inappropriate treatment, and potential harm to the patient. Research has shown that providing the right information about the right patient to healthcare providers at the right time could eliminate up to 18 percent of the general adverse events. In this paper, we assess the applicability of the work system framework (WSF) to evaluate the health information-exchange processes that occur when patients are transferred from home healthcare services and nursing homes to hospitals. From our analysis, we identify possible improvements in both work practices and the flow of health information among healthcare providers. Further, we propose a modified work system snapshot template tailored for evaluating the health information-exchange process. The proposed modifications include changing the WSF terminology to healthcare terms (including patient safety indicators) and adding new performance measurement indicators that are relevant to healthcare