Identifying and addressing barriers to implementing core electronic health record use metrics for ambulatory care: Virtual consensus conference proceedings

Precise, reliable, valid metrics that are cost-effective and require reasonable implementation time and effort are needed to drive electronic health record (EHR) improvements and decrease EHR burden. Differences exist between research and vendor definitions of metrics. PROCESS:  We convened three stakeholder groups (health system informatics leaders, EHR vendor representatives, and researchers) in a virtual workshop series to achieve consensus on barriers, solutions, and next steps to implementing the core EHR use metrics in ambulatory care. CONCLUSION:  Actionable solutions identified to address core categories of EHR metric implementation challenges include: (1) maintaining broad stakeholder engagement, (2) reaching agreement on standardized measure definitions across vendors, (3) integrating clinician perspectives, and (4) addressing cognitive and EHR burden. Building upon the momentum of this workshop\u27s outputs offers promise for overcoming barriers to implementing EHR use metrics

Patterns of rod and cone dysfunction in Bardet-Biedl syndrome

We studied visual function in 16 patients with the Bardet-Biedl syndrome. Visual acuity, kinetic perimetry, and electroretinography results indicated a severe loss of central and peripheral vision and rod and cone function by the second or third decade of life. Light- and dark-adapted static perimetry in patients 10 to 15 years of age with early involvement showed a parallel and marked loss of rod and cone sensitivity across the visual field. Patients with more advanced disease and no measurable peripheral visual field showed different patterns of central visual dysfunction: an island of only cone function centered in a bull's-eye lesion; patches of rod function surrounding geographic atrophy; or a central island of excellent rod sensitivity but severely impaired cones. In the two least-affected patients, a 13-year-old boy and the asymptomatic 45-year-old sibling of a patient, there were more rod than cone abnormalities as determined by electroretinography and static perimetry

Assessment of Satisfaction With the Electronic Health Record Among Physicians in Physician-Owned vs Non–Physician-Owned Practices

Importance: Despite known benefits, electronic health records (EHRs) have had drawbacks for daily practice and the physician experience. There is evidence that physicians practicing in solo or physician-owned practices are more likely to be satisfied with the EHR and experience lower burnout than those practicing in other ownership arrangements; however, it is unclear how practice ownership patterns interact with physicians' experiences with the EHR and documentation in the EHR now that use of these systems is widespread. Objective: To examine the association between practice ownership and physician perceptions of the EHR. Design, setting, and participants: This cross-sectional study included non-federally employed physicians who provided office-based patient care in 2019 and completed the 2019 National Electronic Health Records Survey. The 2019 survey sample consisted of 1524 eligible responses (41.0% unweighted response rate representing 301 603 physicians); of those, 1368 physicians who reported having an EHR and answered questions regarding location ownership were included in the analysis. Data for the 2019 National Electronic Health Records Survey were collected by RTI International from June 14 to December 11, 2019; the current cross-sectional analysis was conducted from October 1 to November 30, 2021. Main outcomes and measures: Satisfaction with the EHR, perceptions of time spent on clinical documentation, and presence of staff support for documentation. Results: Among 1368 respondents (weighted, 270 813 respondents) included in the analysis, 960 respondents (weighted: 185,385 respondents [68.5%]) were male, and 951 respondents (weighted: 200,622 respondents [74.1%]) were over 50 years of age; 766 respondents (weighted, 161 226 respondents [59.5%]) were working in a practice owned by a physician or physician group, and 700 respondents (weighted, 131 284 respondents [48.5%]) were primary care physicians. A total of 602 respondents (weighted, 109 587 physicians [40.5%]) were working in a non-physician-owned practice. Overall, 529 respondents (weighted, 108 093 respondents [68.1%]) working in physician-owned practices reported being satisfied with their EHR vs 320 respondents (weighted, 63 988 respondents [58.5%]) working in non-physician-owned practices (P = .03). Among those working in physician-owned practices, perceptions that time spent on documentation was appropriate (328 physicians [weighted, 71 827 physicians (44.8%)] vs 191 physicians [weighted, 35 447 physicians (32.4%)]; P = .005) and that staff support for documentation was available (289 physicians [weighted, 57 702 physicians (36.0%)] vs 146 physicians [weighted, 29 267 physicians (26.7%)]; P = .02) were significantly higher compared with those working in non-physician-owned practices. Physicians' perceptions of the appropriateness of time spent and the availability of staff support only partially explained the association between practice ownership type and EHR satisfaction. Conclusions and relevance: The results of this nationally representative cross-sectional study suggest that physicians working in physician-owned practices are more likely to be satisfied with the EHR, to have positive perceptions of time spent on documentation, and to have staff support for documentation compared with their counterparts working in non-physician-owned practices. The workflow and cultural forces underlying these differences are important to understand in the setting of known differences in burnout by practice ownership type and ongoing physician group consolidation and acquisition by health care systems

Are They Aligned? An Analysis of Social Media-Based Nurse Well-Being Concerns and Well-Being Programs

# Background Nurse burnout and distress pose patient safety risks due to impaired nurse attention, increased likelihood of medical error, and increased nurse turnover leading to a reduction in the number of nurses available to deliver care. Some healthcare facilities have launched well-being programs in response to increasing rates of burnout. Many of these programs are based on survey data which may be incomplete, resulting in programs that are not as comprehensive as they should be. We sought to identify nurse concerns related to burnout and well-being through analysis of social media data. We aligned these concerns with well-being program leader perceptions of factors contributing to burnout and well-being program initiatives. # Methods We conducted a qualitative study composed of two parts: social media analysis and semistructured interviews with well-being leaders. The social media analysis focused on 120 nurse comments on Reddit that were retrieved based on a keyword search using the terms "burnout," "stress," and "wellbeing." The interviews were conducted with nine well-being leaders from seven different healthcare systems. Well-being program leaders were asked about factors contributing to burnout and lack of well-being, initiatives to address these factors, and metrics used to evaluate their programs. The social media comments and interview data were reviewed by two experts to identify topics, themes, and subthemes grounded in wellness models. # Results Of the 120 social media comments analyzed, the most frequent topic was Lack of Meaningful Recognition, Compensation, and Influence (n=46 of 120, 38.3%), followed by Work Environment (n=43, 35.8%) and Uninformed or Misinformed Public (n=31, 25.8%). Several themes emerged and the most prevalent was Constrained Professional Agency with the most prevalent subtheme of health system or macrosystem policies or regulations that limit nurses' ability to respond effectively to patient care needs. Of the seven healthcare systems interviewed, the most common topics that emerged from asking about the factors contributing to the lack of nurse well-being were the Work Environment (n=6 of 7, 85.7%), followed by Lack of Meaningful Recognition, Compensation, and Influence (n=4, 57.1%), and Inadequate or Inaccessible Well-Being Resources (n=3, 42.9%). Several novel initiatives were identified, and most healthcare systems relied on surveys as their key metric. # Conclusions The social media analysis revealed nurse concerns that may not be identified as factors contributing to lack of well-being by well-being program leaders. There is an opportunity to optimize our understanding of nurse concerns around well-being through social media, and an opportunity to better align nurse concerns with the focus of well-being programs

Rod or cone dysfunction: uniocular presentations

Two patients presented with unusual uniocular electroretinographic (ERG) phenomena. One patient showed the ERG characteristics of stationary night blindness in one eye only and the other patient presented with ERG evidence of uniocular cone dysfunction. In both patients, however, further electrophysiological and psychophysical studies and serial testing provided evidence for dysfunction of both receptor systems and relatively subtle involvement of the fellow eyes