Journal of the American Medical Informatics Association : JAMIA
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J Am Med Inform Assoc · Apr 2015
The double-edged sword of electronic health records: implications for patient disclosure.
Electronic health record (EHR) systems are linked to improvements in quality of care, yet also privacy and security risks. Results from research studies are mixed about whether patients withhold personal information from their providers to protect against the perceived EHR privacy and security risks. This study seeks to reconcile the mixed findings by focusing on whether accounting for patients' global ratings of care reveals a relationship between EHR provider-use and patient non-disclosure. ⋯ Clinicians should leverage the EHR's value in quality of care and discuss patients' privacy concerns during clinic visits, while policy makers should consider how to address the real and perceived privacy and security risks of EHRs.
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J Am Med Inform Assoc · Mar 2015
VA OpenNotes: exploring the experiences of early patient adopters with access to clinical notes.
To explore the experience of early patient adopters who accessed their clinical notes online using the Blue Button feature of the My HealtheVet portal. ⋯ Initial assessment of the patient experience within the first 9 months of availability provides evidence that patients both value and benefit from online access to clinical notes. These findings are congruent with OpenNotes study findings on a broader scale. Additional outreach and education is needed to enhance patient awareness. Healthcare professionals should author notes keeping in mind the opportunity patient access presents for enhanced communication.
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J Am Med Inform Assoc · Mar 2015
Observational StudyAutomated detection of physiologic deterioration in hospitalized patients.
Develop and evaluate an automated case detection and response triggering system to monitor patients every 5 min and identify early signs of physiologic deterioration. ⋯ We monitored patients every 5 min and provided automated pages of early physiologic deterioration. This before-after study found a significant increase in MET calls and a significant decrease in mortality only in the unit with older patients with multiple comorbidities, and thus further study is warranted to detect potential confounding. Moreover, nurses reported the graphical alerts provided information needed to quickly evaluate patients, and they felt more confident about their assessment and more comfortable requesting help.
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J Am Med Inform Assoc · Mar 2015
Impact of the meaningful use incentive program on electronic health record adoption by US children's hospitals.
We determined adoption rates of pediatric-oriented electronic health record (EHR) features by US children's hospitals and assessed perceptions regarding the suitability of commercial EHRs for pediatric care and the influence of the meaningful use incentive program on implementation of pediatric-oriented features. ⋯ Children's hospitals are implementing pediatric-focused features, but a sizable proportion still finds their systems suboptimal for pediatric care. The meaningful use incentive program is failing to promote and in some cases delaying uptake of pediatric-oriented features.
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J Am Med Inform Assoc · Mar 2015
Optimization of drug-drug interaction alert rules in a pediatric hospital's electronic health record system using a visual analytics dashboard.
To develop and evaluate an electronic dashboard of hospital-wide electronic health record medication alerts for an alert fatigue reduction quality improvement project. ⋯ An alert dashboard facilitated safe rapid-cycle reductions in alert burden that were temporally associated with lower pharmacist override rates in a subgroup of DDIs not directly affected by the interventions; meanwhile, the pharmacists' frequency of selecting the 'cancel' option increased. We hypothesize that reducing the alert burden enabled pharmacists to devote more attention to clinically relevant alerts.