Abstract:
BACKGROUND:Care plan concordance among patients and clinicians during hospitalization is suboptimal. OBJECTIVE:This article determines whether an electronic health record (EHR)-integrated patient portal was associated with increased understanding of the care plan, including the key recovery goal, among patients and clinicians in acute care setting. METHODS:The intervention included (1) a patient portal configured to solicit a single patient-designated recovery goal and display the care plan from the EHR for participating patients; and (2) an electronic care plan for all unit-based nurses that displays patient-inputted information, accessible to all clinicians via the EHR. Patients admitted to an oncology unit, including their nurses and physicians, were enrolled before and after implementation. Main outcomes included mean concordance scores for the overall care plan and individual care plan elements. RESULTS:Of 457 and 283 eligible patients approached during pre- and postintervention periods, 55 and 46 participated in interviews, respectively, including their clinicians. Of 46 postintervention patients, 27 (58.7%) enrolled in the patient portal. The intention-to-treat analysis demonstrated a nonsignificant increase in the mean concordance score for the overall care plan (62.0-67.1, adjusted p = 0.13), and significant increases in mean concordance scores for the recovery goal (30.3-57.7, adjusted p < 0.01) and main reason for hospitalization (58.6-79.2, adjusted p < 0.01). The on-treatment analysis of patient portal enrollees demonstrated significant increases in mean concordance scores for the overall care plan (61.9-70.0, adjusted p < 0.01), the recovery goal (30.4-66.8, adjusted p < 0.01), and main reason for hospitalization (58.3-81.7, adjusted p < 0.01), comparable to the intention-to-treat analysis. CONCLUSION:Implementation of an EHR-integrated patient portal was associated with increased concordance for key care plan components. Future efforts should be directed at improving concordance for other care plan components and conducting larger, randomized studies to evaluate the impact on key outcomes during transitions of care. CLINICAL TRIALS IDENTIFIER:NCT02258594.
journal_name
Appl Clin Informjournal_title
Applied clinical informaticsauthors
Dalal AK,Dykes P,Samal L,McNally K,Mlaver E,Yoon CS,Lipsitz SR,Bates DWdoi
10.1055/s-0039-1688831subject
Has Abstractpub_date
2019-05-01 00:00:00pages
358-366issue
3issn
1869-0327journal_volume
10pub_type
杂志文章abstract:BACKGROUND:Clinical trials are an important research method for improving medical knowledge and patient care. Multiple international and national guidelines stipulate the need for data quality and assurance. Many strategies and interventions are developed to reduce error in trials, including standard operating procedur...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0037-1621702
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND:Kidney disease is under-documented in physician notes. The use of template-guided notes may improve physician recognition of kidney disease early in training. OBJECTIVE:The objective of this study was to determine whether a computerized inpatient renal template note with clinical decision support improves r...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2013-07-RA-0048
更新日期:2013-11-13 00:00:00
abstract:OBJECTIVE:Based on US. Centers for Disease Control and Prevention recommendations, New York State enacted legislation in 2010 requiring healthcare providers to offer non-targeted human immunodeficiency virus (HIV) testing to all patients aged 13-64. Three New York City adult emergency departments implemented an electro...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2013-09-RA-0075
更新日期:2014-03-26 00:00:00
abstract:BACKGROUND:Discrepancies in controlled substance documentation are common and can lead to legal and regulatory repercussions. We introduced a visual analytics dashboard to assist in a quality improvement project to reduce the discrepancies in controlled substance documentation in the operating room (OR) of our free-sta...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0039-1693688
更新日期:2019-05-01 00:00:00
abstract:OBJECTIVE:To understand how clinicians utilize image uploading tools in a home grown electronic health records (EHR) system. METHODS:A content analysis of patient notes containing non-radiological images from the EHR was conducted. Images from 4,000 random notes from July 1, 2009 - June 30, 2010 were reviewed and manu...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2016-10-RA-0180
更新日期:2017-07-12 00:00:00
abstract:BACKGROUND:Medical students may observe and subsequently perpetuate redundancy in clinical documentation, but the degree of redundancy in student notes and whether there is an association with scholastic performance are unknown. OBJECTIVES:This study sought to quantify redundancy, defined generally as the proportion o...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0039-1692402
更新日期:2019-05-01 00:00:00
abstract:: ...
journal_title:Applied clinical informatics
pub_type: 社论
doi:10.1055/s-0038-1676332
更新日期:2018-10-01 00:00:00
abstract:BACKGROUND: Electronic health records (EHRs) are used in long-term care to document the patients' condition, medication, and care, thereby supporting communication among caregivers and counteracting adverse drug events. However, the use of EHRs in long-term care has lagged behind EHR use in hospitals. In addition, most...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0040-1721013
更新日期:2021-01-01 00:00:00
abstract:BACKGROUND:Although patients who work and have related health issues are usually first seen in primary care, providers in these settings do not routinely ask questions about work. Guidelines to help manage such patients are rarely used in primary care. Electronic health record (EHR) systems with worker health clinical ...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0040-1715895
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND:In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) released a revised guideline on statin therapy initiation. The guideline included a 10-year risk calculation based on regression modeling, which made hand calculation infeasible. Compliance to the guideline has been su...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0039-1692186
更新日期:2019-05-01 00:00:00
abstract::Objective Patient instructions are generally written by clinicians. However, clinician-centered language is challenging for patients to understand; in the case of pediatric medication instructions, consequences can be serious. Using examples of clinician-written medication instructions from an electronic health record...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2017-06-RA-0111
更新日期:2017-10-01 00:00:00
abstract:BACKGROUND: Prediabetes and type 2 diabetes mellitus (T2DM) are one of the major long-term health conditions affecting global healthcare delivery. One of the few effective approaches is to actively manage diabetes via a healthy and active lifestyle. OBJECTIVES: This research is focused on early detection of prediabete...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0040-1719043
更新日期:2021-01-01 00:00:00
abstract:BACKGROUND:Electronic prescribing (e-prescribing) technology was introduced as an alternative to handwritten prescriptions allowing health care professionals to send prescriptions directly to pharmacies. While the technology has many advantages, such as improving pharmacy workflow and reducing medication errors, some l...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0039-1691840
更新日期:2019-05-01 00:00:00
abstract:OBJECTIVE:More than 70% of hospitals in the United States have electronic health records (EHRs). Clinical decision support (CDS) presents clinicians with electronic alerts during the course of patient care; however, alert fatigue can influence a provider's response to any EHR alert. The primary goal was to evaluate the...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2016-10-RA-0168
更新日期:2017-05-10 00:00:00
abstract:BACKGROUND:Electronic health record (EHR)-based registries allow for robust data to be derived directly from the patient clinical record and can provide important information about processes of care delivery and patient health outcomes. METHODS:A data dictionary, and subsequent data model, were developed describing EH...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0038-1651496
更新日期:2018-04-01 00:00:00
abstract:BACKGROUND:Early detection and efficient management of sepsis are important for improving health care quality, effectiveness, and costs. Due to its high cost and prevalence, sepsis is a major focus area across institutions and many studies have emerged over the past years with different models or novel machine learning...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0040-1710525
更新日期:2020-05-01 00:00:00
abstract::Patient-generated health data are coming into broader use across the health care spectrum and hold great promise as a means to improve care and health outcomes. At the same time, rapid evolution in the social media and mobile health (mHealth) market has promoted an environment in which creation and transmission of per...
journal_title:Applied clinical informatics
pub_type: 杂志文章,评审
doi:10.4338/ACI-2014-09-R-0082
更新日期:2015-01-14 00:00:00
abstract:OBJECTIVES:Telemonitoring of vital signs is an established option in treatment of patients with chronic heart failure (CHF). In order to allow for early detection of atrial fibrillation (AF) which is highly prevalent in the CHF population telemonitoring programs should include electrocardiogram (ECG) signals. It was th...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2010-12-RA-0078
更新日期:2011-11-23 00:00:00
abstract:BACKGROUND:Semantic interoperability between routine healthcare and clinical research is an unsolved issue, as information systems in the healthcare domain still use proprietary and site-specific data models. However, information exchange and data harmonization are essential for physicians and scientists if they want t...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2012-03-RA-0011
更新日期:2012-07-11 00:00:00
abstract:BACKGROUND:Smartphones are increasingly important for clinical decision support, but smartphone and Internet use are limited by cost or coverage in many settings. txt2MEDLINE provides access to published medical evidence by text messaging. Previous studies have evaluated this approach, but we found no comparisons with ...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2012-06-RA-0024
更新日期:2012-09-06 00:00:00
abstract:UNLABELLED:Nationwide Children's Hospital established an i2b2 (Informatics for Integrating Biology & the Bedside) application for sleep disorder cohort identification. Discrete data were gleaned from semistructured sleep study reports. The system showed to work more efficiently than the traditional manual chart review ...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2014-11-RA-0106
更新日期:2015-05-27 00:00:00
abstract:BACKGROUND:Preventable adverse events continue to be a threat to hospitalized patients. Clinical decision support in the form of dashboards may improve compliance with evidence-based safety practices. However, limited research describes providers' experiences with dashboards integrated into vendor electronic health rec...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0039-3402756
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND:Accurate prediction of future patient census in hospital units is essential for patient safety, health outcomes, and resource planning. Forecasting census in the Neonatal Intensive Care Unit (NICU) is particularly challenging due to limited ability to control the census and clinical trajectories. The fixed a...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2015-09-RA-0127
更新日期:2016-05-04 00:00:00
abstract:OBJECTIVE:The Instrument for Evaluating Human-Factor Principles in Medication-Related Decision Support Alerts (I-MeDeSA) was developed recently in the US with a view towards improving considerations of human-factor principles when designing alerts for clinical decision support (CDS) systems. This study evaluated the ge...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2014-01-RA-0005
更新日期:2014-06-18 00:00:00
abstract:BACKGROUND:Code status (CS) of a patient (part of their end-of-life wishes) can be critical information in healthcare delivery, which can change over time, especially at transitions of care. Although electronic health record (EHR) tools exist for medication reconciliation across transitions of care, much less attention...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2016-08-RA-0133
更新日期:2017-03-08 00:00:00
abstract:OBJECTIVES:Transitions in patient care pose an increased risk to patient safety. One way to reduce this risk is to ensure accurate medication reconciliation during the transition. Here we present an evaluation of an electronic medication reconciliation module we developed to reduce the transition risk in patients refer...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2015-11-RA-0154
更新日期:2016-05-25 00:00:00
abstract:OBJECTIVES:Various computerized health risk appraisals (HRAs) are available, but few of them assess health-related quality of life (HRQoL) in a goal-directed framework. This study describes the user-centered development and usability testing of an innovative HRQoL module that extends a validated HRA tool in primary car...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2014-08-RA-0067
更新日期:2014-12-10 00:00:00
abstract:BACKGROUND:Effective communication is essential to safe and efficient patient care. Additionally, many health information technology (HIT) developments, innovations, and standards aim to implement processes to improve data quality and integrity of electronic health records (EHR) for the purpose of clinical information ...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2011-02-RA-0011
更新日期:2011-06-08 00:00:00
abstract:BACKGROUND:Advances in technology and access to expanded genetic testing have resulted in more children and adolescents receiving genetic testing for diagnostic and prognostic purposes. With increased adoption of the electronic health record (EHR), genetic testing is increasingly resulted in the EHR. However, this lead...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0040-1718753
更新日期:2020-10-01 00:00:00
abstract:BACKGROUND:Care-management tools are typically utilized for chronic disease management. Sonoma County government agencies employed advanced health information technologies, artificial intelligence (AI), and interagency process improvements to help transform health and health care for socially disadvantaged groups and o...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0040-1715894
更新日期:2020-08-01 00:00:00