Abstract:
BACKGROUND:Electronic health record (EHR) systems are often modified through the addition of new features over time. Few studies have examined the specific effects of such changes. We examined whether implementation of a bidirectional laboratory interface for order entry and data reporting within an existing ambulatory EHR would result in more prompt responses to laboratory indications for antiretroviral therapy (ART) changes or in improved communication with HIV+ patients about relevant laboratory results. METHODS:We conducted a single-arm intervention study comparing the timeliness of ART regimen changes, HIV viral load (VL) outcomes and patient-reported assessments of care before and after implementation of a laboratory data exchange interface within an existing EHR, without changing the EHR ordering or results reporting user interface. Patient data was extracted from the EHR covering the period from 1 year before to 2 years after the intervention for a cohort of 1181 patients who had received care during the baseline year. The timeliness of ART changes was represented by the days from a laboratory-result "signal" (CD4 dropping below 350 or 200 or VL increasing by a half-log or to a value over 100,000) to an ART-change "response". Patient assessments of care were collected by interviewing 100 anonymous patients at baseline and another 125 at 2 years post-intervention. RESULTS:A total of 171 laboratory "signal" events were followed within 80 days by a change in ART therapy. The mean time from signal to therapy change (adjusted for clustering by patient) initially increased, from 37.7 days during the pre-intervention year to 48.2 days during the quarter immediately following activation of the lab intervention. It then declined to a mean of 31.4 days over the remaining 21 months of observation (P=0.03 for the 6-day improvement from the pre-period). A majority of patients (65%) achieved undetectable VL values by the end of the observation period; faster signal-response times were not associated with greater achievement of undetectable VL. Patients rated communication about laboratory tests more highly after implementation of the interface (91 vs. 83 on a 100-point scale, P=0.01); ratings were not higher for other aspects of care. CONCLUSIONS:Adding laboratory data exchange interfaces within existing EHRs holds promise for improving HIV care, both in the timeliness of responses to important laboratory results and in the quality of provider communication about lab tests. However, the benefits from this incremental change may be modest unless more extensive redesign of laboratory follow-up workflows is undertaken, with support from enhanced user interfaces that take advantage of the laboratory information delivered. Providers should also consider increased staffing to compensate for dips in follow-up performance during the initial post-implementation months.
journal_name
Int J Med Informjournal_title
International journal of medical informaticsauthors
Bell DS,Cima L,Seiden DS,Nakazono TT,Alcouloumre MS,Cunningham WEdoi
10.1016/j.ijmedinf.2012.07.012subject
Has Abstractpub_date
2012-10-01 00:00:00pages
e74-82issue
10eissn
1386-5056issn
1872-8243pii
S1386-5056(12)00139-6journal_volume
81pub_type
杂志文章abstract:OBJECTIVES:This paper has two objectives. First, it categorizes the Twitter handles tweeted flu related information based on the amount of replies and mentions within the Twitter network. The collected Twitter accounts are categorized as media, health related individuals, organizations, government, individuals with no ...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2016.04.009
更新日期:2016-07-01 00:00:00
abstract::Technology and equipment are often identified as contributors to adverse medical events, however technology is seldom the focal point of investigation as a source of medical error or adverse event. It is often seen as both a means of reducing error (e.g., automated drug dispensing machines) or as a major contributing ...
journal_title:International journal of medical informatics
pub_type: 杂志文章,评审
doi:10.1016/j.ijmedinf.2006.05.046
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2012.11.015
更新日期:2013-05-01 00:00:00
abstract:INTRODUCTION:The rapid scale-up of HIV care and treatment in resource-limited countries requires concurrent, rapid development of health information systems to support quality service delivery. Mozambique, a country with an 11.5% prevalence of HIV, has developed nation-wide patient monitoring systems (PMS) with standar...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2016.11.002
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:Clinical pathways (CPs) increase in popularity and are known to lead to several benefits in the hospital environment. Clinical pathways can be either paper-based or software-based. It is known that paper-based CPs can result in more paperwork instead of simplifying daily routines of healthcare workers. Insuf...
journal_title:International journal of medical informatics
pub_type: 杂志文章
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更新日期:2020-03-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2020.104123
更新日期:2020-06-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2018.01.005
更新日期:2018-04-01 00:00:00
abstract:OBJECTIVE:Increasingly health care facilities are adopting electronic medical record systems and installing computer workstations in patient exam rooms. The introduction of computer workstations into the medical interview process makes it important to consider the impact of such technology on older patients as well as ...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2011.03.005
更新日期:2013-11-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2009.06.002
更新日期:2009-10-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
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更新日期:2015-06-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/s1386-5056(98)00142-7
更新日期:1998-10-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
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更新日期:2020-12-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
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更新日期:2015-05-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2008.07.004
更新日期:2009-03-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2012.07.006
更新日期:2012-10-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2020.104240
更新日期:2020-09-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2020.104194
更新日期:2020-09-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 信件
doi:10.1016/j.ijmedinf.2012.11.016
更新日期:2013-05-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2015.03.001
更新日期:2015-07-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2013.02.008
更新日期:2013-08-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章,评审
doi:10.1016/j.ijmedinf.2007.01.008
更新日期:2007-05-01 00:00:00
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pub_type: 杂志文章
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journal_title:International journal of medical informatics
pub_type: 杂志文章,多中心研究
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更新日期:2019-01-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
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更新日期:2020-02-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2014.06.003
更新日期:2014-08-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
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更新日期:2003-08-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2019.04.010
更新日期:2019-07-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2006.05.017
更新日期:2007-06-01 00:00:00
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pub_type: 杂志文章
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更新日期:2017-03-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章,评审
doi:10.1016/j.ijmedinf.2019.03.018
更新日期:2019-06-01 00:00:00