Dataset Information

Impact of electronic medical record on physician practice in office settings: a systematic review.

ABSTRACT:

Background

Increased investments are being made for electronic medical records (EMRs) in Canada. There is a need to learn from earlier EMR studies on their impact on physician practice in office settings. To address this need, we conducted a systematic review to examine the impact of EMRs in the physician office, factors that influenced their success, and the lessons learned.

Results

For this review we included publications cited in Medline and CINAHL between 2000 and 2009 on physician office EMRs. Studies were included if they evaluated the impact of EMR on physician practice in office settings. The Clinical Adoption Framework provided a conceptual scheme to make sense of the findings and allow for future comparison/alignment to other Canadian eHealth initiatives.In the final selection, we included 27 controlled and 16 descriptive studies. We examined six areas: prescribing support, disease management, clinical documentation, work practice, preventive care, and patient-physician interaction. Overall, 22/43 studies (51.2%) and 50/109 individual measures (45.9%) showed positive impacts, 18.6% studies and 18.3% measures had negative impacts, while the remaining had no effect. Forty-eight distinct factors were identified that influenced EMR success. Several lessons learned were repeated across studies: (a) having robust EMR features that support clinical use; (b) redesigning EMR-supported work practices for optimal fit; (c) demonstrating value for money; (d) having realistic expectations on implementation; and (e) engaging patients in the process.

Conclusions

Currently there is limited positive EMR impact in the physician office. To improve EMR success one needs to draw on the lessons from previous studies such as those in this review.

SUBMITTER: Lau F

PROVIDER: S-EPMC3315440 | biostudies-literature | 2012 Feb

REPOSITORIES: biostudies-literature

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Publications

Impact of electronic medical record on physician practice in office settings: a systematic review.

Lau Francis F Price Morgan M Boyd Jeanette J Partridge Colin C Bell Heidi H Raworth Rebecca R

BMC medical informatics and decision making 20120224

<h4>Background</h4>Increased investments are being made for electronic medical records (EMRs) in Canada. There is a need to learn from earlier EMR studies on their impact on physician practice in office settings. To address this need, we conducted a systematic review to examine the impact of EMRs in the physician office, factors that influenced their success, and the lessons learned.<h4>Results</h4>For this review we included publications cited in Medline and CINAHL between 2000 and 2009 on phys ...[more]

PMID: 22364529

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Project description:BackgroundWhile Electronic Medical Record (EMR) use has increased dramatically, the EMR's impact on the patient-doctor relationship remains unclear. This systematic literature review sought to understand the impact of EMR use on patient-doctor relationships and communication.MethodsParallel searches in Ovid MEDLINE, PubMed, Scopus, PsycINFO, Cochrane Library, reference review of prior systematic reviews, meeting abstract reviews, and expert reviews from August 2013 to March 2015 were conducted. Medical Subject Heading terms related to EMR use were combined with keyword terms identifying face-to-face patient-doctor communication. English language observational or interventional studies (1995-2015) were included. Studies examining physician attitudes only were excluded. Structured data extraction compared study population, design, data collection method, and outcomes.ResultsFifty-three of 7445 studies reviewed met inclusion criteria. Included studies used behavioral analysis (28) to objectively measure communication behaviors using video or direct observation and pre-post or cross-sectional surveys to examine patient perceptions (25). Objective studies reported EMR communication behaviors that were both potentially negative (i.e., interrupted speech, low rates of screen sharing) and positive (i.e., facilitating questions). Studies examining overall patient perceptions of satisfaction, communication or the patient-doctor relationship (n?=?22) reported no change with EMR use (16); a positive impact (5) or showed mixed results (1). Study quality was not assessable. Small sample sizes limited generalizability. Publication bias may limit findings.DiscussionDespite objective evidence that EMR use may negatively impact patient-doctor communication, studies examining patient perceptions found no change in patient satisfaction or patient-doctor communication. Therefore, our findings should encourage providers to adopt the EMR as a communication tool. Future research is needed to better understand how to enhance patient-doctor- EMR communication. This research should correlate observed physician behavior to patient satisfaction, focus on physician communication skills training, and explore inpatient experiences.

Project description:BackgroundElectronic medical records (EMRs) contain large amounts of rich clinical information. Developing EMR-based case definitions, also known as EMR phenotyping, is an active area of research that has implications for epidemiology, clinical care, and health services research.ObjectiveThis review aims to describe and assess the present landscape of EMR-based case phenotyping for the Charlson conditions.MethodsA scoping review of EMR-based algorithms for defining the Charlson comorbidity index conditions was completed. This study covered articles published between January 2000 and April 2020, both inclusive. Embase (Excerpta Medica database) and MEDLINE (Medical Literature Analysis and Retrieval System Online) were searched using keywords developed in the following 3 domains: terms related to EMR, terms related to case finding, and disease-specific terms. The manuscript follows the Preferred Reporting Items for Systematic reviews and Meta-analyses extension for Scoping Reviews (PRISMA) guidelines.ResultsA total of 274 articles representing 299 algorithms were assessed and summarized. Most studies were undertaken in the United States (181/299, 60.5%), followed by the United Kingdom (42/299, 14.0%) and Canada (15/299, 5.0%). These algorithms were mostly developed either in primary care (103/299, 34.4%) or inpatient (168/299, 56.2%) settings. Diabetes, congestive heart failure, myocardial infarction, and rheumatology had the highest number of developed algorithms. Data-driven and clinical rule-based approaches have been identified. EMR-based phenotype and algorithm development reflect the data access allowed by respective health systems, and algorithms vary in their performance.ConclusionsRecognizing similarities and differences in health systems, data collection strategies, extraction, data release protocols, and existing clinical pathways is critical to algorithm development strategies. Several strategies to assist with phenotype-based case definitions have been proposed.

Project description:ObjectivePractice arrangements in physician offices were characterised by examining the share of visits that involved physician assistants (PAs) and nurse practitioners (NPs). The hypothesis was that collaborative practice (ie, care delivered by a dyad of physician-PA and/or physician-NP) was increasing.DesignTemporal ecological study.SettingNon-federal physician offices.ParticipantsPatient visits to a physician, PA or NP, spanning years 2007-2016.MethodsA stratified random sample of visits to office-based physicians was pooled through the National Ambulatory Medical Care Survey public use linkage ﬁle. Among 317 674 visits to physicians, PAs or NPs, solo and collaborative practices were described and compared over two timespans of 2007-2011 and 2012-2016. Weighted patient visits were aggregated in bivariate analyses to achieve nationally representative estimates. Survey statistics assessed patient demographic characteristics, reason for visit and visit specialty by provider type.ResultsWithin years 2007-2011 and 2012-2016, there were 4.4 billion and 4.1 billion physician office visits (POVs), respectively. Comparing the two timespans, the rate of POVs with a solo PA (0.43% vs 0.21%) or NP (0.31% vs 0.17%) decreased. Rate of POVs with a collaborative physician-PA increased non-significantly. Rate of POVs with a collaborative physician-NP (0.49% vs 0.97%, p<0.01) increased. Overall, collaborative practice, in particular physician-NP, has increased in recent years (p<0.01), while visits handled by a solo PA or NP decreased (p<0.01). In models adjusted for patient age and chronic conditions, the odds of collaborative practice in years 2012-2016 compared with years 2007-2011 was 35% higher (95% CI 1.01 to 1.79). Furthermore, in 2012-2016, NPs provided more independent primary care, and PAs provided more independent care in a non-primary care medical specialty. Preventive visits declined among all providers.ConclusionsIn non-federal physician offices, collaborative care with a physician-PA or physician-NP appears to be a growing part of office-based healthcare delivery.

Project description:BACKGROUND:Wearable technologies provide users hands-free access to computer functions and are becoming increasingly popular on both the consumer market and in various industries. The medical industry has pioneered research and implementation of head-mounted wearable devices, such as Google Glass. Most of this research has focused on surgical interventions; however, other medical fields have begun to explore the potential of this technology to support both patients and clinicians. OBJECTIVE:Our aim was to systematically evaluate the feasibility, usability, and acceptability of using Google Glass in nonsurgical medical settings and to determine the benefits, limitations, and future directions of its application. METHODS:This review covers literature published between January 2013 and May 2017. Searches included PubMed MEDLINE, Embase, INSPEC (Ebsco), Cochrane Central Register of Controlled Trials (CENTRAL), IEEE Explore, Web of Science, Scopus, and Compendex. The search strategy sought all articles on Google Glass. Two reviewers independently screened titles and abstracts, assessed full-text articles, and extracted data from articles that met all predefined criteria. Any disagreements were resolved by discussion or consultation by the senior author. Included studies were original research articles that evaluated the feasibility, usability, or acceptability of Google Glass in nonsurgical medical settings. The preferred reporting results of systematic reviews and meta-analyses (PRISMA) guidelines were followed for reporting of results. RESULTS:Of the 852 records examined, 51 met all predefined criteria, including patient-centered (n=21) and clinician-centered studies (n=30). Patient-centered studies explored the utility of Google Glass in supporting patients with motor impairments (n=8), visual impairments (n=5), developmental and psychiatric disorders (n=2), weight management concerns (n=3), allergies (n=1), or other health concerns (n=2). Clinician-centered studies explored the utility of Google Glass in student training (n=9), disaster relief (n=4), diagnostics (n=2), nursing (n=1), autopsy and postmortem examination (n=1), wound care (n=1), behavioral sciences (n=1), and various medical subspecialties, including, cardiology (n=3), radiology (n=3), neurology (n=1), anesthesiology (n=1), pulmonology (n=1), toxicology (n=1), and dermatology (n=1). Most of the studies were conducted in the United States (40/51, 78%), did not report specific age information for participants (38/51, 75%), had sample size <30 participants (29/51, 57%), and were pilot or feasibility studies (31/51, 61%). Most patient-centered studies (19/21, 90%) demonstrated feasibility with high satisfaction and acceptability among participants, despite a few technical challenges with the device. A number of clinician-centered studies (11/30, 37%) reported low to moderate satisfaction among participants, with the most promising results being in the area of student training. Studies varied in sample size, approach for implementation of Google Glass, and outcomes assessment. CONCLUSIONS:The use of Google Glass in nonsurgical medical settings varied. More promising results regarding the feasibility, usability, and acceptability of using Google Glass were seen in patient-centered studies and student training settings. Further research evaluating the efficacy and cost-effectiveness of Google Glass as an intervention to improve important clinical outcomes is warranted.

Dataset Information

Impact of electronic medical record on physician practice in office settings: a systematic review.

Background

Results

Conclusions

Publications

Impact of electronic medical record on physician practice in office settings: a systematic review.

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