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Establishing electronic health record competency testing for first-year residents.

ABSTRACT: BACKGROUND: Despite widespread use of electronic health records (EHRs), it is unclear whether residents possess the EHR skills to perform required tasks. OBJECTIVE: We assessed first-year residents' skills on specific EHR tasks. METHODS: Incoming residents were required to participate in EHR training before starting clinical rotations. The training team developed an assessment tool for 19 EHR tasks. Senior residents used a structured template to assess interns. RESULTS: For ambulatory workflow skills, most participants (range, 70%-100%) demonstrated competence. The 3 skills for which interns needed the most assistance were (1) creating and routing a result note (17 of 68, 25%), (2) deleting a medication or changing a dose in reconciling medications (10 of 68, 15%), and (3) finding results for the past 90 days (10 of 68, 15%). For inpatient workflow skills, most interns (range, 63%-100%) demonstrated competence. The 3 skills in which interns needed the most assistance were (1) placing a referral order at discharge (23 of 68, 34%), (2) finding a temperature on a flow sheet and trending it over time (14 of 68, 21%), and (3) creating a discharge summary, having it reviewed, and forwarding it to the primary care physician (14 of 68, 21%). CONCLUSIONS: Our results should help EHR training teams at other institutions to better understand the strengths and weakness of EHR training approaches and to target training on tasks with the greatest performance deficits as well as toward underperforming individuals or groups.

SUBMITTER: Nuovo J

PROVIDER: S-EPMC3886468 | biostudies-other | 2013 Dec

REPOSITORIES: biostudies-other

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Project description:BackgroundPhysician burnout was first documented in 1974, and the electronic health record (EHR) has been known to contribute to the symptoms of physician burnout. Authors pondered the extent of this effect, recognizing the increased use of telemedicine during the first year of COVID-19.ObjectiveThe aim of this review was to objectively analyze the literature over the last 5 years for empirical evidence of burnout incident to the EHR and to identify barriers to, facilitators to, and associated patient satisfaction with using the EHR to improve symptoms of burnout.MethodsNo human participants were involved in this review; however, 100% of participants in studies analyzed were adult physicians. We queried 4 research databases and 1 targeted journal for studies commensurate with the objective statement from January 1, 2016 through January 31, 2021 (n=25).ResultsThe hours spent in documentation and workflow are responsible for the sense of loss of autonomy, lack of work-life balance, lack of control of one's schedule, cognitive fatigue, a general loss of autonomy, and poor relationships with colleagues. Researchers have identified training, local customization of templates and workflow, and the use of scribes as strategies to alleviate the administrative burden of the EHR and decrease symptoms of burnout.ConclusionsThe solutions provided in the literature only addressed 2 of the 3 factors (workflow and documentation time) but not the third factor (usability). Practitioners and administrators should focus on the former 2 factors because they are within their sphere of control. EHR vendors should focus on empirical evidence to identify and improve the usability features with the greatest impact. Researchers should design experiments to explore solutions that address all 3 factors of the EHR that contribute to burnout.Trial registrationPROSPERO International Prospective Register of Systematic Reviews CRD42020201820; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=201820.International registered report identifier (irrid)RR2-10.2196/15490.

Project description:Introduction Robust randomised trial data have shown that routine preoperative (pre-op) testing for cataract surgery patients is inappropriate. While guidelines have discouraged testing since 2002, cataract pre-op testing rates have remained unchanged since the 1990s. Given the challenges of reducing low-value care despite strong consensus around the evidence, innovative approaches are needed to promote high-value care. This trial evaluates the impact of an interdisciplinary electronic health record (EHR) intervention that is informed by behavioural economic theory. Methods and analysis This pragmatic randomised trial is being conducted at UCLA Health between June 2021 and June 2022 with a 12-month follow-up period. We are randomising all UCLA Health physicians who perform pre-op visits during the study period to one of the three nudge arms or usual care. These three nudge alerts address (1) patient harm, (2) increased out-of-pocket costs for patients and (3) psychological harm to the patients related to pre-op testing. The nudges are triggered when a physician starts to order a pre-op test. We hypothesise that receipt of a nudge will be associated with reduced pre-op testing. The primary outcome will be the change in the percentage of patients undergoing pre-op testing at 12 months. Secondary outcomes will include the percentage of patients undergoing specific categories of pre-op tests (labs, EKGs, chest X-rays (CXRs)), the efficacy of each nudge, same-day surgery cancellations and cost savings. Ethics and dissemination The study protocol was approved by the institutional review board of the University of California, Los Angeles as well as a nominated Data Safety Monitoring Board. If successful, we will have created a tool that can be disseminated rapidly to EHR vendors across the nation to reduce inappropriate testing for the most common low-risk surgical procedures in the country. Trial registration number ClinicalTrials.gov identifier: NCT04104256.

Project description:BackgroundThe rapid expansion in the use of electronic health records (EHR) has increased the number of medical errors originating in health information systems (HIS). The sociotechnical approach helps in understanding risks in the development, implementation, and use of EHR and health information technology (HIT) while accounting for complex interactions of technology within the health care system.ObjectiveThis study addresses two important questions: (1) "which of the common EHR error types are associated with perceived high- and extreme-risk severity ratings among EHR users?", and (2) "which variables are associated with high- and extreme-risk severity ratings?"MethodsThis study was a quantitative, non-experimental, descriptive study of EHR users. We conducted a cross-sectional web-based questionnaire study at the largest hospital district in Finland. Statistical tests included the reliability of the summative scales tested with Cronbach's alpha. Logistic regression served to assess the association of the independent variables to each of the eight risk factors examined.ResultsA total of 2864 eligible respondents provided the final data. Almost half of the respondents reported a high level of risk related to the error type "extended EHR unavailability". The lowest overall risk level was associated with "selecting incorrectly from a list of items". In multivariate analyses, profession and clinical unit proved to be the strongest predictors for high perceived risk. Physicians perceived risk levels to be the highest ( P<.001 in six of eight error types), while emergency departments, operating rooms, and procedure units were associated with higher perceived risk levels ( P<.001 in four of eight error types). Previous participation in eLearning courses on EHR-use was associated with lower risk for some of the risk factors.ConclusionsBased on a large number of Finnish EHR users in hospitals, this study indicates that HIT safety hazards should be taken very seriously, particularly in operating rooms, procedure units, emergency departments, and intensive care units/critical care units. Health care organizations should use proactive and systematic assessments of EHR risks before harmful events occur. An EHR training program should be compulsory for all EHR users in order to address EHR safety concerns resulting from the failure to use HIT appropriately.

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Establishing electronic health record competency testing for first-year residents.

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