Metadata Correction: Meaningful Use of Electronic Health Records: Experiences From the Field and Future Opportunities (original) (raw)
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Meaningful Use of Electronic Health Records: Experiences From the Field and Future Opportunities
JMIR medical informatics, 2015
With the aim of improving health care processes through health information technology (HIT), the US government has promulgated requirements for "meaningful use" (MU) of electronic health records (EHRs) as a condition for providers receiving financial incentives for the adoption and use of these systems. Considerable uncertainty remains about the impact of these requirements on the effective application of EHR systems. The Agency for Healthcare Research and Quality (AHRQ)-sponsored Centers for Education and Research in Therapeutics (CERTs) critically examined the impact of the MU policy relating to the use of medications and jointly developed recommendations to help inform future HIT policy. We gathered perspectives from a wide range of stakeholders (N=35) who had experience with MU requirements, including academicians, practitioners, and policy makers from different health care organizations including and beyond the CERTs. Specific issues and recommendations were discussed...
Electronic health records (EHRs) have emerged among health information technology as Bmeaningful use^ to improve the quality and efficiency of healthcare, and health disparities in population health. In other instances, they have also shown lack of interoperability, functionality and many medical errors. With proper implementation and training, are electronic health records a viable source in managing population health? The primary objective of this systematic review is to assess the relationship of electronic health records' use on population health through the identification and analysis of facilitators and barriers to its adoption for this purpose. Authors searched Cumulative Index of Nursing and Allied Health Literature (CINAHL) and MEDLINE (PubMed), 10/02/2012-10/02/2017, core clinical/academic journals, MEDLINE full text, English only, human species and evaluated the articles that were germane to our research objective. Each article was analyzed by multiple reviewers. Group members recognized common facilitators and barriers associated with EHRs effect on population health. A final list of articles was selected by the group after three consensus meetings (n = 55). Among a total of 26 factors identified, 63% (147/232) of those were facilitators and 37% (85/232) barriers. About 70% of the facilitators consisted of productivity/efficiency in EHRs occurring 33 times, increased quality and data management each occurring 19 times, surveillance occurring 17 times, and preventative care occurring 15 times. About 70% of the barriers consisted of missing data occurring 24 times, no standards (interoperability) occurring 13 times, productivity loss occurring 12 times, and technology too complex occurring 10 times. The analysis identified more facilitators than barriers to the use of the EHR to support public health. Wider adoption of the EHR and more comprehensive standards for interoperability will only enhance the ability for the EHR to support this important area of surveillance and disease prevention. This review identifies more facilitators than barriers to using the EHR to support public health, which implies a certain level of usability and acceptance to use the EHR in this manner. The public-health industry should combine their efforts with the interoperability projects to make the EHR both fully adopted and fully interoperable. This will greatly increase the availability, accuracy, and comprehensiveness of data across the country, which will enhance benchmarking and disease surveillance/prevention capabilities.
Seven years after Meaningful Use: Physicians’ and nurses’ experiences with electronic health records
Health Care Management Review, 2019
Although the federal government's Meaningful Use electronic health record (EHR) implementation program resulted in some successes, there have been many challenges. The purpose of this study was to obtain detailed empirical data to better understand physicians' and nurses' experiences with EHRs. We conducted in-depth interviews with 30 physicians and nurses from two large health systems that were focused on attaining Stage 3 Meaningful Use criteria. Thematic framework analysis identified themes related to perceived benefits and challenges with EHR use. Participants appreciated benefits such as real-time patient data and easier access to information. Challenges included lack of interoperability across units, and this seemed to underlie many other noted challenges such as increased workload, insufficient training, and the perceived need for workarounds. Two key findings included mixed messages about trust in the EHR's information and its interference with interpersonal relationships. Results suggest that conservation of resources theory may be a useful strategy for understanding behaviors that enhance or undermine effective EHR use. Implications for policy and practice are discussed. I n 2009, the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act created incentives for electronic health record (EHR) adoption (HealthIT.gov, 2015). HITECH's Meaningful Use program, managed by the Centers for Medicare & Medicaid Services (CMS), intended to move providers beyond EHR basics, tying financial incentives to increasingly sophisticated use of EHRs for decision support over time (Blumenthal & Tavenner, 2010). However, as of 2014 only 2% of U.S. hospitals and 12% of physician practices had systems that could meet the Meaningful Use criteria (DeAngelis, 2014). In 2016, CMS announced the existing Meaningful Use program would be discontinued and replaced because of persistent resistance, problems, and concerns with EHR use (AHIMA,
Journal of Medical Internet Research, 2021
Coincident with the tsunami of COVID-19–related publications, there has been a surge of studies using real-world data, including those obtained from the electronic health record (EHR). Unfortunately, several of these high-profile publications were retracted because of concerns regarding the soundness and quality of the studies and the EHR data they purported to analyze. These retractions highlight that although a small community of EHR informatics experts can readily identify strengths and flaws in EHR-derived studies, many medical editorial teams and otherwise sophisticated medical readers lack the framework to fully critically appraise these studies. In addition, conventional statistical analyses cannot overcome the need for an understanding of the opportunities and limitations of EHR-derived studies. We distill here from the broader informatics literature six key considerations that are crucial for appraising studies utilizing EHR data: data completeness, data collection and hand...
New Unintended Adverse Consequences of Electronic Health Records
IMIA Yearbook
SummaryAlthough the health information technology industry has made considerable progress in the design, development, implementation, and use of electronic health records (EHRs), the lofty expectations of the early pioneers have not been met. In 2006, the Provider Order Entry Team at Oregon Health & Science University described a set of unintended adverse consequences (UACs), or unpredictable, emergent problems associated with computer-based provider order entry implementation, use, and maintenance. Many of these originally identified UACs have not been completely addressed or alleviated, some have evolved over time, and some new ones have emerged as EHRs became more widely available. The rapid increase in the adoption of EHRs, coupled with the changes in the types and attitudes of clinical users, has led to several new UACs, specifically: complete clinical information unavailable at the point of care; lack of innovations to improve system usability leading to frustrating user exper...
Journal of the American Medical Informatics Association, 2012
Background Electronic health records (EHR) have the potential to improve patient care through efficient access to complete patient health information. This potential may not be reached because many of the most important determinants of health outcome are rarely included. Successful health promotion and disease prevention requires patient-reported data reflecting health behaviors and psychosocial issues. Furthermore, there is a need to harmonize this information across different EHR systems. Methods To fill this gap a three-phased process was used to conceptualize, identify and recommend patientreported data elements on health behaviors and psychosocial factors for the EHR. Expert panels (n¼13) identified candidate measures (phase 1) that were reviewed and rated by a wide range of health professionals (n¼93) using the grid-enabled measures wiki social media platform (phase 2). Recommendations were finalized through a town hall meeting with key stakeholders including patients, providers, researchers, policy makers, and representatives from healthcare settings (phase 3). Results Nine key elements from three areas emerged as the initial critical patient-reported elements to incorporate systematically into EHRdhealth behaviors (eg, exercise), psychosocial issues (eg, distress), and patient-centered factors (eg, demographics). Recommendations were also made regarding the frequency of collection ranging from a single assessment (eg, demographic characteristics), to annual assessment (eg, health behaviors), or more frequent (eg, patient goals).
Medical Teacher, 2013
Electronic Health Records (EHRs) have the potential to increase the quality of care and to reduce healthcare costs. Governments in many countries have stimulated the adoption of EHRs as part of healthcare reform policies. However, the general availability of EHRs has not resulted in better quality of care or a reduction in costs. There is widespread consensus that the inability of healthcare professionals to use EHRs in a meaningful way is an important factor that precludes the realization of the full potential of EHRs. Meaningful use is defined as EHR use that contributes to achieve significant improvements in quality of care.
Electronic health records: An awkward third wheel
2014
An integrated perspective consisting of macro-and micro-level approaches to health policy research and evaluation is presented. Analytical strategies are suggested for policy analysis, targeting on health disparities at individual and population levels. This systems approach enables investigators to view how scientific public policy analysis can be implemented to assess policy impacts. In this special issue, five papers are introduced.