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electronic medical record (EMR); electronic health record (EHR)

Entry, retrieval & maintenance of medical records in electronic form (computerized medical record). Popular electronic medical records include Epic, Cerner, & eClinicalWorks. [20] Procedure: - doctors do not have to redocument medical student entries for parts of Medicare claims [15] Complications: - "alerts rendered meaningless by their sheer number" [7] - primary care physicians receive ~77 notifications daily [9] - dismissing concerns of the people who must use EHRs - physicians who voice reservations to EHRs may be labeled "technophobic, resistant, & uncooperative" [7] - frequent computer use by clinicians during patient visits may negatively affect communication & patient satisfaction [8] - use of electronic medical records does not adverse affect inpatient outcomes [10] - difficult to use electronic medical records linked to physician burnout [18] - inadvertantly selecting "Walking Corpse Syndrome" from dropdown menu [16] Notes: - no other industry has been under a universal mandate to adopt a new technology before its effects are fully understood [7] - operational productivity in the emergency department has remained unchanged by EMRs [4] - poorly designed EMRs can detract from the patient encounter rather than enhance it [5] - 0.11% of adverse safety events attributed to EMR [17] - 0.03% suggested EHR usability contributed to patient harm - usability challenges include - data entry (27%) - safety alerts (22%) - interoperability (18%) - visual display (9%) - availability of information (9%) - system automation & defaults (8%) - workflow support (7%) - usability challenges occurred during - order placement (38%) - medication administration (37%) - review of results (16%) - documentation (9%) [17] - ~1/3 of ophthalmologists' time with patients is spent using their electronic health record [13] - EMR should provide concise, context sensitive, real-time data uncluttered by extraneous information [5] - data to be easily shared with other healthcare facilities [5] - users should be able to provide feedback easily [5] - 49% of physicians' office hours are spent on EHR & desk work while 27% was spent directly with patients [11] - physicians in ambulatory care spend ~16 minutes/encounter actively using an electronic health record [19] - speech recognition more error prone & time consuming than keyboard/mouse data entry for emergency department doctors entering electronic medical records [14] - hackers may 'bring down' a hospital information system, then hold the hospital(s) ransom to restore access [12]

Related

electronic health information exchange (HIE) meaningful use of electronic health records safety alert

General

medical record software; computer program; electronic application

References

  1. Journal Watch 25(10):81, 2005 Garrido T, Jamieson L, Zhou Y, Wiesenthal A, Liang L. Effect of electronic health records in ambulatory care: retrospective, serial, cross sectional study. BMJ. 2005 Mar 12;330(7491):581. PMID: 15760999 http://bmj.bmjjournals.com/cgi/content/full/330/7491/581
  2. Journal Watch 25(10):81-82, 2005 Johnson KB, Serwint JR, Fagan LM, Thompson RE, Wilson MH. Computer-based documentation: effect on parent and physician satisfaction during a pediatric health maintenance encounter. Arch Pediatr Adolesc Med. 2005 Mar;159(3):250-4. PMID: 15753268
  3. Schiff GD, Bates DW. Can electronic clinical documentation help prevent diagnostic errors? N Engl J Med. 2010 Mar 25;362(12):1066-9. PMID: 20335582
  4. Ward MJ et al. The effect of electronic health record implementation on community emergency department operational measures of performance. Ann Emerg Med 2014 Jun; 63:723 PMID: 24412667
  5. Young K, Sadoughi S, Saitz R AMA Recommends 8 Ways EHRs Can Be Improved Physician's First Watch. September 18, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief https://download.ama-assn.org/resources/doc/ps2/x-pub/ehr-priorities.pdf
  6. Payne TH et al Report of the AMIA EHR 2020 Task Force on the Status and Future Direction of EHRs. J Am Med Inform Assoc. 2015 May 28 PMID: 26024883 http://jamia.oxfordjournals.org/content/early/2015/05/22/jamia.ocv066
  7. Rosenbaum L Transitional Chaos or Enduring Harm? The EHR and the Disruption of Medicine. N Engl J Med 2015; 373:1585-1588. October 22, 2015. PMID: 26488690 http://www.nejm.org/doi/full/10.1056/NEJMp1509961
  8. Ratanawongsa N et al Association Between Clinician Computer Use and Communication With Patients in Safety-Net Clinics. JAMA Intern Med. Published online November 30, 2015 PMID: 26619393 http://archinte.jamanetwork.com/article.aspx?articleid=2473628 - Frankel RM Computers in the Examination Room JAMA Intern Med. Published online November 30, 2015. PMID: 26619228 http://archinte.jamanetwork.com/article.aspx?articleid=2473626
  9. Murphy DR, Meyer AN, Russo E The Burden of Inbox Notifications in Commercial Electronic Health Records. JAMA Intern Med. 2016 Apr 1;176(4):559-60. PMID: 26974737
  10. Barnett ML et al Adverse inpatient outcomes during the transition to a new electronic health record system: observational study. BMJ 2016;354:i3835 PMID: 27471242 http://www.bmj.com/content/354/bmj.i3835
  11. Sinsky C, Colligan L, Li L et al Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Ann Intern Med. Published online 6 September 2016 PMID: 27595430 http://annals.org/article.aspx?articleid=2546704 - Hingle S Electronic Health Records: An Unfulfilled Promise and a Call to Action. Ann Intern Med. Published online 6 September 2016 PMID: 27595501 http://annals.org/article.aspx?articleid=2546705
  12. Chinthapalli K Heads Up. The hackers holding hospitals to ransom. BMJ 2017;357:j2214 PMID: 28490432 http://www.bmj.com/content/357/bmj.j2214
  13. Read-Brown S, Hribar MR, Reznick LG et al Time Requirements for Electronic Health Record Use in an Academic Ophthalmology Center. JAMA Ophthalmol. Published online October 12, 2017 PMID: 29049512 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2656337
  14. Hodgson T, Magrabi F, Coiera E. Efficiency and safety of speech recognition for documentation in the electronic health record. J Am Med Inform Assoc. 2017;24:1127-1133 PMID: 29016971 https://psnet.ahrq.gov/resources/resource/31516
  15. Young KD Doctors Don't Need to Redocument Students' EHR Entries: CMS Medscape - Feb 15, 2018. https://www.medscape.com/viewarticle/892715
  16. Burton JR The Walking Corpse Syndrome: Geriatrics and the Electronic Health Record. J Am Geriatr Soc. 2018 Feb 20 PMID: 29461624 http://onlinelibrary.wiley.com/doi/10.1111/jgs.15293/full
  17. Howe JL, Adams KT, Hettinger AZ, et al Electronic Health Record Usability Issues and Potential Contribution to Patient Harm. JAMA. 2018;319(12):1276-1278 PMID: 29584833 https://jamanetwork.com/journals/jama/article-abstract/2676098
  18. Melnick ER et al The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians Mayo Clinic Proceedings Nov 2019 PMID: 31735343 https://www.mayoclinicproceedings.org/article/S0025-6196(19)30836-5/fulltext
  19. Overhage JM, Jr DM. Physician Time Spent Using the Electronic Health Record During Outpatient Encounters: A Descriptive Study. Ann Intern Med. 2020. Jan 14. PMID: 31931523 https://annals.org/aim/article-abstract/2758843/physician-time-spent-using-electronic-health-record-during-outpatient-encounters
  20. Brodke D Electronic Medical Records Are Strangling American Medicine. The implications for burnout are staggering MedPage Today. October 23, 2022 https://www.medpagetoday.com/opinion/second-opinions/101354
  21. SelectHub Top EMR Software https://www.selecthub.com/emr-software/