Quality of Hospital Electronic Health Record (EHR) Data Based on the International Consortium for Health Outcomes Measurement (ICHOM) in Heart Failure: Pilot Data Quality Assessment Study.

BACKGROUND: There is increasing recognition that health care providers need to focus attention, and be judged against, the impact they have on the health outcomes experienced by patients. The measurement of health outcomes as a routine part of clinical documentation is probably the only scalable way of collecting outcomes evidence, since secondary data collection is expensive and error-prone. However, there is uncertainty about whether routinely collected clinical data within electronic health record (EHR) systems includes the data most relevant to measuring and comparing outcomes and if those items are collected to a good enough data quality to be relied upon for outcomes assessment, since several studies have pointed out significant issues regarding EHR data availability and quality. OBJECTIVE: In this paper, we first describe a practical approach to data quality assessment of health outcomes, based on a literature review of existing frameworks for quality assessment of health data and multistakeholder consultation. Adopting this approach, we performed a pilot study on a subset of 21 International Consortium for Health Outcomes Measurement (ICHOM) outcomes data items from patients with congestive heart failure. METHODS: All available registries compatible with the diagnosis of heart failure within an EHR data repository of a general hospital (142,345 visits and 12,503 patients) were extracted and mapped to the ICHOM format. We focused our pilot assessment on 5 commonly used data quality dimensions: completeness, correctness, consistency, uniqueness, and temporal stability. RESULTS: We found high scores (>95%) for the consistency, completeness, and uniqueness dimensions. Temporal stability analyses showed some changes over time in the reported use of medication to treat heart failure, as well as in the recording of past medical conditions. Finally, the investigation of data correctness suggested several issues concerning the characterization of missing data values. Many of these issues appear to be introduced while mapping the IMASIS-2 relational database contents to the ICHOM format, as the latter requires a level of detail that is not explicitly available in the coded data of an EHR. CONCLUSIONS: Overall, results of this pilot study revealed good data quality for the subset of heart failure outcomes collected at the Hospital del Mar. Nevertheless, some important data errors were identified that were caused by fundamentally different data collection practices in routine clinical care versus research, for which the ICHOM standard set was originally developed. To truly examine to what extent hospitals today are able to routinely collect the evidence of their success in achieving good health outcomes, future research would benefit from performing more extensive data quality assessments, including all data items from the ICHOM standards set and across multiple hospitals.

Efficacy, feasibility and acceptability of the OptiMEDs tool for multidisciplinary medication review in nursing homes.

AIM(S): Exploring efficacy, feasibility and acceptability of a complex multifaced intervention (OptiMEDs) supporting multidisciplinary medication reviews in Belgian nursing homes (NHs). METHODS: A pilot study in 2 intervention, 1 control NH was held, involving dementia and non-dementia NH residents (>65 years). OptiMEDs provided automated assessment of possible inappropriate medications (PIMs) and patient-specific nurse observation lists of potential side-effects. Medication changes were evaluated one month after the medication review. Feasibility and acceptability was collected via surveys among the health-care professionals. Trial registration NCT04142645, 31/10/2019. RESULTS: Participants (n = 148, n = 100 in the intervention NHs) had a mean age of 87.2 years, with 75.0% females and 49.3% non-dementia patients. Prevalence of PIM use was 84.7% and of potential medication side-effects 84.5%, (range 1-19 per resident). One month after the intervention, the medication use decreased in 35.8% and PIM use in 25.9% of surviving intervention NHresidents (n = 88). GPs changed more medications when side-effects were observed (42% when side-effects present versus 12% when no side-effects, p = 0.019). Median workload for nurses was 45 min, 20 for pharmacists, and 8 for GPs. User satisfaction for the OptiMEDs tool was high (n = 33, median score of 8, IQR 6 -8), with GPs (n = 19) showing the highest appreciation. Nurses (n = 9) reported a median score on the System Usability Scale of 70 (IQR 55 - 72), with lower scores for learnability aspects. CONCLUSION: The OptiMEDs intervention was feasible and user-friendly, showing decreases in the medication and PIM use; without affecting patient safety. A cluster-randomized trial is needed to explore impact on patient-related outcomes.

Perception of Belgian nurses about evidence-based clinical practice implementation: a focus group study.

BACKGROUND/OBJECTIVES: Despite recommendations to integrate evidence-based practice into nursing care, evidence-based nursing (EBN) implementation is generally lacking. Strategies for developing an EBN implementation plan require an evaluation of nurses' needs and expectations. The aim of this study was to evaluate how Belgian nurses perceive EBN. METHODS: Descriptive qualitative data were obtained via focus groups. Fifty-six nurses took part in the study and were assigned to one of seven focus groups based on their work setting and the local language. RESULTS: The main results revealed little familiarity with the EBN concept. There were a number of reported barriers to integrating EBN into practice: lack of time; lack of skills needed to find, process, and apply information; lack of support from management; and lack of recognition of the nursing profession. CONCLUSION: Participants identified four strategies for facilitating EBN development: specific staff dedicated to supporting EBN implementation; an interactive web-based platform to help nurses find, select, and interpret relevant scientific sources; an electronic tool to help nurses in clinical decision-making based on patients' clinical data; and a change in clinical culture to include EBN in decision-making processes.

European Interoperability Assets Register and Quality Framework Implementation.

Interoperability assets is the term applied to refer to any resource that can support the design, implementation and successful adoption of eHealth services that can exchange data meaningfully. Some examples may include functional requirements, specifications, standards, clinical models and term lists, guidance on how standards may be used concurrently, implementation guides, educational resources, and other resources. Unfortunately, these are largely accessible in ad hoc ways and result in scattered fragments of a solution space that urgently need to be brought together. At present, it is well known that new initiatives and projects will reinvent assets of which they were unaware, while those assets which were potentially of great value are forgotten, not maintained and eventually fall into disuse. This research has defined a quality in use model and assessed the suitability of this quality framework based on the feedback and opinion of a representative sample of potential end users. This quality framework covers the following domains of asset development and adoption: (i) Development process, (ii) Maturity level, (iii) Trustworthiness, (iv) Support & skills, (v) Sustainability, (vi) Semantic interoperability, (vii) Cost & effort of adoption (viii) Maintenance. When participants were requested to evaluate how the overall quality in use framework, 70% would recommend using the register to their colleagues, 70% felt that it could provide relevant benefits for discovering new assets, and 50% responded that it would support their decision making about the recommended asset to adopt or implement in their organisation. Several European projects have expressed interest in using the register, which will now be sustained and promoted by the the European Institute for Innovation through Health Data.

Using electronic health records for clinical research: the case of the EHR4CR project.

OBJECTIVES: To describe the IMI EHR4CR project which is designing and developing, and aims to demonstrate, a scalable, widely acceptable and efficient approach to interoperability between EHR systems and clinical research systems. METHODS: The IMI EHR4CR project is combining and extending several previously isolated state-of-the-art technical components through a new approach to develop a platform for reusing EHR data to support medical research. This will be achieved through multiple but unified initiatives across different major disease areas (e.g. cardiovascular, cancer) and clinical research use cases (protocol feasibility, patient identification and recruitment, clinical trial execution and serious adverse event reporting), with various local and national stakeholders across several countries and therefore under various legal frameworks. RESULTS: An initial instance of the platform has been built, providing communication, security and terminology services to the eleven participating hospitals and ten pharmaceutical companies located in seven European countries. Proof-of-concept demonstrators have been built and evaluated for the protocol feasibility and patient recruitment scenarios. The specifications of the clinical trial execution and the adverse event reporting scenarios have been documented and reviewed. CONCLUSIONS: Through a combination of a consortium that brings collectively many years of experience from previous relevant EU projects and of the global conduct of clinical trials, of an approach to ethics that engages many important stakeholders across Europe to ensure acceptability, of a robust iterative design methodology for the platform services that is anchored on requirements of an underlying Service Oriented Architecture that has been designed to be scalable and adaptable, EHR4CR could be well placed to deliver a sound, useful and well accepted pan-European solution for the reuse of hospital EHR data to support clinical research studies.

Trans-eCare: creating a transparent data exchange platform.

Home health care (HHC) organizations as well as hospitals encounter information-tracking problems regarding their patients. When a patient is admitted to the hospital, it is not always possible/easy to find out if this person already had HHC and if so, by which organization it was provided. HHC organizations also not always know to which hospital a person is admitted. At discharge, although discharge documents exist, HHC organizations not always receive the necessary information. However, sharing information between the different care-partners involved is important, among others for the continuity of care. Hospitals will gain better insight in the provided home care before admission, and HHC organizations will get a more complete and direct insight in the course of care at the hospital. In doing so, they are better prepared to provide the necessary care for the patient admitted to the hospital or returning at home. Discussion with the partners involved in the IBBT-Trans-eCare project resulted in tracking the current problems, defining goals and presenting a solution to meet the defined problems.

Cost-effectiveness of telemonitoring for high-risk pregnant women.

PURPOSE: Cost-minimization is a main topic in present-day health care. Clinicians are urged to keep hospital stays as short as possible, also in Obstetrics and Gynaecology Departments. At present stabilized high-risk pregnant women stay in hospital for the sole purpose of being monitored. METHOD: In this retrospective study the cost-effectiveness of telemonitoring of such high-risk pregnant women was calculated by analyzing the data of 456 episodes originating from 415 patients of the Ghent University Hospital. RESULTS AND CONCLUSIONS: It was determined that telemonitoring made a cost-reduction of euro 145,822 per year possible. However, variables such as educational level, psychosocial situation, time-travel distance from home to the hospital, reimbursement system and actual clinical status were not included. Furthermore, the Belgian health authorities does not provide for a specific code to allow the billing of teleinterpretation of transmitted results.