Assessing organizational capacity for achieving meaningful use of electronic health records.

BACKGROUND: Health care institutions are scrambling to manage the complex organizational change required for achieving meaningful use (MU) of electronic health records (EHR). Assessing baseline organizational capacity for the change can be a useful step toward effective planning and resource allocation. PURPOSE: The aim of this article is to describe an adaptable method and tool for assessing organizational capacity for achieving MU of EHR. Data on organizational capacity (people, processes, and technology resources) and barriers are presented from outpatient clinics within one integrated health care delivery system; thus, the focus is on MU requirements for eligible professionals, not eligible hospitals. METHODS: We conducted 109 interviews with representatives from 46 outpatient clinics. FINDINGS: Most clinics had core elements of the people domain of capacity in place. However, the process domain was problematic for many clinics, specifically, capturing problem lists as structured data and having standard processes for maintaining the problem list in the EHR. Also, nearly half of all clinics did not have methods for tracking compliance with their existing processes. Finally, most clinics maintained clinical information in multiple systems, not just the EHR. The most common perceived barriers to MU for eligible professionals included EHR functionality, changes to workflows, increased workload, and resistance to change. PRACTICE IMPLICATIONS: Organizational capacity assessments provide a broad institutional perspective and an in-depth clinic-level perspective useful for making resource decisions and tailoring strategies to support the MU change effort for eligible professionals.

Prediction of clinical outcomes from rTMS in depressed patients with lateral visual field stimulation: a replication.

The authors sought to replicate an earlier finding that baseline lateral visual field stimulation, a procedure shown to activate the contralateral hemisphere and induce affective changes, predicted the clinical outcomes of a 10-day course of left-sided rapid transcranial magnetic stimulation (rTMS). For 23 patients there was a significant 1-tailed Pearson correlation between the percent improvement in response to rTMS and their lateralized affective responses to lateral visual field stimulation. These correlations, across the whole group and within genders, were almost identical to those previously reported from 37 patients studied at a different site.