RESUMEN
OBJECTIVES: This study aimed to describe the current landscape of electronic health record (EHR) training and optimization programs (ETOPs) and their impact on healthcare workers' (HCWs) experience with the EHR. METHODS: A 72-question electronic survey was developed and distributed to healthcare organization (HCO) leaders in clinical informatics through various channels such as national informatics conferences, social media, and email distribution lists of vendors and informatics associations. The survey collected data on the characteristics, resourcing, approach, and outcomes of ETOPs. Descriptive statistics were applied to analyze the data. RESULTS: There were 193 responses from 147 distinct HCOs. Of these, 69% offer ongoing EHR training, and 52% offer some version of an ETOP. Offered ETOPs vary in their timing, modality, audience, team composition, duration, and EHR build strategy. The most commonly measured outcomes were EHR satisfaction, efficiency, and provider burnout, and most ETOPs reported improvement in these areas. CONCLUSIONS: The findings suggest that ETOPs are inconsistently implemented across HCOs, and while there are some commonalities, there is a wide variety of design and methods of evaluation for the programs. Though the problems to solve for (EHR efficiency, proficiency, and satisfaction) are the same, the organizational structure and culture of HCOs varies widely, which may partially explain the variability seen in reported ETOPs. When considering the measured outcomes, ETOPs may have direct and indirect effects on HCW burnout by improving EHR efficiency and satisfaction, as well as driving organizational culture towards teamwork and flexible problem solving. For this reason, ETOPs may also serve as a model for addressing other challenges in healthcare delivery. ETOPs are a promising intervention to enhance HCW experience with the EHR and reduce burnout. More research is needed to identify the optimal features, methods, and outcomes of ETOPs, and to disseminate them across HCOs.
RESUMEN
OBJECTIVES: Extreme endurance exercise is known to be associated with an enlargement of the left ventricular (LV) chamber, whereas inactivity results in inverse changes. It is unknown if these dimensional relationships exist in patients. METHODS: We analyzed the relationship of exercise capacity and LV dimension in a cohort of sequential patients with a normal ejection fraction undergoing stress echocardiography. In a total of 137 studies the following questions were addressed: (a) is there a difference in LV dimensions of patients with an excellent exercise capacity versus patients with a poor exercise capacity, (b) how is LV dimension and exercise capacity affected by LV wall thickness and (c) how do LV dimensions of patients who are unable to walk on a treadmill compare to the above groups. RESULTS: Patients with a poor exercise capacity or who are unable to physically exercise have a 34 percent smaller LV cavity size when compared to patients with an excellent exercise capacity (p<0.001). This reduction in LV chamber size is associated with concentric LV hypertrophy and a reciprocal increase in resting heart rate. In addition, cardiac output reserve is further blunted by chronotropic incompetence and a tachycardia-induced LV volume reduction. In conclusion the relationship of exercise capacity and cardiac dimensions described in extreme athletes also applies to patients. Our exploratory analysis suggests that patients who cannot sufficiently exercise have small LV cavities.