Embedding a State-Wide Prescription Drug Monitoring Program into the Electronic Health Record.

A new FHIR-based (fast healthcare interoperability resource), EHR-integrated (electronic health record) application was created that embeds directly into prescribers' workflows. The intervention automatically performs MME (morphine milligram equivalent) calculations, highlights unsafe thresholds, while also presenting controlled-substance medications each patient is using. Using this intervention, the number of clinicians who have checked a patient's controlled substance prescription data has increased 57.4%. The number of patients being checked increased by 9.2%. The number of opioid prescriptions written after checking the new interventions data increased from 9% to 14%. Integrating these data into the EHR has saved over 1600 hours of labor per year. This work has also led to accruing five bonus points from the Medicare promoting interoperability attestation program. This initiative, and others like it, have helped Intermountain Healthcare decrease controlled substance pills by nearly 11 million, in the past five years.

Developing and Validating a Model for Detecting Longitudinal Inconsistencies in the Electronic Problem List.

Clinicians from different care settings can distort the problem list from conveying a patient's actual health status, affecting quality and patient safety. To measure this effect, a reference standard was built to derive a problem-list based model. Real-world problem lists were used to derive an ideal categorization cutoff score. The model was tested against patient records to categorize problem lists as either having longitudinal inconsistencies or not. The model was able to successfully categorize these events with ~87% accuracy, ~83% sensitivity, and ~89% specificity. This new model can be used to quantify intervention effects, can be reported in problem list studies, and can be used to measure problem list changes based on policy, workflow, or system changes.

Electronic problem lists: a thematic analysis of a systematic literature review to identify aspects critical to success.

Objective: Problem list data is a driving force for many beneficial clinical tools, yet these data remain underutilized. We performed a systematic literature review, pulling insights from previous research, aggregating insights into themes, and distilling themes into actionable advice. We sought to learn what changes we could make to existing applications, to the clinical workflow, and to clinicians' perceptions that would improve problem list utilization and increase the prevalence of problems data in the electronic medical record. Materials and Methods: We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to systematically curate a corpus of pertinent articles. We performed a thematic analysis, looking for interesting excerpts and ideas. By aggregating excerpts from many authors, we gained broader, more inclusive insights into what makes a good problem list and what factors are conducive to its success. Results: Analysis led to a list of 7 benefits of using the problem list, 15 aspects critical to problem list success, and knowledge to help inform policy development, such as consensus on what belongs on the problem list, who should maintain the problem list, and when. Conclusions: A list of suggestions is made on ways in which the problem list can be improved to increase utilization by clinicians. There is also a need for standard measurements of the problem list, so that lists can be measured, compared, and discussed with rigor and a common vocabulary.

Problem management module: an innovative system to improve problem list workflow.

Electronic problem lists are essential to modern health record systems, with a primary goal to serve as the repository of a patient's current health issues. Additionally, coded problems can be used to drive downstream activities such as decision support, evidence-based medicine, billing, and cohort generation for research. Meaningful Use also requires use of a coded problem list. Over the course of three years, Intermountain Healthcare developed a problem management module (PMM) that provided innovative functionality to improve clinical workflow and boost problem list adoption, e.g. smart search, user customizable views, problem evolution, and problem timelines. In 23 months of clinical use, clinicians entered over 70,000 health issues, the percentage of free-text items dropped to 1.2%, completeness of problem list items increased by 14%, and more collaborative habits were initiated.