Hospital rounding--EHR's impact.

PURPOSE: The purpose of this paper is to understand the time spent on various tasks during physician inpatient rounds and to examine the new electronic health records (EHRs) impact on time distribution. DESIGN/METHODOLOGY/APPROACH: Trained observers shadowed hospital physicians to record times for various tasks before and after EHR implementation. FINDINGS: Electronic records did not improve efficiency. However, task times were redistributed. Physicians spent more time reviewing patient charts using time saved from miscellaneous work. RESEARCH LIMITATIONS/IMPLICATIONS: The study focusses solely on work distribution and the changes it underwent. It does not include quality measures either on patient results or physician satisfaction. PRACTICAL IMPLICATIONS: As EHR provides rich information and easier access to patient records, it motivates physicians to spend more time reviewing patient charts. Hospital administrators seeking immediate returns on EHR investment, therefore, may be disappointed. ORIGINALITY/VALUE: Unlike previous work, this study was conducted in a non-teaching hospital, providing a task-time comparison without any educational and team factor influence. The result serves as a benchmark for many community hospital managers seeking to address the same issue.

Reducing free-text communication orders placed by providers using association rule mining.

Electronic health record (EHR) systems are used to collect, store and retrieve the details of patient care. Computer Provider Order Entry (CPOE) is a process by which providers directly enter patient care orders into the EHR. Providers may enter free-text orders when they are unable to find standard orders. These free-text orders require translation into a structured order which reducing efficiency, may bypass duplicate checking and can be associated with medical errors. To overcome these problems we developed a system to automatically detect free-text orders and assign them to the appropriate order categories. This system applies association rule mining on structured orders to extract the patterns of orders in the related categories. The extracted patterns were tested on a set of free-text orders for evaluation and to determine the closest matching category of structured orders. This process may be used to improve future iterations of CPOE applications.

Employing clinical decision support to attain our strategic goal: the safe care of the surgical patient.

Clinical decision support can be employed to increase patient safety and improve workflow efficiencies for physicians and other healthcare providers. Physician input into the design and deployment of clinical decision support systems can increase the utility of the alerts and reduce the likelihood of "alert fatigue." The Hospital for Special Surgery is a 146-bed orthopedic facility that performs approximately 18,000 surgeries a year Efficient work processes are a necessity. The facility began implementing a new electronic health record system in June 2005 and plan to go live in summer 2007. This article reports on some of the clinical decision support rules and alerts being incorporated into the facility's system in the following categories--high-risk, high-frequency scenarios, rules that provide efficiencies and value from the presciber perspective, and rules that relate to patient safety.

Design and evaluation of a personal digital assistant- based alerting service for clinicians.

PURPOSE: This study describes the system architecture and user acceptance of a suite of programs that deliver information about newly updated library resources to clinicians' personal digital assistants (PDAs). DESCRIPTION: Participants received headlines delivered to their PDAs alerting them to new books, National Guideline Clearinghouse guidelines, Cochrane Reviews, and National Institutes of Health (NIH) Clinical Alerts, as well as updated content in UpToDate, Harrison's Online, Scientific American Medicine, and Clinical Evidence. Participants could request additional information for any of the headlines, and the information was delivered via e-mail during their next synchronization. Participants completed a survey at the conclusion of the study to gauge their opinions about the service. RESULTS/OUTCOME: Of the 816 headlines delivered to the 16 study participants' PDAs during the project, Scientific American Medicine generated the highest proportion of headline requests at 35%. Most users of the PDA Alerts software reported that they learned about new medical developments sooner than they otherwise would have, and half reported that they learned about developments that they would not have heard about at all. While some users liked the PDA platform for receiving headlines, it seemed that a Web database that allowed tailored searches and alerts could be configured to satisfy both PDA-oriented and e-mail-oriented users.

Physician PDA use and the HIPAA Privacy Rule.

Physicians need better access to information when making patient care decisions. Hospitals should allow electronic data transfers to physician PDAs to improve patient care, and physicians must institute measures to secure the confidentiality of patient information on their PDAs. By explicitly excluding copies from their designated record set, hospitals need not maintain copies or track access of information on personally owned PDAs.