RESUMEN
This study uses electronic health record data to evaluate medical record closure outcomes before and after the use of medical scribes at a large academic medical center.
Asunto(s)
Documentación , Administradores de Registros Médicos , Registros Médicos , Práctica Profesional , Documentación/métodos , Registros Electrónicos de Salud/organización & administración , Humanos , Administradores de Registros Médicos/organización & administración , Satisfacción del Paciente , Pautas de la Práctica en Medicina/organización & administración , Práctica Profesional/organización & administraciónRESUMEN
PURPOSE: The immense clerical burden felt by physicians is one of the leading causes of burnout. Scribes are increasingly being used to help alleviate this burden, yet few published studies investigate how scribes affect physicians' daily work, attitudes and behaviors, and relationships with patients and the workplace. METHODS: Using a longitudinal observational design, data were collected, over 1 year, from 4 physicians working with 2 scribes at a single academic family medicine practice. Physician experience was measured by open-ended written reflections requested after each 4-hour clinic session. A data-driven codebook was generated using a constant comparative method with grounded theory approach. RESULTS: A total of 361 physician reflections were completed, yielding 150 distinct excerpts; 289 codes were assigned. The 11 themes that emerged were further categorized under 4 domains. The most frequently recurring domain was clinic operations, which comprised 51.6% of the codes. Joy of practice, quality of care, and patient experience comprised 22.1%, 16.3%, and 10.0% of the codes, respectively. CONCLUSIONS: Our study suggests that integrating scribes into a primary care clinic can produce positive outcomes that go beyond reducing clerical burden for physicians. Scribes may benefit patient experience, quality of care, clinic operations, and joy of practice.
Asunto(s)
Agotamiento Profesional/prevención & control , Medicina Familiar y Comunitaria/organización & administración , Administradores de Registros Médicos/organización & administración , Médicos de Familia/organización & administración , Atención Primaria de Salud/organización & administración , Documentación/métodos , Eficiencia Organizacional , Registros Electrónicos de Salud/organización & administración , Fuerza Laboral en Salud/organización & administración , Humanos , Estudios Longitudinales , Calidad de la Atención de Salud , Flujo de TrabajoRESUMEN
In recent years the use of geographic information systems (GIS) in healthcare has expanded rapidly. Although the use of GIS has increased quickly, very little consensus has been reached on which healthcare professionals are best suited to be trained in and use GIS. A moderate amount of research has addressed the use of GIS in healthcare, but very little research has addressed selecting and training healthcare professionals in the area of GIS. As the use of GIS becomes more closely tied to electronic health records (EHRs), the thought arises that those best versed in EHRs, health information management (HIM) professionals, would be best suited to take on the GIS role. This mixed-methods study explored the current status of HIM professionals' role in GIS as well as the extent to which GIS is being taught in health information educational programs. Although the findings indicate that few HIM professionals are currently using GIS in their jobs and few HIM programs are currently teaching GIS, there is interest in GIS in the future for HIM professionals and in HIM educational programs.
Asunto(s)
Sistemas de Información Geográfica/estadística & datos numéricos , Gestión de la Información en Salud/organización & administración , Administradores de Registros Médicos/organización & administración , Escolaridad , Registros Electrónicos de Salud/estadística & datos numéricos , Sistemas de Información Geográfica/normas , Gestión de la Información en Salud/normas , Fuerza Laboral en Salud , Humanos , Administradores de Registros Médicos/educación , Administradores de Registros Médicos/normas , Competencia ProfesionalRESUMEN
OBJECTIVES: Assess the impact of scribes on an academic emergency department's (ED) throughput one year after implementation. METHODS: A prospective cohort design compared throughput metrics of patients managed when scribes were and were not a part of the treatment team during pre-defined study hours in a tertiary academic ED with both an adult and pediatric ED. An alternating-day pattern one year following scribe implementation ensured balance between the scribe and non-scribe groups in time of day, day of week, and patient complexity. RESULTS: Adult: Overall length of stay (LOS) was essentially the same in both groups (214 vs. 215min, p=0.34). In area A where staffing includes an attending and residents, scribes made a significant impact in treatment room time in the afternoon (190 vs 179min, p=0.021) with an increase in patients seen per hour on scribed days (2.00 vs. 2.13). There was no statistically significant changes in throughput metrics in area B staffed by an attending and a nurse practitioner/physician assistant, however scribed days did average more patients per hour (2.01 vs. 2.14). Pediatric: All throughput measurements were significantly longer when the treatment team had a scribe; however, patients per hour increased from 2.33 to 2.49 on scribed days. CONCLUSIONS: Overall patient throughput was not enhanced by scribes. Certain areas and staffing combinations yielded improvements in treatment room and door to provider time, however, scribes appear to have enabled attending physicians to see more patients per hour. This effect varied across treatment areas and times of day.
Asunto(s)
Servicio de Urgencia en Hospital/organización & administración , Tiempo de Internación/estadística & datos numéricos , Administradores de Registros Médicos/organización & administración , Medicina de Urgencia Pediátrica/organización & administración , Centros Médicos Académicos/organización & administración , Preescolar , Documentación/métodos , Documentación/normas , Eficiencia Organizacional , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Masculino , Administradores de Registros Médicos/educación , Administradores de Registros Médicos/estadística & datos numéricos , Persona de Mediana Edad , Medicina de Urgencia Pediátrica/estadística & datos numéricos , Estudios ProspectivosRESUMEN
There are little published data on the use of medical scribes in the primary care setting. We assessed the feasibility of incorporating medical scribes in our ambulatory clinic to support provider documentation in the electronic medical record. In our convenience sampling of patient, provider, and staff perceptions of scribes, we found that patients were comfortable having scribes in the clinic. Overall indicators of patient satisfaction were slightly decreased. Providers found scribe support to be valuable and overall clinician documentation time was reduced by more than 50% using scribes.
Asunto(s)
Actitud del Personal de Salud , Registros Electrónicos de Salud/organización & administración , Administradores de Registros Médicos/organización & administración , Servicio Ambulatorio en Hospital/organización & administración , Atención Primaria de Salud/organización & administración , Recolección de Datos/métodos , Documentación/métodos , Documentación/normas , Eficiencia Organizacional , Registros Electrónicos de Salud/normas , Estudios de Factibilidad , Humanos , Satisfacción en el Trabajo , Administradores de Registros Médicos/normas , Servicio Ambulatorio en Hospital/normas , Satisfacción del Paciente/estadística & datos numéricos , Atención Primaria de Salud/normas , Encuestas y Cuestionarios , Factores de Tiempo , Recursos HumanosRESUMEN
BACKGROUND: Cost consequences analysis was completed from randomized controlled trial (RCT) data for the Just-in-time (JIT) librarian consultation service in primary care that ran from October 2005 to April 2006. The service was aimed at providing answers to clinical questions arising during the clinical encounter while the patient waits. Cost saving and cost avoidance were also analyzed. The data comes from eighty-eight primary care providers in the Ottawa area working in Family Health Networks (FHNs) and Family Health Groups (FHGs). METHODS: We conducted a cost consequences analysis based on data from the JIT project. We also estimated the potential economic benefit of JIT librarian consultation service to the health care system. RESULTS: The results show that the cost per question for the JIT service was $38.20. The cost could be as low as $5.70 per question for a regular service. Nationally, if this service was implemented and if family physicians saw additional patients when the JIT service saved them time, up to 61,100 extra patients could be seen annually. A conservative estimate of the cost savings and cost avoidance per question for JIT was $11.55. CONCLUSIONS: The cost per question, if the librarian service was used at full capacity, is quite low. Financial savings to the health care system might exceed the cost of the service. Saving physician's time during their day could potentially lead to better access to family physicians by patients. Implementing a librarian consultation service can happen quickly as the time required to train professional librarians to do this service is short.
Asunto(s)
Administradores de Registros Médicos/economía , Atención Primaria de Salud/economía , Consulta Remota/economía , Canadá , Costos y Análisis de Costo , Educación Continua/economía , Humanos , Administradores de Registros Médicos/organización & administración , Administradores de Registros Médicos/normas , Atención Primaria de Salud/organización & administración , Atención Primaria de Salud/normas , Consulta Remota/organización & administración , Consulta Remota/normasRESUMEN
Medical scribes and electronic health records (EHRs) are increasingly being introduced into ambulatory clinics with variable outcomes. Characteristics of a successful implementation of medical scribes are described. Tips for optimization of the composition and presentation of the EHR as well as medical processes associated with medical documentation are presented.
Asunto(s)
Administradores de Registros Médicos , Instituciones de Atención Ambulatoria , Registros Electrónicos de Salud , Registros de Salud Personal , Administradores de Registros Médicos/organización & administración , Estados UnidosRESUMEN
The purpose of this article is to describe the creation of a transdisciplinary group, consisting of nurse educators, a medical librarian, lab technologists, and a technology expert. to lead the integration of electronic health technology, including high-fidelity simulation, handheld technology, and electronic health records, within a school of nursing. The use of innovative educational tools by nursing faculty can be daunting because of the steep learning curve. The model described here is effective in developing faculty to use simulation and other technologies as teaching-learning strategies.
Asunto(s)
Capacitación de Usuario de Computador/métodos , Bachillerato en Enfermería/organización & administración , Tecnología Educacional , Docentes de Enfermería/organización & administración , Personal de Laboratorio Clínico/organización & administración , Administradores de Registros Médicos/organización & administración , Computadoras de Mano , Conducta Cooperativa , Curriculum , Tecnología Educacional/educación , Tecnología Educacional/organización & administración , Registros Electrónicos de Salud/organización & administración , Humanos , Relaciones Interprofesionales , Modelos Educacionales , Modelos de Enfermería , Ciudad de Nueva York , Investigación en Educación de Enfermería , Rol Profesional , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Desarrollo de Personal/organización & administraciónRESUMEN
Teamwork has been emphasised as a key feature of health service reform, essential for safe, efficient and patient-centred care. Bringing together literatures from the sociology of healthcare and organizational theory, we examine how the teamwork phenomenon plays out in practice. Drawing upon material from two ethnographic studies, conducted in an operating theatre and a medical-records department in separate UK NHS hospitals, we explore some of the discursive teamwork practices of healthcare staff. Our analysis presents a very different picture from the normative, evangelistic promotion of teamwork within much management and health policy writing. We reveal how the ambiguity of teamwork opens up opportunities for a complex, diverse range of responses to the managerial discourse among diverse occupational groups, mobilizing the discourse to enact identity in different ways. We highlight how teamwork discourse can be instrumentally co-opted in the reproduction of the very occupational divisions it is designed to ameliorate, or simply ignored as irrelevant when compared to more attractive forms of collective identity. These responses challenge both those who believe that teamwork is a solution to problems in healthcare, as well as those concerned about the oppressive effects of pervasive managerialism.
Asunto(s)
Atención a la Salud/organización & administración , Relaciones Interprofesionales , Administradores de Registros Médicos/organización & administración , Quirófanos/organización & administración , Grupo de Atención al Paciente/organización & administración , Actitud del Personal de Salud , Conducta Cooperativa , Reforma de la Atención de Salud , Humanos , Estudios de Casos Organizacionales , Cultura Organizacional , Medicina Estatal , Reino UnidoRESUMEN
Overlay and duplicate records pose a particularly insidious problem today for healthcare organizations--and pediatric hospitals in particular--that are introducing new information systems or upgrading their existing systems. Such erroneous records can be costly and time-consuming to identify and correct, and can lead to lost reimbursement and compromised quality of care. To address the problem, senior financial leaders need to recognize the critical importance of data integrity and take steps to ensure that the people and processes are in place to establish and maintain it.
Asunto(s)
Administradores de Registros Médicos/organización & administración , Sistemas de Registros Médicos Computarizados/normas , Difusión de Innovaciones , Administración Financiera de Hospitales , Hospitales Pediátricos/economía , Humanos , Sistemas de Registros Médicos Computarizados/economía , Estados UnidosAsunto(s)
Información de Salud al Consumidor/organización & administración , Gestión de la Información/organización & administración , Informática Médica/organización & administración , Administradores de Registros Médicos/organización & administración , Rol Profesional , Certificación , Defensa del Consumidor , Curriculum , Alfabetización en Salud , Promoción de la Salud , Registros de Salud Personal , Necesidades y Demandas de Servicios de Salud , Humanos , Internet/organización & administración , Perfil Laboral , Informática Médica/educación , Administradores de Registros Médicos/educación , EspecializaciónAsunto(s)
Información de Salud al Consumidor/organización & administración , Gestión de la Información/organización & administración , Administradores de Registros Médicos/organización & administración , Rol Profesional , Informática en Salud Pública/organización & administración , Práctica de Salud Pública , Recolección de Datos , Interpretación Estadística de Datos , Planificación en Desastres/organización & administración , Política de Salud , Humanos , Evaluación de Necesidades , Vigilancia de la Población , Sistema de Registros , Investigación , Medición de Riesgo , Estados UnidosAsunto(s)
Gestión de la Información/organización & administración , Liderazgo , Informática Médica/organización & administración , Administradores de Registros Médicos/organización & administración , Rol Profesional , Conducta Cooperativa , Necesidades y Demandas de Servicios de Salud , Humanos , Relaciones Interprofesionales , Modelos Organizacionales , Modelos Psicológicos , Innovación Organizacional , Competencia Profesional , Rol Profesional/psicología , Estados Unidos , Lugar de Trabajo/organización & administración , Lugar de Trabajo/psicologíaAsunto(s)
Seguridad Computacional , Confidencialidad , Gestión de la Información/organización & administración , Informática Médica/organización & administración , Administradores de Registros Médicos/organización & administración , Rol Profesional , Acceso a la Información/legislación & jurisprudencia , American Recovery and Reinvestment Act , Certificación/organización & administración , Seguridad Computacional/legislación & jurisprudencia , Seguridad Computacional/normas , Confidencialidad/legislación & jurisprudencia , Confidencialidad/normas , Registros Electrónicos de Salud/organización & administración , Adhesión a Directriz , Guías como Asunto , Health Insurance Portability and Accountability Act/legislación & jurisprudencia , Humanos , Liderazgo , Defensa del Paciente/legislación & jurisprudencia , Privacidad , Estados UnidosAsunto(s)
Registros Electrónicos de Salud/organización & administración , Gestión de la Información/organización & administración , Informática Médica/organización & administración , Administradores de Registros Médicos/organización & administración , Rol Profesional , Investigación/organización & administración , Benchmarking , Curriculum , Becas , Humanos , Gestión de la Información/educación , Informática Médica/educación , Administradores de Registros Médicos/educación , Innovación Organizacional , Autonomía Profesional , Competencia Profesional , Investigación/educación , Apoyo a la Investigación como Asunto , Estados Unidos , United States Agency for Healthcare Research and QualityAsunto(s)
Política de Salud , Gestión de la Información/organización & administración , Informática Médica/organización & administración , Administradores de Registros Médicos/organización & administración , Modelos Organizacionales , Investigación/organización & administración , Recolección de Datos , Humanos , Conocimiento , Formulación de Políticas , Rol Profesional , Estados UnidosAsunto(s)
Registros Electrónicos de Salud/organización & administración , Gestión de la Información/organización & administración , Informática Médica/organización & administración , Administradores de Registros Médicos/organización & administración , Rol Profesional , American Recovery and Reinvestment Act , Seguridad Computacional , Confidencialidad , Difusión de Innovaciones , Reforma de la Atención de Salud/organización & administración , Health Insurance Portability and Accountability Act , Registros de Salud Personal , Humanos , Registro Médico Coordinado , Innovación Organizacional , Objetivos Organizacionales , Competencia Profesional , Integración de Sistemas , Estados UnidosRESUMEN
HIM professionals have always been actively involved in various aspects of healthcare quality management. In the decade since publication of To Err Is Human, the scope and volume of quality management activities have accelerated. Having quality at the forefront of the national agenda has inevitably created employment opportunities as well as expansion of professional responsibilities. This article describes the contemporary quality-related functions of HIM professionals and the core competencies necessary to support these functions.