Enhancing Health IT Functionality for Children: The 2015 Children's EHR Format.

Electronic health record (EHR) use throughout the United States has advanced considerably, but functionality to support the optimal care of children has been slower to develop and deploy. A previous team of experts systematically identified gaps in EHR functionality during collaborative work from 2010 to 2013 that produced the Children's EHR Format (Format), funded under the Children's Health Insurance Program Reauthorization Act of 2009, Public Law 111-3. After that, a team of practitioners, software developers, health policy leaders, and other stakeholders examined the Format's exhaustive list of 547 EHR functional requirements in 26 topic areas and found them to be valuable but in need of further refinement and prioritization. Work began in 2014 to develop a shortened high priority list of requirements and provide guidance to improve their use. Through a modified Delphi process that included key document review, selection criteria, multiple rounds of voting, and small group discussion, a multistakeholder work group identified and refined 47 items on the basis of earlier requirements to form the 2015 Children's EHR Format Priority List and developed 16 recommended uses of the Format. The full report of the Format enhancement activities is publicly available. In this article, we aim to promote awareness of these high priority EHR functional requirements for the care of children, sharpen industry focus on adopting these changes, and align all stakeholders in prioritizing specific health information technology functionalities including those essential for well-child preventive care, medication management, immunization tracking, and growth data for specific pediatric subgroups.

Electrochemical "read-write" microscale patterning of boron doped diamond electrodes.

Scanning electrochemical cell microscopy is utilised as a read-write pipette-based probe to both electrochemically modify the local surface chemistry of boron doped diamond and "read" the resulting modification, at the micron scale. In this specific application, localised electrochemical oxidation results in conversion of the H-terminated surface to -O, electrochemically visualised by monitoring the current change for reduction of Ru(NH3)6(3+). This methodology, in general, provides a platform for read-write analysis of electrodes, opening up new analytical avenues, particularly as the pipette can be viewed as a microfluidic device.

Impact of electronic prescribing on medication use in ambulatory care.

OBJECTIVES: To investigate differences before and after rollout of electronic prescribing (e-prescribing) in (1) patients' primary adherence to newly prescribed medications, (2) patients' understanding of how to use their medications, and (3) multiple pharmacy use. STUDY DESIGN: Postvisit interviews and follow-up phone calls were done with 344 patients at an academic general internal medicine clinic. METHODS: Patient interviews and follow-up phone calls were done (1) before e-prescribing, (2) 1 to 6 months after e-prescribing, and (3) 12 to 18 months after e-prescribing. RESULTS: Overall, rates of abandoned prescriptions were 6.9% before e-prescribing, 10.6% 1 to 6 months after e-prescribing, and 2.5% 12 to 18 months after e-prescribing (P = .07). There was a reduction in awareness of the indication for a newly prescribed medicine among patients after e-prescribing (95.4%, 97.9%, and 89.8%, respectively; P = .03). There was a decrease in patients' ability to demonstrate proper use of their new medicine after e-prescribing (69.0% before e-prescribing, 67.1% 1-6 months after e-prescribing, 51.9% 12 -18 months after e-prescribing; P = .02). There was an increasing trend in the percentage of patients using multiple pharmacies after e-prescribing was implemented. CONCLUSIONS: We found both potential benefits and unexpected consequences as a result of the rollout of electronic prescribing. Adaptation to e-prescribing might be improved with outreach and education, including explicitly informing patients of the change during the first months of rollout. Tangible prescription information for reminder purposes only may also be beneficial.

Can electronic health records help improve patients' understanding of medications?

OBJECTIVES: To present pilot data from an ongoing electronic health record (EHR) quality improvement study to improve medication management using patient previsit review of the EHR medication list and a plain-language new medication information sheet to provide with every new EHR prescription. STUDY DESIGN: Postvisit survey of 191 patients at an academic general internal medicine clinic. METHODS: Patients were asked about discrepancies and problems, concerns, and questions (PCQs) in their EHR summary for up to 10 current medications and about knowledge of new prescriptions. Findings describe the extent of medication discrepancies, perceived PCQs about current medications, and patient knowledge about new medications. RESULTS: Overall, 78.0% of patients had at least 1 discrepancy, more than half had a drug listed that they were not taking or dose or frequency discrepancies, and 8.9% reported an omission; 41.9% indicated at least 1 PCQ about their current medications. Among patients who received a new prescription, most knew what the new medication was for and how to take it. However, 66.0% indicated uncertainty about potential adverse effects that they should telephone the physician about. CONCLUSIONS: Discrepancies can be efficiently categorized by previsit review of EHR medication lists. Prereview offers physicians the opportunity to better address important medication PCQs. Testing the value of EHR-generated plain-language medication information sheets requires follow-up interviews after medications are filled. Patients may not understand the actual benefits of new medications.