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Electronic Communication of the Health Record and Information With Pediatric Patients and Their Guardians

Webber, Emily C.; Brick, David; Scibilia, James P.; Dehnel, Peter; Weinberg, Stuart T.; Alexander, Gregg M.; Beyer, Eric L.; Hamling, Alexander M.; Kirkendall, Eric S.; Lighter, Donald E.; Mann, Ann M.; Morgan, Stephen J.; Shelov, Eric; Wright, Jeffrey A.; Alverson, Dale C.; Chan, Francis D.; Van Cain, Melissa S.; Krams, Lisa A.; Altman, Robin L.; Bondi, Steven A.; Fanaroff, Jonathan M.; Narang, Sandeep K.; Oken, Richard L.; Rusher, John W.; Santucci, Karen A.; Scibilia, James P.; Scott, Susan M.; Ake, Julie Kersten; Alexander, Joshua J.; Bodnar, Chelsea E. F.; Curfman, Alison; Herendeen, Neil E.; Kahn, Joseph A.; McSwain, Steven D.; Garber, Kelli M.; Calabrese, Trisha M.
ISI:000479007500051
ISSN: 0031-4005
CID: 4048542

Differences in coder and physician perspectives on the transition to ICD-10-CM/PCS: A survey study

Butz, Jenna; Brick, David; Rinehart-Thompson, Laurie A; Brodnik, Melanie; Agnew, Amanda M; Patterson, Emily S
Background: We hypothesized that coders would be less likely than physicians to avoid, delay, or bypass the transition to ICD-10, and more likely to want codes to distinguish between the left and right side of the body and have only one set of codes and documentation to meet both clinical and billing objectives. Objective: Assess similarities and differences in perspectives between coders and physicians on the use of ICD-10. Methods: A cross-sectional survey study was conducted with a convenience sample of coders and physicians using an online survey. Statistical differences for six a priori hypotheses were analyzed. Thematic analyses were conducted on open-ended responses. Results: 71 coders and 56 physicians completed the survey. All six hypotheses were confirmed (p<0.001). Few physician respondents agreed that there would be clinical care (0%) or reimbursement (7%) benefits from the transition to ICD10, and the majority (59%) believed that ICD-10 will always be a burden. A considerable number of coder respondents disagreed that physicians would be willing to learn how to correctly document in support of an ICD-10 code (41%), change how they document progress notes (41%), and change how progress notes are documented following a query from a coder (32%). A number of physician respondents anticipated increasing the use of coding and documentation strategies which could reduce the data quality. Discussion: Coders and physicians have polarized perspectives on the usefulness of ICD-10. Three strategies may improve data quality and efficiency: Computer-Assisted Coding, templates, and scribes becoming certified to do codes. (C) 2016 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved.
ISI:000383527000005
ISSN: 2211-8837
CID: 2275462

Changes in medical errors with a handoff program [Letter]

Colligan, Lacey; Brick, David; Patterson, Emily S
PMID: 25629754
ISSN: 0028-4793
CID: 1477582

Improving Clinical Workflow in Ambulatory Care: Implemented Recommendations in an Innovation Prototype for the Veteran's Health Administration

Patterson, Emily S; Lowry, Svetlana Z; Ramaiah, Mala; Gibbons, Michael C; Brick, David; Calco, Robert; Matton, Greg; Miller, Anne; Makar, Ellen; Ferrer, Jorge A
INTRODUCTION: Human factors workflow analyses in healthcare settings prior to technology implemented are recommended to improve workflow in ambulatory care settings. In this paper we describe how insights from a workflow analysis conducted by NIST were implemented in a software prototype developed for a Veteran's Health Administration (VHA) VAi2 innovation project and associated lessons learned. METHODS: We organize the original recommendations and associated stages and steps visualized in process maps from NIST and the VA's lessons learned from implementing the recommendations in the VAi2 prototype according to four stages: 1) before the patient visit, 2) during the visit, 3) discharge, and 4) visit documentation. NIST recommendations to improve workflow in ambulatory care (outpatient) settings and process map representations were based on reflective statements collected during one-hour discussions with three physicians. The development of the VAi2 prototype was conducted initially independently from the NIST recommendations, but at a midpoint in the process development, all of the implementation elements were compared with the NIST recommendations and lessons learned were documented. FINDINGS: Story-based displays and templates with default preliminary order sets were used to support scheduling, time-critical notifications, drafting medication orders, and supporting a diagnosis-based workflow. These templates enabled customization to the level of diagnostic uncertainty. Functionality was designed to support cooperative work across interdisciplinary team members, including shared documentation sessions with tracking of text modifications, medication lists, and patient education features. Displays were customized to the role and included access for consultants and site-defined educator teams. DISCUSSION: Workflow, usability, and patient safety can be enhanced through clinician-centered design of electronic health records. The lessons learned from implementing NIST recommendations to improve workflow in ambulatory care using an EHR provide a first step in moving from a billing-centered perspective on how to maintain accurate, comprehensive, and up-to-date information about a group of patients to a clinician-centered perspective. These recommendations point the way towards a "patient visit management system," which incorporates broader notions of supporting workload management, supporting flexible flow of patients and tasks, enabling accountable distributed work across members of the clinical team, and supporting dynamic tracking of steps in tasks that have longer time distributions.
PMCID:4537152
PMID: 26290887
ISSN: 2327-9214
CID: 1732412

Integrating electronic health records into clinical workflow : an application of human factors modeling methods to ambulatory care

Lowry, Sventlana Z; Ramaiah, Mala; Patterson, Emily S; Brick, David; Gurses, Ayse P; Ozok, Ant; Simmons, Debora; Gibbons, Michael
[S.l. : s.n.], 2014
Extent: 46 pages
ISBN: n/a
CID: 1032702

Enhancing electronic health record usability in pediatric patient care: a scenario-based approach

Patterson, Emily S; Zhang, Jiajie; Abbott, Patricia; Gibbons, Michael C; Lowry, Svetlana Z; Quinn, Matthew T; Ramaiah, Mala; Brick, David
BACKGROUND: Usability of electronic health records (EHRs) is an important factor affecting patient safety and the EHR adoption rate for both adult and pediatric care providers. A panel of interdisciplinary experts (the authors) was convened by the National Institute of Standards and Technology to generate consensus recommendations to improve EHR usefulness, usability, and patient safety when supporting pediatric care, with a focus on critical user interactions. METHODS: The panel members represented expertise in the disciplines of human factors engineering (HFE), usability, informatics, and pediatrics in ambulatory care and pediatric intensive care. An iterative, scenario-based approach was used to identify unique considerations in pediatric care and relevant human factors concepts. A draft of the recommendations were reviewed by invited experts in pediatric informatics, emergency medicine, neonatology, pediatrics, HFE, nursing, usability engineering, and software development and implementation. RECOMMENDATIONS: Recommendations for EHR developers, small-group pediatric medical practices, and children's hospitals were identified out of the original 54 recommendations, in terms of nine critical user interaction categories: patient identification, medications, alerts, growth chart, vaccinations, labs, newborn care, privacy, and radiology. CONCLUSION: Pediatric patient care has unique dimensions, with great complexity and high stakes for adverse events. The recommendations are anticipated to increase the rate of EHR adoption by pediatric care providers and improve patient safety for pediatric patients. The described methodology might be useful for accelerating adoption and increasing safety in a variety of clinical areas where the adoption of EHRs is lagging or usability issues are believed to reduce potential patient safety, efficiency, and quality benefits.
PMID: 23516763
ISSN: 1553-7250
CID: 857892

Outcome of prenatally diagnosed congenital heart disease: an update

Brick, D H; Allan, L D
The objective of this study was to compare the outcome of prenatally diagnosed congenital heart disease (CHD) in a recent time period with previously reported experience. All cases of fetal CHD during the time period 1993 to 1999 were analyzed in terms of their outcome. During this time frame, 408 cases of fetal CHD were detected. Of these, 84% of mothers were referred because of suspicion of a cardiac anomaly during an obstetric scan. The mean gestational age at diagnosis was 26 weeks. Termination of pregnancy occurred in 98 cases. There were 92 deaths in the continuing pregnancies and a survival rate of 60%. The detection rate of CHD prenatally continues to increase as obstetric screening for cardiac malformations becomes more widespread. Diagnostic categories continue to be skewed toward more complex forms of malformation, although comparisons with previous studies show some trends. In particular, there are proportionately fewer pregnancies with extracardiac malformations. In addition, the outcome in continuing pregnancies is substantially improved from previous reports
PMID: 12170364
ISSN: 0172-0643
CID: 105694

Low yield of bacterial stool culture in children with nosocomial diarrhea

Craven, D; Brick, D; Morrisey, A; O'Riordan, M A; Petran, V; Schreiber, J R
OBJECTIVE:To determine whether bacterial stool cultures (BSC) are useful in initial evaluation of children with symptoms of nosocomial diarrhea. To answer this question we performed a retrospective record review to determine the yield of BSC in children who developed diarrhea after the third hospital day (HD-3). METHODS:The hospital computer record keeping system was utilized to compile the result of BSC collected from children and adolescents ages 0 to 20 years between January 1, 1988, and October 31, 1996. All specimens were analyzed for Salmonella, Shigella, Yersinia and Campylobacter. We reviewed hospital charts of all children who developed a positive BSC beyond HD-3 to determine the time of onset of diarrhea and clinical circumstances. RESULTS:A total of 11 516 BSCs were submitted from 9262 children during the 8 1/2-year period. Five hundred sixty-eight (6.6%) of 9262 children had at least 1 positive BSC. Two thousand five hundred seventy-two children had the first BSC submitted after HD-3 and 13 (0.5%) of these children had a positive result. Chart review of these 13 children demonstrated that 6 had onset of diarrhea during the first 3 hospital days. Therefore only 7 children met our criteria for having nosocomially acquired diarrhea caused by a bacterial pathogen. Children whose first BSC was submitted after HD-3 accounted for 3767 (46%) of the total 8126 inpatient BSCs and in excess of $21000 annually in patient billing charges. CONCLUSION/CONCLUSIONS:In the absence of a known exposure the isolation of a bacterial pathogen from the stool of children with onset of diarrhea beyond HD-3 is a rare event. Under most circumstances BSC should not be part of the initial evaluation of children with symptoms of nosocomial diarrhea.
PMID: 9849989
ISSN: 0891-3668
CID: 4194932