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American Journal of Physical Medicine &... Aug 2023Stigmatizing language can negatively influence providers' attitudes and care toward patients, but this has not been studied among physiatrists. An online survey was... (Randomized Controlled Trial)
Randomized Controlled Trial
Stigmatizing language can negatively influence providers' attitudes and care toward patients, but this has not been studied among physiatrists. An online survey was created to assess whether stigmatizing language can impact physical medicine and rehabilitation trainees' attitudes toward patients. We hypothesized stigmatizing language would negatively impact trainees' attitudes. Participants were randomized to a stigmatizing or neutral language vignette describing the same hypothetical spinal cord injury patient. Questions were asked about attitudes and assumptions toward the patient, pain management based on the vignette, and general views regarding individuals with disabilities. Between August 2021 and January 2022, 75 US physical medicine and rehabilitation residency trainees participated. Thirty-seven (49.3%) identified as women; 52 (69.3%) were White, and half (50.6%) received the stigmatized vignette. Participants exposed to stigmatizing language scored 4.8 points lower ( P < 0.01) on the provider attitude toward patient scale compared with those exposed to neutral language. There were no significant differences in the disability attitude scores between the two groups ( P = 0.81). These findings may indicate that stigmatizing language in the medical record may negatively affect physical medicine and rehabilitation trainees' attitudes toward patients. Further exploration is needed to identify the best way to educate trainees and reduce the propagation of bias in the medical record.
Topics: Humans; Female; Attitude; Medicine; Surveys and Questionnaires; Physical and Rehabilitation Medicine; Medical Records; Attitude of Health Personnel
PubMed: 36757856
DOI: 10.1097/PHM.0000000000002186 -
Nutrition in Clinical Practice :... Feb 2022Professionals responsible for the nutrition care of hospitalized patients should understand the prevalence of malnutrition, how to accurately and consistently identify... (Review)
Review
Professionals responsible for the nutrition care of hospitalized patients should understand the prevalence of malnutrition, how to accurately and consistently identify and communicate a diagnosis of malnutrition in the medical record, and the sophisticated payment systems used to reimburse hospitals for patient care. Insight into healthcare payment systems and the requirements for clarity, consistency, and accuracy can improve identification, coding, and billing for malnutrition. Hospitals receive reimbursement for services based on anticipated costs for diagnosis-based groups, and documenting the presence of a comorbidity, such as malnutrition, can increase the payment for a diagnosis. It is important to accurately document not only the supporting criteria used to diagnose malnutrition, but also the interventions used to address it during a patient's stay.
Topics: Comorbidity; Hospitals; Humans; Malnutrition; Medical Records
PubMed: 34587310
DOI: 10.1002/ncp.10779 -
Clinical Journal of the American... Jul 2020An unintended consequence of electronic medical record use in the United States is the potential effect on graduate physician training. We assessed educational burdens...
BACKGROUND AND OBJECTIVES
An unintended consequence of electronic medical record use in the United States is the potential effect on graduate physician training. We assessed educational burdens and benefits of electronic medical record use on United States nephrology fellows by means of a survey.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
We used an anonymous online opinion survey of all United States nephrology program directors (=148), their faculty, and fellows. Program directors forwarded survey links to fellows and clinical faculty, indicating to how many they forwarded the link. The three surveys had parallel questions to permit comparisons.
RESULTS
Twenty-two percent of program directors (=33) forwarded surveys to faculty (=387) and fellows (=216; 26% of United States nephrology fellows). Faculty and fellow response rates were 25% and 33%, respectively; 51% of fellows agreed/strongly agreed that the electronic medical record contributed positively to their education. Perceived positive effects included access flexibility and ease of obtaining laboratory/radiology results. Negative effects included copy-forward errors and excessive, irrelevant documentation. Electronic medical record function was reported to be slow, disrupted, or completely lost monthly or more by >40%, and these were significantly less likely to agree that the electronic medical record contributed positively to their education. Electronic medical record completion time demands contributed to fellow reluctance to do procedures (52%), participate in conferences (57%), prolong patient interactions (74%), and do patient-directed reading (55%). Sixty-five percent of fellows reported often/sometimes exceeding work-hours limits due to documentation time demands; 85% of faculty reported often/sometimes observing copy-forward errors. Limitations include potential nonresponse and social desirability bias.
CONCLUSIONS
Respondents reported that the electronic medical record enhances fellow education with efficient and geographically flexible patient data access, but the time demands of data and order entry reduce engagement in educational activities, contribute to work-hours violations, and diminish direct patient interactions.
Topics: Attitude of Health Personnel; Education, Medical, Graduate; Electronic Health Records; Faculty, Medical; Fellowships and Scholarships; Humans; Medical Records Systems, Computerized; Nephrology; Physician-Patient Relations; Surveys and Questionnaires; Time Factors; United States; Workload
PubMed: 32576553
DOI: 10.2215/CJN.14191119 -
International Journal of Environmental... May 2022(1) Backgroud: For future national digital healthcare policy development, it is vital to collect baseline data on the infrastructure and services of medical...
(1) Backgroud: For future national digital healthcare policy development, it is vital to collect baseline data on the infrastructure and services of medical institutions' information and communication technology (ICT). To assess the state of medical ICT across the nation, we devised and administered a comprehensive digital healthcare survey to medical institutions across the nation. (2) Methods: From 16 November through 11 December 2020, this study targeted 42 tertiary hospitals, 311 general hospitals, and 1431 hospital locations countrywide. (3) Results: Since 2015, most hospitals have implemented electronic medical record (EMR) systems (90.5 percent of hospitals, which is the smallest unit, and 100 percent of tertiary hospitals). The rate of implementation of personal health records (PHRs) varied significantly between 61.9 percent and 2.4 percent, depending on the size of the hospital. Hospitals have implemented around three to seven government-sponsored information/data transmission and receiving systems for statistical or investigative objectives. For secondary usage of medical data, more than half of tertiary hospitals have implemented a clinical data warehouse or shared data model. However, new service establishments utilizing modern medical technologies such as artificial intelligence or lifelogging were scarce and in the planning stages. (4) Conclusion: This study shows that the level of digitalization in Korean medical institutions is significant, despite the fact that the development and spending in ICT infrastructure and services provided by individual institutions imposes a significant cost. This illustrates that, in the face of a pandemic, strong government backing and policymaking are essential to activate ICT-based medical services and efficiently use medical data.
Topics: Artificial Intelligence; Cross-Sectional Studies; Electronic Health Records; Hospitals, General; Republic of Korea
PubMed: 35627866
DOI: 10.3390/ijerph19106329 -
Journal of Biomedical Informatics Jun 2022Record linkage is an important problem studied widely in many domains including biomedical informatics. A standard version of this problem is to cluster records from...
Record linkage is an important problem studied widely in many domains including biomedical informatics. A standard version of this problem is to cluster records from several datasets, such that each cluster has records pertinent to just one individual. Typically, datasets are huge in size. Hence, existing record linkage algorithms take a very long time. It is thus essential to develop novel fast algorithms for record linkage. The incremental version of this problem is to link previously clustered records with new records added to the input datasets. A novel algorithm has been created to efficiently perform standard and incremental record linkage. This algorithm leverages a set of efficient techniques that significantly restrict the number of record pair comparisons and distance computations. Our algorithm shows an average speed-up of 2.4x (up to 4x) for the standard linkage problem as compared to the state-of-the-art, without any drop in linkage performance at all. On average, our algorithm can incrementally link records in just 33% of the time required for linking them from scratch. Our algorithms achieve comparable or superior linkage performance and outperform the state-of-the-art in terms of linking time in all cases where the number of comparison attributes is greater than two. In practice, more than two comparison attributes are quite common. The proposed algorithm is very efficient and could be used in practice for record linkage applications especially when records are being added over time and linkage output needs to be updated frequently.
Topics: Algorithms; Medical Record Linkage
PubMed: 35550929
DOI: 10.1016/j.jbi.2022.104094 -
The Journal of Applied Laboratory... Jan 2021Providing a positive patient experience for transgender individuals includes making the best care decisions and providing an inclusive care environment in which... (Review)
Review
BACKGROUND
Providing a positive patient experience for transgender individuals includes making the best care decisions and providing an inclusive care environment in which individuals are welcomed and respected. Over the past decades, introduction of electronic medical record (EMR) systems into healthcare has improved quality of care and patient outcomes through improved communications among care providers and patients and reduced medical errors. Promoting the highest standards of care for the transgender populations requires collecting and documenting detailed information about patient identity, including sex and gender information in both the EMR and laboratory information system (LIS).
CONTENT
As EMR systems are beginning to incorporate sex and gender information to accommodate transgender and gender nonconforming patients, it is important for clinical laboratories to understand the importance and complexity of this endeavor. In this review, we highlight the current progress and gaps in EMR/LIS to capture relevant sex and gender information.
SUMMARY
Many EMR and LIS systems have the capability to capture sexual orientation and gender identity (SOGI). Fully integrating SOGI into medical records can be challenging, but is very much needed to provide inclusive care for transgender individuals.
Topics: Clinical Laboratory Services; Delivery of Health Care; Electronic Health Records; Female; Gender Identity; Humans; Male; Transgender Persons
PubMed: 33332539
DOI: 10.1093/jalm/jfaa214 -
Current Allergy and Asthma Reports Jul 2020In the ever-changing healthcare system, along with new advancements in the field of allergy, the workflow for the allergist continues to evolve requiring more time spent... (Review)
Review
PURPOSE OF REVIEW
In the ever-changing healthcare system, along with new advancements in the field of allergy, the workflow for the allergist continues to evolve requiring more time spent doing non-clinical duties such as documentation and reviewing reimbursement challenges in the midst of busy clinics. The use of electronic medical records and medical scribes has emerged as tactics to aid the clinic's workflow and efficiency in the modern allergy and immunology clinic.
RECENT FINDINGS
The practicing allergist can implement various additional strategies in their office workflow to maximize and synthesize good medicine and good business. Optimal use of office staff, electronic health records, and various workflow efficiencies has been shown to improve job satisfaction and reduce physician burnout. By utilizing these methods and integrating them into their practices, allergists will be able to meet the demands of the healthcare system and still provide patients with evidence based, compassionate, and cost-effective care.
Topics: Electronic Health Records; Humans; Hypersensitivity; Medical Record Administrators; Workflow
PubMed: 32648003
DOI: 10.1007/s11882-020-00950-4 -
Journal of Medical Internet Research Feb 2021Online medical records are being used to organize processes in clinical and outpatient settings and to forge doctor-patient communication techniques that build mutual...
BACKGROUND
Online medical records are being used to organize processes in clinical and outpatient settings and to forge doctor-patient communication techniques that build mutual understanding and trust.
OBJECTIVE
We aimed to understand the reasons why patients tend to avoid using online medical records and to compare the perceptions that patients have of online medical records based on demographics and cancer diagnosis.
METHODS
We used data from the Health Information National Trends Survey Cycle 3, a nationally representative survey, and assessed outcomes using descriptive statistics and chi-square tests. The patients (N=4328) included in the analysis had experienced an outpatient visit within the previous 12 months and had answered the online behavior question regarding their use of online medical records.
RESULTS
Patients who were nonusers of online medical records consisted of 58.36% of the sample (2526/4328). The highest nonuser rates were for patients who were Hispanic (460/683, 67.35%), patients who were non-Hispanic Black (434/653, 66.46%), and patients who were older than 65 years (968/1520, 63.6%). Patients older than 65 years were less likely to use online medical records (odds ratio [OR] 1.51, 95% CI 1.24-1.84, P<.001). Patients who were White were more likely to use online medical records than patients who were Black (OR 1.71, 95% CI 1.43-2.05, P<.001) or Hispanic (OR 1.65, 95% CI 1.37-1.98, P<.001). Patients who were diagnosed with cancer were more likely to use online medical records compared to patients with no cancer (OR 1.31, 95% CI 1.11-1.55, 95% CI 1.11-1.55, P=.001). Among nonusers, older patients (≥65 years old) preferred speaking directly to their health care providers (OR 1.76, 95% CI 1.35-2.31, P<.001), were more concerned about privacy issues caused by online medical records (OR 1.79, 95% CI 1.22-2.66, P<.001), and felt uncomfortable using the online medical record systems (OR 10.55, 95% CI 6.06-19.89, P<.001) compared to those aged 18-34 years. Patients who were Black or Hispanic were more concerned about privacy issues (OR 1.42, 1.09-1.84, P=.007).
CONCLUSIONS
Studies should consider social factors such as gender, race/ethnicity, and age when monitoring trends in eHealth use to ensure that eHealth use does not induce greater health status and health care disparities between people with different backgrounds and demographic characteristics.
Topics: Adolescent; Adult; Aged; Data Analysis; Electronic Health Records; Female; Health Information Exchange; History, 21st Century; Humans; Internet Use; Male; Middle Aged; Physician-Patient Relations; Surveys and Questionnaires; Telemedicine; Young Adult
PubMed: 33616539
DOI: 10.2196/24767 -
Nurse Education Today Jun 2021Use of academic electronic medical records is internationally recognised as a means for preparing health professional students for the digital healthcare environment.... (Review)
Review
BACKGROUND
Use of academic electronic medical records is internationally recognised as a means for preparing health professional students for the digital healthcare environment. Reported practice benefits include skills for electronic documentation, health informatics, point-of-care clinical decision support systems, as well as preparation for information technology-enabled clinical settings, while challenges include lack of access to simulation software, faculty-related barriers, limited finances and educational software costs. However, little is known about best practices related to its use within pre-licensure or entry-to-practice nursing curricula and impact on clinical practice outcomes.
OBJECTIVE
This review sought to explore how academic electronic medical records are used in entry-to-practice nursing curricula.
DESIGN
A scoping review guided by the Joanna Briggs Institute three-step search strategy, exploring existing publications and grey literature.
INCLUSION CRITERIA
Quantitative and qualitative studies related to use of academic electronic medical records in pre-licensure nurse education.
INFORMATION SOURCES
A range of databases were searched including CINAHL, Medline, Proquest Central, ERIC, ScienceDirect, PubMed, IOS Press, as well as grey literature, reference lists and handsearching.
REVIEW METHODS
The search yielded 580 articles, from which inductive thematic analysis of 34 included studies was conducted.
RESULTS
Included articles were nine qualitative, 21 quantitative and five mixed methods studies. Most originated from the USA. Academic electronic medical records are mainly used to teach documentation, safe use of health technology, and for clinical preparation. Most are used for fundamental or junior levels courses, with problem-based learning and simulation embedded. Institution's technology resources and faculty capability are essential to implementation.
CONCLUSIONS
There is a need for more research that examines optimal timing and duration of use of academic electronic medical records in curricula, and their impact on critical thinking and clinical performance. Finally, there is a need to explore greater academic-clinical partnerships in the education process.
Topics: Clinical Competence; Curriculum; Electronic Health Records; Faculty; Health Personnel; Humans
PubMed: 33865191
DOI: 10.1016/j.nedt.2021.104889 -
Expert Review of Medical Devices Mar 2024Medical device (MD)-integrated (I) electronic medical record (EMR) (MDI-EMR) poses cyber threats that undermine patient safety, and thus, they require effective control... (Review)
Review
INTRODUCTION
Medical device (MD)-integrated (I) electronic medical record (EMR) (MDI-EMR) poses cyber threats that undermine patient safety, and thus, they require effective control mechanisms. We reviewed the related literature, including existing EMR and MD risk assessment approaches, to identify MDI-EMR comprehensive evaluation dimensions and measures.
AREAS COVERED
We searched multiple databases, including PubMed, Web of Knowledge, Scopus, ACM, Embase, IEEE and Ingenta. We explored various evaluation aspects of MD and EMR to gain a better understanding of their complex integration. We reviewed numerous risk management and assessment frameworks related to MD and EMR security aspects and mitigation controls and then identified their common evaluation aspects. Our review indicated that previous evaluation frameworks assessed MD and EMR independently. To address this gap, we proposed an evaluation framework based on the sociotechnical dimensions of health information systems and risk assessment approaches for MDs to evaluate MDI-EMR integratively.
EXPERT OPINION
The emergence of MDI-EMR cyber threats requires appropriate evaluation tools to ensure the safe development and application of MDI-EMR. Consequently, our proposed framework will continue to evolve through subsequent validations and refinements. This process aims to establish its applicability in informing stakeholders of the safety level and assessing its effectiveness in mitigating risks for future improvements.
Topics: Humans; Electronic Health Records; Patient Safety; Risk Assessment
PubMed: 38318674
DOI: 10.1080/17434440.2024.2315024