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1 | NAFP presentation (Cole's) for March 2021 - EMR and data management | Dead link. Ask NAFP people? | https://univnebrmedcntr-my.sharepoint.com/:p:/g/personal/cole_marolf_unmc_edu/EShz5YuEFedHhpj4NBe2BVAB6HnTjZ9Gkx2BafZFQf1BlA | |||||||
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3 | Reddit page for viewing of Cole’s mock-up of EHR | https://www.reddit.com/r/EMR/comments/fkdjsj/rethinking_medical_records_visual_emr_idea/ | ||||||||
4 | interactive medication timeline (Inspired EHRs) | http://inspiredehrs.org/timeline/ https://github.com/goinvo/EHR | ||||||||
5 | Company providing a layering timeline product to ride atop other EHRs | https://juxly.com/products/timeline/#timeline-video https://code.cerner.com/apps/juxly-timeline | ||||||||
6 | Turf is an EHR usability toolkit software developed by SHARPC at the University of Texas Health Science Center at Houston. It is an all-in-one integrated software system and the first software program designed specifically for safety-enhanced design validation for EHRs. Turf hosts a variety of features for usability testing of an EHR by streamlining User Testing and Heuristic Evaluation using descriptive analysis, inferential statistics, etc. The methodology of Turf is based upon the TURF framework of four analyses (Task, User, Representation, and Function) that should be conducted prior to and during development of an EHR system. This framework created by Drs. Zhang and Walji (2011) is intended to aid researchers define, evaluate, measure, and design EHR systems. | https://sbmi.uth.edu/nccd/research/sharpc/ | ||||||||
7 | Legal requirements for EHRs (see “ONC certification” on the web generally) | https://www.healthit.gov/topic/certification-ehrs/2015-edition https://www.healthit.gov/topic/standards-technology/health-it-standards http://build.fhir.org/ig/HL7/VhDir/index.html | ||||||||
8 | Apparent leading research group (survey physicians on their EHRs, report to the EHR vendors on what to do better, presumably make money off the interchange?). Awaiting e-mail back on collaborating on “sandbox”/”bake-off” possibilities using demo versions of all EHRs possible | https://klasresearch.com/home | ||||||||
9 | NIH/ “Computer” editorial/white paper: Visualization and visual analytics re- searchers can contribute substantial technological advances to support the reliable, effective, safe, and validated systems required for personal health, clinical healthcare, and public health policymaking. | Shneiderman B, Plaisant C, Hesse BW. "Improving Healthcare with Interactive Visualization," in Computer, vol. 46, no. 5, pp. 58-66, May 2013, doi: 10.1109/MC.2013.38. | https://www.cs.umd.edu/users/ben/Shneiderman2013Improving.pdf | |||||||
10 | Microsoft health patient journey demonstrator (MSCUI) paper | Kirsten D. “Microsoft health patient journey demonstrator.” Informatics in primary care 16 4 (2008): 297-302 . | https://www.slideshare.net/vaibhavbhandari/programming-healthcare-silos https://pdfs.semanticscholar.org/a389/0d8806032c95d255cde52e10342778452698.pdf https://news.microsoft.com/2008/05/13/updated-microsoft-health-common-user-interface-furthers-clinical-effectiveness-increases-patient-safety/ https://digital.nhs.uk/data-and-information/information-standards/information-standards-and-data-collections-including-extractions/publications-and-notifications/standards-and-collections/isb-1500-1508-common-user-interface | |||||||
11 | Microsoft health patient journey demonstrator (MSCUI) Developed for UK’s NHS. “Microsoft has been working with the National Health Service (NHS) in England to improve patient safety by creating a common look and feel for NHS systems through the NHS Common User Interface (CUI) Programme.” Video demo too from 2008. CUI = Common User Interface, mostly for patient registry info (name, DOB, etc) | https://archive.codeplex.com/?p=mscui https://www.healthcareguy.com/2007/08/08/microsoft-health-common-user-interface-cui-guidance-and-controls/ https://github.com/rbirkby/mscui https://www.youtube.com/watch?v=Ebq_0duBmd8 https://www.slideserve.com/Gideon/the-common-user-interface-cui-project | ||||||||
12 | Research paper on medication list vs medication timeline Triangulating Methodologies from Software, Medicine and Human Factors Industries to Measure Usability and Clinical Efficacy of Medication Data Visualization in an Electronic Health Record System This study was a randomized, controlled trial aimed to quantifiably measure the impact of a medication timeline visualization on usability and clinical reasoning. Simulated electronic medical record environments, built as web applications, hosted the control and intervention variables (Figure 1 & 2). | Chang B, Kanagaraj M, Neely B, Segall N, Huang E. Triangulating Methodologies from Software, Medicine and Human Factors Industries to Measure Usability and Clinical Efficacy of Medication Data Visualization in an Electronic Health Record System. AMIA Jt Summits Transl Sci Proc. 2017 Jul 26;2017:473-482. PMID: 28815147; PMCID: PMC5543381. | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5543381/ | |||||||
13 | From Dr. Belden: the above references this 1998 paper on timelines LifeLines: using visualization to enhance navigation and analysis of patient records. | Plaisant C, Mushlin R, Snyder A, Li J, Heller D, Shneiderman B. LifeLines: using visualization to enhance navigation and analysis of patient records. Proc AMIA Symp. 1998:76-80. PMID: 9929185; PMCID: PMC2232192. | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2232192/ | |||||||
14 | Dr. Belden’s paper on the development of the medication timeline demo. Will have to discuss with him more (videocall) what the Tiger Institute at Missouri, as well as Cerner, have mocked up/built, and why they wouldn’t do an extension build of the Med Timeline project. He also mentioned a 2D prototype “whole system” that they couldn’t/wouldn’t build, but couldn’t share it because of IPO “fuzziness”. Goinvo.com for the timeline website. jennifer@goinvo = Jennifer Patel, programmer. Juhan Sonin = creative director Jonathan Nebeker = MD @ VA working on EHR stuff David Kreda PhD not actively working on EHR stuff but has | Belden, J. L., Wegier, P., Patel, J., Hutson, A., Plaisant, C., Moore, J. L., . . . Koopman, R. J. (2018, December 24). Designing a medication timeline for patients and physicians. Retrieved from https://academic.oup.com/jamia/article/26/2/95/5260829 | https://academic.oup.com/jamia/article/26/2/95/5260829 | |||||||
15 | LifeLines 1998 demo build, EXACTLY what VisualEMR would be. From Human-Computer Intaraction Laboratory @ University of Maryland Institute for Advanced Computer Studies. ...Link to their historical links website ...Linked out to a video archive with them describing their project ...Link to another ancestor project, TeleMed, described in this paper (not good, but a predecessor and lots of developer ideas included, including what looks like primitive machine learning/image lookup | Plaisant C, Mushlin R, Snyder A, Li J, Heller D, Shneiderman B. LifeLines: using visualization to enhance navigation and analysis of patient records. Proc AMIA Symp. 1998;76-80. Forslund, D, Phillips, R, & Tomlinson, B. TeleMed: An example of a new system developed with object technology. United States. | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2232192/pdf/procamiasymp00005-0112.pdf http://www.cs.umd.edu/hcil/trs/index.shtml https://open-video.org//details.php?videoid=700 https://www.osti.gov/servlets/purl/414354 | |||||||
16 | The developer of LifeLines and TwinList (referenced by Belden) LifeFlow = predecessor? Lifelines website had the linked video with a higher quality video on Youtube than the downloadable one above (from 1998 Lifelines) | https://hcil.umd.edu/catherine-plaisant/ http://www.cs.umd.edu/hcil/lifeflow/ http://www.cs.umd.edu/hcil/lifelines/ https://www.youtube.com/watch?time_continue=29&v=aeRklur2Zc4&feature=emb_logo | ||||||||
17 | Demo of LifeLines (have to reconfigure browser to access somehow) | http://www.cs.umd.edu/hcil/lifelines/latestdemo/kaiser.html | ||||||||
18 | Bora Chang’s research (CEO of Kela Health now) Triangulating Methodologies from Software, Medicine and Human Factors Industries to Measure Usability and Clinical Efficacy of Medication Data Visualization in an Electronic Health Record System | Chang B, Kanagaraj M, Neely B, Segall N, Huang E. Triangulating Methodologies from Software, Medicine and Human Factors Industries to Measure Usability and Clinical Efficacy of Medication Data Visualization in an Electronic Health Record System. AMIA Jt Summits Transl Sci Proc. 2017 Jul 26;2017:473-482. PMID: 28815147; PMCID: PMC5543381. | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5543381/ | |||||||
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21 | EHR list | https://www.selecthub.com/emr-software blog.capterra.com/ehr-comparison-eclinicalworks-vs-mckesson-vs-epic | ||||||||
22 | blog.capterra.com/ehr-comparison-eclinicalworks-vs-mckesson-vs-epic | |||||||||
23 | American Medial Informatics Association – Belden suggests going to a meeting? | https://www.amia.org/about-amia-american-medical-informatics-association-%C2%AE | ||||||||
24 | Omaha Startup Collaborative | https://www.omahachamber.org/startupcollaborative/ | ||||||||
25 | Nebraska Innovation Fund | https://opportunity.nebraska.gov/program/prototype-grant/ | ||||||||
26 | Waterfall development a bad idea?? per David Thompson (via Bob Rauner) of Myelin.health | https://www.google.com/search?client=ubuntu&channel=fs&q=waterfall+development+model&ie=utf-8&oe=utf-8 | ||||||||
27 | Direct primary care | https://www.aafp.org/practice-management/payment/dpc.html | ||||||||
28 | Research on how much outpatient docs spend on EHRs See details in duplicate entry below | Overhage, J. Marc, et al. “Physician Time Spent Using the Electronic Health Record During Outpatient Encounters.” Annals of Internal Medicine, www.acpjournals.org/doi/10.7326/M18-3684. | https://annals.org/aim/article-abstract/2758843/physician-time-spent-using-electronic-health-record-during-outpatient-encounters | |||||||
29 | VA project screenshot | |||||||||
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31 | Juxly: Howard Follis, MD Juxly = 2nd start-up He built UroChart for Urologist in 2004 after previously using Cerner and Centricity "Small cut of physicians that are willing to get up and do anything about stuff there not interested" "Went to Barnes and Noble and bought all the books I could" starting in 2002 -- "I wonder if I could build a better mousetrap". Read user interface books. "Not a coder". Approached a computer science guy at a university in Springfield, MO. "Bootstrapped the first company out of my checking account". "Only UI expert in our company", and "wrote the paychecks". Built it with big touchscreen buttons "because I had a bias against typing", then iPad just happened to come out and Meaningful Use 1 came out --> 11th company in country to get federal certification, did benefit from stimulus money that Urologists used to buy his product. And EndoPharmaceuticals had just bought some device companies and wanted to buy a Urology EHR. "I thought it was a prank call", they had been "secret shopping" him for a year. Sold to them in 2011, they wanted him to work for them (he didn't want to be a drug company employee), but they wouldn't buy if he didn't stay on as a consultant. Continued practicing full time up to that point. After a year and 3 days he got out. Did have a non-compete, so sat out for that and then started Juxly... Juxly does FHR apps that plug into EHRs to make them better. Rasied caital 6-7y ago, wrote first code as a company 5 years ago. Decided not to go head to head with EHR companies because 75-95% of docs are already on EHRs, "the land grab is done". If you find a business person, you'll know quickly they don't understand why this is important. Have to talk to other providers to get it. "We won 90% of our deals against other EHRs" because they could talk clinically better Buzz words: "Problem-based longitudinal record"; "Payor based health record"; government saying patients own data; everbody talks about claims data like it's some "magic crystal", but real data is still siloed. Just because you can't punch through at Cerner/Epic, doesn't mean...??? Docs that work for Cerner/Epic don't have an incentive to think about longitudinal record. They may exist but would be hard to find. He does know people at Cerner... "Bootstrapped what I was doing long enough to get people's attention"... "MD... outside of medicine is not always a good thing, can even carry negative weight with MBA types" "I was a good physician, and I went there for the right reasons" and enjoyed it. "Moved with my 3000 charts to a multi-specialty clinic" with GE Centricity; went to head of HR there, and asked them to put him in touch with Centricity! Centricity promised to put it in front of the UI committee... who didn't meet for a year and a half!! "If you think you're gonna have a significant entrepreneurial bent, you're gonna have to figure out how it's going to fit into clinical practice" "If you wanna do your own thing, I would be very encouraging". "I would love you to show you what I've been doing" "Juxly Timeline" was one of their original products -- but couldn't sell it worth a shit. Couldn't get anyone to buy it, even though it's in the Cerner app store. Providers thought it was cool, but the CFO/CEO would always look at it and say Cerner should do it. Cerner couldn't (?!?!?!?!). Hopes it still will when value based care really comes on. Later app was called Vault, was commercially viable which is something you need. "Fundamentallyl an optimistic person"... hope to not come across as pessimistic... "not as easy as I thought it would be" (trying to be realistic and not pessimistic, wouldn't have done a second startup as a pessimist) "Could be a couple of Skunkworks projects doing this, but what if there's not??" When he was starting his, there were 450 registered EMRs in the country, but there really wasn't anything like his product. "You're gonna need a big boat" - Jaws reference "Could choose a hybrid where you practice 2/3 time"... "Would be difficult to build a successful health IT company from scratch while being full time". "Maybe don't have to do it on your own"...??? "Don't ever discount how strong your position is as a physician who also has a strong interest in health IT" "Iterate… start with Step A then iterate…" "Oldest son works for Amazon" "Longitudinal outcomes-based platform" (throw out the term EHR)… "Don’t think you want to do a replacement deal" to compete directly, but instead try to co-exist with EHRs. ""Be careful which gorrilla you poke". "Company has a relationship with Humana, who has a longitudinal medical record version" "Capital is there for the right people" . | |||||||||
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33 | Windle’s EHR screenshot. $5 million over 5 years??? Must include research, not just the build | |||||||||
34 | ||||||||||
35 | Juhan of GoInvo: Juhan: the tools we have "suck" 1) no data standard 2) 3) EHRs have been "primarily designed by doctors and nurses";??? so workflows hdon't reflect human workflows?? Thinks we're getting closer to data standardization with FHIR Inspired EHRs based on a simple and scaled down data set. But now with standard approaches to data elements, "can make much more interesting prototypes" to go from "workbench to reality" "Coming in at a time" after people haevf worked unsuccessfully for decades. "Think it is time to leverage what has been happening" "Timelines are hard" because no-one can do them right... "Love hate relationship with them in the design community" Metero/Medero or Mandrean art*** Go after funding (thru AAFP, or ARC?) SMART is "partially criminal activity" $1-$2 million for a prototype Vista was open-source code but community support wasn't Need a "small micro-story" down, a couple screens/pages to get interest/first funding... "No way to see a human person in their entirety right now" "No way to see lust to dust" Use Inspired EHRs as a baseline. $275k-____ funding built this. (NIH, California, SMART-C) **Track down funding | https://www.goinvo.com/about/studio-timeline/ | ||||||||
36 | Building a portable data and information interoperability infrastructure-framework for a standard Taiwan Electronic Medical Record Template - USB portable EHR | Jian, W., Wen, H., Scholl, J., Shabbir, S., Lee, P., Hsu, C. and Li, Y., 2021. The Taiwanese method for providing patients data from multiple hospital EHR systems. Jian WS, Hsu CY, Hao TH, Wen HC, Hsu MH, Lee YL, Li YC, Chang P. Building a portable data and information interoperability infrastructure-framework for a standard Taiwan Electronic Medical Record Template. Comput Methods Programs Biomed. 2007 Nov;88(2):102-11. doi: 10.1016/j.cmpb.2007.07.014. PMID: 17936402. | https://www.sciencedirect.com/science/article/pii/S153204641000170X https://pubmed.ncbi.nlm.nih.gov/17936402/ | |||||||
37 | Op-ed-like research paper on unintended consequences (Ucs) of EHRs: failed expectations, EHR market saturation, innovation vacuum, and physician burnout, and data obfuscation | Colicchio TK, Cimino JJ, Del Fiol G. Unintended Consequences of Nationwide Electronic Health Record Adoption: Challenges and Opportunities in the Post-Meaningful Use Era. J Med Internet Res. 2019 Jun 3;21(6):e13313. doi: 10.2196/13313. PMID: 31162125; PMCID: PMC6682280. | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6682280/ | |||||||
38 | PCORI – Patient Centered Outcomes Research Institute. Government funded. Probably not right for this project, more focused on direct patient care things, psychosocial stuff, and not pilot projects | https://www.pcori.org/funding-opportunities | ||||||||
39 | “Single Patient Viewer”, Western Cape of South Africa web-based EHR with a timeline-like view | Bibliography.com Boulle A, Heekes A, Tiffin N, et al. Data Centre Profile: The Provincial Health Data Centre of the Western Cape Province, South Africa. International Journal of Population Data Science. 2019;(2). doi:10.23889/ijpds.v4i2.1143 | https://www.researchgate.net/publication/337412326_Data_Centre_Profile_The_Provincial_Health_Data_Centre_of_the_Western_Cape_Province_South_Africa https://www.researchgate.net/figure/Web-based-clinical-view-Single-Patient-Viewer-graphical-integration-example_fig3_337412326 https://spv.jembi.org/session | |||||||
40 | EHR adoption from ONC HIT desk – graphic 90% by 2019 (though only 72% certified) | https://dashboard.healthit.gov/quickstats/pages/physician-ehr-adoption-trends.php https://www.healthit.gov/data/quickstats/office-based-physician-electronic-health-record-adoption | ||||||||
41 | Legal to screenshot EHRs per ONC Final Rule | https://www.law.cornell.edu/cfr/text/45/170.403 | ||||||||
42 | Who owns EHR data – all 50 states comparison. See saved screenshot in desktop->EHR | http://www.healthinfolaw.org/comparative-analysis/who-owns-medical-records-50-state-comparison https://www.forbes.com/sites/forbestechcouncil/2018/04/23/who-really-owns-your-health-data/?sh=bcbd226d62bb | ||||||||
43 | GoInvo Who Uses My Health Data graphic | https://www.goinvo.com/vision/who-uses-my-health-data/ | ||||||||
44 | History of PROMIS, computer system Dr. Lawrence (Larry) Weed helped develop | http://www.campwoodsw.com/mentorwizard/PROMISHistory.pdf https://en.wikipedia.org/wiki/Lawrence_Weed | ||||||||
45 | Medical Records that Guide and Teach, NEJM, by Dr. Weed. SEE LINKED DROPBOX ARTICLES TO RIGHT *Immensely detailed problem list demonstration, with SOAP for each numbered problem **Lays out his problem-oriented approach to medical data management Also advocates for increased utilization of technicians/non-physician personnel in data collection References the PROMIS work by Slack (researcher) | N Engl J Med. 1968 Mar 14;278(11):593-600. doi: 10.1056/NEJM196803142781105 Medical Records that Guide and Teach NEJM Dr. Lawrence Weed | https://www.nejm.org/doi/10.1056/NEJM196803142781105?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed https://pubmed.ncbi.nlm.nih.gov/5637758/ Downloaded version available on Cole's Dropbox: Part 1 -> Part 2 | |||||||
46 | ||||||||||
47 | Juhan Will need to combine ideas, polish Prototype/Feeasibility OK to start with Nebraska funding while applying for federal funding Take the prototype Come up with a magic wand to get funding vs a plunger Juhan familiar with FHIR, not too hard to see if feasible from that perspective Synthea.org = synthetic patient generator from Delaware. Google and IBM have their own versions. Build timelines... "magic wand concept" build in 3 months. Not a "working prototype". Another few months to create true prottype. (1 month ideas -> PCORI easier to get, hands off (were working with Milken...), but money is smaller --> sell as a way for complex patients to see themselves SBIR challenging... AHRQ have worked with thru contracts not grants. "Where middlemen go to die" but maybe they would fund. Maybe more accessible than SBIR, not quite as easy as PCORI. Use PCORI and AHRQ to seed SBIR? Start with $250,000 grant application. 501c3. (c4 is a sister organization thing??). Redhat's model. The Open Organization book. University of Illinois | |||||||||
48 | Developing Visual Thinking in the Electronic Health Record. A non-exhaustive review of the literature indicates that respective to the growth and development of the EHR, the maturity of data visualization in healthcare is in its infancy. Visual analytics has been only cursorily applied to healthcare. A fundamental issue contributing to fragmentation and poor coordination of healthcare delivery is that each member of the healthcare team, including patients, has a different view. Summarizing all of this care comprehensively for any member of the healthcare team is a "wickedly hard" visual analytics and data visualization problem to solve. | Boyd AD, Young CD, Amatayakul M, Dieter MG, Pawola LM. Developing Visual Thinking in the Electronic Health Record. Stud Health Technol Inform. 2017;245:308-312. PMID: 29295105. | https://pubmed.ncbi.nlm.nih.gov/29295105/ | |||||||
49 | A Daily Hospital Progress Note that Increases Physician Usability of the Electronic Health Record by Facilitating a Problem-Oriented Approach to the Patient and Reducing Physician Clerical Burden We suggest changes in the electronic health record (EHR) in hospitalized patients to increase EHR usability by optimizing the physician's ability to approach the patient in a problem-oriented fashion and by reducing physician data entry and chart navigation. The framework for these changes is a Physician's Daily Hospital Progress Note organized into 3 sections: Subjective, Objective, and a combined Assessment and Plan section, subdivided by problem titles. The EHR would consolidate information for each problem by: 1) juxtaposing to each problem title relevant medications, key durable results, and limitations; 2) entering in the running lists under Assessment and Plan the most relevant information for that day, including abbreviated versions of relevant reports; and 3) generating a flow sheet in a problem's progress note for any key results tracked daily. To reduce physician EHR navigation, the EHR would place in the Objective section abbreviated versions of notes of other physicians, nurses, and allied health professionals as well as recent orders. The physician would enter only the analysis and plan and new information not included in the EHR. The consolidation of information for each problem would facilitate physician communication at points of transition of care including generation of a problem-oriented discharge summary. MODIFICATIONS IN COMPUTERIZED PHYSICIAN ORDER ENTRY This article addresses computerized physician data entry (CPOE) only to point out the redundancy of the physician documenting in the progress note that a medication change is going to be made and the rationale, and to also enter the medication name into CPOE. One could easily forget to make this second entry, especially if the physician’s workflow is to enter orders only after all the progress notes have been entered. Seamless integration of the medication name from the progress note into CPOE would prevent this potential error and any quality and cost consequences. In physician satisfaction surveys, if questions on CPOE are excluded from those on other EHR components, the correlation between physician burnout and the EHR is no longer evident. | Sutton JM, Ash SR, Al Makki A, Kalakeche R. A Daily Hospital Progress Note that Increases Physician Usability of the Electronic Health Record by Facilitating a Problem-Oriented Approach to the Patient and Reducing Physician Clerical Burden. Perm J. 2019;23:18-221. doi: 10.7812/TPP/18-221. Epub 2019 Jun 14. PMID: 31314721; PMCID: PMC6636503. | https://pubmed.ncbi.nlm.nih.gov/31314721/ | |||||||
50 | Halyos (http://halyos.gehlenborglab.org), a visual EHR web application that complements the functionality of existing patient portals. Halyos is designed to integrate with existing EHR systems to help patients interpret their health data. We are still using email! To contact Nils, just send an email to nils@hms.harvard.edu. To schedule a meeting with Nils, please contact Nichole Parker at nichole_parker@hms.harvard.edu. | http://halyos.gehlenborglab.org http://gehlenborglab.org/contact/ | ||||||||
51 | Halyos build paper. We have developed Halyos (http://halyos.gehlenborglab.org), a visual EHR web application that complementsthe functionality of existing patient portals. Halyos is designed to integrate with existing EHR systems to helppatients interpret their health data. The Halyos application utilizes the SMART on FHIR (Substitutable MedicalApplications and Reusable Technologies on Fast Healthcare Interoperability Resources) platform to create aninteroperable interface that provides interactive visualizations of clinically validated risk scores and longitudinaldata derived from a patient’s clinical measurements. This work wasenabled by NIH grants U54HG007963 and R00HG007583. grants.nih.gov/funding/search → U54 and R00 | Mataraso S, Socrates V, Lekschas F, Gehlenborg N. Halyos: A patient-facing visual EHR interface for longitudinal risk awareness. bioRxiv; 2019. DOI: 10.1101/597583. | https://www.biorxiv.org/content/10.1101/597583v1.full.pdf | |||||||
52 | Jaime Bland – Cync Focus on ambulatory and not hospital based? Has had the conversation about offering EHRs with board members – portal vs offering a true EHR Would like to see less money spent on technology “Have not had anything formally presented to the board” Would have you spend time with the CTO – from Utah Business plan, scalability, → Collaborative, creating economic value (governor wants this), what data quality issues it can solve Interchange collaboration started with COVID. Aggregate dashboard got presented to White House. Of the 6 HIEs in the Consortium, no others have invested clinical employees Ann Polich – Chief Medical Officer?? Did residency with human centered design thru VA → She’s leading a design group on something... | |||||||||
53 | Meditech's data analysis/patient registries done with SQL and "BCA" (Business & Clinical Analytics --> $2-4k/month) | https://ehr.meditech.com/ehr-solutions/meditech-business-clinical-analytics | ||||||||
54 | "CommonWell Health Alliance is a not-for-profit trade association devoted to the simple vision that health data should be available to individuals and caregivers regardless of where care occurs. Additionally, access to this data must be built into health IT at a reasonable cost for use by a broad range of health care providers and the people they serve." "At CommonWell, together with our service provider and members, we have created and deployed a vendor-neutral platform that breaks down the technological and process barriers that inhibit effective health data exchange. We aren’t looking to reinvent the wheel; rather, we are leveraging existing standards and policies in order to enable scalable, secure and reliable interoperability as easily as possible for our members and their customers across the nation." CommonWell was founded in 2013 by a handful of health IT companies committed to helping solve the longstanding problem of interoperability in the health care industry. Traditionally competitors, these seven companies set aside their differences to focus on this simple vision. | https://www.commonwellalliance.org/how-to-participate/ | ||||||||
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56 | Toward Designing Information Display to Support Critical Care. A Qualitative Contextual Evaluation and Visioning Effort Visions for the future included designs that: 1) provide rapid access to new information, 2) organize by systems or problems as well as by current versus historical patient data, and 3) apply intelligence toward detecting and representing change and urgency. | Wright MC, Dunbar S, Macpherson BC, Moretti EW, Del Fiol G, Bolte J, Taekman JM, Segall N. Toward Designing Information Display to Support Critical Care. A Qualitative Contextual Evaluation and Visioning Effort. Appl Clin Inform. 2016 Oct 5;7(4):912-929. doi: 10.4338/ACI-2016-03-RA-0033. PMID: 27704138; PMCID: PMC5228134. | https://pubmed.ncbi.nlm.nih.gov/27704138/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5228134/ | |||||||
57 | Determining primary care physician information needs to inform ambulatory visit note display Physicians identified History of Present Illness (HPI), Assessment, and Plan (A&P) as the most important sections of a visit note. In contrast, they largely judged the Review of Systems (ROS) to be superfluous. | Clarke MA, Steege LM, Moore JL, Koopman RJ, Belden JL, Kim MS. Determining primary care physician information needs to inform ambulatory visit note display. Appl Clin Inform. 2014 Feb 26;5(1):169-90. doi: 10.4338/ACI-2013-08-RA-0064. Erratum in: Appl Clin Inform. 2014;5(1):190. PMID: 24734131; PMCID: PMC3974234. | https://pubmed.ncbi.nlm.nih.gov/24734131/ | |||||||
58 | User-composable Electronic Health Record Improves Efficiency of Clinician Data Viewing for Patient Case Appraisal: A Mixed-Methods Study Objective: We compare MedWISE-a novel EHR that supports user-composable displays-with a conventional EHR in terms of the number of repeat views of data elements for patient case appraisal. Results: There was a significant difference (p<.0001) in proportion of cases with repeat data element viewing between the user-composable EHR (14.6 percent) and conventional EHR (72.6 percent). | Senathirajah Y, Kaufman D, Bakken S. User-composable Electronic Health Record Improves Efficiency of Clinician Data Viewing for Patient Case Appraisal: A Mixed-Methods Study. EGEMS (Wash DC). 2016 May 2;4(1):1176. doi: 10.13063/2327-9214.1176. PMID: 27195306; PMCID: PMC4862763. | https://pubmed.ncbi.nlm.nih.gov/27195306/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4862763/figure/f2-egems1176/ | |||||||
59 | MedWISE: A Highly User-configurable ‘web 2.0’ EHR Published in 2010 | Senathirajah, Y., & Bakken, S. (2010). MedWISE: a highly user-configurable 'web 2.0' EHR. IHI. | https://www.researchgate.net/publication/221629819_MedWISE_a_highly_user-configurable_%27web_20%27_EHR | |||||||
60 | Challenges and Opportunities to Improve the Clinician Experience Reviewing Electronic Progress Notes VISTA-like program Our findings support the need to improve EHR note design and presentation to support optimal note review patterns for clinicians. | Hultman GM, Marquard JL, Lindemann E, Arsoniadis E, Pakhomov S, Melton GB. Challenges and Opportunities to Improve the Clinician Experience Reviewing Electronic Progress Notes. Appl Clin Inform. 2019 May;10(3):446-453. doi: 10.1055/s-0039-1692164. Epub 2019 Jun 19. PMID: 31216591; PMCID: PMC6584143. | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584143/ | |||||||
61 | Electronic Health Records: Then, Now, and in the Future Describe the state of Electronic Health Records (EHRs) in 1992 and their evolution by 2015 and where EHRs are expected to be in 25 years. Further to discuss the expectations for EHRs in 1992 and explore which of them were realized and what events accelerated or disrupted/derailed how EHRs evolved. Translation of ancient Egyptian hieroglyphic inscriptions and papyri from 1,600-3,000 BC indicate the use of medical records. However, paper medical records were not steadily used until 1900-1920. Design and capabilities of EHRs in the next 25 years - Not shaped by paper-chart thinking?? | Evans RS. Electronic Health Records: Then, Now, and in the Future. Yearb Med Inform. 2016 May 20;Suppl 1(Suppl 1):S48-61. doi: 10.15265/IYS-2016-s006. PMID: 27199197; PMCID: PMC5171496. | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5171496/ | |||||||
62 | Exploring the persistence of paper with the electronic health record Objective Healthcare organizations are increasingly implementing electronic health records (EHRs) and other related health information technology (IT). Even in institutions which have long adopted these computerized systems, employees continue to rely on paper to complete their work. The objective of this study was to explore and understand human-technology integration factors that may be causing employees to rely on paper alternatives to the EHR. We conducted semi-structured interviews with 20 key-informants in a large Veterans Affairs Medical Center (VAMC), with a fully implemented EHR, to understand the use of paper-based alternatives. Participants included clinicians, administrators, and IT specialists across several service areas in the medical center. Results We found 11 distinct categories of paper-based workarounds to the use of the EHR. Paper use related to the following: (1) efficiency; (2) knowledge/skill/ease of use; (3) memory; (4) sensorimotor preferences; (5) awareness; (6) task specificity; (7) task complexity; (8) data organization; (9) longitudinal data processes; (10) trust; and (11) security. We define each of these and provide examples that demonstrate how these categories promoted paper use in spite of a fully implemented EHR. Conclusions In several cases, paper served as an important tool and assisted healthcare employees in their work. In other cases, paper use circumvented the intended EHR design, introduced potential gaps in documentation, and generated possible paths to medical error. We discuss implications of these findings for EHR design and implementation. | Saleem JJ, Russ AL, Justice CF, Hagg H, Ebright PR, Woodbridge PA, Doebbeling BN. Exploring the persistence of paper with the electronic health record. Int J Med Inform. 2009 Sep;78(9):618-28. doi: 10.1016/j.ijmedinf.2009.04.001. Epub 2009 May 21. PMID: 19464231. | https://www.sciencedirect.com/science/article/pii/S1386505609000689 | |||||||
63 | Evaluating the Epic electronic medical record system: A dichotomy in perspectives and solution recommendations Table 1. Advantages of EMR systems in prior literature. the majority of the reviewed articles found that, by decreasing medical errors, EMR systems have had a positive impact on patient safety and quality of care However, as a result of modifying the EPIC system by more than 10%, some of the functionalities have changed, creating unintended complications. | Davis Z, Khansa L. Evaluating the epic electronic medical record system: A dichotomy in perspectives and solution recommendations. Health Policy and Technology,Volume 5, Issue 1, 2016, Pages 65-73, ISSN 2211-8837, https://doi.org/10.1016/j.hlpt.2015.10.004. (https://www.sciencedirect.com/science/article/pii/S2211883715000799) | https://www.sciencedirect.com/science/article/pii/S2211883715000799 | |||||||
64 | Patient-centered communication in the era of electronic health records: What does the evidence say? Highlights • EHR use appears to improve capture of patient biomedical information. • EHR use may interfere with nonverbal engagement between patients and physicians. • EHR use may interfere with capture of psychosocial and emotional information. • Patient access and use of EHR may increase engagement and self-management. | Rathert C, Mittler JN, Banerjee S, McDaniel J. Patient-centered communication in the era of electronic health records: What does the evidence say?. Patient Education and Counseling, Volume 100, Issue 1, 2017, Pages 50-64, ISSN 0738-3991, https://doi.org/10.1016/j.pec.2016.07.031. (https://www.sciencedirect.com/science/article/pii/S0738399116303263) | https://www.sciencedirect.com/science/article/pii/S0738399116303263 | |||||||
65 | Twinlist: Novel User Interface Designs for Medication Reconciliation Catherine Plaisant | Plaisant, C., Chao, T.C., Wu, J., Hettinger, A.Z., Herskovic, J., Johnson, T., Bernstam, E., Markowitz, E., Powsner, S., & Shneiderman, B. (2013). Twinlist: Novel User Interface Designs for Medication Reconciliation. AMIA ... Annual Symposium proceedings. AMIA Symposium, 2013, 1150-9 . | https://www.semanticscholar.org/paper/Twinlist%3A-Novel-User-Interface-Designs-for-Plaisant-Chao/675361d3dc49ea016a86e26313248814f25471d7 | |||||||
66 | Evaluation of a Commercial Electronic Medical Record (EMR) by Primary Care Physicians 5 Years after Implementation We have had the EpicCare EMR by Epic Systems Incorporated in our tertiary care, university affiliated hospital since 1999. We currently use the Hyperspace Summer 2004 implementation of EpicCare. We developed a web-based survey for all primary care providers EMR Function% use/change in practice SmartPhrase/Text77% | Kaelber D, Greco P, Cebul RD. Evaluation of a commercial electronic medical record (EMR) by primary care physicians 5 years after implementation. AMIA Annu Symp Proc. 2005;2005:1002. PMID: 16779289; PMCID: PMC1560716. | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1560716/ | |||||||
67 | 7/13/21 with CyncHealth Process for project submission... Open source = sustainable?? Cync currently writing a couple grants. $750,000 over 3 years for a dashboard... And grantors do want a product... "Could be creative" - license for learners but sell for profit Ann Polic - historically a data company ? venture capital instead? CEO of HomeCare advocacy Rob Fox creator of FoxBox.com??? Cync will have patient portal later this year. LB411 = data sharing requirement "you can do anything but you can't do everything" CPRS with MUMPS development?? Next year or 2 for Cync "will be pivotal" USCDI standards Consider working with industrial or human factors engineers, process improvement at CHI too? (Collaborative Care note was created after a request put to "red coat" people @ CHI??) | |||||||||
68 | Objectives Open-source Electronic Health Record (EHR) systems have gained importance. The main aim of our research is to guide organizational choice by comparing the features, functionality, and user-facing system performance of the five most popular open-source EHR systems. Methods We performed qualitative content analysis with a directed approach on recently published literature (2012–2017) to develop an integrated set of criteria to compare the EHR systems. The functional criteria are an integration of the literature, meaningful use criteria, and the Institute of Medicine's functional requirements of EHR, whereas the user-facing system performance is based on the time required to perform basic tasks within the EHR system. Results Based on the Alexa web ranking and Google Trends, the five most popular EHR systems at the time of our study were OSHERA VistA, GNU Health, the Open Medical Record System (OpenMRS), Open Electronic Medical Record (OpenEMR), and OpenEHR. We also found the trends in popularity of the EHR systems and the locations where they were more popular than others. OpenEMR met all the 32 functional criteria, OSHERA VistA met 28, OpenMRS met 12 fully and 11 partially, OpenEHR-based EHR met 10 fully and 3 partially, and GNU Health met the least with only 10 criteria fully and 2 partially. Conclusions Based on our functional criteria, OpenEMR is the most promising EHR system, closely followed by VistA. With regards to user-facing system performance, OpenMRS has superior performance in comparison to OpenEMR. | Comparison of Open-Source Electronic Health Record Systems Based on Functional and User Performance Criteria Saptarshi Purkayastha,corresponding author1 Roshini Allam,1 Pallavi Maity,1 and Judy W. Gichoya2 | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6517630/ | |||||||
69 | Conclusions and Relevance The results of this nationally representative cross-sectional study suggest that physicians working in physician-owned practices are more likely to be satisfied with the EHR, to have positive perceptions of time spent on documentation, and to have staff support for documentation compared with their counterparts working in non–physician-owned practices. The workflow and cultural forces underlying these differences are important to understand in the setting of known differences in burnout by practice ownership type and ongoing physician group consolidation and acquisition by health care systems. Previous research18-20 has also found an association between the practice’s structural characteristics and physician well-being. For instance, physicians practicing in solo or physician-owned practices have lower rates of burnout19 and are more satisfied,18 and solo and physician-owned practices may be more likely to adopt leadership behaviors that support physician satisfaction and well-being.20 However, fewer physicians have been practicing in physician-owned practices over time. For example, a recent national report21 found a 12% increase in physicians employed by hospital systems or other corporate entities between 2019 and 2021. | Assessment of Satisfaction With the Electronic Health Record Among Physicians in Physician-Owned vs Non–Physician-Owned Practices | https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2791439 | |||||||
70 | The Harris Poll on behalf of Stanford Medicine between March 2 and March 27, 2018 among 521 PCPs 1. Doctors see value in EHRs, but want substantial improvements. • While roughly two-thirds of PCPs think EHRs have generally led to improved care (63%) and are at least somewhat satisfied with their current EHR systems (66%), they continue to report problems • Four in 10 PCPs (40%) believe there are more challenges with EHRs than benefits • 62% of time devoted to each patient is being spent in the EHR and half of office-based PCPs (49%) think using an EHR actually detracts from their clinical effectiveness • Seven out of 10 physicians (71%) agree that EHRs greatly contribute to physician burnout • Six out of 10 physicians (59%) think EHRs need a complete overhaul 2. EHRs aren’t seen as powerful clinical tools; their primary value, according to PCPs, is data storage (44%). • Only 8% say the primary value of their EHR is clinically related 3. Physicians agree on what needs to be fixed right away, and what needs to be fixed over the next decade: • Nearly three out of four PCPs (72%) think that improving EHRs’ user interfaces could best address EHR challenges in the immediate future • Seven out of 10 PCPs (67%) think solving interoperability deficiencies should be the top priority for EHRs in the next decade— and 43% want improved predictive analytics to support disease diagnosis, prevention, and population health managemen 5 Despite 70% saying EHRs have improved over the last five years, more than half still agree that: ü EHRs need a complete overhaul (59%) ü Using an EHR detracts from their professional satisfaction (54%) Six in 10 agree that EHRs have led to improved patient care, both in general (63%), and within their practice (61%) | How Doctors Feel About Electronic Health Records National Physician Poll by The Harris Poll Slide set | https://med.stanford.edu/content/dam/sm/ehr/documents/EHR-Poll-Presentation.pdf | |||||||
71 | A total of 529 respondents (weighted, 108 093 respondents [68.1%]) working in physician-owned practices reported being satisfied with their EHR vs 320 respondents (weighted, 63 988 respondents [58.5%]) working in non–physician-owned practices (P = .03). **Good numbers on EHR user #’s, Epic with 24% of a predicted 271,000 users, eClinicalWorks 10%, Allscripts 7% | https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2791439 | ||||||||
72 | Ten years ago, one doctor in 10 kept digital records on their patients. The other 90 percent made notes on paper and stored them in manila folders on shelves and in filing cabinets. Paper records had some obvious disadvantages. They took up space, they were difficult to share with other physicians, hospitals, and insurance companies. **Some good stuff, but more focused on AI, billing, and information sharing | STANFORD MEDICINE SEPTEMBER 2018 White Paper: The Future of Electronic Health Records | http://med.stanford.edu/content/dam/sm/ehr/documents/EHR-White-Paper.pdf | |||||||
73 | The specialty scoring the highest EHR satisfaction (compared to each vendor’s average) is the same for Cerner and Epic – hospital medicine providers scored over 10 points higher than the average for their respective EHRs. These providers are satisfied with their workflow training, EHR functionality and ease of learning how to use the system – 70% agreed their EHR had the needed functionality while only 49% of doctors in cardiology and 47% in orthopedics reported feeling that way. There were similar findings among these groups for agreement that EHR was efficient and enabled patient care | Physician EHR satisfaction varies by specialty, says KLAS report | https://www.healthcareitnews.com/news/physician-ehr-satisfaction-varies-specialty-says-klas-report | |||||||
74 | Results: The majority of the studies stemmed from the United States (19/23, 83%). Mostly, the studies used publicly available data (“secondary data studies”; 17/23, 74%). A total of 18 studies analyzed the effect of an EMR on the quality of health care (78%), 16 the effect on the efficiency of health care (70%). The primary data studies achieved a mean score of 4.3 (SD 1.37; theoretical maximum 10); the secondary data studies a mean score of 7.1 (SD 1.26; theoretical maximum 9). From the primary data studies, 2 demonstrated a reduction of costs. There was not one study that failed to demonstrate a positive effect on the quality of health care. Overall, 9/16 respective studies showed a reduction of costs (56%); 14/18 studies showed an increase of health care quality (78%); the remaining 4 studies missed explicit information about the proposed positive effect. | Value of the Electronic Medical Record for Hospital Care: Update From the Literature | https://www.jmir.org/2021/12/e26323 | |||||||
75 | ?? Really?? ** As there can never be a perfect spouse, there can never be a perfect EMR. EMRs must evolve and the potential users synchronously need to retrain themselves and change their mindset until a sweet spot is reached. ** Really just defending their own EMR system… It is natural for people to forget, but Anthony Vipin Das must remember that it took us a lot of effort to initiate and carry forward an in-house coding and development of EMR at the LV Prasad Eye Institute (LVPEI) about 10 years ago. | Electronic medical records – The good, the bad and the ugly Indian J Ophthalmol. 2020 Mar; 68(3): 417–418. | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7043175/ | |||||||
76 | AI study finds 50% of patient notes duplicated For the cross-sectional analysis, they worked with TrekIT Health, Inc, CareAlign, a Philadelphia start-up with a clinical workflow platform that connects with any EHR, and Jamaica Plain, Massachusetts-based River Records, an automated data processing firm. Launched and operated by four doctors in residency, River Records aims to address the "historically unquestioned concepts in clinical documentation" through natural language processing and deep learning. The firm's website also indicates the firm's AI model condenses data collection and processing efforts into a few steps and its software can deliver a user-friendly interface to interact with the findings. Sanford Health, a system based in Sioux Falls, South Dakota, with more than 46 hospitals tackled "note bloat" by creating a standardized note form in their Epic electronic health record system. The form encourages providers to document everything they need to – and nothing they don't, according to Dr. Roxana Lupu, CMO of Sanford Health. (https://www.healthcareitnews.com/news/sanford-health-builds-ehr-templates-epic-eliminate-note-bloat) It started from the basic principle that a note is a form of communication, not a review tool for the note's author, she explained to Healthcare IT News last year. "It was important to keep in mind that providers were not only writing the note for themselves but for others. We wanted the assessment and plan to be the most prominent part of the note, as that was the reason for reviewing notes," she said. | AI study finds 50% of patient notes duplicated | https://www.healthcareitnews.com/news/ai-study-finds-50-patient-notes-duplicated | |||||||
77 | RESULTS The provider now is incentivized to address and maintain the problem list, an important part of a patient's record, which often is put aside because it is considered double work, she added. "Having standard templates for our notes allows us to make changes to meet regulatory and compliance requirements," Lupu noted. Primary care specialties, like family medicine and internal medicine, are the heaviest users of the Sanford Health-created standard notes, with 42% of notes generated by family practice providers and 52% of notes generated by internal medicine providers being standard notes. Based on Epic Signal data, which keeps track of EHR utilization like time in notes, length of notes and more, both specialties now have short, efficient notes, with time in notes and note length below Epic's overall average. | https://www.healthcareitnews.com/news/sanford-health-builds-ehr-templates-epic-eliminate-note-bloat | ||||||||
78 | The industry press was full of pieces discussing the issues that the Offices of Inspector General for the Departments of Defense and Veterans Affairs have had exchanging information between their systems, and clinicians’ ability able to find what they need when they need it. Users reported issues that could negatively impact patient care. Considering that these issues were between systems based on the same core product, imagine the additional complexity of sharing information between disparate platforms. In any transmission system where just about anything goes into the pipes, a filtering system is needed on the receiving end. Ignoring the challenges of free-text narratives for a moment, consider clinical data coded in the various terminologies and code sets commonly in use. The combined number of possible codes in ICD10-CM, SNOMED, LOINC, RxNorm, CPT, HCPCS, DSM5, UNII, CVX, and CTCAE total more than 200,000––any of which may be relevant for a specific patient. A key requirement in the coming world of 21st Century Cures, TEFCA, and interoperability will be the ability for a clinician to see a diagnostically filtered view of that incoming information for a specific patient and for any specific patient problem or condition. The ideal solution is to enable a clinical user to select any item on a patient’s problem list and instantly see all relevant information for that problem––including the symptoms, history, physical exam findings, lab orders and results, procedures, therapies, comorbidities, and potential complications and sequelae. | https://journal.ahima.org/page/time-to-address-the-inter-without-operability-issue Time to Address the ‘Inter (Without) Operability’ Issue | ||||||||
79 | Dunn Lopez and her colleagues spent 2.5 years studying the usability and workload associated with EHR use before and after the switch to a large vendor system—one of the longest studies of its kind. Published in the February 2021 issue of Applied Ergonomics, “Electronic Health Record Usability and Workload Changes Over Time for Provider and Nursing Staff Following Transition to New EHR” found that poor usability and workload associated with EHRs continued to be a significant concern among clinicians, with issues persisting for 30 months for both physicians and nurses. EHR workload more than doubled six months following the system switch and remained at about that level for the full 30 months. The only exception was in the “physical activity" subscale, “suggesting EHR adoption primarily increased cognitive workload, presumably in part because the EHR was now used to deliver patient care during visits rather than to document care after these visits. Stephanie Murray, senior director of CereCore, Epic Services, was not surprised by the findings, but cautioned against applying them too broadly. The study focused on two Midwest ambulatory urgent care centers within the same health care system that transitioned to the same full EHR from the same hybrid model—the system was rarely used while seeing patients and was essentially an information repository. “Given this context, this study would not equate to a study that compares cognitive workload when transitioning from one full EHR to another,” Murray says. “Additionally, key variables such as what type of system the users were trained on while in school—paper vs electronic—were not outlined in the article but could also play a factor in cognitive workload.” Wellsheet CEO and Founder Craig Limoli points out that the study makes a strong case that the frustration and dissatisfaction clinicians have with EHRs are largely driven by design failures. However, the recommendations for addressing those failures—training providers to better report usability issues—was a surprise While placing “the lion’s share of responsibility on the EHR vendors whose product may cost individual health systems upward of $1 billion … and indirectly on government agencies [that] can set incentives to improve EHR usability,” the study went on to recommend that provider organizations have strong and transparent governance processes to prioritize change requests and vet them for unintended consequences. Change Has Happened Other lessons have also been put into action regarding EHR usability, most of which have come from third-party innovation in conjunction with the EHR, according to Limoli. While most innovation has been in the realm of revenue cycle management, “the APIs that enable solutions to integrate into EHR systems and provide value to clinician users in care delivery have advanced very meaningfully in the past several years,” Limoli says. This has, in turn, paved the way for technologies that can be added on to the EHR to significantly improve usability. | July/August 2021 EHRs, Usability Remain at Odds By Elizabeth S. Goar For The Record Vol. 33 No. 4 P. 16 | https://www.fortherecordmag.com/archives/JA21p16.shtml | |||||||
80 | System Usability Scale (SUS) Score of EHR vs Excel vs DVR vs Word vs ATM vs Microwave vs Google EHR = F grade, Google = A | The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians | https://www.mayoclinicproceedings.org/article/S0025-6196(19)30836-5/fulltext Found here: https://himss-ondemand-webinars.himsshelp.net/2022-08/GMT20220727-170126_Recording_1920x1080.mp4 at 9:02 From: https://www.himss.org/resources/focus-usability-improving-clinician-workflow-and-reducing-cognitive-burden Originally found: http://inspiredehrs.org/designing-for-clinicians/health-it-usability.php | |||||||
81 | White Paper on Blockchain EHR data decentralization Abstract A long-standing focus on compliance has traditionally constrained development of fundamental design changes for Electronic Health Records (EHRs). We now face a critical need for such innovation, as personalization and data science prompt patients to engage in the details of their healthcare and restore agency over their medical data. In this paper, we propose MedRec: a novel, decentralized record management system to handle EHRs, using blockchain technology. Our system gives patients a comprehensive, immutable log and easy access to their medical information across providers and treatment sites. Leveraging unique blockchain properties, MedRec manages authentication, confidentiality, accountability and data sharing—crucial considerations when handling sensitive information. A modular design integrates with providers' existing, local data storage solutions, facilitating interoperability and making our system convenient and adaptable. We incentivize medical stakeholders (researchers, public health authorities, etc.) to participate in the network as blockchain “miners”. This provides them with access to aggregate, anonymized data as mining rewards, in return for sustaining and securing the network via Proof of Work. MedRec thus enables the emergence of data economics, supplying big data to empower researchers while engaging patients and providers in the choice to release metadata. The purpose of this paper is to expose, in preparation for field tests, a working prototype through which we analyze and discuss our approach and the potential for blockchain in health IT and research | A Case Study for Blockchain in Healthcare: “MedRec” prototype for electronic health records and medical research data | https://www.healthit.gov/sites/default/files/5-56-onc_blockchainchallenge_mitwhitepaper.pdf Link-out: http://www.healthinfolaw.org/comparative-analysis/who-owns-medical-records-50-state-comparison (Who owns medical records) Additional link-out: http://healthdesignchallenge.com/ Opened in 2013, I think closed, but government sponsored EHR design program (ONC-sponsored) | |||||||
82 | Book Cover "Better EHR: Usability, Workflow and Cognitive Support in Electronic Health Records" -- a book published by the National Center for Cognitive Informatics & Decision Making in Healthcare. One of the biggest complaints we hear from healthcare providers is that the EHR is clunky, difficult to use, and sometimes gets in the way of taking care of patients. SHARPC was funded to help conduct short term and long term research to address the usability, workflow, and cognitive support issues of EHR. This book documents some of the results of the SHARPC project: frameworks for EHR usability, methods for evaluating and designing EHR usability, and tools for clinical decision support. eg. Making good use of Color = pg 205 | Better EHR: Usability, workflow and cognitive support in electronic health records (Book) | https://sbmi.uth.edu/nccd/better-ehr/ https://sbmi.uth.edu/nccd/ehrusability/design/guidelines/ | |||||||
83 | Airline ticket flight search that uses sortable timelines (formerly “Hipmunk” referenced by Jeff Belden on toomanyclicks.com | https://flightpenguin.com/ | ||||||||
84 | Tools to help healthcare providers deliver better care | Care Studio | Google Health Google Care Studio. Leverages a lot of the text (and PDF scanned documents) search tools of Google (native language and clinical abbreviations/shorthand and acronyms included), nice overlay windows for graphical/charting view of data). Highlighting of similar keyword search terms. Auto-complete. “Based on a knowledge graph and tuned specifically to the medical field” | https://www.youtube.com/watch?v=P3SYqcPXqNk https://health.google/caregivers/care-studio/ | ||||||||
85 | SMART on FHIR, referenced to site by Belden | https://smarthealthit.org/join-discussion-group/ https://smarthealthit.org/ | ||||||||
86 | Graphical Summary of Patient Status By Powsner and Tufte (referenced to me in email by Powsner) Nice history of charting developments in the 1900s, predictions of electronic records, suggestion of graphical ways of displaying computer stored data. Doesn’t show any sparklines but similar dense summaries | Graphical summary of patient status SM Powsner, ER Tufte - Lancet, 1994 – cs.tufts.edu | https://www.cs.tufts.edu/~nr/cs257/archive/edward-tufte/Graphical%20Summary%20of%20Patient.pdf | |||||||
87 | 2nd Reference by Powsner Almost a Cerner-like note format with multiple columns used to summarize narrative abstracts and visual/graphical data display **Sparklines clearly a thing we need to incorporate | Summarizing clinical psychiatric data SM Powsner, ER Tufte - Psychiatric Services, 1997 – cs.tufts.edu | https://www.cs.tufts.edu/~nr/cs257/archive/edward-tufte/Summarizing%20Clinical.pdf | |||||||
88 | Medical Record TimeLine = MeRLin. Shared by Vitaly Herasevich, MD/PhD, researcher (no longer clinician) at Mayo. Developed just prior to their adoption of Epic. ~2016. “After Epic launched, revenues went up 20%…” “Epic develops on Visual Basic” “Epic isn’t very welcoming to outside developers. They took the ideas from MerLin and a previous project/company (???) and said ‘We’ll just make our own version’” | https://www.proquest.com/openview/481b322e6e126038d019a98c589fa446/1.pdf?pq-origsite=gscholar&cbl=40575 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802307/ https://www.healthcareitnews.com/news/guide-ehrs-himss17 https://www.researchgate.net/publication/325833364_A_timeline-based_framework_for_aggregating_and_summarizing_electronic_health_records | ||||||||
89 | Linked out from MerLin publication pages. A Timeline-based Framework for Aggregating and Summarizing Electronic Health Records VERY good additional timeline data, similar to ours in some way. Some lower quality graphical lab reporting. Background has an even better review of timeline-like projects: Tufte → Lifelines → Lifelines2 → Event-Flow (Shneiderman et al?) → Care-Flow → CareCruiser → | Filip Dabek, E. Jimenez, Jesus J. Caban Published 1 October 2017 Medicine 2017 IEEE Workshop on Visual Analytics in Healthcare (VAHC) | https://www.researchgate.net/publication/325833364_A_timeline-based_framework_for_aggregating_and_summarizing_electronic_health_records https://www.researchgate.net/profile/Filip-Dabek/publication/325833364_A_timeline-based_framework_for_aggregating_and_summarizing_electronic_health_records/links/6137f8999520966a6b03a9f4/A-timeline-based-framework-for-aggregating-and-summarizing-electronic-health-records.pdf | |||||||
90 | For the visual representation of a patient’s history we display every event as a dot (see Figure 1a), similar to LifeLines. The color of the dot represents the group of the event, i.e. a diagnosis, a performed procedure, a lab test result, a prescribed medication, etc. To reduce vertical space requirements we also provide different levels of aggregation according to the CCS hierarchy for diagnosis and procedures. The software is web based using a flexible format allowing for multiple datasets as input. We developed the system using health claims from a private insurer, and also the semi synthetic data set from CMS | Visual Exploration of Temporal Data in Electronic Medical Records Josua Krause, Narges Razavian, Enrico Bertini, David Sontag 2015 | http://people.csail.mit.edu/dsontag/papers/KrauseEtAl_PatientViz_AMIA15_abstract.pdf | |||||||
91 | Clinical Documents Summarization using Text Visualization Technique Another more text-focused visualization strategy, plus a “map of the human body as an index for medical problems”, and another decent table of Visualization projects in healthcare Unstructured electronic health documents such as clinical notes present enormous opportunities in healthcare delivery and also for knowledge discovery through secondary uses such as data mining [127], [128] big data analytics [129], [130] Natural language processing [131], [132] clinical text analysis [133] and data visualization [134], [135] and the emerging commercial software applications such as Tableau [136] used for visualizing real world health data From the foregoing discussions it’s irrefutable that existing health visualization techniques suffer a combination of the following issues:- c) Lack of semantics in text visualization - Lack of semantics in text visualization [145]. Most medical applications visualize patient data without integrating additional semantic information to structure the analysis [146] d) Several information visualization toolkits and tools have been developed to facilitate users work. However, evaluation studies for these toolkits and tools from a user perspective have been overlooked [147]. | Clinical Documents Summarization using Text Visualization Technique Kenei, Jonah Kipcirchir; Opiyo, Elisha T. O.; Moso, Juliet Chebet; Oboko, Robert 7/2018 | http://41.89.227.156:8080/xmlui/bitstream/handle/123456789/767/Clinical%20Documents%20Summarization%20using%20Text%20Visualization%20Technique.pdf?sequence=1&isAllowed=y | |||||||
92 | Visual Analytics for Performing Complex Tasks with Electronic Health Records (From Western Ontario University) PhD project/dissertation review. Looks at both EHRs and public health tools, and how they’re built/data analytics philosophy Lots of decision trees, quite a bit of algorthithm stuff | Visual Analytics for Performing Complex Tasks with Electronic Health RecordsHealth Records Neda Rostamzadeh, The University of Western Ontario 2/2021 | https://ir.lib.uwo.ca/cgi/viewcontent.cgi?article=10140&context=etd | |||||||
93 | Visual Analytics in HealthCare 2016 Conference – Including a work called “Clinically Relevant Filters to Consider when Designing a Visualization for Longitudinal EHRs” (Page 51) Visual Analytics in HealthCare – conference opportunity? Workshop on VAHC has been successfully organized and hosted seven times at the IEEE Visualization Conference (2010, 2011, 2012, 2015, 2017, 2019, and 2021) and five times at the AMIA Annual Symposium (2013, 2014, 2016, 2018, and 2020). This year, the VAHC 2022 workshop is going to be held in conjunction with the AMIA 2022 Annual Symposium in Washington, DC, USA, November 5-9, 2022. Additional info: https://ieeevis.org/year/2023/welcome.html = Institute of Electrical and Electronics Engineers Visualization and Visual Analytics Conference AMIA = American Medical Informatics Association | Filip J. Dabek, MSc, Jefferson E. McMillan, Jesus J. Caban, PhD 1 National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD | https://www.visualanalyticshealthcare.org/VAHC2018/docs/VAHC2016_Proceedings.pdf | |||||||
94 | website from a paper reviewing the "State of the art of EHR visualization approaches". It is not comprehensive, and is a lot of public health types of data displays. LifeLines is in there toward the end We identify trends and challenges in the field, introduce novel literature and data classifications, and incorporate a popular medical terminology standard called the Unified Medical Language System (UMLS). We provide a curated list of electronic and population healthcare data sources and open access datasets as a resource for potential researchers, in order to address one of the main challenges in this field. We classify the literature based on multidisciplinary research themes stemming from reoccurring topics. | EHR STAR: The State-Of-the-Art in Interactive EHR Visualization Q. Wang, R.S. Laramee December 2021 | https://onlinelibrary.wiley.com/doi/10.1111/cgf.14424 https://ehr.wangqiru.com/table | |||||||
95 | In this paper, we propose ClinicalPath, a visualization tool for users to track a patient’s clinical path through a series of tests and data, which can aid in treatments and diagnoses. Our proposal is focused on patient’s data analysis, presenting the test results and clinical history longitudinally. Both the visualization design and the system functionality were developed in close collaboration with experts in the medical domain to ensure a right fit of the technical solutions and the real needs of the professionals. We validated the proposed visualization based on case studies and user assessments through tasks based on the physician’s daily activities. Our results show that our proposed system improves the physicians’ experience in decision-making tasks, made with more confidence and better usage of the physicians’ time, allowing them to take other needed care for the patients Table 1. Comparison of EHR systems (including Lifelines2 (population health) and MIVA (ICU data tracking) according to seven different aspects: (1) selecting; (2) grouping; (3) filtering; (4) test result classification; (5) clinical history and outcome; (6) user evaluation; (7) scalability of tests over time. | ClinicalPath: a Visualization tool to Improve the Evaluation of Electronic Health Records in Clinical Decision-Making Claudio D. G. Linhares*, Daniel M. Lima, Jean R. Ponciano, Mauro M. Olivatto, Marco A. Gutierrez, Jorge Poco, Caetano Traina Jr., and Agma J. M. Traina *Brazil May 2022 | https://www.semanticscholar.org/reader/24bba0721b86ccedbc65a242a28e4b9f5df01893 | |||||||
96 | Heimdall Conclusion: The “Heimdall” prototype provides a comprehensive and efficient graphical interface for EHR data visualization. It is open source, can be used with an R package, and is available at https://koromix.dev/files/R. The Heimdall interface takes profit from combining foldable hierarchical view with a timeline. Alignment, filtering and custom views enhance data exploration. Heimdall is very fast and easy to use. However, this tool is still not able to display non-temporal data (e.g. birthdate), or data with imprecise timing (e.g. ancient medical history). Nonstructured data can be displayed as document icons. | Heimdall, a Computer Program for Electronic Health Records Data Visualization Authors Niels Martignene, Thibaut Balcaen, Guillaume Bouzille, Matthieu Calafiore, Jean-Baptiste Beuscart, Antoine Lamer, Bertrand Legrand, Grégoire Ficheur, Emmanuel Chazard | https://ebooks.iospress.nl/publication/54162 | |||||||
97 | In this paper, we propose an 8-dimensional design space to provide a framework when designing interfaces for accessing a patient’s record. We present our methodology to define this design space: first we used the 5W1H method to set the dimensions, then we studied existing systems and interviewed doctors to define main values or categories of each dimension, we present many illustrative examples of these categories. Finally, we showcase the utility of our work for designers of EHR systems through a scenario. Overall, our design space can help building systems which will improve health data visualization and interface design. | Investigating a Design Space for Developing Design Thinking in Electronic Healthcare Records Ilyasse Belkacem, Isabelle Pecci, Anthony Faiola & Benoît Martin Conference paper First Online: 03 October 2020 | https://link.springer.com/chapter/10.1007/978-3-030-60114-0_2 | |||||||
98 | Objective The electronic chart review habits of intensive care unit (ICU) clinicians admitting new patients are largely unknown but necessary to inform the design of existing and future critical care information systems Results Of 234 clinicians invited, 156 completed the full survey (67% response rate). Ninety-two percent of medical ICU clinicians performed electronic chart review for the majority of new patients. Clinicians estimated spending a median (interquartile range (IQR)) of 15 (10–20) minutes for a typical case, and 25 (15–40) minutes for complex cases, with no difference across training levels. | A Multisite Survey Study of EMR Review Habits, Information Needs, and Display Preferences among Medical ICU Clinicians Evaluating New Patients Matthew E. Nolan,1 Rodrigo Cartin-Ceba,2 Pablo Moreno-Franco,3 Brian Pickering,4 and Vitaly Herasevich Appl Clin Inform. 2017 Oct; 8(4): 1197–1207. | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5802307/ | |||||||
99 | Medium Graphic: A Brief History of EHRs Timeline of electronic health record systems in US Hospitals Not exhaustive. Does contain a small pie chart of current EHR prevalence/market share in 2021 | https://mayaberlerner.medium.com/a-brief-history-of-ehrs-c51a2125a247 | ||||||||
100 | To Err is Human (2020) Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. | To Err is Human: Building a Safer Health System Institute of Medicine (US) Committee on Quality of Health Care in America Linda T. Kohn, Janet M. Corrigan, Molla S. Donaldson , editors. Washington (DC): National Academies Press (US); 2000. | https://pubmed.ncbi.nlm.nih.gov/25077248/ |