J Am Med Inform Assoc - How is the electronic health record being used? Use of EHR data to assess physician-level variability in technology use.

Tópicos

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Resumo

CKGROUND: Studies of the effects of electronic health records (EHRs) have had mixed findings, which may be attributable to unmeasured confounders such as individual variability in use of EHR features.OBJECTIVE: To capture physician-level variations in use of EHR features, associations with other predictors, and usage intensity over time.METHODS: Retrospective cohort study of primary care providers eligible for meaningful use at a network of federally qualified health centers, using commercial EHR data from January 2010 through June 2013, a period during which the organization was preparing for and in the early stages of meaningful use.RESULTS: Data were analyzed for 112 physicians and nurse practitioners, consisting of 430,803 encounters with 99,649 patients. EHR usage metrics were developed to capture how providers accessed and added to patient data (eg, problem list updates), used clinical decision support (eg, responses to alerts), communicated (eg, printing after-visit summaries), and used panel management options (eg, viewed panel reports). Provider-level variability was high: for example, the annual average proportion of encounters with problem lists updated ranged from 5% to 60% per provider. Some metrics were associated with provider, patient, or encounter characteristics. For example, problem list updates were more likely for new patients than established ones, and alert acceptance was negatively correlated with alert frequency.CONCLUSIONS: Providers using the same EHR developed personalized patterns of use of EHR features. We conclude that physician-level usage of EHR features may be a valuable additional predictor in research on the effects of EHRs on healthcare quality and costs.

Resumo Limpo

ckground studi effect electron health record ehr mix find may attribut unmeasur confound individu variabl use ehr featuresobject captur physicianlevel variat use ehr featur associ predictor usag intens timemethod retrospect cohort studi primari care provid elig meaning use network feder qualifi health center use commerci ehr data januari june period organ prepar earli stage meaning useresult data analyz physician nurs practition consist encount patient ehr usag metric develop captur provid access ad patient data eg problem list updat use clinic decis support eg respons alert communic eg print aftervisit summari use panel manag option eg view panel report providerlevel variabl high exampl annual averag proport encount problem list updat rang per provid metric associ provid patient encount characterist exampl problem list updat like new patient establish one alert accept negat correl alert frequencyconclus provid use ehr develop person pattern use ehr featur conclud physicianlevel usag ehr featur may valuabl addit predictor research effect ehr healthcar qualiti cost

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