Objective: To describe the implementation of technological support important for optimizing clinical management of the COVID-19 pandemic. Materials and Methods: Our health system has confirmed prior and current cases of COVID-19. An Incident Command Center was established early in the crisis and helped identify electronic health record (EHR)-based tools to support clinical care. Results: We outline the design and implementation of EHR-based rapid screening processes, laboratory testing, clinical decision support, reporting tools, and patient-facing technology related to COVID-19. Discussion: The EHR is a useful tool to enable rapid deployment of standardized processes. UC San Diego Health built multiple COVID-19-specific tools to support outbreak management, including scripted triaging, electronic check-in, standard ordering and documentation, secure messaging, real-time data analytics, and telemedicine capabilities. Challenges included the need to frequently adjust build to meet rapidly evolving requirements, communication, and adoption, and to coordinate the needs of multiple stakeholders while maintaining high-quality, prepandemic medical care. Conclusion: The EHR is an essential tool in supporting the clinical needs of a health system managing the COVID-19 pandemic.

Many topics compete for visit time, resulting in small amount of time being spent on each topic. A highly regimented schedule might interfere with having sufficient time for patients with complex or multiple problems. Efforts to improve the quality of care need to recognize the time pressure on both patients and physicians, the effects of financial incentives, and the time costs of improving patient-physician interactions.

Time spent by physicians is a key resource in health care delivery. This study used data captured by the access time stamp functionality of an electronic health record (EHR) to examine physician work effort. This is a potentially powerful, yet unobtrusive, way to study physicians' use of time. We used data on physicians' time allocation patterns captured by over thirty-one million EHR transactions in the period 2011-14 recorded by 471 primary care physicians, who collectively worked on 765,129 patients' EHRs. Our results suggest that the physicians logged an average of 3.08 hours on office visits and 3.17 hours on desktop medicine each day. Desktop medicine consists of activities such as communicating with patients through a secure patient portal, responding to patients' online requests for prescription refills or medical advice, ordering tests, sending staff messages, and reviewing test results. Over time, log records from physicians showed a decline in the time allocated to face-to-face visits, accompanied by an increase in time allocated HHS Public AccessAuthor manuscript Health Aff (Millwood). Author manuscript; available in PMC 2017 August 07. Author Manuscript Author ManuscriptAuthor Manuscript Author Manuscript to desktop medicine. Staffing and scheduling in the physician's office, as well as provider payment models for primary care practice, should account for these desktop medicine efforts.Physician time is a key resource in health services delivery. Understanding how physicians spend their clinical time is essential, given the need to understand practical capacity; guide staffing, scheduling, and support models in the physician's office; and improve the accuracy of payment for physician services. Fee-for-service payments are intended to reflect resources (captured as relative value units, or RVUs) used before, during, and after clinical encounters associated with face-to-face ambulatory care visits. 1-3 Questions have been raised about whether the reports underlying the RVU estimates are accurate and representative of true physician effort in providing patient care services. In the age of electronic health records (EHRs) with patient portals, patients often request services (such as prescription refills and medical advice) online, without face-to-face visits. Physician effort in addressing these online requests was absent from the original RVU calculations. [1][2][3] In addition to physician reports of their own efforts, 2,4,5 researchers have used time-andmotion studies 6 and video 7 and audio recordings. 8 While these methods capture significant physician effort, 6,9-11 they are costly to use and often evaluate only a limited number of physicians. Even the resource-based relative values scale (RBRVS) was built, for some specialties, on survey responses to vignettes from about twenty physicians. 1 This scale is still the chief tool used to determine the periodic updates to the Medicare Fee Schedule. Furthermore, concerns about the Hawthorne effect preclude ongoing, broad-based direct observa...

These findings demonstrate the feasibility and potential utility of identifying and reporting contextual factors. Involving diverse stakeholders in assessing context at multiple stages of the research process, examining their association with outcomes, and consistently reporting critical contextual factors are important challenges for a field interested in improving the internal and external validity and impact of health care research.

Defining complexity in terms of the misalignment between patient needs and services offers new insights in how to research and develop solutions to patient care needs.

This paper will review the existing student voice work in higher education and critique its current weaknesses, particularly in relation to conceptualisations of and commitments to participation, transformation and empowerment. It will be argued that the employment of participatory methods in higher education student voice work, offers a way to address these weaknesses. The potential of participatory methods is illustrated and discussed using two case examples drawn from one higher education

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