Adoption and Perceptions of Electronic Health Record Systems by Ophthalmologists: An American Academy of Ophthalmology Survey

Chiang, Michael F.; Boland, Michael V.; Margolis, James W.; Lum, Flora; Abràmoff, Michael D.; Hildebrand, P. Lloyd

doi:10.1016/j.ophtha.2008.03.024

Cited by 72 publications

(68 citation statements)

References 23 publications

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“…Finally, we found that there was no significant difference in the rate of EHR adoption among specialties over time; the odds increased in all specialties, by about 40% per year. These results demonstrate that EHR adoption varies among specialties, but the rate of adoption of EHRs over time is roughly uniform throughout all fields of medicine.Our analysis agrees with previous work showing psychiatrists [12,26], ophthalmologists [13], dermatologists [12], and pediatricians [23,26] each have a relatively low prevalence of EHR adoption, compared with generalists. Our findings build on this work by examining all specialties simultaneously, add robustness via analysis of four measures of EHR adoption, and illustrate the gains made in all specialties over time.…”

supporting

confidence: 91%

Physician Specialty and Variations in Adoption of Electronic Health Records

Grinspan

Banerjee²,

Kaushal³

et al. 2013

Appl Clin Inform

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SummaryObjective: Efforts to promote adoption of electronic health records (EHRs) have focused on primary care physicians, who are now expected to exchange data electronically with other providers, including specialists. However, the variation of EHR adoption among specialists is underexplored. Methods: We conducted a retrospective cross-sectional study to determine the association between physician specialty and the prevalence of EHR adoption, and a retrospective serial cross-sectional study to determine the association of physician specialty and the rate of EHR adoption over time. We used the 2005-2009 National Ambulatory Medical Care Survey. We considered fourteen specialties, and four definitions of EHR adoption (any EHR, basic EHR, full EHR, and a novel definition of EHR sophistication). We used multivariable logistic regression, and adjusted for several covariates (geography, practice characteristics, revenue characteristics, physician degree). Results: Physician specialty was significantly associated with EHR adoption, regardless of the EHR definition, after adjusting for covariates. Psychiatrists, dermatologists, pediatricians, ophthalmologists, and general surgeons were significantly less likely to adopt EHRs, compared to the reference group of family medicine / general practitioners. After adjustment for covariates, these specialties were 44 -94% less likely to adopt EHRs than the reference group. EHR adoption increased in all specialties, by approximately 40% per year. The rate of EHR adoption over time did not significantly vary by specialty. Conclusions: Although EHR adoption is increasing in all specialties, adoption varies widely by specialty. In order to insure each individual's network of providers can electronically share data, widespread adoption of EHRs is needed across all specialties. BackgroundThe United States (U.S.) federal government has committed more than $20 billion to encourage physicians to adopt electronic health records (EHRs) [8]. Driving these incentives is the expectation that large scale appropriate use of EHRs will facilitate coordination of care, improve health care quality, and lower national health care costs [5,9]. To receive incentive payments, physicians must purchase and install a certified EHR, then demonstrate "meaningful use" by meeting specific criteria. Example criteria include use of software to reduce medical errors (i.e. electronic prescribing), collection of data relevant for clinical quality measurement (i.e. smoking status), and maintenance of patient summaries to facilitate sharing of data among providers (i.e. electronic problem lists and medication lists) [10].Several previous initiatives, such as national recognition programs for the Patient-Centered Medical Home, have encouraged adoption of EHRs among primary care physicians [17]. Many of the most common quality measures, including those for EHRs, also focus on primary care [24]. However, there is an increasing effort to facilitate electronic exchange of clinical data across providers caring for commo...

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supporting

confidence: 91%

Physician Specialty and Variations in Adoption of Electronic Health Records

Grinspan

Banerjee²,

Kaushal³

et al. 2013

Appl Clin Inform

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“…[17][18][19][20] It is possible that some nonparticipating programs did not respond because their fellowships do not offer ROP training, but future studies and a more accurate count of these fellowship programs would be helpful. Attending and fellow responses on the percentage of ROP examinations performed by a fellow that are also seen by an attending, stratified by specialty.…”

Section: Discussionmentioning

confidence: 99%

Training fellows for retinopathy of prematurity care: A web-based survey

Wong

Ventura

Espiritu

et al. 2011

Journal of American Association for Pediatric Ophthalmology and

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Purpose-To characterize the training received by pediatric ophthalmology and retina fellows in ROP management.Methods-Pediatric ophthalmology and retina fellowship programs were emailed a Web-based survey to assess fellowship training in ROP management.Results-Of 140 programs contacted, 42 (30%) participated, resulting in 87 surveys for analysis. Of the 87 respondents, 25 (29%) reported that two-thirds or less of ROP examinations performed by fellows were also seen by an attending. When stratified by specialty, this trend was statistically different between pediatric ophthalmology and retina fellows (P = 0.03). Additionally, pediatric ophthalmology fellows performed fewer laser photocoagulation procedures than retina fellows (P < 0.001). Regarding fellows' perceived competency in ROP management, 3 of 51 (6%) felt competent at the start of their fellowship and 43 of 51 (84%) felt competent at the time of the survey. Only 7% of respondents reported the use of formal evaluations at their programs to assess fellow competence in ROP examination.Conclusions-Training programs for fellows in pediatric ophthalmology and retina vary greatly with respect to ROP training and the quality of clinical care. Many clinical ROP examinations are being performed by pediatric ophthalmology and retina fellows without involvement and/or direct supervision by attending ophthalmologists. Our findings have important implications for the development of a future workforce for ROP management.Despite recent advances in the management of retinopathy of prematurity (ROP), the disease remains a major clinical challenge and a leading cause of childhood blindness in the United States. 1 Improvements in medical care have translated into increased neonatal survival rates and a growing number of infants at risk for ROP. 2,3 Meanwhile, the number of ophthalmologists who manage ROP is limited and expected to decrease. A 2006 American Academy of Ophthalmology survey showed that only half of retinal specialists and pediatric ophthalmologists were willing to manage ROP and that over 20% planned to stop providing ROP care in the future because of concerns over issues such as medicolegal liability and the complexity of scheduling care. 4 Presumably in response to such pressures, a recent study showed that a large number of practicing ophthalmologists without pediatric ophthalmology or retina subspeciality training are performing ROP screening and treatment. 5 We are aware of institutions that are utilizing

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“…The use of EHR in different medical settings and particularly into ophthalmic practices has been limited and it has been reported that only the 34% of ophthalmology units have adopted an EHR system into the practice [8,9] in comparison to 50% of all physicians, maybe related to the particular needs of ophthalmic evaluation as drawing the ocular fundus or writing the refractive correction. We believe that all the learning difficulties for the use of the tool should be overcome also for epidemiological data analysis in consideration of the evolving need of changing population demographics, where the number of patients with visual impairment who need to access to the low vision rehabilitation center will increase.…”

Section: Discussionmentioning

confidence: 99%

“…Considering patient's residual visual function and needs, a customized rehabilitation program is defined. Therefore, patients can start with the devices training sessions supported by the orthoptist in order to identify and correctly use magnifying aids.In the recent years, our team adopted an Electronic Health Record (EHR), a digital version of patient's paper charts implemented with several tools, in order to achieve specified improvement in patient care delivery, provide more effective methods of communicating and sharing information among multidisciplinary team and better manage patient medical records as reported by other authors [6][7][8][9][10]. The EHR is based on an electronic medical database that resides on a web server (Figure1).…”

mentioning

confidence: 99%

“…It has been demonstrated that EHR offers clinicians several advantages including improved productivity, better disease management, care coordination and patient safety with the evidence of a data base collection improved quality. On the other hand the lack of time for the accuracy of patient record content and the need for adequate learning and support are considered as disadvantages for the HER diffusion [13,14].The use of EHR in different medical settings and particularly into ophthalmic practices has been limited and it has been reported that only the 34% of ophthalmology units have adopted an EHR system into the practice [8,9] in comparison to 50% of all physicians, maybe related to the particular needs of ophthalmic evaluation as drawing the ocular fundus or writing the refractive correction. We believe that all the learning difficulties for the use of the tool should be overcome also for epidemiological data analysis in consideration of the evolving need of changing population demographics, where the number of patients with visual impairment who need to access to the low vision rehabilitation center will increase.…”

mentioning

confidence: 99%

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Low Vision Service Activities Review and Use of the Electronic Health Record

Sasso¹

2017

OCR

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BackgroundLow vision is defined as any form of visual impairment due to different chronic eye diseases not correctable by eyeglasses or surgery; patients have a visual acuity less than of 20/60 or a visual field inferior of 60° in the better eye. World Health Organization in 2014 estimated that 285 million people worldwide had vision impairment; 39 million people are blind and 246 were low vision [1].Visual disability negatively impacts on daily life activities. Visually impaired became unable to perform many Activities of Daily Living (ADLs) such as reading, recognizing faces, watching television and driving resulting in a poor quality of life. According to some author's findings, visual impairment has an effect on psychological status and quality of life and it can be related to feelings of inadequacy and higher level of depressive symptoms [2][3][4][5]. Based on clinical and psychological features of visually impaired, an holistic and multidisciplinary approach should be recommended. Our National Center of Services and Research for the Prevention of Blindness and Rehabilitation of Visually Impaired, IAPB Italia onlus, has a multidisciplinary team including psychologist, ophthalmologist, orthoptist, orientation and mobility teacher and expert in tiphlology. As our standard procedure, first of all the psychologist approaches the patient focusing on psychological status and personal demands. A complete ophthalmological examination is performed subsequently. Considering patient's residual visual function and needs, a customized rehabilitation program is defined. Therefore, patients can start with the devices training sessions supported by the orthoptist in order to identify and correctly use magnifying aids.In the recent years, our team adopted an Electronic Health Record (EHR), a digital version of patient's paper charts implemented with several tools, in order to achieve specified improvement in patient care delivery, provide more effective methods of communicating and sharing information among multidisciplinary team and better manage patient medical records as reported by other authors [6][7][8][9][10]. The EHR is based on an electronic medical database that resides on a web server (Figure1). Therefore, inside of an integrated health system, the EHR adoption can impact on the improvement of clinical care and research quality. Before EHR adoption our center used paper charts to collected clinical data divided in specific sections considering the different professional roles.The aim of this study was to describe two years activities in our low vision rehabilitation center based on a multidisciplinary approach using an EHR in order to highlight the benefits of the tool and its impact on clinicians care delivering. MethodsThe retrospective review was carried out in 420 patients with low vision who attended the National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Visually Impaired, IAPB Italia Onlus, in Rome from January 2015 to December 2016. Patients were referred to our ...

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Adoption and Perceptions of Electronic Health Record Systems by Ophthalmologists: An American Academy of Ophthalmology Survey

Cited by 72 publications

References 23 publications

Physician Specialty and Variations in Adoption of Electronic Health Records

Physician Specialty and Variations in Adoption of Electronic Health Records

Training fellows for retinopathy of prematurity care: A web-based survey

Low Vision Service Activities Review and Use of the Electronic Health Record

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