Early cost and safety benefits of an inpatient electronic health record

Zlabek, Jonathan A; Wickus, Jared W; Mathiason, Michelle A.

doi:10.1136/jamia.2010.007229

Cited by 94 publications

(72 citation statements)

References 15 publications

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“…1 Computerized physician order entry (CPOE) has been recognized as an important tool in optimal health care provision that can reduce medication errors and improve patient safety. 2,3 By incorporating a CPOE program with clinical decision support into an electronic health record (EHR), the health care team can effectively and safely provide quality patient care. CPOE systems designed for the outpatient oncology setting have only recently become available and widely used.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Computerized Physician Order Entry in an Electronic Health Record After Implementation in an Outpatient Oncology Setting

Harshberger

Harper

Carro

et al. 2011

JOP

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Purpose: Computerized physician order entry (CPOE) in electronic health records (EHR) has been recognized as an important tool in optimal health care provision that can reduce errors and improve safety. The objective of this study is to describe documentation completeness and user satisfaction of medical charts before and after implementation of an outpatient oncology EHR/ CPOE system in a hospital-based outpatient cancer center within three treatment sites. Methods:This study is a retrospective chart review of 90 patients who received one of the following regimens between 1999 and 2006: FOLFOX, AC, carboplatin ϩ paclitaxel, ABVD, cisplatin ϩ etoposide, R-CHOP, and clinical trials. Documentation completeness scores were assigned to each chart based on the number of documented data points found out of the total data points assessed. EHR/CPOE documentation completeness was compared with completeness of paper charts orders of the same regimens. A user satisfaction survey of the paper chart and EHR/CPOE system was conducted among the physicians, nurses, and pharmacists who worked with both systems. Results:The mean percentage of identified data points successfully found in the EHR/CPOE charts was 93% versus 67% in the paper charts (P Ͻ .001). Regimen complexity did not alter the number of data points found. The survey response rate was 64%, and the results showed that satisfaction was statistically significant in favor of the EHR/CPOE system. Conclusion:Using EHR/CPOE systems improves completeness of medical record and chemotherapy order documentation and improves user satisfaction with the medical record system. EHR/CPOE requires constant vigilance and maintenance to optimize patient safety.

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Section: Introductionmentioning

confidence: 99%

Outcomes of Computerized Physician Order Entry in an Electronic Health Record After Implementation in an Outpatient Oncology Setting

Harshberger

Harper

Carro

et al. 2011

JOP

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“…14 Currently, this method is applied in most research projects for baseline comorbidities adjustments, 5,10 although the literature has reported various concerns about the accuracy and underreporting of comorbidities using ICD-9 codes. [15][16][17][18][19][20][21] With the growing notion of EMRs as a tool to reduce cost and improve safety, 22 adoption of EMR systems in US hospitals is steadily increasing. The information overload becomes a hindrance to the effective use of EMRs, which may lead to reduction in performance and alter patient safety.…”

mentioning

confidence: 99%

Derivation and Validation of Automated Electronic Search Strategies to Extract Charlson Comorbidities From Electronic Medical Records

Singh

Ahmed

et al. 2012

Mayo Clinic Proceedings

186

140

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Objective: To develop and validate automated electronic note search strategies (automated digital algorithm) to identify Charlson comorbidities. Patients and Methods: The automated digital algorithm was built by a series of programmatic queries applied to an institutional electronic medical record database. The automated digital algorithm was derived from secondary analysis of an observational cohort study of 1447 patients admitted to the intensive care unit from January 1 through December 31, 2006, and validated in an independent cohort of 240 patients. The sensitivity, specificity, and positive and negative predictive values of the automated digital algorithm and International Classification of Diseases, codes were compared with comprehensive medical record review (reference standard) for the Charlson comorbidities. Results: In the derivation cohort, the automated digital algorithm achieved a median sensitivity of 100% (range, 99%-100%) and a median specificity of 99.7% (range, 99%-100%). In the validation cohort, the sensitivity of the automated digital algorithm ranged from 91% to 100%, and the specificity ranged from 98% to 100%. The sensitivity of the ICD-9 codes ranged from 8% for dementia to 100% for leukemia, whereas specificity ranged from 86% for congestive heart failure to 100% for leukemia, dementia, and AIDS. Conclusion: Our results suggest that search strategies that use automated electronic search strategies to extract Charlson comorbidities from the clinical notes contained within the electronic medical record are feasible and reliable. Automated digital algorithm outperformed ICD-9 codes in all the Charlson variables except leukemia, with greater sensitivity, specificity, and positive and negative predictive values.

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“…We were not able to include some economic evaluations of CPOE where systems were used for ordering more than just medicines if studies did not report the financial impact related to medications separately [6,24,25]. There were also two recent papers that couldn't be included as it was not possible to separate the cost outcomes of EP or CPOE from those of a wider intervention such as an electronic health record [26,27].…”

Section: Limitation Of This Reviewmentioning

confidence: 99%

Economic impact of electronic prescribing in the hospital setting: A systematic review

Ahmed

Barber

Jani

et al. 2016

International Journal of Medical Informatics

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Objective: To examine evidence on the economic impact of electronic prescribing (EP) systems in the hospital setting. Method: We conducted a systematic search of MEDLINE, EMBASE, PsycINFO, International Pharmaceutical Abstracts, the NHS Economic Evaluation Database, the European Network of Health Economic Evaluation Database and Web of Science from inception to October 2013. Full and partial economic evaluations of EP or computerised provider order entry were included. We excluded studies assessing prescribing packages for specific drugs, and monetary outcomes that were not related to medicines. A checklist was used to evaluate risk of bias and evidence quality. Results: The search yielded 1,160 articles of which three met the inclusion criteria. Two were full economic evaluations and one a partial economic evaluation. A meta-analysis wasn't appropriate as studies were heterogeneous in design, economic evaluation method, interventions and outcome measures. Two studies investigated the financial impact of reducing preventable adverse drug events. The third measured savings related to various aspects of the system including those related to medication. Two studies reported positive financial effects. However the overall quality of the economic evidence was low and key details often not reported. Discussion There seems to be some evidence of financial benefits of EP in the hospital setting. However, it is not clear if evidence is transferable to other settings. Research is scarce and limited in quality, and reported methods are not always transparent. Further robust, high quality research is required to establish if hospital EP is cost effective and thus inform policy makers' decisions. We are pleased to submit our manuscript entitled: "Economic impact of electronic prescribing in the hospital setting: a systematic review". This systematic review examines the evidence to establish if electronic prescribing systems use in the hospital setting is cost effective. We conducted a systematic search of seven databases from inception to October 2013 and included full and partial economic evaluations of electronic prescribing systems or computerised provider order entry. COVER LETTERWe found some evidence of financial benefits of EP use. However, it is not clear if evidence is transferable to other settings. Our review also shows that studies exploring the economic impact of electronic prescribing systems in this context are scarce and limited in quality. Therefore we endorse further robust research to establish if electronic prescribing systems use in hospitals is good value for money. This manuscript has not been previously published and is not under consideration in the same or substantially similar form in any other peer-reviewed media. All authors listed have contributed sufficiently to the project to be included as authors, and all those who are qualified to be authors are listed in the author byline. To the best of our knowledge, no conflict of interest, financial or other, exists. We have included acknowle...

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Early cost and safety benefits of an inpatient electronic health record

Cited by 94 publications

References 15 publications

Outcomes of Computerized Physician Order Entry in an Electronic Health Record After Implementation in an Outpatient Oncology Setting

Outcomes of Computerized Physician Order Entry in an Electronic Health Record After Implementation in an Outpatient Oncology Setting

Derivation and Validation of Automated Electronic Search Strategies to Extract Charlson Comorbidities From Electronic Medical Records

Economic impact of electronic prescribing in the hospital setting: A systematic review

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