Electronic Health Record–Based Messages to Primary Care Providers: Valuable Information or Just Noise?

Murphy, Daniel R.; Reis, Brian; Kadiyala, Himabindu; Hirani, Kamal; Sittig, Dean F.; Khan, Myrna M.; Singh, Hardeep

doi:10.1001/archinternmed.2011.740

Cited by 44 publications

(38 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, the alerts create interruptions known to adversely affect patient care. 12,13 A 2013 survey of 30 physician practices found that electronic health record (EHR) technology has worsened professional satisfaction through time-consuming data entry and interference with patient care. 7 Emergency medicine physicians spend 44% of their day doing data entry, with 4,000 EHR clicks per day; only 28% of the day is spent with patients.…”

Section: Physician Burnoutmentioning

confidence: 99%

From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider

Bodenheimer

Sinsky

2014

The Annals of Family Medicine

2,525

1,882

View full text Add to dashboard Cite

The Triple Aim-enhancing patient experience, improving population health, and reducing costs-is widely accepted as a compass to optimize health system performance. Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs. Burnout thus imperils the Triple Aim. This article recommends that the Triple Aim be expanded to a Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff. INTRODUCTION Since Don Berwick and colleagues introduced the Triple Aim into the health care lexicon, this concept has spread to all corners of the health care system. The Triple Aim is an approach to optimizing health system performance, proposing that health care institutions simultaneously pursue 3 dimensions of performance: improving the health of populations, enhancing the patient experience of care, and reducing the per capita cost of health care.1 The primary Triple Aim goal is to improve the health of the population, with 2 secondary goals-improving patient experience and reducing costs-contributing to the achievement of the primary goal.In visiting primary care practices around the country, 2 the authors have repeatedly heard statements such as, "We have adopted the Triple Aim as our framework, but the stressful work life of our clinicians and staff impacts our ability to achieve the 3 aims." These sentiments made us wonder, might there be a fourth aim-improving the work life of health care clinicians and staff-that, like the patient experience and cost reduction aims, must be achieved in order to succeed in improving population health? Should the Triple Aim become the Quadruple Aim? RISING EXPECTATIONS OF PHYSICIANS AND PRACTICESSociety expects more and more of physicians and practices, particularly in primary care. Patients want their health to be better, to be seen in a timely fashion with empathy, and to enjoy a continuous relationship with a high-quality clinician whom they choose.3 A patient-centered practice has been described as, "They give me exactly the help I need and want exactly when I need and want it."4 Yet for primary care, society has not provided the resources to meet these lofty benchmarks. PHYSICIAN BURNOUTThe wide gap between societal expectations and professional reality has set the stage for 46% of US physicians to experience symptoms of Professional burnout is characterized by loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment and is associated with early retirement, alcohol use, and suicidal ideation. 5,7 According to a recent RAND Corporation survey, the principal driver of physician satisfaction is the ability to provide quality care.7 Physician dissatisfaction, therefore, is an early warning sign of a health care system creating barriers to high-quality practice.We have heard physicians making such statements as:"The joy of practicing medici...

show abstract

Section: Physician Burnoutmentioning

confidence: 99%

From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider

Bodenheimer

Sinsky

2014

The Annals of Family Medicine

2,525

1,882

View full text Add to dashboard Cite

show abstract

“…In addition to increasing the difficulty of extracting pertinent information, this also raises legal concerns should a critical piece of information be missed. Information overload is a common and emerging issue in today’s health care [44]. It is estimated that primary care providers receive 50–60 notifications (or “alerts”) each day consisting of hundreds of data points [14, 15].…”

Section: Communication Of Test Results In Ehr-based Record Systemsmentioning

confidence: 99%

“…For example, providing insufficient non-face-to-face time for clinicians to process notifications can compound the problem. In addition to reducing clinician job satisfaction, this may have an untoward effect of causing providers to miss critical information within the vast amounts of data [44]. …”

Section: Communication Of Test Results In Ehr-based Record Systemsmentioning

confidence: 99%

Communication breakdowns and diagnostic errors: a radiology perspective

Murphy¹,

Singh²,

Berlin³

2014

Diagnosis

Self Cite

View full text Add to dashboard Cite

Timely and accurate communication is essential to safe and effective health care. Despite increased awareness over the past decade of the frequency of medical errors and greater efforts directed towards improving patient safety, patient harm due to communication breakdowns remains a significant problem. Communication problems related to diagnostic testing may account for nearly half of all errors made by typical primary care physicians in their medical practices. This article provides an overview of communication breakdowns in the context of radiology related diagnostic errors. In radiology, communication breakdowns between radiologists, referring clinicians, and patients can lead to failure of critical information to be relayed, resulting in delayed or missed diagnosis. New technologies, such electronic health records (EHRs), contribute to the increasing complexity of communication in health care, but if used correctly, they can provide several benefits to safe and effective communication. To address the complexity of communication breakdowns, a multifaceted sociotechnical approach is needed to address both technical and non-technical aspects of health care delivery. The article also provides some future directions in reducing communication breakdowns related to diagnostic testing, including proactive risk assessment of communication practices using recently released SAFER self-assessment guides.

show abstract

“…Additionally, many providers can receive over 50 different types of notifications a day (28) and due to a large number of notifications, a “needle in haystack” phenomenon might result where abnormal pathology reports may be under-prioritized or overlooked. (29) This might explain why general medicine providers, who typically receive more alerts, were less likely to provide timely follow-up than sub-specialists.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of an Electronic Health Record-based Intervention to Improve Follow-up of Abnormal Pathology Results

et al. 2012

View full text Add to dashboard Cite

Background and Objective On March 11, 2009, the Veterans Health Administration (VA) implemented an electronic health record (EHR)-based intervention that required all pathology results to be transmitted to ordering providers via mandatory automated notifications. We examined the impact of this intervention on improving follow-up of abnormal outpatient pathology results. Research Design and Subjects We extracted pathology reports from the EHR of two VA sites. From 16,738 pre- and 17,305 post-intervention reports between 09/01/2008 and 09/30/2009, we randomly selected about 5% and evaluated follow-up outcomes using a standardized chart review instrument. Documented responses to the alerted report (e.g., ordering follow-up tests or referrals, notifying patients, and prescribing/changing treatment) were recorded. Measures Primary outcome measures included proportion of timely follow-up responses (within 30 days) and median time to direct response for abnormal reports. Results Of 816 pre- and 798 post-intervention reports reviewed, 666 (81.6%) and 688 (86.2%) were abnormal. Overall, there was no apparent intervention effect on timely follow-up (69% vs. 67.1%;p=0.4) or median time to direct response (8 days vs. 8 days; p=0.7). However, logistic regression uncovered a significant intervention effect (pre-intervention OR, 0.7; 95%CI 0.5-1.0) after accounting for site-specific differences in follow-up, with a lower likelihood of timely follow-up at one site (OR,0.4; 95%CI 0.2-0.7). Conclusion An electronic intervention to improve test result follow-up at two VA institutions using the same EHR was found effective only after accounting for certain local contextual factors. Aggregating the effect of EHR interventions across different institutions and EHRs without controlling for contextual factors might underestimate their potential benefits.

show abstract

Electronic Health Record–Based Messages to Primary Care Providers: Valuable Information or Just Noise?

Cited by 44 publications

References 9 publications

From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider

From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider

Communication breakdowns and diagnostic errors: a radiology perspective

Effectiveness of an Electronic Health Record-based Intervention to Improve Follow-up of Abnormal Pathology Results

Contact Info

Product

Resources

About