Electronic records of obstetrics and gynecology encounter

Tandon, Ayushi; Kandathil, George; Deodhar, Swanand J.; Mathur, Navdeep

doi:10.1145/3364183.3364196

Cited by 4 publications

(4 citation statements)

References 43 publications

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“…I followed suggestion by Stern and Pyles [29] and tried to use concept of affordance described in previous studies on EMR to tell my story (analysis); But as it did not neatly fit my work, I conceptualized "practical affordance" to describe how functionalities available via EMR systems were put to use by doctors in order to support women patients. I have also included one episodic instance from Hospital_R, reconstructed as vignettes using field notes and interview data in the hope of evoking empathy towards participants of this study [11]. Vignette allows reader to engage with situation arising in the field and supports my argument that we need to take into account practical implications of EMR features (where and when is affordances) for patients.…”

Section: Methods and Sites Descriptionmentioning

confidence: 78%

“…These cases (doctors) are located at various sites and are part of larger project. Details of project are available in already published peer reviewed study [11]. The study design was approved by institution's ethical review board and each participant (pseudonyms used) was briefed about the purpose of study before they signed the consent form.…”

Section: Methods and Sites Descriptionmentioning

confidence: 99%

“…Each setting had (some form of) electronic medical record keeping of OB/GYN outpatient consultation. Details of project are available in already published peer reviewed study [11]. In this paper, I introduce the concept of "practical affordances" by empirically engaging with affordances for whom and where not only what is affordance [12,13].…”

Section: Introductionmentioning

confidence: 99%

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Practical Affordance: EMR Use Within Outpatient Consulting on Women’s Health

Tandon¹

2020

IFIP Advances in Information and Communication Technology

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We have seen increased adoption of electronic medical records (EMR) to facilitate monitoring and recording about patient trajectories. Information systems and allied discipline researchers have argued that paper persistence post EMR implementation is pervasive because of system design and institutional policies lacking understanding of clinical workflow. I question this doctor focused understanding of medical record keeping focusing on clinical workflow and, ideas about the EMR that limits its role within the hospital boundaries. By providing empirical data from two settings, one rural secondary care hospital and other metropolitan multinational hospital, I show that ensuring healthcare needs of patients are met was central to doctor's work instead of using information technologies i.e. EMR. The projection of EMRs as artefact limited to hospital setting and only for clinical purposes, discounting role of patients' life worlds in clinical interactions and managing their health runs the risk of devaluing the experiential and affective knowledge of both patients and doctors. EMR, I argue, cannot support work by doctors unless patient's role is recognized and EMR is defined as flexible, situated in practical context of patient, rather than administrative and clinical work oriented only.

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Section: Methods and Sites Descriptionmentioning

confidence: 78%

Section: Methods and Sites Descriptionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Practical Affordance: EMR Use Within Outpatient Consulting on Women’s Health

Tandon¹

2020

IFIP Advances in Information and Communication Technology

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“…In contrast to all the limitations mentioned above, EMR-based studies have rich data on patient, provider, and health care factors. However, like insurance-claims-based studies, EMR-based studies from single hospitals or small health systems fail to capture the breadth of people affected by gynecologic conditions [19][20][21].…”

Section: Introductionmentioning

confidence: 99%

The Carolina hysterectomy cohort (CHC): a novel case series of reproductive-aged hysterectomy patients across 10 hospitals in the US south

Haji-Noor,

Mathias,

Beltran

et al. 2023

BMC Women's Health

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Background Hysterectomy is a common surgery among reproductive-aged U.S. patients, with rates highest among Black patients in the South. There is limited insight on causes of these racial differences. In the U.S., electronic medical records (EMR) data can offer richer detail on factors driving surgical decision-making among reproductive-aged populations than insurance claims-based data. Our objective in this cohort profile paper is to describe the Carolina Hysterectomy Cohort (CHC), a large EMR-based case-series of premenopausal hysterectomy patients in the U.S. South, supplemented with census and surgeon licensing data. To demonstrate one strength of the data, we evaluate whether patient and surgeon characteristics differ by insurance payor type. Methods We used structured and abstracted EMR data to identify and characterize patients aged 18–44 years who received hysterectomies for non-cancerous conditions between 10/02/2014–12/31/2017 in a large health care system comprised of 10 hospitals in North Carolina. We used Chi-squared and Kruskal Wallis tests to compare whether patients’ socio-demographic and relevant clinical characteristics, and surgeon characteristics differed by patient insurance payor (public, private, uninsured). Results Of 1857 patients (including 55% non-Hispanic White, 30% non-Hispanic Black, 9% Hispanic), 75% were privately-insured, 17% were publicly-insured, and 7% were uninsured. Menorrhagia was more prevalent among the publicly-insured (74% vs 68% overall). Fibroids were more prevalent among the privately-insured (62%) and the uninsured (68%). Most privately insured patients were treated at non-academic hospitals (65%) whereas most publicly insured and uninsured patients were treated at academic centers (66 and 86%, respectively). Publicly insured and uninsured patients had higher median bleeding (public: 7.0, uninsured: 9.0, private: 5.0) and pain (public: 6.0, uninsured: 6.0, private: 3.0) symptom scores than the privately insured. There were no statistical differences in surgeon characteristics by payor groups. Conclusion This novel study design, a large EMR-based case series of hysterectomies linked to physician licensing data and manually abstracted data from unstructured clinical notes, enabled identification and characterization of a diverse reproductive-aged patient population more comprehensively than claims data would allow. In subsequent phases of this research, the CHC will leverage these rich clinical data to investigate multilevel drivers of hysterectomy in an ethnoracially, economically, and clinically diverse series of hysterectomy patients.

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