Neurology steering board effects change for a major electronic health record vendor

Weathers, Allison L.; Haq, Ihtsham; Ficker, David M.; Ney, John P.; Meyers, Steven

doi:10.1212/cpj.0000000000000666

Cited by 7 publications

(6 citation statements)

References 3 publications

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“…Other integrated health systems such as Kaiser have formed groups to focus on care delivery research and practice in hepatology (22). Outside of integrated health systems, some QI efforts have been driven by large EMR vendors in collaboration with practicing clinicians by forming specialty steering boards to improve data capture and the EMR experience for specific conditions (23). Nevertheless, sustainable QI has many challenges; most clinicians do not have protected time for QI and lack formal We find that while overall mortality remained constant, there was a divergence in COVID-19 cases and hospitalizations in the postvaccine era, outpatient visits remained stable, and total hospitalizations decreased.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Care Utilization and Hepatocellular Carcinoma Surveillance: Tracking Care Across the Pandemic

et al. 2022

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INTRODUCTION:We studied longitudinal trends in mortality, outpatient, and inpatient care for cirrhosis in a national cohort in the first 2 years of the coronavirus disease-2019 pandemic. We evaluated trends in hepatocellular carcinoma (HCC) surveillance and factors associated with completion.METHODS:Within the national cirrhosis cohort in the Veterans Administration from 2020 to 2021, we captured mortality, outpatient primary care provider, gastroenterology/hepatology (GI/HEP) visits, and hospitalizations. HCC surveillance was computed as percentage of time up to date with surveillance every 6 months (PTUDS). Multivariable models for PTUDS were adjusted for patient demographics, clinical factors, and facility-level variables.RESULTS:The total cohort was 68,073; 28,678 were eligible for HCC surveillance. Outpatient primary care provider and GI/HEP appointment rates initially dropped from 30% to 7% with a rebound 1 year into the pandemic and steady subsequent use. Telemedicine monthly visit rates rose from less than 10% to a peak of 20% with a steady gradual decline. Nearly 70% of Veterans were up to date with HCC surveillance before the pandemic with an early pandemic nadir of approximately 50% and 60% PTUDS 2 years into the pandemic. In adjusted models, use of a population-based cirrhosis dashboard (β 8.5, 95% CI 6.9–10.2) and GI/HEP visits both in-person (β 3.2, 95% CI 2.9–3.6) and telemedicine (β 2.1, 95% CI 1.9–2.4) were associated with a higher PTUDS.DISCUSSION:Outpatient utilization and HCC surveillance rates have rebounded but remain below at baseline. Population-based approaches and specialty care for cirrhosis were associated with a higher completion of HCC surveillance.

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Section: Discussionmentioning

confidence: 99%

Patterns of Care Utilization and Hepatocellular Carcinoma Surveillance: Tracking Care Across the Pandemic

et al. 2022

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“…An epilepsy practice in the USA created and implemented a tool for detailed data collection for use in a well‐staffed outpatient practice 40 . One vendor (Epic Systems Corporation, Verona, WI) hosts neuroscience specialty steering boards (pediatric and adult), which successfully created multiple tools for neurologists’ use in clinical care, including for epilepsy 10 . Our work builds upon and expands these efforts.…”

Section: Discussionmentioning

confidence: 99%

“…Second, variations in implementation (see Figure 4) demonstrate that user experience will differ from center to center. Dissemination of the CDEs centrally may help reduce these variations 10 …”

Section: Discussionmentioning

confidence: 99%

“…This draft was disseminated via email to PELHS participants for comment and iteratively refined, based on feedback from email, discussions at four PELHS in‐person meetings (December 2017 to May 2018), and weekly PELHS operational calls December 2017 to November 2018. Concurrently, we consulted with electronic health record (EHR) vendors 10 and institutional operational health information technology teams (Appendix ) for guidance on implementation.…”

Section: Methodsmentioning

confidence: 99%

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Design and implementation of electronic health record common data elements for pediatric epilepsy: Foundations for a learning health care system

et al. 2020

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ObjectiveCommon data elements (CDEs) are standardized questions and answer choices that allow aggregation, analysis, and comparison of observations from multiple sources. Clinical CDEs are foundational for learning health care systems, a data‐driven approach to health care focused on continuous improvement of outcomes. We aimed to create clinical CDEs for pediatric epilepsy.MethodsA multiple stakeholder group (clinicians, researchers, parents, caregivers, advocates, and electronic health record [EHR] vendors) developed clinical CDEs for routine care of children with epilepsy. Initial drafts drew from clinical epilepsy note templates, CDEs created for clinical research, items in existing registries, consensus documents and guidelines, quality metrics, and outcomes needed for demonstration projects. The CDEs were refined through discussion and field testing. We describe the development process, rationale for CDE selection, findings from piloting, and the CDEs themselves. We also describe early implementation, including experience with EHR systems and compatibility with the International League Against Epilepsy classification of seizure types.ResultsCommon data elements were drafted in August 2017 and finalized in January 2020. Prioritized outcomes included seizure control, seizure freedom, American Academy of Neurology quality measures, presence of common comorbidities, and quality of life. The CDEs were piloted at 224 visits at 10 centers. The final CDEs included 36 questions in nine sections (number of questions): diagnosis (1), seizure frequency (9), quality of life (2), epilepsy history (6), etiology (8), comorbidities (2), treatment (2), process measures (5), and longitudinal history notes (1). Seizures are categorized as generalized tonic‐clonic (regardless of onset), motor, nonmotor, and epileptic spasms. Focality is collected as epilepsy type rather than seizure type. Seizure frequency is measured in nine levels (all used during piloting). The CDEs were implemented in three vendor systems. Early clinical adoption included 1294 encounters at one center.SignificanceWe created, piloted, refined, finalized, and implemented a novel set of clinical CDEs for pediatric epilepsy.

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“…Our goal is to highlight health services research articles published in Neurology ® or Neurology ® Clinical Practice as well as to give opinions by experts in the field. A commentary by Weathers et al 2 described the efforts of the American Academy of Neurology to work with a major electronic health record vendor to improve usability specifically for neurologists.…”

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confidence: 99%

What's happening in Innovations in Care Delivery

2019

Neurology

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Innovations in Care Delivery strives to highlight articles that feature advances in care delivery in our Editors' Blog, Editors' Top Five Recommended Reading, and Latest Articles sections. Periodically, we also include interviews with leaders in the field of health services research. Editor's Blog BlogRead the Innovations in Care Delivery blog for timely posts by the editors and invited guests on Neurology articles. NPub.org/icdblog

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Neurology steering board effects change for a major electronic health record vendor

Cited by 7 publications

References 3 publications

Patterns of Care Utilization and Hepatocellular Carcinoma Surveillance: Tracking Care Across the Pandemic

Patterns of Care Utilization and Hepatocellular Carcinoma Surveillance: Tracking Care Across the Pandemic

Design and implementation of electronic health record common data elements for pediatric epilepsy: Foundations for a learning health care system

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