Search

Background There is a common belief that seniority and gender are associated with clinicians' perceptions of the value of electronic health record (EHR) technology and the propensity for burnout. Insufficient evidence exists on the relationship between these variables. Objective The aim of this study was to investigate how seniority/years of practice, gender, and screened burnout status are associated with opinions of EHR use on quality, cost, and efficiency of care. Methods We surveyed ambulatory primary care and subspecialty clinicians at three different institutions to screen for burnout status and to measure their opinions (positive, none, negative, don't know) on how EHR technology has impacted three important attributes of health care: quality, cost, and efficiency of care. We used chi-square tests to analyze association between years of practice (≤10 years or 11+ years), gender, and screened burnout status and the reported attributes. We used a Bonferroni-corrected α = 0.0167 for significance to protect against type I error among multiple comparisons. Results Overall, 281 clinicians responded from 640 that were surveyed with 44% overall response rate. There were no significant associations of years in practice (≤10 years or 11+ years) or gender (p > 0.0167 for both) with any of the health care attributes. Clinicians who screened burnout negative (n = 154, 55%) were more likely to indicate that EHR technology has a positive impact on both the quality (p = 0.0025) and efficiency (p = 0.0003) health care attributes compared with those who screened burnout positive (n = 127, 45%). Conclusion Burnout status is significantly associated with clinicians' perceived value of EHR technologies, while years of practice and gender are not. This contests the popular notion that junior clinicians view EHR technology more favorably than their more senior counterparts. Hence, burnout status may be an important factor associated with the overall value clinicians ascribe to EHR technologies.

We examine the characteristics associated with the availability of therapeutic acupuncture in substance use disorder (SUD) treatment facilities in the United States (US).This study utilizes data from the 2018 National Survey of Substance Abuse Treatment Services (N-SSATS). Multivariable logistic regression was performed.Only 5.5% (Although complementary and holistic approaches such as acupuncture are accepted adjunct methods to treat persons with SUD, the findings suggest that their utilization in SUD treatment facilities in the US is minimal. Results, however, highlight that facilities operated by tribal and federal governments, those that are located in the Western region of the US, and non-hospital facilities have the highest odds of incorporating therapeutic acupuncture as treatment for SUD.

Postoperative complications place a major burden on the healthcare systems. The type of hospital’s ownership could be one factor associated with this adverse outcome. Using CMS’s publicly available “Complications and Deaths—Hospitals” and “Hospital General Information” datasets, we analyzed the association between four postoperative complications (venous thromboembolism, joint replacement complications, wound dehiscence, postoperative sepsis) and hospital ownership. These data were collected by Medicare between April 2013 and March 2016. We found a significant association ( p = 0.029) between ownership types and the postoperative complication score. A 6-percent drop in the share of not-for-profit ownership, accompanied by a 3-percent increase in each of the government and for-profit ownership, resulted in a 20-percent drop in postoperative complication scores (from 5.75 to 4.6). There is an association between hospital ownership type and postoperative complications. Creating this awareness in leadership should prompt for redesigning of hospitals’ operations and workflows to become more compatible with safe and effective care delivery.

Background A minimum dataset (MDS) can be determined ad hoc by an investigator or small team; by a metadata expert; or by using a consensus method to take advantage of the global knowledge and expertise of a large group of experts. The first method is the most commonly applied. Objective Here, we describe a use of the third approach using a modified Delphi method to determine the optimal MDS for a dataset of full body computed tomography scans. The scans are of decedents whose deaths were investigated at the New Mexico Office of the Medical Investigator and constitute the New Mexico Decedent Image Database (NMDID). Methods The authors initiated the consensus process by suggesting 50 original variables to elicit expert reactions. Experts were recruited from a variety of scientific disciplines and from around the world. Three rounds of variable selection showed high rates of consensus. Results In total, 59 variables were selected, only 52% of which the original resource authors selected. Using a snowball method, a second set of experts was recruited to validate the variables chosen in the design phase. During the validation phase, no variables were selected for deletion. Conclusion NMDID is likely to remain more “future proof” than if a single metadata expert or only the original team of investigators designed the metadata.

ObjectivesDetermine the specific aspects of health information and communications technologies (HICT), including electronic health records (EHRs), most associated with physician burnout, and identify effective coping strategies.Materials and methodsWe performed a qualitative analysis of transcripts from 2 focus groups and a burnout assessment of ambulatory physicians—each at 3 different health care institutions with 3 different EHRs.ResultsOf the 41 clinicians, 71% were women, 98% were physicians, and 73% worked in primary care for an average of 11 years. Only 22% indicated sufficient time for documentation. Fifty-six percent noted “a great deal of stress” because of their job. Forty-two percent reported “poor” or “marginal” control over workload. Even though 90% reported EHR proficiency, 56% indicated EHR time at home was “excessive” or “moderately high.” Focus group themes included HICT “successes” where all patients’ information is accessible from multiple locations. HICT “stressors” included inefficient user interfaces, unpredictable system response times, poor interoperability between systems and excessive data entry. “Adverse outcomes” included ergonomic problems (eg, eye strain and hand, wrist, and back pain) and decreased attractiveness of primary care. Suggested “organizational changes” included EHR training, improved HICT usability, and scribes. “Personal/resilience” strategies focused on self-care (eg, exercise, maintaining work-life boundaries, and positive thinking).Discussion and conclusionHICT use, while beneficial in many ways for patients and providers, has also increased the burden of ambulatory practice with personal and professional consequences. HICT and clinic architectural and process redesign are likely necessary to make significant overall improvements.

Objective To quantify how stress related to use of health information technology (HIT) predicts burnout among physicians. Methods All 4197 practicing physicians in Rhode Island were surveyed in 2017 on their HIT use. Our main outcome was self-reported burnout. The presence of HIT-related stress was defined by report of at least 1 of the following: poor/marginal time for documentation, moderately high/excessive time spent on the electronic health record (EHR) at home, and agreement that using an EHR adds to daily frustration. We used logistic regression to assess the association between each HIT-related stress measure and burnout, adjusting for respondent demographics, practice characteristics, and the other stress measures. Results Of the 1792 physician respondents (43% response rate), 26% reported burnout. Among EHR users (91%), 70% reported HIT-related stress, with the highest prevalence in primary care-oriented specialties. After adjustment, physicians reporting poor/marginal time for documentation had 2.8 times the odds of burnout (95% CI: 2.0–4.1; P Conclusion HIT-related stress is measurable, common (about 70% among respondents), specialty-related, and independently predictive of burnout symptoms. Identifying HIT-specific factors associated with burnout may guide healthcare organizations seeking to measure and remediate burnout among their physicians and staff.

Key Points Question Which electronic health record (EHR) design and use factors are associated with clinician stress and burnout? Findings In this survey study of 282 clinicians, clinician stress and burnout were associated with 7 EHR design and use factors. These 7 plus 2 other design and use factors collectively accounted for a modest amount of the variance in stress (12.5%) and burnout (6.8%); models incorporating other work conditions (such as chaotic work atmosphere and workload control) accounted for considerably more of the variance in stress (58.1%) and burnout (36.2%). Meaning While EHR design and use factors may appropriately be targeted by health systems and EHR designers to address stress and burnout, other non-EHR issues, especially clinician work conditions, appear to play a substantial role in adverse clinician outcomes., This survey study determines which electronic health record (EHR) design and use factors are associated with clinician stress and burnout and identifies other sources that contribute to this problem., Importance Many believe a major cause of the epidemic of clinician burnout is poorly designed electronic health records (EHRs). Objectives To determine which EHR design and use factors are associated with clinician stress and burnout and to identify other sources that contribute to this problem. Design, Setting, and Participants This survey study of 282 ambulatory primary care and subspecialty clinicians from 3 institutions measured stress and burnout, opinions on EHR design and use factors, and helpful coping strategies. Linear and logistic regressions were used to estimate associations of work conditions with stress on a continuous scale and burnout as a binary outcome from an ordered categorical scale. The survey was conducted between August 2016 and July 2017, with data analyzed from January 2019 to May 2019. Main Outcomes and Measures Clinician stress and burnout as measured with validated questions, the EHR design and use factors identified by clinicians as most associated with stress and burnout, and measures of clinician working conditions. Results Of 640 clinicians, 282 (44.1%) responded. Of these, 241 (85.5%) were physicians, 160 (56.7%) were women, and 193 (68.4%) worked in primary care. The most prevalent concerns about EHR design and use were excessive data entry requirements (245 [86.9%]), long cut-and-pasted notes (212 [75.2%]), inaccessibility of information from multiple institutions (206 [73.1%]), notes geared toward billing (206 [73.1%]), interference with work-life balance (178 [63.1%]), and problems with posture (144 [51.1%]) and pain (134 [47.5%]) attributed to the use of EHRs. Overall, EHR design and use factors accounted for 12.5% of variance in measures of stress and 6.8% of variance in measures of burnout. Work conditions, including EHR use and design factors, accounted for 58.1% of variance in stress; key work conditions were office atmospheres (β̂ = 1.26; P

The National Institutes of Health encourages its research partners to use VIVO™ software to enhance research investigator collaboration. VIVO provides a dynamic online directory to facilitate professional networking opportunities for investigators who share similar or complementary research interests (VIVO, 2015). VIVO Harvester performs author searches in PubMed™ to populate VIVO profiles with article citations. Harvester only provides 65% of the total number of references (Eldredge et al., 2015), however. This study describes how the VIVO Harvester query design impacts Harvester's ability to populate the VIVO database with the correct citations to investigator publications. This action research project analyzed elements critical to optimizing Harvester's accuracy, thereby informing the development of similar queries for other institutions. Institution-specific knowledge coupled to expert PubMed search skills are essential to optimizing the accuracy of VIVO. This development fosters discovery and enhances translational research capable of benefitting society.

Many health sciences librarians as well as other professionals attend conferences on a regular basis. This study sought to link an innovative peer review process of presented research papers to long-term conference outcomes in the peer-reviewed professional journal literature. An evidence-based conference included a proof-of-concept study to gauge the long-term outcomes from research papers presented during the program. Real-time peer review recommendations from the conference were linked to final versions of articles published in the peer-reviewed literature. The real-time peer review feedback served as the basis for further mentoring to guide prospective authors toward publishing their research results. These efforts resulted in the publication of two of the four research papers in the peer-viewed literature. A third presented paper appeared in a blog because the authors wanted to disseminate their findings more quickly than through the journal literature. The presenters of the fourth paper never published their study. Real-time peer review from this study can be adapted to other professional conferences that include presented research papers.

Graphical abstractDisplay Omitted Highlights? Ten existing cephalometric standards were unified to one terminology set. ? LOINC was used as the unifying standard the 10 standards mapped to. ? This methodology could be used for other similar projects. Despite the existence of multiple standards for the coding of biomedical data and the known benefits of doing so, there remain a myriad of biomedical information domain spaces that are essentially un-coded and unstandardized. Perhaps a worse situation is when the same or similar information in a given domain is coded to a variety of different standards. Such is the case with cephalometrics - standardized measurements of angles and distances between specified landmarks on X-ray film used for orthodontic treatment planning and a variety of research applications. We describe how we unified the existing cephalometric definitions from 10 existing cephalometric standards to one unifying terminology set using an existing standard (LOINC). Using our example of an open and web-based orthodontic case file system, we describe how this work benefited our project and discuss how adopting or expanding established standards can benefit other similar projects in specialized domains.

The authors analyze monthly Internet access to traditionally unpublished academic content in one university's institutional repository (IR). Content selected for analysis include materials supplementary to peer-reviewed publications, poster images, graduate course research papers, and presentation slides. The content types represent academic output that would not likely be otherwise collected and made freely available were it not for its availability in an IR. The average first-year access rates per month are similar across content types, and evidence of access persists over time, indicating the value of this content to others and the utility of posting nontraditional academic materials in an institutional repository.

PURPOSE The advent of Web-based survey tools has provided the investigator with an alternative to paper-based survey methods that in many instances may be less expensive to implement than traditional paper-based surveys. Newer technology, however, does not diminish the importance of obtaining an adequate response rate. METHODS We analyzed response rate data obtained from a survey implemented across 3 practice-based research networks (PBRNs) in which the survey was first implemented electronically with 5 rounds of electronic solicitation for an Internet-based questionnaire and then by 2 rounds of a paper-based version mailed only to nonresponders. RESULTS Overall, 24% of the total survey responses received were in the paper mode despite intense promotion of the survey in the electronic phase. CONCLUSIONS Our results suggest there is still an important role for the use of paper-based methods in PBRN survey research. Both hard copy and electronic survey collection methods may be required to enhance clinician response rates in PBRNs.

OBJECTIVE The research tested the accuracy of the VIVO Harvester software in identifying publications authored by faculty members affiliated with a National Institutes of Health Clinical and Translational Sciences Award (CTSA) site. METHODS Health sciences librarians created "gold standard" lists of references for the years 2001 to 2011 from PubMed for twenty-five randomly selected investigators from one CTSA site. These gold standard lists were compared to the same twenty-five investigators' reference lists produced by VIVO Harvester. The authors subjected the discrepancies between the lists to sensitivity and specificity analyses. RESULTS The VIVO Harvester correctly identified only about 65% of the total eligible PubMed references for the years 2001-2011 for the CTSA-affiliated investigators. The identified references produced by VIVO Harvester were precise yet incomplete. The sensitivity rate was 0.65, and the specificity rate was 1.00. CONCLUSION While the references produced by VIVO Harvester could be confirmed in PubMed, the VIVO Harvester retrieved only two-thirds of the required references from PubMed. National Institutes of Health CTSA sites will need to supplement VIVO Harvester-produced references with the expert searching skills of health sciences librarians. IMPLICATIONS Health sciences librarians with searching skills need to alert their CTSA sites about these deficiencies and offer their skills to advance their sites' missions.

Background/Aims HIEs are secure computer networks that allow sharing of patients’ health records across health care organizations in a standard format to provide more comprehensive information to providers at the point of care. Potential HIE benefits include improved quality (better care coordination, decreased errors) and reduced costs (reduced redundant lab and radiology orders). The New Mexico Health Information Collaborative (NMHIC), the State’s HIE, is implementing pilot clinical use sites in Albuquerque area Emergency Departments (EDs). Here we present the approach evaluating our pilots HIE implementation in the ED setting for its effect on the rate of redundant lab and radiology orders.

Health sciences librarians serve society by making needed health-related information available to our users. The Medical Library Association's (MLA's) slogan, “Professionals providing quality information for improved health”; the 2010 revised MLA Code of Ethics [1]; and the American Library Association's code of ethics [2] all reflect our profession's central purpose. One formal research study on the core values of librarians and information professionals also verified that, on the international scale, our profession seeks to provide access to quality information [3].

The Evidence-Based Scholarly Communication Conference (EBSCC) was held March 11-12, 2010 in Albuquerque, NM. The conference addressed the perceived gap in knowledge and training for scholarly communication principles in the National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA) Program. The EBSCC brought together librarians and information specialists to share evidence -based strategies for developing effective local scholarly communication support and training and, it is hoped, to form new coalitions to address this topic at the local and national levels. This brief communication summarizes the need for the conference, highlights the general sessions in order of presentation, and introduces the EBSCC research papers appearing in this issue of Evidence Based Library and Information Practice (EBLIP). It also includes a description of a unique peer-review process methodology pioneered at EBSCC.

This program evaluation reports on the curricular development and integration of library, biomedical informatics, and scholarly communications (LBS) skills into a required informatics course for a new graduate degree program in the University of New Mexico's Clinical and Translational Sciences Center (CTSC). The course built on the opportunity presented by the new degree program to integrate LBS competencies rarely included in most traditional clinical research training programs. This report tracks the experiences and evaluations of two cohorts of graduate students who have completed the course. This article presents lessons learned on curricular integration and offers thoughts for future work.

Background A growing body of literature shows that patients accept the use of computers in clinical care. Nonetheless, studies have shown that computers unequivocally change both verbal and non-verbal communication style and increase patients' concerns about the privacy of their records. We found no studies which evaluated the use of Electronic Health Records (EHRs) specifically on psychiatric patient satisfaction, nor any that took place exclusively in a psychiatric treatment setting. Due to the special reliance on communication for psychiatric diagnosis and evaluation, and the emphasis on confidentiality of psychiatric records, the results of previous studies may not apply equally to psychiatric patients. Method We examined the association between EHR use and changes to the patient-psychiatrist relationship. A patient satisfaction survey was administered to psychiatric patient volunteers prior to and following implementation of an EHR. All subjects were adult outpatients with chronic mental illness. Results Survey responses were grouped into categories of "Overall," "Technical," "Interpersonal," "Communication & Education,," "Time," "Confidentiality," "Anxiety," and "Computer Use." Multiple, unpaired, two-tailed t-tests comparing pre- and post-implementation groups showed no significant differences (at the 0.05 level) to any questionnaire category for all subjects combined or when subjects were stratified by primary diagnosis category. Conclusions While many barriers to the adoption of electronic health records do exist, concerns about disruption to the patient-psychiatrist relationship need not be a prominent focus. Attention to communication style, interpersonal manner, and computer proficiency may help maintain the quality of the patient-psychiatrist relationship following EHR implementation.

Consortium Background: The importance of Hepatitis C (HCV) as a public and individual health concern is well es- tablished. However, national groups differ in their recommendations to primary care clinicians about screening people at high risk for HCV. The purpose of this study was to explore the context of care within which primary care clinicians decide to detect and initially manage HCV. Methods: The Primary Care Multiethnic Network conducted a web- and paper-based survey of pri- mary care clinicians who largely practice in low-income, medically underserved communities in 3 re- gions across the country. Results: A total of 494 clinicians participated, for a response rate of 61%. Most (68%) clinicians view HCV as an important problem; more than half (59%) consider screening for HCV to be important when compared with other conditions they screen for in practice. With regard to reported screening habits for risk factors, 54% of clinicians routinely ask new patients whether they have used intravenous drugs and 28% inquire about blood transfusions before 1992. Sixty-one percent order an alanine aminotrans- ferase test when patients present with other risk factors for HCV. The majority of clinicians (54%) refer 75% or fewer of their patients with HCV for treatment; nearly one-fifth (18%) provide antiviral treat- ment themselves. Key factors influencing clinician HCV decision making are patient comorbidities (74% reported this as a factor), access to treatment (55% reported this as a factor), and tolerance (44% re- ported this as a factor) of treatment. Conclusions: In the face of conflicting national guideline recommendations about screening people at high risk for HCV, clinicians have varied views and practice habits influenced by multiple patient, access, and treatment issues. (J Am Board Fam Med 2009;22:638-646.)

The science of cephalometry has been invaluable for guiding orthodontic diagnosis, treatment planning, and outcomes tracking. Though software packages easily calculate most cephalometric measurements, the ability to exchange cephalometric data bet ween software packages is poorly developed. Hindering this effort is the lack of an agreed-upon standard for electronic exchange of cephalometric measurements. Unlike more technological issues, the problem of creating such a standard is one of formalizing decisions already established through historical precedent. Solving this problem will require education, cooperation, and consensus in order to reap the potential improvements to patient care, dental education, and research. The first step in overcoming these remaining issues is awareness. This article reviews those factors that place cephalometric measurements in an excellent position for standardization, outlines those decisions that must be made in order to realize the goal of electronic exchange of cephalometric information, and describes some of the options for these decisions as well as some advantages and disadvantages of each.

The value of human biospecimens available for research dramatically increases when linked with their accumulated clinical and molecular (genomic, proteomic, subcellular modeling) data. Further, informatics tools make it possible for researchers (both intra- and inter-institutionally) to locate tissue needed for research faster and more reliably. We are developing a virtual human biospecimen repository to both inventory and link all human biospecimens with clinical and genomics data to optimize their value for research, while satisfying all privacy and human subjects protections regulations.

Background: Fractures attributable to ostcoporosis are responsible for preventable suffering and health care costs. Until they experience a fracture, many older adults, particularly women, are unaware that they have osteoporosis. Although radiographs taken for reasons other than evaluating the possibility of osteoporosis may suggest the presence of fracture, such fractures often go undetected and effective treatments are not implemented. Objective: The goal of this study was to determine the adequacy of treatment of osteoporotic vertebral compression fractures in middle-aged and older women in an internal medicine clinic, as ascertained by reports of chest radiography. The hypothesis was that patients having chest radiographs with observable vertebral compression fractures often did not receive adequate treatment. Methods: This was a retrospective, cross-sectional study conducted at a general internal medicine clinic at a university-affiliated county hospital. The records of an academic internal medicine practice were searched to identify women aged ≥40 years with radiologic evidence of vertebral compression fractures during the period from June 1, 1992, through May 31, 2002. Electronic prescription records were then searched to determine whether patients had received a prescription for a medication for the treatment of osteoporosis. An analysis also was conducted to describe the frequency distribution of various medications for the treatment of osteoporosis. Results: One hundred thirteen women were identified who met the study criteria. Their mean (SD) age was 68.1 (21.9) years. Fifty-six (50%) of these women received pharmacologic treatment for osteoporosis. The most commonly prescribed medications were estrogens (35%), calcitonin (16%), and bisphosphonates (12%). Conclusions: No more than half of patients identified as having a vertebral compression fracture on chest radiography received even 1 prescription for the treatment of osteoporosis. Because this study did not examine adherence or long-term medication use, the proportion of women who received adequate osteoporosis therapy was probably much less than half. Physicians should be alert to the possible presence of vertebral compression fractures and take a more aggressive approach to treatment when a fracture is present.

Health and socioeconomic disparities tend to be experienced along racial and ethnic lines, but investigators are not sure how individuals are assigned to groups, or how consistent this process is. To address these issues, 1,919 orthodontic patient records were examined by at least two observers who estimated each individual's race and the characteristics that influenced each estimate. Agreement regarding race is high for African and European Americans, but not as high for Asian, Hispanic, and Native Americans. The indicator observers most often agreed upon as important in estimating group membership is name, especially for Asian and Hispanic Americans. The observers, who were almost all European American, most often agreed that skin color is an important indicator of race only when they also agreed the subject was European American. This suggests that in a diverse community, light skin color is associated with a particular group, while a range of darker shades can be associated with members of any other group. This research supports comparable studies showing that race estimations in medical records are likely reliable for African and European Americans, but are less so for other groups. Further, these results show that skin color is not consistently the primary indicator of an individual's race, but that other characteristics such as facial features add significant information.