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Electronic health records and computer-based clinical decision support: are we there yet?

Electronic health records and computer-based clinical decision support: are we there yet? Highlights Electronic health records and computer-based clinical decision support: are we there yet? doi:10.1136/amiajnl-2011-000141 Lucila Ohno-Machado, Editor-in-Chief Electronic health record systems are in viewing notes at one academic medical improved CD4 monitoring for people living with HIV), Haynes (seepage164 different phases of implementation in the center. Yet, a significant number of these on improved discontinuation of antibi- US and abroad. From the perspective of notes were never viewed. The authors enhancing the quality of healthcare, one speculate that oral communication at turn otics after surgery), and Zlabek (see of the most attractive features of elec- of shifts may obviate the role of certain page 169 on improved patient safety tronic health record systems is the ability written notes for immediate care. Never- markers after implementation of a to implement computer-based clinical theless, these notes are still important for commercial EMR). Florez-Arango also decision support. However, utilization of documentation, and Hripcsak’s study reports increased adherence to guidelines two main subsets of electronic health should motivate more research in this by healthcare workers using CDSs record systems, electronic medical area. on mobile devices in a controlled experi- records systems (EMRs) and personal Developing new ways of documenting mental setting (see page 131). El-Kareh, health records systems (PHRs), is still oral communications and evaluating the on the other hand, describes and discusses very heterogeneous across institutions balance between clinical usefulness and a case in which such improvements could and individuals. EMRs are not always legal documentation in electronic health not be realized (see page 160). Further- perceived as advantageous from the record systems will require multi-centric more, CDSs are not easy to design, standpoint of individual clinicians, with studies conducted by multidisciplinary implement, and maintain. Wright paper records still being the main form of teams of researchers, since ease of use and discusses the difficulties in maintaining documentation in several institutions. decreased time in documentation are very knowledge bases for CDSs and how the PHRs are still not well integrated into important factors in EMR adoption. governance structure in different institu- EMRs and their adoption by patients is Related to this topic, Rosenbloom discusses tionsisorganized to addressthisissue not widespread. tradeoffs between structured and narrative (see page 187). Moreover, Liu evaluated In this issue, we include articles that text entry in EMRs (seepage181). Aziz methods for evaluating clinical informa- focus on how electronic health records are briefly presents personal sensors that can tion systems (see page 173 and accom- being used and how clinical decision augment health data collection in the panying editorial by Lehmann on page support is making an impact on clinical home environment (see page 156). Also 110). care. Do describes the results of a pilot related to usability of EMRs are the articles Lastly, trained professionals are by Sykes on clinician attitudes related to study on PHR usage and users’ percep- needed to design, implement, and evaluate tions (see page 118). The results are very EMR implementation in an Emergency electronic health records systems and encouraging, showing that concerns about Department (see page 125), by Pearce on CDSs. Kampov-Polevoi surveyed training privacy are not an impediment for use, whether computers intrude on the rela- programs and confirmed that electronic and that patients perceive benefits in tionship between physicians and patients health records and computer-based CDSs using PHRs that are not tethered to (see page 138), and by Vest on factors that are core components of biomedical and a particular healthcare system. However, motivate health information exchange (see health informatics curricula in the US (see more research and further studies in this page 143). page 195). area are needed. Use of an electronic health record We hope that this issue of JAMIA will From the clinician’s perspective, system is the first step toward computer- communicate to clinicians, researchers, Hripcsak reports on whether and how based clinical decision support systems healthcare administrators, and many notes from an EMR are utilized by (CDSs). Different outcomes for CDSs other decision makers the relevant, new, members of the clinical team (see page are reported in this issue. Positive and actionable information related to 112). Clinicians spent an average of results in real clinical settings are usage and usefulness of electronic health 54 min/day authoring and 21 min/day reported by Were (seepage150 on record systems and CDSs. J Am Med Inform Assoc March 2011 Vol 18 No 2 109 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of the American Medical Informatics Association Oxford University Press

Electronic health records and computer-based clinical decision support: are we there yet?

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Publisher
Oxford University Press
Copyright
© 2011, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
ISSN
1067-5027
eISSN
1527-974X
DOI
10.1136/amiajnl-2011-000141
Publisher site
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Abstract

Highlights Electronic health records and computer-based clinical decision support: are we there yet? doi:10.1136/amiajnl-2011-000141 Lucila Ohno-Machado, Editor-in-Chief Electronic health record systems are in viewing notes at one academic medical improved CD4 monitoring for people living with HIV), Haynes (seepage164 different phases of implementation in the center. Yet, a significant number of these on improved discontinuation of antibi- US and abroad. From the perspective of notes were never viewed. The authors enhancing the quality of healthcare, one speculate that oral communication at turn otics after surgery), and Zlabek (see of the most attractive features of elec- of shifts may obviate the role of certain page 169 on improved patient safety tronic health record systems is the ability written notes for immediate care. Never- markers after implementation of a to implement computer-based clinical theless, these notes are still important for commercial EMR). Florez-Arango also decision support. However, utilization of documentation, and Hripcsak’s study reports increased adherence to guidelines two main subsets of electronic health should motivate more research in this by healthcare workers using CDSs record systems, electronic medical area. on mobile devices in a controlled experi- records systems (EMRs) and personal Developing new ways of documenting mental setting (see page 131). El-Kareh, health records systems (PHRs), is still oral communications and evaluating the on the other hand, describes and discusses very heterogeneous across institutions balance between clinical usefulness and a case in which such improvements could and individuals. EMRs are not always legal documentation in electronic health not be realized (see page 160). Further- perceived as advantageous from the record systems will require multi-centric more, CDSs are not easy to design, standpoint of individual clinicians, with studies conducted by multidisciplinary implement, and maintain. Wright paper records still being the main form of teams of researchers, since ease of use and discusses the difficulties in maintaining documentation in several institutions. decreased time in documentation are very knowledge bases for CDSs and how the PHRs are still not well integrated into important factors in EMR adoption. governance structure in different institu- EMRs and their adoption by patients is Related to this topic, Rosenbloom discusses tionsisorganized to addressthisissue not widespread. tradeoffs between structured and narrative (see page 187). Moreover, Liu evaluated In this issue, we include articles that text entry in EMRs (seepage181). Aziz methods for evaluating clinical informa- focus on how electronic health records are briefly presents personal sensors that can tion systems (see page 173 and accom- being used and how clinical decision augment health data collection in the panying editorial by Lehmann on page support is making an impact on clinical home environment (see page 156). Also 110). care. Do describes the results of a pilot related to usability of EMRs are the articles Lastly, trained professionals are by Sykes on clinician attitudes related to study on PHR usage and users’ percep- needed to design, implement, and evaluate tions (see page 118). The results are very EMR implementation in an Emergency electronic health records systems and encouraging, showing that concerns about Department (see page 125), by Pearce on CDSs. Kampov-Polevoi surveyed training privacy are not an impediment for use, whether computers intrude on the rela- programs and confirmed that electronic and that patients perceive benefits in tionship between physicians and patients health records and computer-based CDSs using PHRs that are not tethered to (see page 138), and by Vest on factors that are core components of biomedical and a particular healthcare system. However, motivate health information exchange (see health informatics curricula in the US (see more research and further studies in this page 143). page 195). area are needed. Use of an electronic health record We hope that this issue of JAMIA will From the clinician’s perspective, system is the first step toward computer- communicate to clinicians, researchers, Hripcsak reports on whether and how based clinical decision support systems healthcare administrators, and many notes from an EMR are utilized by (CDSs). Different outcomes for CDSs other decision makers the relevant, new, members of the clinical team (see page are reported in this issue. Positive and actionable information related to 112). Clinicians spent an average of results in real clinical settings are usage and usefulness of electronic health 54 min/day authoring and 21 min/day reported by Were (seepage150 on record systems and CDSs. J Am Med Inform Assoc March 2011 Vol 18 No 2 109

Journal

Journal of the American Medical Informatics AssociationOxford University Press

Published: Mar 1, 2011

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