Download PDF
CC BY 4.0 · ACI open 2019; 03(01): e26-e36
DOI: 10.1055/s-0039-1688804
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Design and Implementation of a Novel Electronic Health Record Tool to Enhance the Care of Individuals with Cystic Fibrosis: The Cystic Fibrosis Note Template

David M. Leander
1   Dartmouth Geisel School of Medicine, Hanover, New Hampshire, United States
,
Alex H. Gifford
2   Department of Pulmonary and Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
,
John N. Mecchella
3   Department of Rheumatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
,
Kathryn A. Sabadosa
4   The Dartmouth Institute for Health Policy and Practice, Lebanon, New Hampshire, United States
,
Aricca Van Citters
4   The Dartmouth Institute for Health Policy and Practice, Lebanon, New Hampshire, United States
,
Jennifer A. Snide
5   Analytics Institute, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
,
Eugene C. Nelson
4   The Dartmouth Institute for Health Policy and Practice, Lebanon, New Hampshire, United States
› Author Affiliations Funding This work was supported by a grant (#72313) from the Robert Wood Johnson Foundation (Nelson, P.I.) and a grant (#OCONNO04Q10) from the Cystic Fibrosis Foundation (Gifford, P.I.).
Further Information

Publication History

20 February 2018

03 April 2019

Publication Date:
21 May 2019 (online)

   Permissions and Reprints

Abstract

Cystic fibrosis (CF) is a genetic disease in which dysfunction of a single protein channel leads to organ damage, resulting in chronic health problems and premature death. In the United States, medical care of individuals living with CF is delivered by care centers accredited and subsidized by the CF Foundation. CF outcomes have improved significantly through the use of collaborative networks, registry data, and research. CF clinicians are perpetually challenged to assimilate and act upon large quantities of data generated by the care of these individuals. CF Foundation accreditation also requires care centers to enter patient-level data from clinical encounters into the CF Foundation Patient Registry (CFFPR). Commercially available electronic health record systems often lack tools with sufficient context specificity and ease of use to facilitate productive interactions between clinicians and patients. We describe a CF-specific NoteWriter template built and implemented in Epic, which captures discrete data and simultaneously generates clinical documentation during ambulatory encounters. Unlike other examples of note templates in CF, this project involves SmartData Elements (SDEs) using the NoteWriter tool in Epic, which enables data to be entered in the exact way in which the CFFPR captures data. By conducting a pre-/poststudy of its use in our health system, we found that the template can expedite note completion when clinicians have adequate time to become familiar with the tool. We anticipate that the NoteWriter template will become a vehicle for delivering standardized, structured patient data to the CFFPR.

Keywords

electronic health record - coproduction - note template - cystic fibrosis

Protection of Human and Animal Subjects

The patient identities of the participants in this study were deidentified in accordance with DHMC policy. No animal subjects were used in this study.


 

  • References

  • 1 Gold M, McLAUGHLIN C. Assessing HITECH implementation and lessons: 5 years later. Milbank Q 2016; 94 (03) 654-687
    CrossrefPubMedGoogle Scholar
  • 2 Adler-Milstein J, Jha AK. HITECH act drove large gains in hospital electronic health record adoption. Health Aff (Millwood) 2017; 36 (08) 1416-1422
    CrossrefPubMedGoogle Scholar
  • 3 Rittenhouse DR, Ramsay PP, Casalino LP, McClellan S, Kandel ZK, Shortell SM. Increased health information technology adoption and use among small primary care physician practices over time: a national cohort study. Ann Fam Med 2017; 15 (01) 56-62
    CrossrefPubMedGoogle Scholar
  • 4 Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med 2010; 363 (06) 501-504
    CrossrefPubMedGoogle Scholar
  • 5 Tai-Seale M, Olson CW, Li J. , et al. Electronic health record logs indicate that physicians split time evenly between seeing patients and desktop medicine. Health Aff (Millwood) 2017; 36 (04) 655-662
    CrossrefPubMedGoogle Scholar
  • 6 Sinsky C, Colligan L, Li L. , et al. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med 2016; 165 (11) 753-760
    CrossrefPubMedGoogle Scholar
  • 7 Young RA, Burge SK, Kumar KA, Wilson JM, Ortiz DF. A time-motion study of primary care physicians' work in the electronic health record era. Fam Med 2018; 50 (02) 91-99
    CrossrefPubMedGoogle Scholar
  • 8 Shanafelt TD, Dyrbye LN, Sinsky C. , et al. Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction. Mayo Clin Proc 2016; 91 (07) 836-848
    CrossrefPubMedGoogle Scholar
  • 9 Arndt BG, Beasley JW, Watkinson MD. , et al. Tethered to the EHR: primary care physician workload assessment using EHR event log data and time-motion observations. Ann Fam Med 2017; 15 (05) 419-426
    CrossrefPubMedGoogle Scholar
  • 10 O'Malley AS, Draper K, Gourevitch R, Cross DA, Scholle SH. Electronic health records and support for primary care teamwork. J Am Med Inform Assoc 2015; 22 (02) 426-434
    CrossrefPubMedGoogle Scholar
  • 11 Hassey A, Gerrett D, Wilson A. A survey of validity and utility of electronic patient records in a general practice. BMJ 2001; 322 (7299): 1401-1405
    CrossrefPubMedGoogle Scholar
  • 12 Bae J, Encinosa WE. National estimates of the impact of electronic health records on the workload of primary care physicians. BMC Health Serv Res 2016; 16: 172
    CrossrefPubMedGoogle Scholar
  • 13 Lo HG, Newmark LP, Yoon C. , et al. Electronic health records in specialty care: a time-motion study. J Am Med Inform Assoc 2007; 14 (05) 609-615
    CrossrefPubMedGoogle Scholar
  • 14 Grinspan ZM, Banerjee S, Kaushal R, Kern LM. Physician specialty and variations in adoption of electronic health records. Appl Clin Inform 2013; 4 (02) 225-240
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Slotwiner DJ. Electronic health records and cardiac implantable electronic devices: new paradigms and efficiencies. J Interv Card Electrophysiol 2016; 47 (01) 29-35
    CrossrefPubMedGoogle Scholar
  • 16 Boland MV, Chiang MF, Lim MC. , et al; American Academy of Ophthalmology Medical Information Technology Committee. Adoption of electronic health records and preparations for demonstrating meaningful use: an American Academy of Ophthalmology survey. Ophthalmology 2013; 120 (08) 1702-1710
    CrossrefPubMedGoogle Scholar
  • 17 Redd TK, Doberne JW, Lattin D. , et al. Variability in electronic health record usage and perceptions among specialty vs. primary care physicians. AMIA Annu Symp Proc 2015; 2015: 2053-2062
    PubMedGoogle Scholar
  • 18 Resneck Jr JS, VanBeek M. What dermatology still needs to create meaningful patient outcome measurements. JAMA Dermatol 2015; 151 (04) 371-372
    CrossrefPubMedGoogle Scholar
  • 19 Peckham D, Etherington C, White H. , et al. The development and deployment of integrated electronic care records in a regional adult and paediatric cystic fibrosis unit. J Cyst Fibros 2014; 13 (06) 681-686
    CrossrefPubMedGoogle Scholar
  • 20 Schechter MS, Fink AK, Homa K, Goss CH. The Cystic Fibrosis Foundation Patient Registry as a tool for use in quality improvement. BMJ Qual Saf 2014; 23 (Suppl. 01) i9-i14
    CrossrefPubMedGoogle Scholar
  • 21 Knapp EA, Fink AK, Goss CH. , et al. The Cystic Fibrosis Foundation Patient Registry. Design and methods of a national observational disease registry. Ann Am Thorac Soc 2016; 13 (07) 1173-1179
    CrossrefPubMedGoogle Scholar
  • 22 Wu AW, Kharrazi H, Boulware LE, Snyder CF. Measure once, cut twice--adding patient-reported outcome measures to the electronic health record for comparative effectiveness research. J Clin Epidemiol 2013; 66 (8, Suppl): S12-S20
    CrossrefPubMedGoogle Scholar
  • 23 Delbanco T, Walker J, Bell SK. , et al. Inviting patients to read their doctors' notes: a quasi-experimental study and a look ahead. Ann Intern Med 2012; 157 (07) 461-470
    CrossrefPubMedGoogle Scholar
  • 24 Newman ED, Lerch V, Billet J, Berger A, Kirchner HL. Improving the quality of care of patients with rheumatic disease using patient-centric electronic redesign software. Arthritis Care Res (Hoboken) 2015; 67 (04) 546-553
    PubMedGoogle Scholar
  • 25 Aakre C, Franco PM, Ferreyra M, Kitson J, Li M, Herasevich V. Prospective validation of a near real-time EHR-integrated automated SOFA score calculator. Int J Med Inform 2017; 103: 1-6
    CrossrefPubMedGoogle Scholar
  • 26 Banerjee D, Thompson C, Kell C. , et al. An informatics-based approach to reducing heart failure all-cause readmissions: the Stanford heart failure dashboard. J Am Med Inform Assoc 2017; 24 (03) 550-555
    CrossrefPubMedGoogle Scholar
  • 27 Azad TD, Kalani M, Wolf T. , et al. Building an electronic health record integrated quality of life outcomes registry for spine surgery. J Neurosurg Spine 2016; 24 (01) 176-185
    CrossrefPubMedGoogle Scholar
  • 28 Batalden M, Batalden P, Margolis P. , et al. Coproduction of healthcare service. BMJ Qual Saf 2016; 25 (07) 509-517
    CrossrefPubMedGoogle Scholar
  • 29 Sabadosa KA, Batalden PB. The interdependent roles of patients, families and professionals in cystic fibrosis: a system for the coproduction of healthcare and its improvement. BMJ Qual Saf 2014; 23 (Suppl. 01) i90-i94
    CrossrefPubMedGoogle Scholar
  • 30 Kaplan HC, Thakkar SN, Burns L. , et al. Protocol of a pilot study of technology-enabled coproduction in pediatric chronic illness care. JMIR Res Protoc 2017; 6 (04) e71
    CrossrefPubMedGoogle Scholar
  • 31 CF Health Check: Building Partnerships Through Shared Information. Available at: https://www.cff.org/Care/Clinician-Resources/Network-News/March-2018/CF-Health-Check-Building-Partnerships-Through-Shared-Information/ . Accessed June 28, 2018
    PubMed
  • 32 Success With Therapies Research Consortium. Available at: https://www.cff.org/Research/Researcher-Resources/Success-With-Therapies-Research-Consortium/ . Accessed June 28, 2018
    PubMed
  • 33 Flume PA, O'Sullivan BP, Robinson KA. , et al; Cystic Fibrosis Foundation, Pulmonary Therapies Committee. Cystic fibrosis pulmonary guidelines: chronic medications for maintenance of lung health. Am J Respir Crit Care Med 2007; 176 (10) 957-969
    CrossrefPubMedGoogle Scholar
  • 34 Stallings VA, Stark LJ, Robinson KA, Feranchak AP, Quinton H. ; Clinical Practice Guidelines on Growth and Nutrition Subcommittee; Ad Hoc Working Group. Evidence-based practice recommendations for nutrition-related management of children and adults with cystic fibrosis and pancreatic insufficiency: results of a systematic review. J Am Diet Assoc 2008; 108 (05) 832-839
    CrossrefPubMedGoogle Scholar
  • 35 Schwarzenberg SJ, Hempstead SE, McDonald CM. , et al. Enteral tube feeding for individuals with cystic fibrosis: Cystic Fibrosis Foundation evidence-informed guidelines. J Cyst Fibros 2016; 15 (06) 724-735
    CrossrefPubMedGoogle Scholar
  • 36 Schnipper JL, Linder JA, Palchuk MB. , et al. “Smart Forms” in an Electronic Medical Record: documentation-based clinical decision support to improve disease management. J Am Med Inform Assoc 2008; 15 (04) 513-523
    CrossrefPubMedGoogle Scholar
  • 37 Marsolo K, Margolis PA, Forrest CB, Colletti RB, Hutton JJ. A digital architecture for a network-based learning health system: integrating chronic care management, quality improvement, and research. EGEMS (Wash DC) 2015; 3 (01) 1168
    PubMedGoogle Scholar
  • 38 Kannan V, Fish JS, Mutz JM. , et al. Rapid development of specialty population registries and quality measures from electronic health record data*. An Agile framework. Methods Inf Med 2017; 56 (99) e74-e83
    Article in Thieme ConnectPubMedGoogle Scholar
  • 39 Retsch-Bogart GZ, Quittner AL, Gibson RL. , et al. Efficacy and safety of inhaled aztreonam lysine for airway pseudomonas in cystic fibrosis. Chest 2009; 135 (05) 1223-1232
    CrossrefPubMedGoogle Scholar
  • 40 Ramsey BW, Pepe MS, Quan JM. , et al; Cystic Fibrosis Inhaled Tobramycin Study Group. Intermittent administration of inhaled tobramycin in patients with cystic fibrosis. N Engl J Med 1999; 340 (01) 23-30
    CrossrefPubMedGoogle Scholar
  • 41 Moran A, Brunzell C, Cohen RC. , et al; CFRD Guidelines Committee. Clinical care guidelines for cystic fibrosis-related diabetes: a position statement of the American Diabetes Association and a clinical practice guideline of the Cystic Fibrosis Foundation, endorsed by the Pediatric Endocrine Society. Diabetes Care 2010; 33 (12) 2697-2708
    CrossrefPubMedGoogle Scholar
  • 42 Debray D, Kelly D, Houwen R, Strandvik B, Colombo C. Best practice guidance for the diagnosis and management of cystic fibrosis-associated liver disease. J Cyst Fibros 2011; 10 (Suppl. 02) S29-S36
    PubMedGoogle Scholar
  • 43 Schneiderman-Walker J, Pollock SL, Corey M. , et al. A randomized controlled trial of a 3-year home exercise program in cystic fibrosis. J Pediatr 2000; 136 (03) 304-310
    CrossrefPubMedGoogle Scholar
  • 44 Orenstein DM, Franklin BA, Doershuk CF. , et al. Exercise conditioning and cardiopulmonary fitness in cystic fibrosis. The effects of a three-month supervised running program. Chest 1981; 80 (04) 392-398
    CrossrefPubMedGoogle Scholar
  • 45 Selvadurai HC, Blimkie CJ, Meyers N, Mellis CM, Cooper PJ, Van Asperen PP. Randomized controlled study of in-hospital exercise training programs in children with cystic fibrosis. Pediatr Pulmonol 2002; 33 (03) 194-200
    CrossrefPubMedGoogle Scholar
  • 46 Wilschanski M, Novak I. The cystic fibrosis of exocrine pancreas. Cold Spring Harb Perspect Med 2013; 3 (05) a009746
    PubMedGoogle Scholar
  • 47 Rayner RJ. Fat-soluble vitamins in cystic fibrosis. Proc Nutr Soc 1992; 51 (02) 245-250
    CrossrefPubMedGoogle Scholar
  • 48 Wenghofer EF, Williams AP, Klass DJ. Factors affecting physician performance: implications for performance improvement and governance. Healthc Policy 2009; 5 (02) e141-e160
    PubMedGoogle Scholar
  • 49 Miller RH, Sim I. Physicians' use of electronic medical records: barriers and solutions. Health Aff (Millwood) 2004; 23 (02) 116-126
    CrossrefPubMedGoogle Scholar
  • 50 Kaufman DR, Sheehan B, Stetson P. , et al. Natural language processing-enabled and conventional data capture methods for input to electronic health records: a comparative usability study. JMIR Med Inform 2016; 4 (04) e35
    CrossrefPubMedGoogle Scholar
  • 51 Barnado A, Casey C, Carroll RJ, Wheless L, Denny JC, Crofford LJ. Developing electronic health record algorithms that accurately identify patients with systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2017; 69 (05) 687-693
    PubMedGoogle Scholar
  • 52 Jensen K, Soguero-Ruiz C, Oyvind Mikalsen K. , et al. Analysis of free text in electronic health records for identification of cancer patient trajectories. Sci Rep 2017; 7: 46226
    CrossrefPubMedGoogle Scholar
  • 53 Ellsworth MA, Dziadzko M, O'Horo JC, Farrell AM, Zhang J, Herasevich V. An appraisal of published usability evaluations of electronic health records via systematic review. J Am Med Inform Assoc 2017; 24 (01) 218-226
    CrossrefPubMedGoogle Scholar
  • 54 Terry AL, Brown JB, Bestard Denomme L, Thind A, Stewart M. Perspectives on electronic medical record implementation after two years of use in primary health care practice. J Am Board Fam Med 2012; 25 (04) 522-527
    CrossrefPubMedGoogle Scholar
  • 55 Al Alawi S, Al Dhaheri A, Al Baloushi D, Al Dhaheri M, Prinsloo EA. Physician user satisfaction with an electronic medical records system in primary healthcare centres in Al Ain: a qualitative study. BMJ Open 2014; 4 (11) e005569
    CrossrefPubMedGoogle Scholar
  • 56 Boonstra A, Broekhuis M. Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Serv Res 2010; 10: 231
    CrossrefPubMedGoogle Scholar
  • 57 Wang MD, Khanna R, Najafi N. Characterizing the source of text in electronic health record progress notes. JAMA Intern Med 2017; 177 (08) 1212-1213
    CrossrefPubMedGoogle Scholar
  • 58 Eakin MN, Bilderback A, Boyle MP, Mogayzel PJ, Riekert KA. Longitudinal association between medication adherence and lung health in people with cystic fibrosis. J Cyst Fibros 2011; 10 (04) 258-264
    CrossrefPubMedGoogle Scholar
  • 59 Eakin MN, Riekert KA. The impact of medication adherence on lung health outcomes in cystic fibrosis. Curr Opin Pulm Med 2013; 19 (06) 687-691
    CrossrefPubMedGoogle Scholar
  • 60 Monte AA, Anderson P, Hoppe JA, Weinshilboum RM, Vasiliou V, Heard KJ. Accuracy of electronic medical record medication reconciliation in emergency department patients. J Emerg Med 2015; 49 (01) 78-84
    CrossrefPubMedGoogle Scholar
  • 61 Wagner MM, Hogan WR. The accuracy of medication data in an outpatient electronic medical record. J Am Med Inform Assoc 1996; 3 (03) 234-244
    CrossrefPubMedGoogle Scholar
  • 62 Hogan WR, Wagner MM. Accuracy of data in computer-based patient records. J Am Med Inform Assoc 1997; 4 (05) 342-355
    CrossrefPubMedGoogle Scholar