The impact of electronic health records on people with diabetes in three different emergency departments.

OBJECTIVE: To evaluate if electronic health records (EHR) with prior clinical information have observable effects for patients with diabetes presenting to emergency departments (ED), we examined measures of quality and resource utilization. MATERIALS AND METHODS: Retrospective observational studies of patients in three ED (A=5510; B=4393; C=3324) were conducted comparing patients with prior information in the EHR to those without such information. Differences with respect to hospitalization, mortality, length of stay (LOS), and numbers of ED orders for tests, procedures and medications were examined after adjusting for age, gender, race, marital status, comorbidities and for acuity level within each ED. RESULTS: There were 7% fewer laboratory test orders at one ED and 3% fewer at another; fewer diagnostic procedures were performed at two of the sites. At one site 36% fewer medications were ordered. The odds of being hospitalized were lower for EHR patients at one site and hospital LOS was shorter at two of the sites. EHR patient ED LOS was 18% longer at one site. There was no demonstrable impact of an EHR on mortality. Results varied in magnitude and direction by site. DISCUSSION: The pattern of significant results varied by ED but tended to reveal reduced utilization and better outcomes for patients although EHR patients' ED LOS was longer at one site. CONCLUSIONS: The presence of prior information in an EHR may be a valuable adjunct in the care of diabetes patients in ED settings but the pattern of impact may vary from ED to ED.

The impact of electronic health records on care of heart failure patients in the emergency room.

OBJECTIVE: To evaluate if electronic health records (EHR) have observable effects on care outcomes, we examined quality and efficiency measures for patients presenting to emergency departments (ED). MATERIALS AND METHODS: We conducted a retrospective study of 5166 adults with heart failure in three metropolitan EDs. Patients were termed internal if prior information was in the EHR upon ED presentation, otherwise external. Associations of internality with hospitalization, mortality, length of stay (LOS), and numbers of tests, procedures, and medications ordered in the ED were examined after adjusting for age, gender, race, marital status, comorbidities and hospitalization as a proxy for acuity level where appropriate. RESULTS: At two EDs internals had lower odds of mortality if hospitalized (OR 0.55; 95% CI 0.38 to 0.81 and 0.45; 0.21 to 0.96), fewer laboratory tests during the ED visit (-4.6%; -8.9% to -0.1% and -14.0%; -19.5% to -8.1%) as well as fewer medications (-33.6%; -38.4% to -28.4% and -21.3%; -33.2% to -7.3%). At one of these two EDs, internals had lower odds of hospitalization (0.37; 0.22 to 0.60). At the third ED, internal patients only experienced a prolonged ED LOS (32.3%; 6.3% to 64.8%) but no other differences. There was no association with hospital LOS or number of procedures ordered. DISCUSSION: EHR availability was associated with salutary outcomes in two of three ED settings and prolongation of ED LOS at a third, but evidence was mixed and causality remains to be determined. CONCLUSIONS: An EHR may have the potential to be a valuable adjunct in the care of heart failure patients.

Impact of prior clinical information in an EHR on care outcomes of emergency patients.

A patient's prior clinical information available electronically can be helpful during the care process, particularly in the emergency department (ED). The effect of such information on quality and efficiency of ED patient care has not been adequately studied. This study uses secondary data to investigate its impact on surrogate measures of care quality and efficiency among 6,143 congestive heart failure, diabetic, and asthmatic patients in 3 EDs. Results show that in some subgroups of chronic patients in some EDs, availability of prior clinical information in the electronic health records was associated with significantly lower hospitalization rates, shorter inpatient length of stay, and reduction in the numbers of laboratory tests and diagnostic procedures ordered during the ED visit. However, there were also contradictory effects and lack of significance in other subgroups. The effects vary by ED and disease, highlighting the possibility of contextual differences influencing the effects of such clinical information.

Personal digital assistant-enabled report content knowledgebase results in more complete pathology reports and enhances resident learning.

We developed a personal digital assistant-based knowledgebase of surgical pathology report content recommendations and performed an experimental trial to test if the knowledgebase improved report completeness. The 15 experimental group and 13 control group residents were given microscope slides and corresponding reports with the final diagnosis section blanked-out, and were asked to complete the final diagnosis section during 3 study episodes (T0, T1, and T2). At T0 (baseline), experimental group and control group produced reports of comparable completeness. During T1, experimental group was allowed to use the knowledgebase while completing reports. During T1, experimental group produced more complete reports and were better judges of report completeness than control group. At T2, when neither group used the knowledgebase, experimental group's performance was still statistically better than control group's. Use of the knowledgebase did not ensure report completeness, but was associated with more complete reports and more accurate judgments of report completeness, and this performance advantage persisted in the absence of the knowledgebase.

Optimization of laser capture microdissection and RNA amplification for gene expression profiling of prostate cancer.

BACKGROUND: To discover prostate cancer biomarkers, we profiled gene expression in benign and malignant cells laser capture microdissected (LCM) from prostate tissues and metastatic prostatic adenocarcinomas. Here we present methods developed, optimized, and validated to obtain high quality gene expression data. RESULTS: RNase inhibitor was included in solutions used to stain frozen tissue sections for LCM, which improved RNA quality significantly. Quantitative PCR assays, requiring minimal amounts of LCM RNA, were developed to determine RNA quality and concentration. SuperScript II reverse transcriptase was replaced with SuperScript III, and SpeedVac concentration was eliminated to optimize linear amplification. The GeneChip(R) IVT labeling kit was used rather than the Enzo BioArray HighYield RNA transcript labeling kit since side-by-side comparisons indicated high-end signal saturation with the latter. We obtained 72 mug of labeled complementary RNA on average after linear amplification of about 2 ng of total RNA. CONCLUSION: Unsupervised clustering placed 5/5 normal and 2/2 benign prostatic hyperplasia cases in one group, 5/7 Gleason pattern 3 cases in another group, and the remaining 2/7 pattern 3 cases in a third group with 8/8 Gleason pattern 5 cases and 3/3 metastatic prostatic adenocarcinomas. Differential expression of alpha-methylacyl coenzyme A racemase (AMACR) and hepsin was confirmed using quantitative PCR.

Synthesis of a database test bed for evaluating record linkage algorithms.

Record linkage algorithm development is a challenging task requiring large databases representative of a target population. As part of an evaluation of a health information exchange project we had the need for a linking algorithm that would not pass protected health information among organizations. We synthesized a test bed for this purpose employing a randomization process and incorporating conditions that represent the study population and possible error generating conditions in real world electronic record systems.

Linking patients' records across organizations while maintaining anonymity.

In an health information exchange (HIE) project, linking patients' health records across organizations while maintaining appropriate patients anonymity is essential. Anonymous identifiers created from various combinations of personal identifiers using one way encryption function were evaluated for linkage quality between two synthesized databases. Preliminary results show that such anonymous identifiers (IDs) based on date of birth, zip code and last name or first name can link records with high specificity and sensitivity.

Emergency room providers' perceptions of MyChart's My Emergency Data: findings from a focus group study.

My Emergency Data (MED), a one-page clinical abstract, has been implemented as the first phase of a health information exchange (HIE) project across three healthcare systems. This study presents findings from one of a series of focus groups of emergency room (ER) providers' perceptions of MED. Barriers to using MED in the ER are identified and recommendations for improved utilization are provided.

Evaluation of the implementation of an electronic medical record.

University of Minnesota Physicians, the faculty clinical practice organization of the Medical School, is implementing an Electronic Medical Record (EMR). During this process, we anticipated the need for an evaluative study of the implementation to examine process and satisfaction. This was in order to monitor the ability of the physicians to use the EMR effectively. The use of these data to evaluate the implementation and user-acceptance of change of process presents a unique research opportunity. The study of the impact of the EMR implementation on patient care, education, and other issues of academic interest make this research study valuable.

Using Web technologies for implementing testing strategies.

Although the application of Web technologies to laboratory services is relatively new, it is evolving rapidly and presents both promises and challenges to those adopting it for test strategy deployment. Its application can be helpful in disseminating information about a testing strategy once it is formulated, but it's more important potential contribution is in facilitating clinicians' use of the strategy. There is an array of ways Web technologies can be used to facilitate both the initiation of a strategy at the point of order entry and ensuring optimal use of the laboratory results that emanate from a testing strategy. Web technologies present a rich set of tools for those dedicated to enhancing the value of the laboratory's contribution to patient care.