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Journal ArticleDOI

Electronic Health Records in Ambulatory Care — A National Survey of Physicians

TL;DR: Physicians who use electronic health records believe such systems improve the quality of care and are generally satisfied with the systems, but as of early 2008, electronic systems had been adopted by only a small minority of U.S. physicians, who may differ from later adopters of these systems.
Abstract: BACKGROUND Electronic health records have the potential to improve the delivery of health care services. However, in the United States, physicians have been slow to adopt such systems. This study assessed physicians' adoption of outpatient electronic health records, their satisfaction with such systems, the perceived effect of the systems on the quality of care, and the perceived barriers to adoption. METHODS In late 2007 and early 2008, we conducted a national survey of 2758 physicians, which represented a response rate of 62%. Using a definition for electronic health records that was based on expert consensus, we determined the proportion of physicians who were using such records in an office setting and the relationship between adoption and the characteristics of individual physicians and their practices. RESULTS Four percent of physicians reported having an extensive, fully functional electronic-records system, and 13% reported having a basic system. In multivariate analyses, primary care physicians and those practicing in large groups, in hospitals or medical centers, and in the western region of the United States were more likely to use electronic health records. Physicians reported positive effects of these systems on several dimensions of quality of care and high levels of satisfaction. Financial barriers were viewed as having the greatest effect on decisions about the adoption of electronic health records. CONCLUSIONS Physicians who use electronic health records believe such systems improve the quality of care and are generally satisfied with the systems. However, as of early 2008, electronic systems had been adopted by only a small minority of U.S. physicians, who may differ from later adopters of these systems.

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Citations
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Journal Article
TL;DR: The number of visits considered emergent or urgent (15.9 million) did not change significantly from 2005, nor did the number of patients arriving by ambulance (18.4 million).
Abstract: Objective—This report presents the most current (2006) nationally representative data on visits to hospital emergency departments (ED) in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Methods—Data are from the 2006 National Hospital Ambulatory Medical

1,860 citations

Book
19 Mar 2013
TL;DR: Clinical Practice Guidelines The authors Can Trust shows how clinical practice guidelines can enhance clinician and patient decision-making by translating complex scientific research findings into recommendations for clinical practice that are relevant to the individual patient encounter, instead of implementing a one size fits all approach to patient care.
Abstract: Advances in medical, biomedical and health services research have reduced the level of uncertainty in clinical practice. Clinical practice guidelines (CPGs) complement this progress by establishing standards of care backed by strong scientific evidence. CPGs are statements that include recommendations intended to optimize patient care. These statements are informed by a systematic review of evidence and an assessment of the benefits and costs of alternative care options. Clinical Practice Guidelines We Can Trust examines the current state of clinical practice guidelines and how they can be improved to enhance healthcare quality and patient outcomes. Clinical practice guidelines now are ubiquitous in our healthcare system. The Guidelines International Network (GIN) database currently lists more than 3,700 guidelines from 39 countries. Developing guidelines presents a number of challenges including lack of transparent methodological practices, difficulty reconciling conflicting guidelines, and conflicts of interest. Clinical Practice Guidelines We Can Trust explores questions surrounding the quality of CPG development processes and the establishment of standards. It proposes eight standards for developing trustworthy clinical practice guidelines emphasizing transparency; management of conflict of interest; systematic review--guideline development intersection; establishing evidence foundations for and rating strength of guideline recommendations; articulation of recommendations; external review; and updating. Clinical Practice Guidelines We Can Trust shows how clinical practice guidelines can enhance clinician and patient decision-making by translating complex scientific research findings into recommendations for clinical practice that are relevant to the individual patient encounter, instead of implementing a one size fits all approach to patient care. This book contains information directly related to the work of the Agency for Healthcare Research and Quality (AHRQ), as well as various Congressional staff and policymakers. It is a vital resource for medical specialty societies, disease advocacy groups, health professionals, private and international organizations that develop or use clinical practice guidelines, consumers, clinicians, and payers.

1,527 citations

Journal ArticleDOI
TL;DR: The very low levels of adoption of electronic health records in U.S. hospitals suggest that policymakers face substantial obstacles to the achievement of health care performance goals that depend on health information technology.
Abstract: We surveyed all acute care hospitals that are members of the American Hospital Association for the presence of specific electronic-record functionalities. Using a definition of electronic health records based on expert consensus, we determined the proportion of hospitals that had such systems in their clinical areas. We also examined the relationship of adoption of electronic health records to specific hospital characteristics and factors that were reported to be barriers to or facilitators of adoption. Results On the basis of responses from 63.1% of hospitals surveyed, only 1.5% of U.S. hospitals have a comprehensive electronic-records system (i.e., present in all clinical units), and an additional 7.6% have a basic system (i.e., present in at least one clinical unit). Computerized provider-order entry for medications has been implemented in only 17% of hospitals. Larger hospitals, those located in urban areas, and teaching hospitals were more likely to have electronic-records systems. Respondents cited capital requirements and high maintenance costs as the primary barriers to implementation, although hospitals with electronic-records systems were less likely to cite these barriers than hospitals without such systems. Conclusions The very low levels of adoption of electronic health records in U.S. hospitals suggest that policymakers face substantial obstacles to the achievement of health care performance goals that depend on health information technology. A policy strategy focused on financial support, interoperability, and training of technical support staff may be necessary to spur adoption of electronic-records systems in U.S. hospitals.

1,326 citations

Journal ArticleDOI
TL;DR: Recent breakthroughs in AI technologies and their biomedical applications are outlined, the challenges for further progress in medical AI systems are identified, and the economic, legal and social implications of AI in healthcare are summarized.
Abstract: Artificial intelligence (AI) is gradually changing medical practice. With recent progress in digitized data acquisition, machine learning and computing infrastructure, AI applications are expanding into areas that were previously thought to be only the province of human experts. In this Review Article, we outline recent breakthroughs in AI technologies and their biomedical applications, identify the challenges for further progress in medical AI systems, and summarize the economic, legal and social implications of AI in healthcare.

1,315 citations

Journal ArticleDOI
TL;DR: The recent literature on health information technology was reviewed to determine its effect on outcomes, including quality, efficiency, and provider satisfaction, and found that the benefits of the technology are beginning to emerge in smaller practices and organizations, as well as in large organizations that were early adopters.
Abstract: An unprecedented federal effort is under way to boost the adoption of electronic health records and spur innovation in health care delivery. We reviewed the recent literature on health information technology to determine its effect on outcomes, including quality, efficiency, and provider satisfaction. We found that 92 percent of the recent articles on health information technology reached conclusions that were positive overall. We also found that the benefits of the technology are beginning to emerge in smaller practices and organizations, as well as in large organizations that were early adopters. However, dissatisfaction with electronic health records among some providers remains a problem and a barrier to achieving the potential of health information technology. These realities highlight the need for studies that document the challenging aspects of implementing health information technology more specifically and how these challenges might be addressed.

1,135 citations

References
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Journal ArticleDOI
TL;DR: This work systematically review evidence on the costs and benefits associated with use of health information technology and to identify gaps in the literature in order to provide organizations, policymakers, clinicians, and consumers an understanding of the effect ofhealth information technology on clinical care.
Abstract: This review found that 4 benchmark institutions have done most of the published research on the effects of the electronic health record on medical care. The research shows that electronic health re...

3,053 citations

17 Aug 2003
TL;DR: The provided compressed bitstreams were uncompressed using provided software and the resulting sequences were compared to the original ones in terms of PSNR and it seems that last frames from some cameras give significantly worse PSNR than the rest of frames.
Abstract: The provided compressed bitstreams were uncompressed using provided software and the resulting sequences were compared to the original ones in terms of PSNR. Additionally, the sequence Ballroom was compressed using the provided software. Resulting bitstreams were processed as the ones provided by Sejong/ETRI to verify the whole chain of coding and decoding. The results obtained at Poznań University of Technology are included in the accompanying Excel file. They are the same as the ones provided by Sejong/ETRI, except for sequences Race1 and Flamenco2 results. The results for them are slightly worse than the ones presented by Sejong/ETRI. The difference is less than 0.05 dB. It seems that last frames from some cameras give significantly worse PSNR (about 10dB less than the rest of frames). The cause of this difference is unknown.

2,092 citations

01 Jan 2005
TL;DR: It is concluded that effective EMR implementation and networking could eventually save more than $81 billion annually--by improving health care efficiency and safety--and that HIT-enabled prevention and management of chronic disease could eventually double those savings while increasing health and other social benefits.

1,545 citations

Journal ArticleDOI
TL;DR: In this paper, the potential health and financial benefits of health information technology (HIT) are examined and the potential savings and costs of widespread adoption of electronic medical record (EMR) systems, models important health and safety benefits, and concludes that effective EMR implementation and networking could eventually save more than $81 billion annually.
Abstract: To broadly examine the potential health and financial benefits of health information technology (HIT), this paper compares health care with the use of IT in other industries. It estimates potential savings and costs of widespread adoption of electronic medical record (EMR) systems, models important health and safety benefits, and concludes that effective EMR implementation and networking could eventually save more than $81 billion annually—by improving health care efficiency and safety—and that HIT-enabled prevention and management of chronic disease could eventually double those savings while increasing health and other social benefits. However, this is unlikely to be realized without related changes to the health care system.

1,515 citations

Book
12 Aug 1999
TL;DR: Basic Survey Methodology and Statistical Analysis with Survey Data: Cross--Sectional Analyses.
Abstract: Basic Survey Methodology. Statistical Analysis with Survey Data. Sample Weights and Imputation. Additional Issues in Variance Estimation. Cross--Sectional Analyses. Analysis of Longitudinal Surveys. Analyses Using Multiple Surveys. Population--Based Case--Control Studies. Appendices. References. Indexes.

1,167 citations


Additional excerpts

  • ...No. of years since graduation 10 ) 10–19 772 (30) 147,032 (30) 20–29 780 (30) 146,385 (30) ≥30 755 (29) 150,917 (31) Missing data 0 1 (<1)...

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