ELECTRONIC HEALTH RECORDS Your health care provider may be moving from paper records to electronic health records (EHRs) or may be using EHRs already. The content, form, and style of referral letters influences the referral process [5, 16, 59–61]. www.hcinnovationgroup.com is using a security service for protection against online attacks. Specialists may also want to speak directly to referring providers if there is any doubt about a referral’s appropriateness or urgency, even when PCPs and specialists share access to the patient’s record. Electronic systems provide an excellent opportunity to create, maintain, and disseminate the use of standardized templates [64, 65]. What measures do you take to ensure privacy and security of patient health Qual Health Care. Bernstam EV, Hersh WR, Sim I, Eichmann D, Silverstein JC, Smith JW, Becich MJ: Unintended consequences of health information technology: a need for biomedical informatics. The service requires full cookie support in order to view this website. 2008, 15: 729-736. allow them to schedule and cancel appointments, select providers, ask questions). Br J Gen Pract. 2009, 17: 255-260. Nevertheless, as with other types of electronic communication in healthcare, it is important not to overload providers with excessive notifications about status updates [93]. 2009, 169: 1024-1026. If used appropriately, electronic referrals have the potential to enhance provider workflow by automating certain tedious or repetitive steps where manual effort is unnecessary. Hardeep Singh. J Telemed Telecare. 10.1377/hlthaff.2010.0155. 10.1007/s11606-010-1402-1. Proc AMIA Annu Fall Symp. 2009, 17: 201-207. Other considerations. Inform Prim Care. Electronic health records have transformed modern medicine, giving doctors and nurses better data to guide care, supporting enhanced patient safety through new automated tools, and creating more efficient processes by connecting different health systems. 2011, 2: 546-564. 10.1016/S1386-5056(99)00027-1. Tan GB, Cohen H, Taylor FC, Gabbay J: Referral of patients to an anticoagulant clinic: implications for better management. 2009, 24: 614-619. Callahan CW, Malone F, Estroff D, Person DA: Effectiveness of an Internet-based store-and-forward telemedicine system for pediatric subspecialty consultation. Clinical alerts; Data analytics; Electronic prescribing; Integrated billing; Patient portals; Security protocols 2010, 29: 647-654. However, the interface of electronic referral templates should be designed to avoid excessive constraints that can limit providers’ ability to explain and document relevant findings [4]. Within institutions, lack of clear policies and procedures can result in unnecessary heterogeneity across referral processes causing inefficiencies in patient care, provider dissatisfaction, and potential for delays in diagnosis and treatment [9]. BMC Medical Informatics and Decision Making, https://www.federalregister.gov/articles/2012/03/07/2012-04443/electronic-health-record-incentive-program--stage-2-medicare-and-medicaid-programs, http://www.biomedcentral.com/1472-6947/12/107/prepub. 2004, 11: 104-112. Google Scholar. Davis K, Schoenbaum SC, Audet A-M: A 2020 vision of patient-centered primary care. Mountford J, Davie C: Toward an Outcomes-Based Health Care System. With clinicians’ widespread use of electronic health records (EHRs), dissatisfaction with EHRs has become more apparent and the usability of this technology has been identified as a major challenge.1–3 Many EHRs are not prospectively designed, developed, and implemented to support the cognitive needs of clinicians, resulting in stress, frustration, reduced efficiency, and patient safety hazards.4,5 In an effort to promote EHR usability, the Office of the Nationa… However, referral communication related to both provider-provider and provider-patient interactions [3, 11–14] is prone to breakdown [2, 14–22]. Organizations must continuously monitor and evaluate the usability, performance, benefits, and drawbacks of their electronic referral systems [40]. Nutting PA, Miller WL, Crabtree BF, Jaen CR, Stewart EE, Stange KC: Initial lessons from the first national demonstration project on practice transformation to a patient-centered medical home. Kalogriopoulos NA, Baran J, Nimunkar AJ, Webster JG: Electronic medical record systems for developing countries: review. Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ: Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. Service agreements between PCPs and specialists that include referral guidelines can facilitate provider access to specialists and reduce inappropriate referrals by suggesting evidence-based pathways or alternatives to referrals [70–73]. Esquivel, A., Sittig, D.F., Murphy, D.R. Arch Intern Med. 2009, 18: 59-62. Decisions made in the design, regulation, implementation, and individual use of … CAS  AE participated in conceptualization and drafting of the manuscript. However, the design, customization, and use of electronic health records (EHRs) by doctors, nurses, and other clinicians can also lead to inefficiencies or workflow challeng… 2009, 2009: 1730-1733. JAMA. www.hcinnovationgroup.com is using a security service for protection against online attacks. 2005, 2005: 959-, PubMed Central  [https://www.federalregister.gov/articles/2012/03/07/2012-04443/electronic-health-record-incentive-program--stage-2-medicare-and-medicaid-programs]. 2009, 302: 1111-1113. systems. Determination of the Effectiveness Of Electronic Health Records To Document Pressure Ulcers Dan Li Denise M. Korniewicz Adoption of the electronic health record (EHR) has increased in the United States to approximately 17% and continues to rise steadily (Poon et al., 2010). Google Scholar. 2009, 17-21. 2005, 74: 779-10.1016/j.ijmedinf.2005.04.007. Arch Intern Med. They should also incorporate details about the tools available to providers to monitor timeliness and effectiveness of electronic referral communication [19]. Qual Saf Health Care. 2008, 8: 14-, Gandhi TK, Keating NL, Ditmore M, Kiernan D, Johnson R, Burdick E, Hamann C: Advances in Patient Safety: New Directions and Alternative Approaches. Google Scholar. Epstein RM: Communication between primary care physicians and consultants. from beginning to end. “A Comparison of Students’ Perception on Effectiveness of Integrating Electronic Health Records Into Simulation in Undergraduate Nursing Program.” Presented at the 25th International Nursing Research Congress, Hong Kong, July 26, 2014. PubMed Central  1983, 143: 1753-1755. PubMed  2010. Sittig DF, Ash JS, Zhang J, Osheroff JA, Shabot MM: Lessons from “Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system.”. 2009, 169: 1062-1068. “Telehealth” refers to the use of electronic services to support a broad range of remote services, such as patient care, education, and monitoring. Arch Intern Med. 10.1007/BF02596304. You will be redirected once the validation is complete. EHRs allow providers to use information more effectively to improve the quality and eficiency of your care, but 10.1159/000053328. EHRs can facilitate real-time phone conversations or internet-based audio-, video-, or text-based conferencing interactions by providing easily accessible and updated contact information for specialists and PCPs (or their clinics) on the referral interface [54–57]. 1988, 297: 437-438. 1987, 2: 93-98. Elcuaz Viscarret R, Beorlegui Aznárez J, Cortés Ugalde F, Goñi Murillo C, Espelosín Betelu G, Sagredo Arce T: Analysis of emergency referrals to dermatology. 2008, 13: 228-233. Background and Significance. 1993, 13: 6-17. 10.1007/s11606-010-1501-z. Public Inspection: Medicare and Medicaid Programs: Electronic Health Record Incentive Program -Stage 2. 2006, 13: 121-126. https://doi.org/10.1186/1472-6947-12-107, DOI: https://doi.org/10.1186/1472-6947-12-107. Arch Pediatr Adolesc Med. 10.1001/archinte.1983.00350090131022. People comprise one of the key dimensions of the socio-technical model. Mitus AJ: The birth of InterQual: evidence-based decision support criteria that helped change healthcare. Forti S, Galvagni M, Galligioni E, Eccher C: A real time teleconsultation system for sharing an oncologic web-based electronic medical record. Blumenthal D: Launching HITECH. Singh H, Petersen LA, Daci K, Collins C, Khan M, El-Serag HB: Reducing referral delays in colorectal cancer diagnosis: is it about how you ask?. (Prepared by Eastern Maine Medical Center under Grant No. Gibbons MC: Use of Health Information Technology among Racial and Ethnic Underserved Communities. Stud Health Technol Inform. statement and In some cases, such as when a referral is urgent, real-time communication may be required to expedite the referral process [52, 53]. PubMed Central  J Am Med Inform Assoc. They also create an expectation of continuous process improvement based on measurement of clinical quality and outcomes [38]. 10.1007/s11606-009-0955-3. J Gen Intern Med. 1997, USA: Oxford University Press. While EHRs are valuable delivery vehicles for referral guidelines, effective outcomes will only be achieved by collaborative efforts between referring providers and specialists to facilitate communication, decrease referral denials, and clarify referral expectations. 2000, 15: 626-631. 1 In the United States, the progress has been slow in spite of the 2004 executive order that set the goal of universal EHRs by 2014. 2011, 171: 65-67. Finally, they should allow the flexibility to account for different levels of urgency and importance across clinical problems and specialties, permitting providers to expedite a particular referral when necessary [40, 52, 96, 97]. The case of an oncology clinic. As with any health information technology-related process, referral communication should be monitored and revised, as needed, [43] to ensure that all stakeholders’ needs are being met in a safe and efficient manner. J Gen Intern Med. Electronic health records (EHRs) have been adopted by multiple countries in the past two decades. Schumacher RM, Lowry SZ: NIST Guide to the Processes Approach for Improving the Usability of Electronic Health Records. Referral policies and procedures should provide detailed guidance with respect to every facet of the use of technology supporting the referral process. 2010, 304: 2407-2408. California Privacy Statement, PubMed  JAMA. Edited by: Henriksen K, Battles JB, Keyes MA, Grady ML Rockville MD. Munro C: Referral of Patients-A Neglected Aspect of Medical Practice. DRM participated in conceptualization and drafting of the manuscript. 1971, 6: 39-48. Cochrane Database Syst Rev. 2002, 57: 110-112. (to seek advice, to request a technical procedure, and to request co-management of the patient), electronic systems should give providers the option to expand and elaborate on their selection when needed [68]. J Biomed Inform. 09(10)-0091-2-EF. Kim-Hwang JE, Chen AH, Bell DS, Guzman D, Yee HF, Kushel MB: Evaluating electronic referrals for specialty care at a public hospital. Referring providers should receive timely feedback from the specialists upon denial, approval, or completion of each referral [9]. Introduction. Dr. Singh is supported by an NIH K23 career development award (K23CA125585), the VA National Center of Patient Safety, and in part by the Houston VA HSR&D Center for Excellence (HFP90-020). Int J Med Inform. Google Scholar. This process is automatic. CAS  CAS  Google Scholar. 2009, 7: 254-260. The system should also provide relevant reports that will provide relevant data for compliance of the MU of the EHR system. www.hcinnovationgroup.com is using a security service for protection against online attacks. This flexibility should be specified in any policies and procedures governing outpatient referrals [58]. Prof Case Manag. Electronic health records (EHR) that are usable have the potential to improve patient care, which is why the National Institute of Standards and Technology (NIST) has outlined formal procedures for evaluating the usability of EHR systems. Cite this article. We also categorized recommendations according to the dimensions of the socio-technical model with which they are most closely related (Table 1). BMC Medical Informatics and Decision Making Electronic health records are increasingly being used to facilitate referral communication in the outpatient setting. 10.1001/archinternmed.2011.327. security risks of electronic v. paper health records? CM protocol results in decreased denials. 10.1136/bmj.325.7360.370. JAMA. 10.1136/jamia.2009.000927. Additionally, third parties involved in regulatory, reimbursement, or quality improvement activities (e.g., regional extension centers, payers, or medical societies) can facilitate the development and dissemination of a basic set of guidelines as a starting point. 2009, 16: 20-22. Electronic referrals should harness the benefits of EHR data and use it to automatically pre-populate fields in the referral template whenever possible (e.g., demographic data, current medication list, recent relevant laboratory test results [18]). Fam Pract. 1990, 40: 445-449. Whether paper or electronic, the system must meet certain standards to be considered a … The number of doctors and nurses who owned a tablet jumped to 86% in 2013 up from 78% in 2012. 1997, 47: 107-108. Evaluating and Selecting an EHR System The number, variety and complexity of EHR systems in today’s market has made the search for a system complex and sometimes intimidating for many physician practices. Thus, this national cross-sectional study was conducted to evaluate electronic health records, from the perspective of nurses, by examining how they use the records, their opinions on the quality of the systems, and their overall levels of satisfaction with electronic health records. Article  2009, 24: 710-715. Making electronic referral communication effective requires a multifaceted “socio-technical” approach. Electronic health records can facilitate these consultations through more flexible and efficient electronic consultation processes that minimize delays (i.e., “information-only” referrals that do not require a patient visit). Carrell D, Ralston JD: Variation in Adoption Rates of a Patient Web Portal with a Shared Medical Record by Age, Gender, and Morbidity Level. 2009, 15: e71-87. J Am Med Inform Assoc. This resource includes a checklist to help electronic health record (EHR) users make the cultural shift to … 10.1001/archinte.167.3.271. Several studies have shown increased provider satisfaction and more consistent and timely feedback from specialists when referral templates are used to standardize referral communication [16, 62, 63]. The author(s) declare that they have no competing interests. Dr. Sittig is supported in part by a SHARP contract from the Office of the National Coordinator for Health Information Technology (ONC #10510592). 2012, 172: 100-10.1001/archinternmed.2011.1290. PubMed Google Scholar. Newton J, Eccles M, Hutchinson A: Communication between general practitioners and consultants: what should their letters contain?. Chen AH, Yee HF: Improving primary care-specialty care communication: lessons from San Francisco’s safety net: comment on “Referral and consultation communication between primary care and specialist physicians. Terms and Conditions, General practitioner-specialist referral process. 2003, 42: 297-301. 10.1001/jama.2010.1751. This will enable patients to have secure and timely access to relevant information such as referral status updates, reminders to increase patient compliance, and tools to facilitate communication with their physician. J Am Med Inform Assoc. 10.1007/s11606-009-0971-3. 10.1258/jtt.2009.003016. Lucassen A, Watson E, Harcourt J, Rose P, O’Grady J: Guidelines for referral to a regional genetics service: GPs respond by referring more appropriate cases. 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