Medicine & Health Sciences

Electronic Health Records
Challenges in Design and Implementation

Editor: Dean F. Sittig, PhD

Electronic Health Records

Published. Available now.
Pub Date: January 2014
Hardback Price: $179.95 US
Hard ISBN: 9781926895932
Pages: 420pp
Binding Type: hardbound

This book provides an overview of the challenges in EHR design and implementation along with an introduction to the “best practices” that have been identified over the past several years. The book is divided into and introduction and several subsections. Each subsection focuses on a key implementation issue or a specific component of an EHR.

The book:
• looks at concerns surrounding EHR use and proposes 8 rights of safe EHR use
• discusses the complex strategic planning that accompanies the systemic organizational changes associated EHR program and highlights key lessons learned
• defines health information-technology errors
• discusses risk management concerns of EHR safety
• details how EHRs may have significant potential to improve patient safety
• defines the 10 commandments of effective clinical decision support
• presents ways to improve the effectiveness of EHR-based referral processes
• discusses the management of laboratory test results
• provides recommendations for bar-code medication administration
• examines different challenges of adopting EHR practices in developing countries
• discusses the ability to create electronic order sets and their use as well as the benefits
• looks at the role of EHR in the referral process
• considers the reporting of abnormal test results and makes recommendations for effective communication policies of abnormal diagnostic test results
• examines bar-coded medication administration for effective inventory contro
• much more

Establishing a safe and effective electronic health record (EHR)-enabled health care delivery system is one of the most important and complex challenges facing clinicians and the healthcare organizations they work for today. Since the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act, a portion of the American Recovery and Reinvestment Act of 2009, the proportion of clinicians using EHRs on a routine basis has increased from less than 20% to over 60%. Concomitantly, the number of certified EHR vendors in the United States has increased from 60 to more than 1700. When coupled together, this influx of healthcare organizations and clinicians that are new to the uses of health information technology, along with a myriad of new EHR vendors stands to create significant new and often unanticipated challenges. This book provides important information to help health care delivery systems navigate these new waters.

Part I: Introduction
Chapter 1. Eight Rights of Safe Electronic Health Record Use

Dean Sittig and Hardeep Singh

Chapter 2. Ten Key Considerations for the Successful Implementation and Adoption of Large-Scale Health Information Technology

Kathrin M. Cresswell, David W. Bates, and Aziz Sheikh
Part II: Identifying and Preventing EHR Safety Concerns

Chapter 3. Defining Health Information Technology-Related Errors: New Developments Since to Err Is Human

Dean Sittig and Hardeep Singh

Chapter 4. A Red-Flag Based Approach to Risk Management of EHR-Related Safety Concerns

Dean Sittig and Hardeep Singh

Chapter 5. Matching Identifiers in Electronic Health Records: Implications for Duplicate Records and Patient Safety

Allison B. McCoy, Adam Wright, Michael G. Kahn, Jason S. Shapiro, Elmer Victor Bernstam, and Dean F. Sittig
Part III: EHR Users and Usability

Chapter 6. Rights and Responsibilities of Users of Electronic Health Records

Dean Sittig and Hardeep Singh

Chapter 7. A Human Factors Guide to Enhance HER Usability of Critical User Interactions When Supporting Pediatric Patient Care (NISTIR 7865)

Svetlana Z. Lowry, Matthew T. Quinn, Mala Ramaiah, David Brick, Emily S. Patterson, Jiajie Zhang. Patricia Abbott, and Michael C. Gibbons

Chapter 8. Sociotechnical Evaluation of the Safety and Effectiveness of Point-of-Care Mobile Computing Devices: A Case Study Conducted in India

Dean F. Sittig, Kanav Kahol, and Hardeep Singh
Part IV: Clinical Decision Support

Chapter 9. Ten Commandments for Effective Clinical Decision Support: Making the Practice of Evidence-Based Medicine a Reality

David W. Bates, Gilad J. Kuperman, Samuel Wang, Tejal Gandhi, Anne Kittler, Lynn Volk, Cynthia Spurr, Ramin Khorasani, Milenko Tanasijevic, and Blackford Middleton

Chapter 10. Improving Clinical Quality Indicators Through Electronic Health Records: It Takes More Than Just a Reminder

Dean F. Sittig, Jonathan M. Teich, Jerome A. Osheroff, and Hardeep Singh

Chapter 11. Recommended Practices for Computerized Clinical Decision Support and Knowledge Management in Community Settings: A Qualitative Study

Joan S. Ash, Dean F. Sittig, Kenneth P. Guappone, Richard H. Dykstra, Joshua Richardson, Adam Wright, James Carpenter, Carmit Mcmullen, Michael Shapiro, Arwen Bunce, and Blackford Middleton
Part III: Prevention and Treatment

Chapter 12. Governance for Clinical Decision Support: Case Studies and Recommended Practices from Leading Institutions

Adam Wright, Dean F Sittig, Joan S. Ash, David W. Bates, Joshua Feblowitz, Greg Fraser, Saverio M. Maviglia, Carmit Mcmullen, W. Paul Nichol, Justine E. Pang, Jack Starmer, and Blackford Middleton

Chapter 13. Use of Order Sets in Inpatient Computerized Provider Order Entry Systems: A Comparative Analysis of Usage Patterns at Seven Sites

Adam Wright, Joshua C. Feblowitz, Justine E. Pang, James D. Carpenter, Michael A. Krall, Blackford Middleton, and Dean F. Sittig
Part IV: Referrals

Chapter 14. Improving the Effectiveness of Electronic Health Record-Based Referral Processes

Adol Esquivel, Dean F. Sittig, Daniel R. Murphy, and Hardeep Singh
Part V: Laboratory Test Result Management

Chapter 15. Eight Recommendations for Policies for Communicating Abnormal Test Results

Hardeep Singh and Meena S. Vij

Chapter 16. Improving Follow-Up of Abnormal Cancer Screens Using Electronic Health Records: Trust But Verify Test Result Communication

Hardeep Singh, Lindsey Wilson, Laura A Petersen, Mona K. Sawhney, Brian Reis, Donna Espadas, and Dean F. Sittig
Part VI: Bar Coded Medication Administration

Chapter 7. Fifteen Best Practice Recommendations for Bar-Code Medication Administration in the Veterans Health Administration

Emily S. Patterson, Michelle L. Rogers, and Marta L. Render
Part VII: Computer-Based Provider Order Entry

Chapter 18. Computerized Provider Order Entry Adoption: Implications for Clinical Workflow

Emily M. Campbell, Kenneth P. Guappone, Dean F. Sittig, Richard H. Dykstra, and Joan S. Ash

Chapter 19. Lessons From "Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System"

Dean F. Sittig, Joan S. Ash, Jiajie Zhang, Jerome A. Osheroff, and M. Michael Shabot


About the Authors / Editors:
Editor: Dean F. Sittig, PhD
Professor, School of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas

Dean F. Sittig, PhD, is a Professor at the School of Biomedical Informatics in The University of Texas Health Science Center at Houston and a member of the UT Houston-Memorial Hermann Center for Healthcare Quality and Safety. Dr. Sittig's research interests center on the design, development, implementation, and evaluation of all aspects of clinical information systems. In addition to Dr. Sittig's work on measuring the impact of clinical information systems on a large scale, he is working to improve our understanding of both the factors that lead to success, as well as, the unintended consequences associated with computer-based clinical decision support and provider order entry systems.

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