Clinically excellent use of the electronic health record: Review

Research output: Contribution to journalReview article

Abstract

Background: The transition to the electronic health record (EHR) has brought forth a rapid cultural shift in the world of medicine, presenting both new challenges as well as opportunities for improving health care. As clinicians work to adapt to the changes imposed by the EHR, identification of best practices around the clinically excellent use of the EHR is needed. Objective: Using the domains of clinical excellence previously defined by the Johns Hopkins Miller Coulson Academy of Clinical Excellence, this review aims to identify best practices around the clinically excellent use of the EHR. Methods: The authors searched the PubMed database, using keywords related to clinical excellence domains and the EHR, to capture the English-language, peer-reviewed literature published between January 1, 2000, and August 2, 2016. One author independently reviewed each article and extracted relevant data. Results: The search identified 606 titles, with the majority (393/606, 64.9%) in the domain of communication and interpersonal skills. Twenty-eight of the 606 (4.6%) titles were excluded from full-text review, primarily due to lack of availability of the full-text article. The remaining 578 full-text articles reviewed were related to clinical excellence generally (3/578, 0.5%) or the specific domains of communication and interpersonal skills (380/578, 65.7%), diagnostic acumen (31/578, 5.4%), skillful negotiation of the health care system (4/578, 0.7%), scholarly approach to clinical practice (41/578, 7.1%), professionalism and humanism (2/578, 0.4%), knowledge (97/578, 16.8%), and passion for clinical medicine (20/578, 3.5%). Conclusions: Results suggest that as familiarity and expertise are developed, clinicians are leveraging the EHR to provide clinically excellent care. Best practices identified included deliberate physical configuration of the clinical space to involve sharing the screen with patients and limiting EHR use during difficult and emotional topics. Promising horizons for the EHR include the ability to augment participation in pragmatic trials, identify adverse drug effects, correlate genomic data to clinical outcomes, and follow data-driven guidelines. Clinician and patient satisfaction with the EHR has generally improved with time, and hopefully continued clinician, and patient input will lead to a system that satisfies all.

Original languageEnglish (US)
Article numbere10426
JournalJournal of Medical Internet Research
Volume20
Issue number10
DOIs
StatePublished - Oct 1 2018

Fingerprint

Electronic Health Records
Practice Guidelines
Pragmatic Clinical Trials
Communication
Humanism
Delivery of Health Care
Aptitude
Clinical Medicine
Negotiating
Patient Satisfaction
PubMed
Language
Medicine
Databases
Guidelines

Keywords

  • Clinical excellence
  • Communication skills
  • Electronic health record
  • Electronic medical record
  • Humanism
  • Interpersonal skills
  • Patient care
  • Professionalism
  • Technology

ASJC Scopus subject areas

  • Health Informatics

Cite this

Clinically excellent use of the electronic health record : Review. / Wolfe, Leah; Chisolm, Margaret S; Bohsali, Fuad.

In: Journal of Medical Internet Research, Vol. 20, No. 10, e10426, 01.10.2018.

Research output: Contribution to journalReview article

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abstract = "Background: The transition to the electronic health record (EHR) has brought forth a rapid cultural shift in the world of medicine, presenting both new challenges as well as opportunities for improving health care. As clinicians work to adapt to the changes imposed by the EHR, identification of best practices around the clinically excellent use of the EHR is needed. Objective: Using the domains of clinical excellence previously defined by the Johns Hopkins Miller Coulson Academy of Clinical Excellence, this review aims to identify best practices around the clinically excellent use of the EHR. Methods: The authors searched the PubMed database, using keywords related to clinical excellence domains and the EHR, to capture the English-language, peer-reviewed literature published between January 1, 2000, and August 2, 2016. One author independently reviewed each article and extracted relevant data. Results: The search identified 606 titles, with the majority (393/606, 64.9{\%}) in the domain of communication and interpersonal skills. Twenty-eight of the 606 (4.6{\%}) titles were excluded from full-text review, primarily due to lack of availability of the full-text article. The remaining 578 full-text articles reviewed were related to clinical excellence generally (3/578, 0.5{\%}) or the specific domains of communication and interpersonal skills (380/578, 65.7{\%}), diagnostic acumen (31/578, 5.4{\%}), skillful negotiation of the health care system (4/578, 0.7{\%}), scholarly approach to clinical practice (41/578, 7.1{\%}), professionalism and humanism (2/578, 0.4{\%}), knowledge (97/578, 16.8{\%}), and passion for clinical medicine (20/578, 3.5{\%}). Conclusions: Results suggest that as familiarity and expertise are developed, clinicians are leveraging the EHR to provide clinically excellent care. Best practices identified included deliberate physical configuration of the clinical space to involve sharing the screen with patients and limiting EHR use during difficult and emotional topics. Promising horizons for the EHR include the ability to augment participation in pragmatic trials, identify adverse drug effects, correlate genomic data to clinical outcomes, and follow data-driven guidelines. Clinician and patient satisfaction with the EHR has generally improved with time, and hopefully continued clinician, and patient input will lead to a system that satisfies all.",
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