Important study: Hospitals have a digital learning curve. Deaths go UP 0.11% during adoption of a new EMR function, but wind up going DOWN 0.21% per year for each key function. I still hate my computer. But this is a striking effect.https://reut.rs/2LFxe7O
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Here is a structured critical review of the impacts of implementing CPOE in a large tertiary care ED.http://thesgem.com/2016/07/sgem159-computer-games-computer-provider-order-entry-cpoe/ …
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i can help answer (2): this type of data you would expect outliers / unequal variance, which would result in non-parametric analysis, which means medians not means reported. wouldn't worry about normality with the # of patients they had. this new studies lends credibility to (5)
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Appreciate you joining the convo. A question i have is about the allocation of resources. The govt gave $30 billion for this initiative. What impact would that have had on mortality if it was spent on social determinants of health or things proven to save lives (ex vaccination)?
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that's a really good question. $30b is a very small amount for health care in U.S., so I'm not sure. i've only helped admit a few pts w/ paper charts during med school, & it was the worst experience... combing through 100-200 pages of chicken scratch.
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i could see EDs actually not as dependent/needing EHRs compared to inpatient service. EM is a shotgun approach to medicine, inpatient services much more granularity for management (at least in my experience, YMMV). EDs also high cost care anyway, so i'm not sure! :/
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I agree EMRs may be better suited to other environments than the ED. At what cost to the therapeutic relationship? Do all these thing they measure and tract really make a patient important difference. The longer I practice the more I value the human interaction.
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Not sure. iCOMPARE trial secondary outcome showed ~ 63-68% of day more or less on EHR ("indirect pt care")! EHR notes too bloated w/non-vital info. we need patient-oriented EHR, convey only essential info, while mitigating potential for malpractice lawyers to pounce on it?
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Signal to noise ratio is very important. I’m probably not as worried about the legal issues as a
#Canadian. - 4 more replies
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I imagine safety could be even better if EMR users were retrained at intervals not just the hour or so you get when you start. Our department has a physician
@SF_Red in this role and it’s been great@UCDavisEM. Helping prevent burnout tooThanks. Twitter will use this to make your timeline better. UndoUndo
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It did not show EMRs “do save lives”. It showed an association with mortality. Increased in early phase and decrease after implementation. Many limitations to this type of study design. No causation demonstrated. Even authors used the word “suggest”. Be skeptical.
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Great. Now we can submit this poll to an audience of EHR users. Which of the following does the EHR save?
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Article is not Open Access. If Abstract is representative there is no consideration of cost. IT projects notoriously expensive to procure & maintain. What wld be the effect if same resources invested in additional staff? i.e. to enable continuity of carer?
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Deterministic design makes unsubstantiated claims for linear causality. What else changed? Where’s the nuanced narrative?
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yes, increasingly evident that such studies tend to lack the capacity to account for the nuance of work-as-done. so many resources dedicated to studying work-as-imagined. while work-as-done is abandoned to an evidence free zone...
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Important considerations for hospitals undergoing digital transformations: enhanced EHR can help reduce patient deaths and improve safety cc:
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excellent article! curious, why is the EHR adoption slow and not standardized?
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The EMR allows for faster transfer of information which can be useful, however the ones that can most benefit from the utilization of that information are often over worked, treading an uphill battle. Nurses on the frontline do not have time to read the EMR
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