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Article ; Online: The Health Information Technology special issue: tackling new challenges to digital transformation.

Holmgren, A Jay

2023 Volume 29, Issue 1, Page(s) 17–18

Abstract: A letter from the guest editor highlights the potential for the findings in this special issue help us take steps toward realizing the promise of information technology in health care. ...

Abstract	A letter from the guest editor highlights the potential for the findings in this special issue help us take steps toward realizing the promise of information technology in health care.
MeSH term(s)	Humans ; Delivery of Health Care ; Medical Informatics ; Information Technology
Language	English
Publishing date	2023-01-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2035781-3
ISSN	1936-2692 ; 1088-0224 ; 1096-1860
ISSN (online)	1936-2692
ISSN	1088-0224 ; 1096-1860
DOI	10.37765/ajmc.2023.89299
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Article ; Online: COVID exacerbated the gender disparity in physician electronic health record inbox burden.

Rotenstein, Lisa / Jay Holmgren, A

Journal of the American Medical Informatics Association : JAMIA

2023 Volume 30, Issue 10, Page(s) 1720–1724

Abstract: The COVID-19 pandemic was associated with significant changes to the delivery of ambulatory care, including a dramatic increase in patient messages to physicians. While asynchronous messaging is a valuable communication modality for patients, a greater ... ...

Abstract	The COVID-19 pandemic was associated with significant changes to the delivery of ambulatory care, including a dramatic increase in patient messages to physicians. While asynchronous messaging is a valuable communication modality for patients, a greater volume of patient messages is associated with burnout and decreased well-being for physicians. Given that women physicians experienced greater electronic health record (EHR) burden and received more patient messages pre-pandemic, there is concern that COVID may have exacerbated this disparity. Using EHR audit log data of ambulatory physicians at an academic medical center, we used a difference-in-differences framework to evaluate the impact of the pandemic on patient message volume and compare differences between men and women physicians. We found patient message volume increased post-COVID for all physicians, and women physicians saw an additional increase compared to men. Our results contribute to the growing evidence of different communication expectations for women physicians that contribute to the gender disparity in EHR burden.
Language	English
Publishing date	2023-07-12
Publishing country	England
Document type	Journal Article
ZDB-ID	1205156-1
ISSN	1527-974X ; 1067-5027
ISSN (online)	1527-974X
ISSN	1067-5027
DOI	10.1093/jamia/ocad141
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Article ; Online: Trends in US Hospital Electronic Health Record Vendor Market Concentration, 2012-2021.

Holmgren, A Jay / Apathy, Nate C

Journal of general internal medicine

2022 Volume 38, Issue 7, Page(s) 1765–1767

MeSH term(s)	Humans ; Electronic Health Records ; Commerce ; Economic Competition ; Hospitals
Language	English
Publishing date	2022-11-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	639008-0
ISSN	1525-1497 ; 0884-8734
ISSN (online)	1525-1497
ISSN	0884-8734
DOI	10.1007/s11606-022-07917-3
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Article ; Online: National Trends in Billing Secure Messages as E-Visits.

Holmgren, A Jay / Oakes, Allison H / Miller, Austin / Adler-Milstein, Julia / Mehrotra, Ateev

JAMA

2024 Volume 331, Issue 6, Page(s) 526–529

Language	English
Publishing date	2024-01-10
Publishing country	United States
Document type	Letter
ZDB-ID	2958-0
ISSN	1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
ISSN (online)	1538-3598
ISSN	0254-9077 ; 0002-9955 ; 0098-7484
DOI	10.1001/jama.2023.26584
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Article ; Online: Assessing the impact of patient access to clinical notes on clinician EHR documentation.

Holmgren, A Jay / Apathy, Nate C

Journal of the American Medical Informatics Association : JAMIA

2022 Volume 29, Issue 10, Page(s) 1733–1736

Abstract: Recent policy changes have required health care delivery organizations provide patients electronic access to their clinical notes free of charge. There is concern that this could have an unintended consequence of increased electronic health record (EHR) ... ...

Abstract	Recent policy changes have required health care delivery organizations provide patients electronic access to their clinical notes free of charge. There is concern that this could have an unintended consequence of increased electronic health record (EHR) work as clinicians may feel the need to adapt their documentation practices in light of their notes being accessible to patients, potentially exacerbating EHR-induced clinician burnout. Using a national, longitudinal data set consisting of all ambulatory care physicians and advance practice providers using an Epic Systems EHR, we used an interrupted time-series analysis to evaluate the immediate impact of the policy change on clinician note length and time spent documenting in the EHR. We found no evidence of a change in note length or time spent writing notes following the implementation of the policy, suggesting patient access to clinical notes did not increase documentation workload for clinicians.
MeSH term(s)	Burnout, Professional ; Documentation ; Electronic Health Records ; Humans ; Physicians ; Workload
Language	English
Publishing date	2022-07-13
Publishing country	England
Document type	Journal Article
ZDB-ID	1205156-1
ISSN	1527-974X ; 1067-5027
ISSN (online)	1527-974X
ISSN	1067-5027
DOI	10.1093/jamia/ocac120
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Article ; Online: The role of organizations in shaping physician use of electronic health records.

Cross, Dori A / Holmgren, A Jay / Apathy, Nate C

Health services research

2023 Volume 59, Issue 1, Page(s) e14203

Abstract: Objective: The aim of the study was to (1) characterize organizational differences in primary care physicians' electronic health record (EHR) behavior; (2) assess within-organization consistency in EHR behaviors; and (3) identify whether organizational ... ...

Abstract	Objective: The aim of the study was to (1) characterize organizational differences in primary care physicians' electronic health record (EHR) behavior; (2) assess within-organization consistency in EHR behaviors; and (3) identify whether organizational consistency is associated with physician-level efficiency. Data sources: EHR metadata capturing averaged weekly measures of EHR time and documentation composition from 75,124 US primary care physicians across 299 organizations between September 2020 and May 2021 were taken. EHR time measures include active time in orders, chart review, notes, messaging, time spent outside of scheduled hours, and total EHR time. Documentation composition measures include note length and percentage use of templated text or copy/paste. Efficiency is measured as the percent of visits with same-day note completion. Study design: All analyses are cross-sectional. Across-organization differences in EHR use and documentation composition are presented via 90th-to-10th percentile ratios of means and SDs. Multilevel modeling with post-estimation variance partitioning assesses the extent of an organizational signature-the proportion of variation in our measures attributable to organizations (versus specialty and individual behaviors). We measured organizational internal consistency for each measure via organization-level SD, which we grouped into quartiles for regression. Association between internally consistent (i.e., low SD) organizational EHR use and physician-level efficiency was assessed with multi-variable OLS models. Data collection: Extraction from Epic's Signal platform used for measuring provider EHR efficiency. Principal findings: EHR time per visit for physicians at a 90th percentile organization is 1.94 times the average EHR time at a 10th percentile organization. There is little evidence, on average, of an organizational signature. However, physicians in organizations with high internal consistency in EHR use demonstrate increased efficiency. Physicians in organizations with the highest internal consistency (top quartile) have a 3.77 percentage point higher same-day visit closure rates compared with peers in bottom quartile organizations (95% confidence interval: 0.0142-0.0612). Conclusions: Results suggest unrealized opportunities for organizations and policymakers to support consistency in how physicians engage in EHR-supported work.
MeSH term(s)	Humans ; Electronic Health Records ; Cross-Sectional Studies ; Physicians ; Medicine ; Documentation
Language	English
Publishing date	2023-07-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	410435-3
ISSN	1475-6773 ; 0017-9124
ISSN (online)	1475-6773
ISSN	0017-9124
DOI	10.1111/1475-6773.14203
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Article ; Online: Association of Hospital Public Quality Reporting With Electronic Health Record Medication Safety Performance.

Holmgren, A Jay / Bates, David W

JAMA network open

2021 Volume 4, Issue 9, Page(s) e2125173

Abstract: Importance: Despite billions spent in public investment, electronic health records (EHRs) have not delivered on the promise of large quality and safety improvement. Simultaneously, there is debate on whether public quality reporting is a useful tool to ... ...

Abstract	Importance: Despite billions spent in public investment, electronic health records (EHRs) have not delivered on the promise of large quality and safety improvement. Simultaneously, there is debate on whether public quality reporting is a useful tool to incentivize quality improvement. Objective: To evaluate whether publicly reported feedback was associated with hospital improvement in an evaluation of medication-related clinical decision support (CDS) safety performance. Design, settings, and participants: This nonrandomized controlled trial included US hospitals that participated in the Computerized Provider Order Entry (CPOE) Evaluation Tool in the Leapfrog Hospital Survey, a national quality reporting program that evaluates safety performance of hospital CDS using simulated orders and patients, in 2017 to 2018. A sharp regression discontinuity design was used to identify the association of receiving negative feedback with hospital performance improvement in the subsequent year. Data were analyzed from January through September 2020. Exposures: Publicly reported quality feedback. Main outcomes and measures: The main outcome was improvement from 2017 to 2018 on the Leapfrog CPOE Evaluation Tool, using regression discontinuity model estimates of the association of receiving negative publicly reported feedback with quality improvement. Results: A total of 1183 hospitals were included, with a mean (SD) CPOE score of 59.3% (16.3%) at baseline. Hospitals receiving negative feedback improved 8.44 (95% CI, 0.09 to 16.80) percentage points more in the subsequent year compared with hospitals that received positive feedback on the same evaluation. This change was driven by differences in improvement in basic CDS capabilities (β = 8.71 [95%CI, 1.67 to 18.73]) rather than advanced CDS (β = 6.15 [95% CI, -9.11 to 26.83]). Conclusions and relevance: In this nonrandomized controlled trial, publicly reported feedback was associated with quality improvement, suggesting targeted measurement and reporting of process quality may be an effective policy lever to encourage improvement in specific areas. Clinical decision support represents an important tool in ensuring patient safety and decreasing adverse drug events, especially for complex patients and those with multiple chronic conditions who often receive several different drugs during an episode of care.
MeSH term(s)	Electronic Health Records/statistics & numerical data ; Health Care Surveys ; Hospitals/standards ; Hospitals/statistics & numerical data ; Humans ; Medical Order Entry Systems/statistics & numerical data ; Public Reporting of Healthcare Data ; Quality Improvement/statistics & numerical data ; Regression Analysis ; Safety Management/standards ; Safety Management/statistics & numerical data ; United States
Language	English
Publishing date	2021-09-01
Publishing country	United States
Document type	Clinical Trial ; Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2021.25173
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Article ; Online: Ctrl-C: a cross-sectional study of the electronic health record usage patterns of US oncology clinicians.

Sinha, Sumi / Holmgren, A Jay / Hong, Julian C / Rotenstein, Lisa S

JNCI cancer spectrum

2023 Volume 7, Issue 5

Abstract: Despite some positive impact, the use of electronic health records (EHRs) has been associated with negative effects, such as emotional exhaustion. We sought to compare EHR use patterns for oncology vs nononcology medical specialists. In this cross- ... ...

Abstract	Despite some positive impact, the use of electronic health records (EHRs) has been associated with negative effects, such as emotional exhaustion. We sought to compare EHR use patterns for oncology vs nononcology medical specialists. In this cross-sectional study, we employed EHR usage data for 349 ambulatory health-care systems nationwide collected from the vendor Epic from January to August 2019. We compared note composition, message volume, and time in the EHR system for oncology vs nononcology clinicians. Compared with nononcology medical specialists, oncologists had a statistically significantly greater percentage of notes derived from Copy and Paste functions but less SmartPhrase use. They received more total EHR messages per day than other medical specialists, with a higher proportion of results and system-generated messages. Our results point to priorities for enhancing EHR systems to meet the needs of oncology clinicians, particularly as related to facilitating the complex documentation, results, and therapy involved in oncology care.
Language	English
Publishing date	2023-09-09
Publishing country	England
Document type	Journal Article
ISSN	2515-5091
ISSN (online)	2515-5091
DOI	10.1093/jncics/pkad066
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Article ; Online: Health Information Exchange: Understanding the Policy Landscape and Future of Data Interoperability.

Holmgren, A Jay / Esdar, Moritz / Hüsers, Jens / Coutinho-Almeida, João

Yearbook of medical informatics

2023 Volume 32, Issue 1, Page(s) 184–194

Abstract: Objectives: To review recent literature on health information exchange (HIE), focusing on the policy approach of five case study nations: the United States of America, the United Kingdom, Germany, Israel, and Portugal, as well as synthesize lessons ... ...

Abstract	Objectives: To review recent literature on health information exchange (HIE), focusing on the policy approach of five case study nations: the United States of America, the United Kingdom, Germany, Israel, and Portugal, as well as synthesize lessons learned across countries and provide recommendations for future research. Methods: A narrative review of each nation's HIE policy frameworks, current state, and future HIE strategy. Results: Key themes that emerged include the importance of both central decision-making as well as local innovation, the multiple and complex challenges of broad HIE adoption, and the varying role of HIE across different national health system structures. Conclusion: HIE is an increasingly important capability and policy priority as electronic health record (EHR) adoption becomes more common and care delivery is increasingly digitized. While all five case study nations have adopted some level of HIE, there are significant differences across their level of data sharing infrastructure and maturity, and each nation took a different policy approach. While identifying generalizable strategies across disparate international systems is challenging, there are several common themes across successful HIE policy frameworks, such as the importance of central government prioritization of data sharing. Finally, we make several recommendations for future research to expand the breadth and depth of the literature on HIE and guide future decision-making by policymakers and practitioners.
MeSH term(s)	United States ; Health Information Exchange ; Electronic Health Records ; Information Dissemination ; Policy ; Germany
Language	English
Publishing date	2023-07-06
Publishing country	Germany
Document type	Review ; Journal Article
ZDB-ID	2251229-9
ISSN	2364-0502 ; 2364-0502
ISSN (online)	2364-0502
ISSN	2364-0502
DOI	10.1055/s-0043-1768719
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Article: Management Opportunities and Challenges After Achieving Widespread Health System Digitization.

Cross, Dori A / Adler-Milstein, Julia / Holmgren, A Jay

Advances in health care management

2022 Volume 21

Abstract: The adoption of electronic health records (EHRs) and digitization of health data over the past decade is ushering in the next generation of digital health tools that leverage artificial intelligence (AI) to improve varied aspects of health system ... ...

Abstract	The adoption of electronic health records (EHRs) and digitization of health data over the past decade is ushering in the next generation of digital health tools that leverage artificial intelligence (AI) to improve varied aspects of health system performance. The decade ahead is therefore shaping up to be one in which digital health becomes even more at the forefront of health care delivery - demanding the time, attention, and resources of health care leaders and frontline staff, and becoming inextricably linked with all dimensions of health care delivery. In this chapter, we look back and look ahead. There are substantive lessons learned from the first era of large-scale adoption of enterprise EHRs and ongoing challenges that organizations are wrestling with - particularly related to the tension between standardization and flexibility/customization of EHR systems and the processes they support. Managing this tension during efforts to implement and optimize enterprise systems is perhaps the core challenge of the past decade, and one that has impeded consistent realization of value from initial EHR investments. We describe these challenges, how they manifest, and organizational strategies to address them, with a specific focus on alignment with broader value-based care transformation. We then look ahead to the AI wave - the massive number of applications of AI to health care delivery, the expected benefits, the risks and challenges, and approaches that health systems can consider to realize the benefits while avoiding the risks.
MeSH term(s)	Humans ; Artificial Intelligence ; Electronic Health Records ; Government Programs ; Medical Assistance ; Delivery of Health Care
Language	English
Publishing date	2022-11-28
Publishing country	Netherlands
Document type	Journal Article
ISSN	1474-8231
ISSN	1474-8231
DOI	10.1108/S1474-823120220000021004
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