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Matthew Hartman, James Christian Fleming; Analysis and Modification of the Electronic Health Record to Achieve Evidence-Based Ophthalmic Care. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5063.
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Electronic health records (EHRs) offer an opportunity to customize order sets to be used by ophthalmologists and other health care providers. Order sets can improve the quality of patient care by guiding adherence to evidence-based principals. Given the evolving nature of evidence in medicine, order sets that do not undergo periodic review may contain outdated practices. For this study, we analyzed existing order sets that applied to ophthalmic care in two widely used EHRs at two large local health care systems. These order sets were measured by their adherence to evidence-based practices for the treatment of ophthalmic conditions.
We proposed an evidence-based analysis of ophthalmic order sets to the technology review board at each hospital and obtained approval. We then analyzed existing ophthalmic order sets embedded in two widely used EHRs, EPIC and CERNER, at two tertiary care hospitals in Memphis, TN. Order sets addressing ophthalmic conditions utilized by adult and pediatric emergency rooms as well as post-operative order templates were all targets of the review process. Order sets were reviewed by the ophthalmology department for accuracy of evidence-based care and recommendations for changes were made. Next, we met with the stakeholders, including emergency room physicians and pharmacists to elicit their suggestions for improving the quality and utilization of the order sets. With input gathered from from each stakeholder, updated order sets were created.
During the review process, we noted multiple examples of orders inconsistent with current evidence-based practice and medications that were incorrectly dosed. Of all the orders reviewed (169), ten orders ultimately needed revision or deletion (5.9%). We submitted final drafts of the updated order sets to the hospital’s information technology review board. Following the board’s review process, the new order sets were integrated into the EHR for utilization.
The electronic health record offers great advantages in applying efficient evidence-based medical care. However, a continual analysis of electronic based care is needed to ensure current principals are reflected in these electronic tools. While ophthalmology staff are best equipped to guide regular assessments of the EHR, involving non-ophthalmic health care providers in the review process can generate enthusiasm and willingness to accept changes.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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