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A Framework for Analyzing Data from the Electronic Health Record: Verbal Orders as a Case in Point

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Background: Investment in health care information technology is resulting in a large amount of data electronically captured during patient care. These databases offer the opportunity to implement ongoing monitoring and analysis of processes with important patient care quality and safety implications to an extent that was previously not feasible with paper-based records. Thus, there is a growing need for analytic frameworks to efficiently support both ongoing monitoring and as-needed periodic detailed analyses to explore particular issues. One patient care process—the use of verbal orders—is used as a case in point to present a framework for analyzing data pulled from electronic health record (EHR) and computerized provider order entry systems.

Methods: Longitudinal and cross-sectional data on verbal orders (VOs) were analyzed at University of Missouri Health Care, Columbia, an academic medical center composed of five specialty hospitals and other care settings.

Results: A variety of verbal order analyses were conducted, addressing longitudinal-order patterns, provider-specific patterns, order content and urgency, associated computer-generated alerts, and compliance with institutional policy of a provider cosignature within 48 hours. For example, at the individual prescriber level, in July 2011 there were 14 physicians with 50 or more VOs, with the top 2 having 253 and 233 individual VOs, respectively.

Conclusions: Taking advantage of the automatic data-capture features associated with health information technologies now being incorporated into clinical work flows offers new opportunities to expand the ability to analyze care processes. Health care organizations can now study and statistically model, understand, and improve complex patient care processes.

Document Type: Research Article

Publication date: October 1, 2012

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  • Published monthly, The Joint Commission Journal on Quality and Patient Safety is a peer-reviewed publication dedicated to providing health professionals with the information they need to promote the quality and safety of health care. The Joint Commission Journal on Quality and Patient Safety invites original manuscripts on the development, adaptation, and/or implementation of innovative thinking, strategies, and practices in improving quality and safety in health care. Case studies, program or project reports, reports of new methodologies or new applications of methodologies, research studies on the effectiveness of improvement interventions, and commentaries on issues and practices are all considered.

    David W. Baker, MD, MPH, FACP, executive vice president for the Division of Healthcare Quality Evaluation at The Joint Commission, is the inaugural editor-in-chief of The Joint Commission Journal on Quality and Patient Safety.

    Also known as Joint Commission Journal on Quality Improvement and Joint Commission Journal on Quality and Safety
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