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      Emerging Domains for Measuring Health Care Delivery With Electronic Health Record Metadata

      research-article
      Author(s): , MD, MS 1 , , , MS, PhD 2 , , MD 3 , , PhD 4 , , MS, PhD 5 , , MD, PhD 6 , , MD, MS 7 , , MD 8 , , PhD 9 , , MD, MPH, MS 10 , , MD 11 , , MPH, PhD 12 , , MS 13 , , MD 14 , , PhD 15
      Editor(s):
      Other contributor(s): (Reviewer), (Reviewer), (Reviewer), (Reviewer), (Reviewer)
      Publication date (Electronic):
      Journal: Journal of Medical Internet Research
      Publisher: JMIR Publications
      Keywords: metadata, health services research, audit logs, event logs, electronic health record data, health care delivery, patient care, healthcare teams, clinician-patient relationship, cognitive environment

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          Abstract

          This article aims to introduce emerging measurement domains made feasible through the electronic health record (EHR) use metadata, to inform the changing landscape of health care delivery. We reviewed emerging domains in which EHR metadata may be used to measure health care delivery, outlining a framework for evaluating measures based on desirability, feasibility, and viability. We argue that EHR use metadata may be leveraged to develop and operationalize novel measures in the domains of team structure and dynamics, workflows, and cognitive environment to provide a clearer understanding of modern health care delivery. Examples of measures feasible using metadata include quantification of teamwork and collaboration, patient continuity measures, workflow conformity measures, and attention switching. By enabling measures that can be used to inform the next generation of health care delivery, EHR metadata may be used to improve the quality of patient care and support clinician well-being. Careful attention is needed to ensure that these measures are desirable, feasible, and viable.

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          Most cited references84

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          Dissecting racial bias in an algorithm used to manage the health of populations

          Ziad Obermeyer, Brian Powers, Christine Vogeli … (2019)
          Health systems rely on commercial prediction algorithms to identify and help patients with complex health needs. We show that a widely used algorithm, typical of this industry-wide approach and affecting millions of patients, exhibits significant racial bias: At a given risk score, Black patients are considerably sicker than White patients, as evidenced by signs of uncontrolled illnesses. Remedying this disparity would increase the percentage of Black patients receiving additional help from 17.7 to 46.5%. The bias arises because the algorithm predicts health care costs rather than illness, but unequal access to care means that we spend less money caring for Black patients than for White patients. Thus, despite health care cost appearing to be an effective proxy for health by some measures of predictive accuracy, large racial biases arise. We suggest that the choice of convenient, seemingly effective proxies for ground truth can be an important source of algorithmic bias in many contexts.
          Article 0 comments Cited 1197 times – based on 0 reviews     Review now
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            From triple to quadruple aim: care of the patient requires care of the provider.

            Thomas Bodenheimer, Christine Sinsky (2014)
            The Triple Aim-enhancing patient experience, improving population health, and reducing costs-is widely accepted as a compass to optimize health system performance. Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs. Burnout thus imperils the Triple Aim. This article recommends that the Triple Aim be expanded to a Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff.
            Article 0 comments Cited 686 times – based on 0 reviews     Review now
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              Continuity of care with doctors—a matter of life and death? A systematic review of continuity of care and mortality

              Denis Pereira Gray, Kate Sidaway-Lee, Eleanor White … (2018)
              Objective Continuity of care is a long-standing feature of healthcare, especially of general practice. It is associated with increased patient satisfaction, increased take-up of health promotion, greater adherence to medical advice and decreased use of hospital services. This review aims to examine whether there is a relationship between the receipt of continuity of doctor care and mortality. Design Systematic review without meta-analysis. Data sources MEDLINE, Embase and the Web of Science, from 1996 to 2017. Eligibility criteria for selecting studies Peer-reviewed primary research articles, published in English which reported measured continuity of care received by patients from any kind of doctor, in any setting, in any country, related to measured mortality of those patients. Results Of the 726 articles identified in searches, 22 fulfilled the eligibility criteria. The studies were all cohort or cross-sectional and most adjusted for multiple potential confounding factors. These studies came from nine countries with very different cultures and health systems. We found such heterogeneity of continuity and mortality measurement methods and time frames that it was not possible to combine the results of studies. However, 18 (81.8%) high-quality studies reported statistically significant reductions in mortality, with increased continuity of care. 16 of these were with all-cause mortality. Three others showed no association and one demonstrated mixed results. These significant protective effects occurred with both generalist and specialist doctors. Conclusions This first systematic review reveals that increased continuity of care by doctors is associated with lower mortality rates. Although all the evidence is observational, patients across cultural boundaries appear to benefit from continuity of care with both generalist and specialist doctors. Many of these articles called for continuity to be given a higher priority in healthcare planning. Despite substantial, successive, technical advances in medicine, interpersonal factors remain important. PROSPERO registration number CRD42016042091.
              Article 0 comments Cited 274 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Daniel Tawfik:
                ORCID: https://orcid.org/0000-0003-2901-2737
                Department of PediatricsStanford University School of Medicine770 Welch Road, Suite 435Palo Alto, CA, 94304United States1 6507239902dtawfik@stanford.edu
                Journal
                Journal ID (nlm-ta): J Med Internet Res
                Journal ID (iso-abbrev): J Med Internet Res
                Journal ID (publisher-id): JMIR
                Title: Journal of Medical Internet Research
                Publisher: JMIR Publications (Toronto, Canada )
                ISSN (Print): 1439-4456
                ISSN (Electronic): 1438-8871
                Publication date Collection: 2025
                Publication date (Electronic): 6 March 2025
                Volume: 27
                Electronic Location Identifier: e64721
                Affiliations
                [1 ] Department of Pediatrics Stanford University School of Medicine Palo Alto, CA United States
                [2 ] Information School University of Wisconsin-Madison Madison, WI United States
                [3 ] Department of Family Medicine Novant Health Winston-Salem, NC United States
                [4 ] Division of Health Policy and Management University of Minnesota School of Public Health Minneapolis, MN United States
                [5 ] School of Medicine University of California San Francisco San Francisco, CA United States
                [6 ] Department of Anesthesiology Washington University School of Medicine St Louis, MO United States
                [7 ] Department of General Internal Medicine Duke University School of Medicine Durham, NC United States
                [8 ] Department of Emergency Medicine Stanford University School of Medicine Palo Alto, CA United States
                [9 ] Department of Population Health New York University Grossman School of Medicine New York, NY United States
                [10 ] Division of General Internal Medicine Brigham and Women's Hospital Boston, MA United States
                [11 ] Department of Neurology School of Medicine University of Texas Medical Branch Galveston, TX United States
                [12 ] Department of Health Policy and Organization School of Public Health University of Alabama Birmingham, AL United States
                [13 ] Department of Pulmonary, Allergy, and Critical Care Medicine Oregon Health & Science University Portland, OR United States
                [14 ] American Medical Association Chicago, IL United States
                [15 ] Department of Health Policy & Management University of Maryland School of Public Health College Park, MD United States
                Author notes
                Corresponding Author: Daniel Tawfik dtawfik@ 123456stanford.edu
                Author information
                https://orcid.org/0000-0003-2901-2737
                https://orcid.org/0000-0003-2441-3320
                https://orcid.org/0009-0007-3857-7824
                https://orcid.org/0000-0003-3489-3954
                https://orcid.org/0000-0002-7939-6831
                https://orcid.org/0000-0002-4215-605X
                https://orcid.org/0000-0003-3759-9806
                https://orcid.org/0000-0002-5115-649X
                https://orcid.org/0000-0002-9786-2090
                https://orcid.org/0000-0002-4804-3128
                https://orcid.org/0000-0003-4888-2041
                https://orcid.org/0000-0002-7885-0019
                https://orcid.org/0000-0001-6906-2689
                https://orcid.org/0000-0003-1101-5761
                https://orcid.org/0000-0002-7775-8544
                Article
                Publisher ID: v27i1e64721
                DOI: 10.2196/64721
                PMC ID: 11926450
                PubMed ID: 40053814
                SO-VID: dda5b109-1831-4eac-bd6b-e3d804609843
                Copyright © ©Daniel Tawfik, Adam Rule, Aram Alexanian, Dori Cross, A Jay Holmgren, Sunny S Lou, Eugenia McPeek Hinz, Christian Rose, Ratnalekha V N Viswanadham, Rebecca G Mishuris, Jorge M Rodríguez-Fernández, Eric W Ford, Sarah T Florig, Christine A Sinsky, Nate C Apathy. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 06.03.2025.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research (ISSN 1438-8871), is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

                History
                Date received : 24 July 2024
                Date revision requested : 17 December 2024
                Date revision received : 15 January 2025
                Date accepted : 11 February 2025
                Categories
                Subject: Viewpoint
                Subject: Viewpoint

                ScienceOpen disciplines: Medicine
                Keywords: metadata,health services research,audit logs,event logs,electronic health record data,health care delivery,patient care,healthcare teams,clinician-patient relationship,cognitive environment
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: metadata, health services research, audit logs, event logs, electronic health record data, health care delivery, patient care, healthcare teams, clinician-patient relationship, cognitive environment

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