Lindsay Stevens

All Publications

• Electronic health record (EHR) training program identifies a new tool to quantify the EHR time burden and improves providers' perceived control over their workload in the EHR. JAMIA open DiAngi, Y. T., Stevens, L. A., Halpern-Felsher, B., Pageler, N. M., Lee, T. C. 2019; 2 (2): 222–30

  Abstract

  To understand if providers who had additional electronic health record (EHR) training improved their satisfaction, decreased personal EHR-use time, and decreased turnaround time on tasks.This pre-post study with no controls evaluated the impact of a supplemental EHR training program on a group of academic and community practice clinicians that previously had go-live group EHR training and 20 months experience using this EHR on self-reported data, calculated EHR time, and vendor-reported metrics.Providers self-reported significant improvements in their knowledge of efficiency tools in the EHR after training and doubled (significant) their preference list entries (mean pre = 38.1 [65.88], post = 63.5 [90.47], P < .01). Of the 7 EHR satisfaction variables, only 1 self-reported variable significantly improved after training: Control over my workload in the EHR (mean pre = 2.7 [0.96], post = 3.0 [1.04], P < .01). There was no significant decrease in their calculated EHR usage outside of clinic (mean pre = 0.39 [0.77] to post = 0.37 [0.48], P = .73). No significant difference was seen in turnaround time for patient calls (mean pre = 2.3 [2.06] days, post = 1.9 [1.76] days, P = .08) and results (mean before = 4.0 [2.79] days, after = 3.2 [2.33] days, P = .03).Multiple sources of data provide a holistic view of the provider experience in the EHR. This study suggests that individualized EHR training can improve the knowledge of EHR tools and satisfaction with their perceived control of EHR workload, however this did not translate into less Clinician Logged-In Outside Clinic (CLOC) time, a calculated metric, nor quicker turnaround on in box tasks. CLOC time emerged as a potential less-costly surrogate metric for provider satisfaction in EHR work than surveying clinicians. Further study is required to understand the cost-benefit of various interventions to decrease CLOC time.This supplemental EHR training session, 20 months post go-live, where most participants elected to receive 2 or fewer sessions did significantly improve provider satisfaction with perceived control over their workload in the EHR, but it was not effective in decreasing EHR-use time outside of clinic. CLOC time, a calculated metric, could be a practical trackable surrogate for provider satisfaction (inverse correlation) with after-hours time spent in the EHR. Further study into interventions that decrease CLOC time and improve turnaround time to respond to inbox tasks are suggested next steps.

  View details for DOI 10.1093/jamiaopen/ooz003

  View details for PubMedID 31984357

  View details for PubMedCentralID PMC6952029

• The Electronic Health Record The Art and Science of Physician Wellbeing: A Handbook for Physicians and Trainees. Sharp, C., Stevens, L. edited by Trockel, M., Roberts, L. Springer International Publishing. 2019; 1st Ed.: 87–102

  View details for DOI 10.1007/978-3-319-42135-3

• Designing An Individualized EHR Learning Plan For Providers. Applied clinical informatics Stevens, L. A., DiAngi, Y. T., Schremp, J. D., Martorana, M. J., Miller, R. E., Lee, T. C., Pageler, N. M. 2017; 8 (3): 924–35

  Abstract

  Electronic Health Records (EHRs) have been quickly implemented for meaningful use incentives; however these implementations have been associated with provider dissatisfaction and burnout. There are no previously reported instances of a comprehensive EHR educational program designed to engage providers and assist in improving efficiency and understanding of the EHR. Utilizing adult learning theory as a framework, Stanford Children's Health designed a tailored provider efficiency program with various inputs from: (1) provider specific EHR data; (2) provider survey data; and (3) structured observation sessions. This case report outlines the design of this individualized training program including team structure, resource requirements, and early provider response.Stevens LA, DiAngi YT, Schremp JD, Martorana MJ, Miller RE, Lee TC, Pageler NM. Designing An Individualized EHR Learning Plan. Appl Clin Inform 2017; 8:924-935 https://doi.org/10.4338/040054.

  View details for DOI 10.4338/ACI-2017-04-0054

  View details for PubMedID 30027541

• The Value of Clinical Teachers for EMR Implementations and Conversions. Applied clinical informatics Stevens, L. A., Pantaleoni, J. L., Longhurst, C. A. 2015; 6 (1): 75-79

  Abstract

  Effective physician training is an essential aspect of EMR implementation. However, it can be challenging to find instructors who can present the material in a clinically relevant manner. The authors describe a unique physician-training program, utilizing medical students as course instructors. This approach resulted in high learner satisfaction rates and provided significant cost-savings compared to alternative options.

  View details for DOI 10.4338/ACI-2014-09-IE-0075

  View details for PubMedID 25848414

  View details for PubMedCentralID PMC4377561

• Successful Physician Training Program for Large Scale EMR Implementation. Applied clinical informatics Pantaleoni, J. L., Stevens, L. A., Mailes, E. S., Goad, B. A., Longhurst, C. A. 2015; 6 (1): 80-95

  Abstract

  End-user training is an essential element of electronic medical record (EMR) implementation and frequently suffers from minimal institutional investment. In addition, discussion of successful EMR training programs for physicians is limited in the literature. The authors describe a successful physician-training program at Stanford Children's Health as part of a large scale EMR implementation. Evaluations of classroom training, obtained at the conclusion of each class, revealed high physician satisfaction with the program. Free-text comments from learners focused on duration and timing of training, the learning environment, quality of the instructors, and specificity of training to their role or department. Based upon participant feedback and institutional experience, best practice recommendations, including physician engagement, curricular design, and assessment of proficiency and recognition, are suggested for future provider EMR training programs. The authors strongly recommend the creation of coursework to group providers by common workflow.

  View details for DOI 10.4338/ACI-2014-09-CR-0076

  View details for PubMedID 25848415

  View details for PubMedCentralID PMC4377562

• Immunization registries in the EMR Era. Online journal of public health informatics Stevens, L. A., Palma, J. P., Pandher, K. K., Longhurst, C. A. 2013; 5 (2): 211-?

  Abstract

  The CDC established a national objective to create population-based tracking of immunizations through regional and statewide registries nearly 2 decades ago, and these registries have increased coverage rates and reduced duplicate immunizations. With increased adoption of commercial electronic medical records (EMR), some institutions have used unidirectional links to send immunization data to designated registries. However, access to these registries within a vendor EMR has not been previously reported.To develop a visually integrated interface between an EMR and a statewide immunization registry at a previously non-reporting hospital, and to assess subsequent changes in provider use and satisfaction.A group of healthcare providers were surveyed before and after implementation of the new interface. The surveys addressed access of the California Immunization Registry (CAIR), and satisfaction with the availability of immunization information. Information Technology (IT) teams developed a "smart-link" within the electronic patient chart that provides a single-click interface for visual integration of data within the CAIR database.Use of the tool has increased in the months since its initiation, and over 20,000 new immunizations have been exported successfully to CAIR since the hospital began sharing data with the registry. Survey data suggest that providers find this tool improves workflow and overall satisfaction with availability of immunization data. (p=0.009).Visual integration of external registries into a vendor EMR system is feasible and improves provider satisfaction and registry reporting.

  View details for DOI 10.5210/ojphi.v5i2.4696

  View details for PubMedID 23923096

• Clinical Report A Male With Down Syndrome, Fragile X Syndrome, and Autism JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Stevens, L., Tartaglia, N., Hagerman, R., Riley, K. 2010; 31 (4): 333-337

  Abstract

  A case of a 14-year-old boy with both fragile X syndrome and Down syndrome is described. This is the third reported case of a patient with fragile X syndrome plus Down syndrome and the first reported case in a male. Facial features are generally consistent with Down syndrome; however, a prominent forehead and jaw and maccroorchidism were consistent with fragile X syndrome. Joint laxity is also present, which is consistent with both disorders. Cognitive impairment is more significant than in his siblings with fragile X syndrome, and he meets criteria for autistic disorder. Ongoing behavioral dysregulation has been significant, leading to disruption of home and school environments despite many attempted psychopharmacologic and behavioral strategies and a supportive family. Identification and treatment of underlying medical problems (esophagitis) led to improvements in sleep and behavior. We emphasize discussion of challenges in his behavioral management and present a collaborative approach to behavioral management.

  View details for DOI 10.1097/DBP.0b013e3181d5aa56

  View details for Web of Science ID 000277769600010

  View details for PubMedID 20453578