Person: Simon, Steven
Loading...
Email Address
AA Acceptance Date
Birth Date
Research Projects
Organizational Units
Job Title
Last Name
Simon
First Name
Steven
Name
Simon, Steven
11 results
Search Results
Now showing 1 - 10 of 11
Publication Readiness for electronic health records: comparison of characteristics of practices in a collaborative with the remainder of Massachusetts(BCS Learning and Development Limited, 2008-07-01) Simon, Steven; Bates, David; Kaushal, Rainu; Jenter, Chelsea; Volk, Lynn; Burdick, Elisabeth; Poon, Eric; Tumolo, Alexis; Tripathi, MickyObjective The Massachusetts e-Health Collabora- tive (MAeHC) is implementing electronic health records (EHRs) in physicians’ offices throughout three diverse communities. This study’s objective was to assess the degree to which these practices are representative of physicians’ practices statewide. Design We surveyed all MAeHC physicians (n=464) and compared their responses to those of a contemporaneously surveyed statewide random sample (n=1884). Measurements The survey questionnaire assessed practice characteristics related to EHR adoption, prevailing office culture related to quality and safety, attitudes toward health information tech- nology (HIT) and perceptions of medical practice. Results A total of 355 MAeHC physicians (77%) and 1345 physicians from the statewide sample (71%) completed the survey. MAeHC practices resembled practices throughout Massachusetts in terms of practice size, physician age and gender, prevailing financial incentives for quality performance and HIT adoption and available resources for practice expansion. MAeHC practices were more likely to be located in rural areas (9.5% vs 4.4%, P=0.004). Physicians in both samples responded similarly to six of seven self-assessments of the office practice environment for quality and safety. Internet connec- tions were more prevalent among MAeHC practices than across the state (96% vs 83%, P<0.001), but similar proportions of MAeHC physicians (83%) and statewide physicians (86%) used the internet daily (P=0.19). Conclusion MAeHC is implementing EHRs and health information exchange among communities with physicians and practices that appear generally Keywords: health information technology, quality representative of Massachusetts. The lessons of care, regional health information organisations learned from this pilot project should be applicable statewide and to other states with large numbers of physicians in small office practices.Publication Lessons learned from implementation of computerized provider order entry in 5 community hospitals: a qualitative study(Springer Nature, 2013-06-24) Simon, Steven; Keohane, Carol A; Amato, Mary; Coffey, Michael; Cadet, Bismarck; Zimlichman, Eyal; Bates, DavidBackground Computerized Provider Order Entry (CPOE) can improve patient safety, quality and efficiency, but hospitals face a host of barriers to adopting CPOE, ranging from resistance among physicians to the cost of the systems. In response to the incentives for meaningful use of health information technology and other market forces, hospitals in the United States are increasingly moving toward the adoption of CPOE. The purpose of this study was to characterize the experiences of hospitals that have successfully implemented CPOE. Methods We used a qualitative approach to observe clinical activities and capture the experiences of physicians, nurses, pharmacists and administrators at five community hospitals in Massachusetts (USA) that adopted CPOE in the past few years. We conducted formal, structured observations of care processes in diverse inpatient settings within each of the hospitals and completed in-depth, semi-structured interviews with clinicians and staff by telephone. After transcribing the audiorecorded interviews, we analyzed the content of the transcripts iteratively, guided by principles of the Immersion and Crystallization analytic approach. Our objective was to identify attitudes, behaviors and experiences that would constitute useful lessons for other hospitals embarking on CPOE implementation. Results Analysis of observations and interviews resulted in findings about the CPOE implementation process in five domains: governance, preparation, support, perceptions and consequences. Successful institutions implemented clear organizational decision-making mechanisms that involved clinicians (governance). They anticipated the need for education and training of a wide range of users (preparation). These hospitals deployed ample human resources for live, in-person training and support during implementation. Successful implementation hinged on the ability of clinical leaders to address and manage perceptions and the fear of change. Implementation proceeded smoothly when institutions identified and anticipated the consequences of the change. Conclusions The lessons learned in the five domains identified in this study may be useful for other community hospitals embarking on CPOE adoption.Publication The Impact of Prescribing Safety Alerts for Elderly Persons in an Electronic Medical Record(American Medical Association (AMA), 2006) Smith, David H.; Perrin, Nancy; Feldstein, Adrianne; Yang, Xiuhai; Kuang, Daniel; Simon, Steven; Sittig, Dean F.; Platt, Richard; Soumerai, StephenBackground Considerable effort and attention have focused on medication safety in elderly persons; one approach that has been understudied in the outpatient environment is the use of computerized provider order entry with clinical decision support. The objective of this study was to examine the effects of computerized provider order entry with clinical decision support in reducing the use of potentially contraindicated agents in elderly persons. Methods With data from a 39-month period of a natural experiment, we evaluated changes in medication dispensing using interrupted time series analysis to estimate changes, controlling for prealert prescribing trends. The setting was a large health maintenance organization in the Pacific Northwest. All adult enrollees of the health plan participated. The intervention was computerized alerts cautioning against using certain medications in elderly persons. The main outcome measure was dispensing per 10 000 members per month. Results Following the implementation of the drug-specific alerts, a large and persistent reduction (5.1 prescriptions per 10 000, P=.004), a 22% relative decrease from the month before alert implementation, in the exposure of elderly patients to nonpreferred medications was observed. We found no evidence of a decrease in use of nonpreferred agents for nonelderly patients. The reduction seen in use of nonpreferred agents for elderly persons was driven primarily by decreases in dispensing for tertiary tricyclic agents. Conclusions We found that alerts in an outpatient electronic medical record aimed at decreasing prescribing of medication use in elderly persons may be an effective method of reducing prescribing of contraindicated medications. The effect of the alerts on patient outcomes is less certain and deserves further investigation.Publication Improved Therapeutic Monitoring With Several Interventions(American Medical Association (AMA), 2006) Feldstein, Adrianne C.; Smith, David H.; Perrin, Nancy; Yang, Xiuhai; Rix, Mary; Raebel, Marsha A.; Magid, David J.; Simon, Steven; Soumerai, StephenBackground Medication errors are frequently related to failure to appropriately select medications or adjust for laboratory parameters. Differences between guideline recommendations and actual frequency of therapeutic laboratory monitoring are substantial. This study evaluated interventions to improve laboratory monitoring at initiation of medication therapy. Methods This cluster-randomized trial compared 3 interventions to usual care for 10 medications in 15 primary care clinics in a health maintenance organization with an electronic medical record system. Eligible patients, identified from electronic databases, had not received recommended laboratory monitoring within 5 days after new dispensing of a study medication. Interventions were an electronic medical record reminder to the prescribing health care professional, an automated voice message to the patient, and a pharmacy team outreach to the patient. Primary outcome was completion of all recommended baseline laboratory monitoring. Results A total of 961 patients participated in the study. At 25 days, 95 (48.5%) of 196 patients in the electronic medical record reminder group, 177 (66.3%) of 267 in the automated voice message group, 214 (82.0%) of 261 in the pharmacy team outreach group, and 53 (22.4%) of 237 in the usual care group had completed all recommended baseline laboratory monitoring (P<.001). After adjustments, the hazard ratios for completing laboratory monitoring compared with usual care were 2.5 (95% confidence interval, 1.8-3.5) for electronic medical record reminder, 4.1 (95% confidence interval, 3.0-5.6) for automated voice message, and 6.7 (95% confidence interval, 4.9-9.0) for pharmacy team outreach. Conclusions All 3 interventions were effective in increasing laboratory monitoring when initiating new medications in primary care. Further work is necessary to determine if these interventions improve patient outcomes.Publication Failure of Automated Telephone Outreach With Speech Recognition to Improve Colorectal Cancer Screening(American Medical Association (AMA), 2010) Simon, Steven; Zhang, Fang; Soumerai, Stephen; Ensroth, Arthur; Bernstein, Lydia; Fletcher, Robert; Ross-Degnan, DennisBackground Automated telephone outreach with speech recognition (ATO-SR) is used extensively by health plans. Whether ATO-SR can increase rates of colorectal cancer (CRC) screening is unknown. Methods We randomly allocated 40 000 health plan members to ATO-SR and 40 000 to usual care, of whom 10 432 and 10 506 in the intervention and usual care groups, respectively, had not been previously screened and were therefore eligible for analysis. The intervention was a single interactive outreach call using speech recognition to engage participants in conversation about the importance of CRC screening and options for and barriers to screening. The intervention directed participants to contact their primary care provider to schedule screening. The primary end point was any CRC screening in the year following intervention. Colonoscopy in the year following intervention was a secondary outcome. Results The incidence of any CRC screening was 30.6% in the intervention group and 30.4% in the usual care group (P = .76). After adjustment for available covariates, there remained no intervention effect (adjusted odds ratio [OR], 1.01; 95% confidence interval [CI], 0.94-1.07). A total of 21.4% of members in the intervention group and 20.3% in the usual care group underwent colonoscopy (P = .04). In multivariate analysis, there was a small intervention effect on colonoscopy (OR, 1.08; 95% CI, 1.00-1.16). Conclusions This study showed that ATO-SR failed to improve rates of CRC screening. Future studies should examine approaches that combine efforts to target patients and their health care providers to overcome the barriers to CRC screening.Publication Electronic consultations (e-consults) to improve access to specialty care: A systematic review and narrative synthesis(SAGE Publications, 2015) Vimalananda, Varsha G; Gupte, Gouri; Seraj, Siamak M; Orlander, Jay; Berlowitz, Dan; Fincke, Benjamin G; Simon, StevenBackground: We define electronic consultations (“e-consults”) as asynchronous, consultative, provider-to-provider communications within a shared electronic health record (EHR) or web-based platform. E-consults are intended to improve access to specialty expertise for patients and providers without the need for a face-to-face visit. Our goal was to systematically review and summarize the literature describing the use and effects of e-consults. Methods: We searched PubMed, EMBASE, the Cochrane Library, and CINAHL for studies related to e-consults published between 1990 through December 2014. Three reviewers identified empirical studies and system descriptions, including articles on systems that used a shared EHR or web-based platform, connected providers in the same health system, were used for two-way provider communication, and were text-based. Results: Our final review included 27 articles. Twenty-two were research studies and five were system descriptions. Eighteen originated from one of three sites with well-developed e-consult programs. Most studies reported on workflow impact, timeliness of specialty input, and/or provider perceptions of e-consults. E-consultations are used in a variety of ways within and across medical centers. They provide timely access to specialty care and are well-received by primary care providers. Discussion E-consults are feasible in a variety of settings, flexible in their application, and facilitate timely specialty advice. More extensive and rigorous studies are needed to inform the e-consult process and describe its effect on access to specialty visits, cost and clinical outcomes.Publication Reducing Warfarin Medication Interactions(American Medical Association (AMA), 2006) Feldstein, Adrianne C.; Smith, David H.; Perrin, Nancy; Yang, Xiuhai; Simon, Steven; Krall, Michael; Sittig, Dean F.; Ditmer, Diane; Platt, Richard; Soumerai, StephenBackground Computerized decision support reduces medication errors in inpatients, but limited evidence supports its effectiveness in reducing the coprescribing of interacting medications, especially in the outpatient setting. The usefulness of academic detailing to enhance the effectiveness of medication interaction alerts also is uncertain. Methods This study used an interrupted time series design. In a health maintenance organization with an electronic medical record, we evaluated the effectiveness of electronic medical record alerts and group academic detailing to reduce the coprescribing of warfarin and interacting medications. Participants were 239 primary care providers at 15 primary care clinics and 9910 patients taking warfarin. All 15 clinics received electronic medical record alerts for the coprescription of warfarin and 5 interacting medications: acetaminophen, nonsteroidal anti-inflammatory medications, fluconazole, metronidazole, and sulfamethoxazole. Seven clinics were randomly assigned to receive group academic detailing. The primary outcome, the interacting prescription rate (ie, the number of coprescriptions of warfarin-interacting medications per 10 000 warfarin users per month), was analyzed with segmented regression models, controlling for preintervention trends. Results At baseline, nearly a third of patients had an interacting prescription. Coinciding with the alerts, there was an immediate and continued reduction in the warfarin-interacting medication prescription rate (from 3294.0 to 2804.2), resulting in a 14.9% relative reduction (95% confidence interval, −19.5 to −10.2) at 12 months. Group academic detailing did not enhance alert effectiveness. Conclusions This study, using a strong and quasi-experimental design in ambulatory care, found that medication interaction alerts modestly reduced the frequency of coprescribing of interacting medications. Additional efforts will be required to further reduce rates of inappropriate prescribing of warfarin with interacting drugs.Publication Patients’ Perceptions of Their “Most” and “Least” Important Medications: a Retrospective Cohort Study(BioMed Central, 2012) Linsky, Amy; Simon, StevenBackground: Despite benefits of adherence, little is known about the degree to which patients will express their perceptions of medications as more or less important to take as prescribed. We determined the frequency with which Veteran patients would explicitly identify one of their medications as “most important” or “least important.” Findings: We conducted a retrospective cohort study of patients from ambulatory clinics at VA Boston from April 2010-July 2011. Patients answered two questions: “Which one of your medicines, if any, do you think is the most important? (if none, please write ‘none’)” and “Which one of your medicines, if any, do you think is the least important? (if none, please write ‘none’).” We determined the prevalence of response categories for each question. Our cohort of 104 patients was predominantly male (95%), with a mean of 9 medications (SD 5.7). Regarding their most important medication, 41 patients (39%) identified one specific medication; 26 (25%) selected more than one; 21 (20%) wrote “none”; and 16 (15%) did not answer the question. For their least important medication, 31 Veterans (30%) chose one specific medication; two (2%) chose more than one; 51 (49%) wrote “none”; and 20 (19%) did not directly answer the question. Conclusions: Thirty-five percent of patients did not identify a most important medication, and 68% did not identify a least important medication. Better understanding of how patients prioritize medications and how best to elicit this information will improve patient-provider communication, which may in turn lead to better adherence.Publication How Well Do Second-year Students Learn Physical Diagnosis? Observational Study of an Objective Structured Clinical Examination (OSCE)(BioMed Central, 2002) Hamann, Claus; Volkan, Kevin; Fishman, Mary B; Silvestri, Ronald; Simon, Steven; Fletcher, SuzanneBackground: Little is known about using the Objective Structured Clinical Examination (OSCE) in physical diagnosis courses. The purpose of this study was to describe student performance on an OSCE in a physical diagnosis course. Methods: Cross-sectional study at Harvard Medical School, 1997–1999, for 489 second-year students. Results: Average total OSCE score was 57% (range 39–75%). Among clinical skills, students scored highest on patient interaction (72%), followed by examination technique (65%), abnormality identification (62%), history-taking (60%), patient presentation (60%), physical examination knowledge (47%), and differential diagnosis (40%) (p < .0001). Among 16 OSCE stations, scores ranged from 70% for arthritis to 29% for calf pain (p < .0001). Teaching sites accounted for larger adjusted differences in station scores, up to 28%, than in skill scores (9%) (p < .0001). Conclusions: Students scored higher on interpersonal and technical skills than on interpretive or integrative skills. Station scores identified specific content that needs improved teaching.Publication Imminent adopters of electronic health records in ambulatory care(BCS Learning and Development Limited, 2009-03-01) Kaushal, Rainu; Bates, David; Jenter, Chelsea; Mills, Shannon; Volk, Lynn; Burdick, Elisabeth; Tripathi, Micky; Simon, StevenBackground Although evidence suggests electronic health records (EHRs) can improve quality and efficiency, provider adoption rates in the US ambulatory setting are relatively low. Prior studies have identified factors correlated with EHR use, but less is known about characteristics of physicians on the verge of adoption. Objective To compare characteristics of physicians who are imminent adopters of EHRs with EHR users and non-users. Design and participants A survey was mailed (June – November 2005) to a stratified random sample of all medical practices in Massachusetts. One physician from each practice (n=1884) was randomly selected to participate. Overall, 1345 physicians (71.4%) responded to the survey, with 1082 eligible for analysis due to exclusion criteria. ‘Imminent adopters’ were those planning to adopt EHRs within 12 months. Measurements We assessed physician and practice characteristics, availability of technology, barriers to adoption or expansion of health information technology (HIT), computer proficiency, and financial considerations. Results Compared to non-users, imminent adopters were younger, more experienced with technology, and more often in practices engaged in quality improvement. More imminent adopters owned or partly owned their practices (57.4%) than users (33.5%; p<0.001), but fewer imminent adopters owned their practices than non-users (65.7%; p<0.001). Additionally, more imminent adopters (26.0%) reported personal financial incentives for HIT use than users (14.8%; p<0.001) and non-users (10.8%; p<0.001). Conclusions Imminent adopters of EHRs differed from users and non-users. Financial considerations appear to play a major role in adoption decisions. Knowledge of these differences may assist policy- makers and healthcare leaders as they work to increase EHR adoption rates.