Gilad J Kuperman's research while affiliated with New York Presbyterian Hospital and other places
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Publications (162)
The United States Preventive Services Taskforce recommends that primary care providers screen patients for an increased risk of carrying a BRCA1 or BRCA2 mutation and refer those who meet family history criteria to genetic counseling. Such screening requires detailed and accurate family history data, which often goes uncollected during a primary ca...
Study objective:
Frequent emergency department (ED) users are of interest to policymakers and hospitals. The objective of this study is to examine the effect of health information exchange size on the identification of frequent ED users.
Methods:
We retrospectively analyzed data from Healthix, a health information exchange in New York that previ...
Objective:
To systematically review the literature pertaining to asynchronous automated electronic notifications of laboratory results to clinicians.
Methods:
PubMed, Web of Science, and the Cochrane Collaboration were queried for studies pertaining to automated electronic notifications of laboratory results. A title review was performed on the...
Community health workers, an important and emerging role in the evolution of the care delivery system, are uniquely positioned to play a vital role in information gathering and exchange. NewYork-Presbyterian Hospital carried out a feasibility study to assess community health worker use and impressions of a medication documentation application that...
Clinical data warehouses, initially directed towards clinical research or financial analyses, are evolving to support quality improvement efforts, and must now address the quality improvement life cycle. In addition, data that are needed for quality improvement often do not reside in a single database, requiring easier methods to query data across...
Critical value reporting is crucial to patient care in the hospital setting, but some normal or non-critical values are valuable to clinical decision making as well. We designed a system that allows providers to subscribe to electronic notifications of laboratory results to improve workflow and potentially patient care.
Objective:
The purpose of this study was to measure the number of repeat computed tomography (CT) scans performed across an established health information exchange (HIE) in New York City. The long-term objective is to build an HIE-based duplicate CT alerting system to reduce potentially avoidable duplicate CTs.
Methods:
This retrospective cohort...
Objective:
Engaging patients in their care has become a topic of increasing importance, and enabling patients to have access to their clinical data is a key aspect of such engagement. We investigated, on an international scale, the current state of approaches for providing patients with access to their own clinical information.
Methods:
Individu...
Engaging patients in their care has become a topic of increasing importance, and enabling patients to have access to their clinical data is a key aspect of such engagement. To investigate on an international scale the current state of approaches for providing patients with access to their own clinical information, individuals from 16 countries, acr...
Hospital closures are becoming increasingly common in the United States. Patients who received care at the closing hospitals must travel to different, often farther hospitals for care, and nearby remaining hospitals may have difficulty coping with a sudden influx of patients.
Our objectives are to analyze the dispersion patterns of patients from a...
To establish preferred strategies for presenting drug-drug interaction (DDI) clinical decision support alerts.
A DDI Clinical Decision Support Conference Series included a workgroup consisting of 24 clinical, usability, and informatics experts representing academia, health information technology (IT) vendors, healthcare organizations, and the Offic...
Homeless patients experience poor health outcomes and consume a disproportionate amount of health care resources compared with domiciled patients. There is increasing interest in the federal government in providing care coordination for homeless patients, which will require a systematic way of identifying these individuals.
We analyzed address data...
Engaging patients in their care has become a topic of increasing importance, and enabling patients to have access to their clinical data is a key aspect of such engagement. To investigate on an international scale the current state of approaches for providing patients with access to their own clinical information, individuals from 16 countries, acr...
We hypothesized that using communitywide data from a health information exchange (HIE) could improve the ability to identify frequent emergency department (ED) users-those with four or more ED visits in thirty days-by allowing ED use to be measured across unaffiliated hospitals. When we analyzed HIE-wide data instead of site-specific data, we ident...
Biomedical informatics (BMI) covers a broad spectrum of subfields that range in scope from molecules to populations and range in application from research to operations. Subfields include translational bioinformatics (TBI), clinical research informatics (CRI), public health informatics, and others.
Recognizing the diversity of BMI, AMIA developed...
We evaluated the performance of LOINC® and RadLex standard terminologies for covering CT test names from three sites in a health information exchange (HIE) with the eventual goal of building an HIE-based clinical decision support system to alert providers of prior duplicate CTs. Given the goal, the most important parameter to assess was coverage fo...
In the 1990s, NewYork-Presbyterian Hospital began developing a comprehensive, standards-based immunization information system. The system, known as EzVac, has been operational since 1998 and now includes information on 2 million immunizations administered to more than 260,000 individuals. The system exchanges data with multiple electronic health re...
Accountable models of care delivery demand that health care provider organizations be able to exchange clinical data about the patient. The "Meaningful Use" program is helping to advance health information exchange by requiring physicians and hospitals to exchange clinical data about patients in order to qualify for incentive payments for electroni...
Delivering outstanding medical care requires providing care that is both high-quality and safe. However, while the knowledge base regarding effective medical therapies continues to improve, the practice of medicine continues to lag behind, and errors are distressingly frequent. [1] Regarding the gaps between evidence and practice, Lomas et al. [2]...
Notifying ambulatory providers when their patients visit the hospital is a simple concept but potentially a powerful tool for improving care coordination. A health information exchange (HIE) can provide automatic notifications to its members by building services on top of their existing infrastructure. NYCLIX, Inc., a functioning HIE in New York Ci...
Objective
For a health information exchange (HIE) organization to succeed in any given region, it is important to understand the optimal catchment area for the patient population it is serving. The objective of this analysis was to understand the geographical distribution of the patients being served by one HIE organization in New York City (NYC)....
Background:
The trend towards hospitalist medicine can lead to disjointed patient care. Outpatient clinicians may be unaware of patients' encounters with a disparate healthcare system. Electronic notifications to outpatient clinicians of patients' emergency department (ED) visits and inpatient admissions and discharges using health information exc...
To develop and apply formal ontology creation methods to the domain of antimicrobial prescribing and to formally evaluate the resulting ontology through intrinsic and extrinsic evaluation studies.
We extended existing ontology development methods to create the ontology and implemented the ontology using Protégé-OWL. Correctness of the ontology was...
The results of a retrospective evaluation of the frequency and preventability of adverse drug events (ADEs) involving multiple drugs among hospital inpatients are reported.
Data collected in a previous cohort study of 180 actual ADEs and 552 potential ADEs (PADEs) at six community hospitals in Massachusetts were analyzed to determine the frequency...
Healthcare delivery organizations are increasingly using online personal health records (PHRs) to provide patients with direct access to their clinical information; however, there may be a lack of consistency in the data made available. We aimed to understand the general use and functionality of PHRs and the organizational policies and decision-mak...
Emergency physicians are trained to make decisions quickly and with limited patient information. Health Information Exchange (HIE) has the potential to improve emergency care by bringing relevant patient data from non-affiliated organizations to the bedside. NYCLIX (New York CLinical Information eXchange) offers HIE functionality among multiple New...
Health-information exchange, that is, enabling the interoperability of automated health data, can facilitate important improvements in healthcare quality and efficiency. A vision of interoperability and its benefits was articulated more than a decade ago. Since then, important advances toward the goal have been made. The advent of the Health Inform...
Clinical decision support (CDS) can improve safety, quality, and cost-effectiveness of patient care, especially when implemented in computerized provider order entry (CPOE) applications. Medication-related decision support logic forms a large component of the CDS logic in any CPOE system. However, organizations wishing to implement CDS must either...
Public health relies on data reported by health care partners, and information technology makes such reporting easier than ever. However, data are often structured according to a variety of different terminologies and formats, making data interfaces complex and costly.
As one strategy to address these challenges, health information organizations (H...
This study tested the hypothesis that lactate testing in ED sepsis patients could be increased using a computer alert that automatically recognizes systemic inflammatory response syndrome (SIRS) criteria and recommends lactate testing in cases of sepsis defined as ≥2 SIRS criteria plus physician suspicion of infection. Secondary outcomes included t...
Background: Evidence demonstrates that clinical decision support (CDS) is a powerful tool for improving healthcare quality and ensuring patient safety. However, implementing and maintaining effective decision support interventions presents multiple technical and organizational challenges.
Purpose: To identify best practices for CDS, using the domai...
To determine the accuracy of troponin laboratory results versus International Classification of Diseases clinical modification codes (ICD-9-CM) in identifying acute coronary syndrome (ACS) rule-out (R/O) patients who present to emergency departments (EDs).
Retrospective data analysis and chart review (to establish gold standard) were conducted on E...
Novel H1N1 influenza spread rapidly around the world in spring 2009. Few places were as widely affected as the New York metropolitan area. Emergency departments (EDs) in the region experienced daily visit increases in 2 distinct temporal peaks, with means of 36.8% and 60.7% over baseline in April and May, respectively, and became, in a sense, the "...
In 2007, the Department of Health and Human Services commissioned the Nationwide Health Information Network (NHIN) Trial Implementations project to demonstrate the secure exchange of data among health information exchange organizations around the country. The project's Core Services Content Work Group (CSCWG) developed the content specifications fo...
Challenges in implementing electronic health records (EHRs) have received some attention, but less is known about the process of transitioning from legacy EHRs to newer systems.
To determine how ambulatory leaders differentiate implementation approaches between practices that are currently paper-based and those with a legacy EHR system (EHR-based)....
To determine pre-implementation perspectives of institutional, practice and vendor leadership regarding best practice for implementation of two ambulatory electronic health records (EHRs) at an academic institution.
Semi-structured interviews with ambulatory care network and information systems leadership, medical directors, practice managers and v...
Little is known about how providers expect the implementation of a new electronic health record (EHR) will affect their clinical workflow. We found that providers currently completing clinical tasks electronically are more satisfied with task completion than those completing similar tasks on paper. Yet, these already electronic providers expect les...
Practitioners' resistance towards electronic health records (EHRs) is a known barrier to implementation and use. This is a cross-sectional study 467 practitioners working at 12 ambulatory care outpatient practices. We analyzed how mean expected satisfaction for future use of EHRs differed at both the level of the provider and the practice. We found...
To prepare for the evaluation of a health information exchange (HIE) project in New York City, we collected pre-implementation data regarding aspects of care that might be affected by the HIE initiative. The first application of the HIE will be to provide data to emergency physicians; therefore, we focused on measures relevant to emergency care. Th...
One of the most effective and immediate solutions to the growing antimicrobial resistance problem is to address the role of inappropriate prescribing. Ontologies can support judicious prescribing, but use of an ontology as part of a CDSS to support antibiotic therapeutic planning has not been fully explored. The proposed research project will creat...
In 2007, the Leapfrog CPOE standard required that all clinical alert overrides be accompanied by an override reason. We wanted to know how many of the free text comments left by clinicians were actually override reasons, and how many were other types of communication. We reviewed 3583 free text comments left voluntarily by clinicians while respondi...
Few reliable and efficient systems support the communication of test results to outpatients, and this may lead to patient dissatisfaction with test result communication. The objective of this study was to assess the impact of physicians' use of a test results management tool embedded in an electronic health record on patient satisfaction with test...
Health information exchange (HIE) is a potentially powerful technology that can improve the quality of care delivered in emergency departments, but little is known about emergency physicians' current perceptions of HIE.
This study sought to assess emergency physicians' perceived needs and knowledge of HIE.
A questionnaire was developed based on heu...
Parallel to the monumental problem of replacing paper-and-pen-based patient information management systems with electronic ones is the problem of evaluating the extent to which the change represents an improvement. All clinicians must grapple with this daunting challenge; those with little or no informatics expertise may be particularly surprised b...
Pediatric medication errors occur frequently among hospitalized patients and are often related to dosing. Computerized physician order entry systems with decision support can decrease dosing errors, as well as other types of errors; however, their use in pediatrics has not been extensively studied. Our objective was to determine physician acceptanc...
While medications can improve patients' health, the process of prescribing them is complex and error prone, and medication errors cause many preventable injuries. Computer provider order entry (CPOE) with clinical decision support (CDS), can improve patient safety and lower medication-related costs.
To realize the medication-related benefits of CDS...
Regional health information organizations and electronic health information exchange may have an important impact on the practice of emergency medicine in the United States. Regional health information organizations are local or regional information-sharing networks that enable electronic data interchange among stakeholders in a given geographic ar...
The quality and safety of health care leaves much to be desired.1,2 Automated clinical decision support (CDS) tools embedded in clinical information systems (CISs) such as computer provider order entry (CPOE) and electronic health records (EHR) applications have the potential to improve care and should be part of any comprehensive approach to impro...
Although computerized physician order entry (CPOE) may decrease errors and improve quality, hospital adoption has been slow. The high costs and limited data on financial benefits of CPOE systems are a major barrier to adoption. The authors assessed the costs and financial benefits of the CPOE system at Brigham and Women's Hospital over ten years.
C...
We present a model for architectural strategies and issues regarding health information exchange (HIE). This model is a continuum of options, between separated systems and a monolithic approach. We discuss characteristics, examples and potential impacts of each approach, based on generalized observations of practical implementations. The continuum...
At NewYork-Presbyterian Hospital, we are committed to the delivery of high quality care. We have implemented a strategic planning process to determine the information technology initiatives that will best help us improve quality. The process began with the creation of a Clinical Quality and IT Committee. The Committee identified 2 high priority goa...
The New York Clinical Information Exchange (NYCLIX) was established to facilitate data sharing across 14 organizations. Workflow evaluations were conducted to identify mechanisms by which clinicians could be informed of NYCLIX data in the Emergency Department (ED). Interviews focused on the interval between patient arrival to the ED and clinician n...
Infobuttons are message-based content search and retrieval functions embedded within other applications that dynamically return information relevant to the clinical task at hand. The objective of this study was to determine whether infobuttons effectively answer providers' questions about medications or affect patient care decisions.
The authors im...
Numerous regional health information organizations (RHIOs) throughout the country are in various stages of developing computer-based health information exchange (HIE) networks. The promise of HIE is that by bringing vital clinical information to the point-of-care, it will help improve the safety and quality of health care while decreasing overall h...
Computerized drug prescribing alerts can improve patient safety, but are often overridden because of poor specificity and alert overload. Our objective was to improve clinician acceptance of drug alerts by designing a selective set of drug alerts for the ambulatory care setting and minimizing workflow disruptions by designating only critical to hig...
Computerized drug prescribing alerts can improve patient safety, but are often overridden because of poor specificity and alert overload. Our objective was to improve clinician acceptance of drug alerts by designing a selective set of drug alerts for the ambulatory care setting and minimizing workflow disruptions by designating only critical to hig...
The use of information technology may result in a safer and more efficient health care system. However, consensus does not exist about the structure or costs of a national health information network (NHIN).
To describe the potential structure and estimate the costs of an NHIN.
Cost estimates of an NHIN model developed by an expert panel.
U.S. healt...
This case study of a serious medication error demonstrates the necessity of a comprehensive methodology for the analysis of failures in interaction between humans and information systems. The authors used a novel approach to analyze a dosing error related to computer-based ordering of potassium chloride (KCl). The method included a chronological re...
Computerized drug prescribing alerts can improve patient safety, but are often overridden because of poor specificity and alert overload. We developed a selective knowledge base of only clinically significant drug alerts and designated only critical-high severity alerts to be interruptive to clinician workflow (a tiered approach). Using this approa...
Clinical decision support can improve the quality of care, but requires substantial knowledge management activities. At NewYork-Presbyterian Hospital in New York City, we have implemented a formal alert management process whereby only hospital committees and departments can request alerts. An explicit requestor, who will help resolve the details of...
The aim of this study was to determine characteristics of drug allergy alert overrides, assess how often they lead to preventable adverse drug events (ADEs), and suggest methods for improving the allergy-alerting system.
Chart review was performed on a stratified random subset of all allergy alerts occurring during a 3-month period (August through...
This article describes the process utilized to create research questions which promote technology as an infrastructure to enable safe nursing practice. Beginning with scenarios of safety problems related to nursing practice, the team identified information technology including hardware, software, and organizational and operational components to hel...
This project explored functional requirements for an institution-wide method, at Partners HealthCare, for interpreting clinical knowledge for decision support. Such knowledge is currently incorporated in a variety of clinical applications, yet the methods of representation and of execution vary and the ability to author/edit the rules by human expe...
The health care environment is communications and information intensive. Nurses especially have communications as part of their routine activities, yet little is known about specific nursing communications needs and technologies that might address these needs. This project analyzed the specific communications needs of nurses at Massachusetts Genera...
Problem lists are fundamental to electronic medical records (EMRs). However, obtaining an appropriate problem list dictionary is difficult, and getting users to code their problems at the time of data entry can be challenging.
To develop a problem list dictionary and search algorithm for an EMR system and evaluate its use.
We developed a problem li...
While evidence-based medicine has increasingly broad-based support in health care, it remains difficult to get physicians to actually practice it. Across most domains in medicine, practice has lagged behind knowledge by at least several years. The authors believe that the key tools for closing this gap will be information systems that provide decis...
Several analyses have detected substantial quality problems throughout the health care system. Information technology has consistently been identified as an important component of any approach for improvement. Computerized physician order entry (CPOE) is a promising technology that allows physicians to enter orders into a computer instead of handwr...
Electronic medical record systems improve the quality of patient care and decrease medical errors, but their financial effects have not been as well documented. The purpose of this study was to estimate the net financial benefit or cost of implementing electronic medical record systems in primary care. We performed a cost-benefit study to analyze t...
In May of 2001, thirteen experts on computerized provider order entry (CPOE) from around the world gathered at a 2-day conference to develop a consensus statement on successful CPOE implementation. A qualitative research approach was used to generate and validate a list of categories and considerations to guide CPOE implementation.
We designed and implemented 2 automated, computerized screens for use at the time of antiepileptic drug (AED) test order entry to improve appropriateness by reminding physicians when a potentially redundant test was ordered and providing common indications for monitoring and pharmacokinetics of the specific AED. All computerized orders for inpatien...
There is scant published experience with implementing complex, multistep computerized practice guidelines for the long-term management of chronic diseases. We have implemented a system for creating, maintaining, and navigating computer-based clinical algorithms integrated with our electronic medical record. This article describes our progress and r...
As the focus of medicine moves from acute episodic care in the hospital to chronic disease management in outpatients, the primary care physician will play an increasingly important role in the coordination of patient care activities. Traditional outpatient informatics systems have largely focused on the workflow during the clinical encounter. Many...
Clinical decision support such as alerts, reminders and guidance are driven by rules often distributed among a variety of applications in a healthcare information system. Due to the increasing size of rule bases, there is a growing need to manage this dispersed knowledge in an integrated environment. A system for management of executable clinical k...
Medical knowledge expands at a pace that makes it impossible for the individual clinician to keep up, especially for medications. Medication-related queries are the most common type of query that typically go unanswered during the course of providing care.1 Unanswered questions may result in errors, as found in one study evaluating systems failures...
Partners Health Online is a portal to a broad set of consumer health information. As such, the site allows public access to health and disease information as well as Partners-specific information resources (e.g., departments, physicians, clinical trials, classes, support groups). Partners Health Online licenses its health care articles from Healthw...