2024
Benchmarking Emergency Physician EHR Time per Encounter Based on Patient and Clinical Factors
Iscoe M, Venkatesh A, Holland M, Krumholz H, Sheares K, Melnick E. Benchmarking Emergency Physician EHR Time per Encounter Based on Patient and Clinical Factors. JAMA Network Open 2024, 7: e2427389. PMID: 39136949, PMCID: PMC11322841, DOI: 10.1001/jamanetworkopen.2024.27389.Peer-Reviewed Original ResearchVirtual Scribes and Physician Time Spent on Electronic Health Records
Rotenstein L, Melnick E, Iannaccone C, Zhang J, Mugal A, Lipsitz S, Healey M, Holland C, Snyder R, Sinsky C, Ting D, Bates D. Virtual Scribes and Physician Time Spent on Electronic Health Records. JAMA Network Open 2024, 7: e2413140. PMID: 38787556, PMCID: PMC11127114, DOI: 10.1001/jamanetworkopen.2024.13140.Peer-Reviewed Original ResearchConceptsEHR timeElectronic health recordsHealth recordsPhysician timePre-post quality improvement studyPrimary care specialtiesQuality improvement studyFactors associated with changesAssociated with significant decreasesAssociated with burnoutMultivariate linear regression modelAcademic medical centerCare specialtiesImprovement studyLinear regression modelsMedical specialistsMedical specialtiesOutpatient settingStudy sampleSignificant decreasePhysiciansMedical CenterParticipation episodesAppointmentWomen's Hospital
2023
Why Do Physicians Depart Their Practice? A Qualitative Study of Attrition in a Multispecialty Ambulatory Practice Network
O'Connell R, Hosain F, Colucci L, Nath B, Melnick E. Why Do Physicians Depart Their Practice? A Qualitative Study of Attrition in a Multispecialty Ambulatory Practice Network. The Journal Of The American Board Of Family Medicine 2023, 36: 1050-1057. PMID: 37857441, DOI: 10.3122/jabfm.2023.230052r2.Peer-Reviewed Original ResearchCT With CTA Versus MRI in Patients Presenting to the Emergency Department With Dizziness: Analysis Using Propensity Score Matching.
Tu L, Navaratnam D, Melnick E, Forman H, Venkatesh A, Malhotra A, Yaesoubi R, Sureshanand S, Sheth K, Mahajan A. CT With CTA Versus MRI in Patients Presenting to the Emergency Department With Dizziness: Analysis Using Propensity Score Matching. American Journal Of Roentgenology 2023, 221: 836-845. PMID: 37404082, DOI: 10.2214/ajr.23.29617.Peer-Reviewed Original ResearchConceptsSecondary stroke prevention medicationsStroke prevention medicationsEmergency departmentPrevention medicationsEchocardiography evaluationPosterior circulation strokeProportion of patientsGroup of patientsPhysical examination findingsNeuroimaging resultsUse of MRIReview of systemsGreater frequencyPropensity-score matchingExamination findingsRetrospective studyED readmissionMedical historyHead CTClinical impactMRI examinationsBrain MRINeck CTADizzinessPatients
2021
Analysis of Electronic Health Record Use and Clinical Productivity and Their Association With Physician Turnover
Melnick ER, Fong A, Nath B, Williams B, Ratwani RM, Goldstein R, O’Connell R, Sinsky CA, Marchalik D, Mete M. Analysis of Electronic Health Record Use and Clinical Productivity and Their Association With Physician Turnover. JAMA Network Open 2021, 4: e2128790. PMID: 34636911, PMCID: PMC8511970, DOI: 10.1001/jamanetworkopen.2021.28790.Peer-Reviewed Original ResearchConceptsElectronic health recordsPhysician turnoverRetrospective cohort studyElectronic health record usePractice networkPhysician productivityWarrants further investigationCohort studyEHR timeAge 45Care teamPhysician departurePhysician ordersMAIN OUTCOMEHigh riskPatient timeAmbulatory physiciansPatient volumeUnique physiciansRecord useEHR useHealth care organizationsPhysiciansHealth recordsClinical timeImplementing Measurement Science for Electronic Health Record Use
Melnick ER, Sinsky CA, Krumholz HM. Implementing Measurement Science for Electronic Health Record Use. JAMA 2021, 325: 2149-2150. PMID: 33818587, DOI: 10.1001/jama.2021.5487.Peer-Reviewed Original ResearchCharacterizing physician EHR use with vendor derived data: a feasibility study and cross-sectional analysis
Melnick ER, Ong SY, Fong A, Socrates V, Ratwani RM, Nath B, Simonov M, Salgia A, Williams B, Marchalik D, Goldstein R, Sinsky CA. Characterizing physician EHR use with vendor derived data: a feasibility study and cross-sectional analysis. Journal Of The American Medical Informatics Association 2021, 28: 1383-1392. PMID: 33822970, PMCID: PMC8279798, DOI: 10.1093/jamia/ocab011.Peer-Reviewed Original ResearchConceptsElectronic health recordsEHR timeCross-sectional analysisAmbulatory physiciansPatient timeHealth systemClinical hoursHours of patientsMedStar Health systemYale-New HavenObstetrics/gynecologyNeurology/psychiatryMultivariable analysisPhysician genderCertain medical specialtiesPhysical medicineFemale physiciansEHR usePhysiciansHealth recordsHealthcare systemMedical specialtiesHoursSpecialtiesGender
2020
Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US
Jeffery MM, D’Onofrio G, Paek H, Platts-Mills TF, Soares WE, Hoppe JA, Genes N, Nath B, Melnick ER. Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US. JAMA Internal Medicine 2020, 180: 1328-1333. PMID: 32744612, PMCID: PMC7400214, DOI: 10.1001/jamainternmed.2020.3288.Peer-Reviewed Original ResearchConceptsHospital admission ratesEmergency department visitsED visitsHealth care systemAdmission ratesDepartment visitsHospital admissionCare systemCOVID-19 pandemicLarge health care systemAcute care deliveryCross-sectional studyAnnual ED volumeCoronavirus disease 2019Daily ED visitsInflux of patientsPublic health officialsCOVID-19 case ratesCOVID-19 casesNational public healthDisease 2019MAIN OUTCOMEED volumeSerious symptomsContagious infection
2019
The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians
Melnick ER, Dyrbye LN, Sinsky CA, Trockel M, West CP, Nedelec L, Tutty MA, Shanafelt T. The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians. Mayo Clinic Proceedings 2019, 95: 476-487. PMID: 31735343, DOI: 10.1016/j.mayocp.2019.09.024.Peer-Reviewed Original ResearchConceptsElectronic health record usabilityOdds of burnoutUS physiciansStrong dose-response relationshipAmerican Medical Association Physician MasterfileEHR usabilityDose-response relationshipCross-sectional surveyLower oddsPhysician MasterfileMultivariate analysisPractice settingsCurrent EHR systemsMaslach Burnout InventoryPhysiciansSUS scoreProfessional burnoutMedical specialtiesNumber of nightsPrevious studiesOddsScoresPhysician usersTechnology usabilityBurnout InventoryUser-centred clinical decision support to implement emergency department-initiated buprenorphine for opioid use disorder: protocol for the pragmatic group randomised EMBED trial
Melnick ER, Jeffery MM, Dziura JD, Mao JA, Hess EP, Platts-Mills TF, Solad Y, Paek H, Martel S, Patel MD, Bankowski L, Lu C, Brandt C, D’Onofrio G. User-centred clinical decision support to implement emergency department-initiated buprenorphine for opioid use disorder: protocol for the pragmatic group randomised EMBED trial. BMJ Open 2019, 9: e028488. PMID: 31152039, PMCID: PMC6550013, DOI: 10.1136/bmjopen-2018-028488.Peer-Reviewed Original ResearchMeSH KeywordsAdultBuprenorphineCluster AnalysisDecision Support Systems, ClinicalEmergency Service, HospitalFemaleHumansMaleMiddle AgedMulticenter Studies as TopicNarcotic AntagonistsOpiate Substitution TreatmentOpioid-Related DisordersPragmatic Clinical Trials as TopicRandomized Controlled Trials as TopicUnited StatesYoung AdultConceptsOpioid use disorderEmergency departmentSecondary outcomesUse disordersEmergency department-initiated buprenorphineWestern Institutional Review BoardData Safety Monitoring BoardIndependent study monitorsRates of cliniciansRoutine emergency careSafety monitoring boardInstitutional review boardClinical decision support systemClinician prescribingPragmatic clusterPatient characteristicsPeer-reviewed journalsClinical decision supportPrimary outcomeED cliniciansWithdrawal symptomsOngoing treatmentPatients' willingnessMonitoring boardBuprenorphine
2017
Patient-Centered Decision Support: Formative Usability Evaluation of Integrated Clinical Decision Support With a Patient Decision Aid for Minor Head Injury in the Emergency Department
Melnick ER, Hess EP, Guo G, Breslin M, Lopez K, Pavlo AJ, Abujarad F, Powsner SM, Post LA. Patient-Centered Decision Support: Formative Usability Evaluation of Integrated Clinical Decision Support With a Patient Decision Aid for Minor Head Injury in the Emergency Department. Journal Of Medical Internet Research 2017, 19: e174. PMID: 28526667, PMCID: PMC5457532, DOI: 10.2196/jmir.7846.Peer-Reviewed Original ResearchConceptsMinor head injuryCanadian CT Head RuleClinician-patient relationshipPatient-specific riskHead injuryPatient decision aidClinical decision supportDecision supportCT useEmergency departmentPatient concernsCanadian Computed Tomography Head RuleUser interface developmentMinor head injury patientsFormative usability evaluationPatient-centered decision supportEmergency care cliniciansUser-centered designHead injury patientsClinical decision rulePatients' specific concernsIntegrated clinical decision supportTomography Head RuleInitial prototype developmentHealth information technology
2015
Understanding Overuse of Computed Tomography for Minor Head Injury in the Emergency Department: A Triangulated Qualitative Study
Melnick ER, Shafer K, Rodulfo N, Shi J, Hess EP, Wears RL, Qureshi RA, Post LA. Understanding Overuse of Computed Tomography for Minor Head Injury in the Emergency Department: A Triangulated Qualitative Study. Academic Emergency Medicine 2015, 22: 1474-1483. PMID: 26568523, DOI: 10.1111/acem.12824.Peer-Reviewed Original ResearchConceptsMinor head injuryCanadian CT Head RuleEmergency departmentHead injuryComputed tomographyPatient expectationsUrban academic emergency departmentUse of CTCommunity emergency departmentsClinical decision ruleHigh-quality evidenceAcademic emergency departmentHealth care providersFocus groupsPatient anxietyCT useED practiceCT scanCare providersProvider confidenceED contextPatient engagementQualitative studyTriangulated qualitative studyMultidisciplinary teamRedefining Overuse to Include Costs: A Decision Analysis for Computed Tomography in Minor Head Injury
Melnick ER, Keegan J, Taylor RA. Redefining Overuse to Include Costs: A Decision Analysis for Computed Tomography in Minor Head Injury. The Joint Commission Journal On Quality And Patient Safety 2015, 41: 313-ap2. PMID: 26108124, DOI: 10.1016/s1553-7250(15)41041-4.Peer-Reviewed Original ResearchConceptsNet monetary benefitCurrent clinical decision rulesMonetary benefitsInclusion of costsCosts outweigh benefitsDecision analysisDecision analytic modelTwo-way sensitivity analysesDecision rulesProbability of lesionCanadian CT Head RuleMain driversOnly effectivenessCostSignificant impactSensitivity analysisCost of CT
2012
CT Overuse for Mild Traumatic Brain Injury
Melnick ER, Szlezak CM, Bentley SK, Dziura JD, Kotlyar S, Post LA. CT Overuse for Mild Traumatic Brain Injury. The Joint Commission Journal On Quality And Patient Safety 2012, 38: 483-489. PMID: 23173394, DOI: 10.1016/s1553-7250(12)38064-1.Peer-Reviewed Original ResearchConceptsMild traumatic brain injuryCanadian CT Head RuleNew Orleans CriteriaTraumatic brain injuryProportion of casesComputed tomographyEmergency departmentBrain injuryCT useEmergency Physicians Clinical PolicyLevel I emergency departmentImportant brain injuryClinical Excellence (NICE) guidelinesMinor head injuryProspective observational studyCurrent guideline recommendationsHead CT findingsEvidence-based guidelinesHealth care costsRadiation-induced cancerCT overuseAdult patientsExcellence guidelinesCT findingsGuideline recommendations
2007
Clinicopathological conference: 29-year-old with visual loss, hypertension, and a seizure.
Suchard J, Melnick E. Clinicopathological conference: 29-year-old with visual loss, hypertension, and a seizure. Academic Emergency Medicine 2007, 14: 819-24. PMID: 17726128, DOI: 10.1197/j.aem.2007.06.019.Peer-Reviewed Original Research