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Scholarly Works (2 results)

  • Thesis
  • Peer Reviewed
UC San Francisco Electronic Theses and Dissertations (2010)

Research objectives: This dissertation examines the state of development of each of the eight core electronic health record (EHR) functionalities as described by the IOM and describes how the current state of these functionalities limit quality improvement efforts in ambulatory care settings. There is a great deal of literature describing both the potential of the EHR to improve quality of care and showing a lack of improvement associated with EHR use. This study examines the role that the state of development of EHR functionalities plays in the quality improvement.

Study design: A qualitative study of four community health center (CHC) networks that provide EHR services to members and three CHCs from each network. Each network used different, commonly used and CCHIT certified EHRs. Sixty five hours of interviews were transcribed, coded, and analyzed from seventy five semi-structured interviews of leaders/staff. The analysis focused on the eight core EHR functionalities as identified by the IOM.

Principal findings: Out-of-the-box, none of the EHRs studied strongly supported the provision of guideline based care to individual patients or the management of populations of patients. Extensive EHR modification was needed, with some EHRs requiring more work. Challenges were most acutely felt with templates, interfaces, decision support, and reporting functionalities. Limitations were found less often in administrative processes and within practice messaging. Though EHR functionalities greatly improved based on network and CHC development efforts, focus on quality improvement activities was diminished by the consumption of scarce resources to fix poorly functioning software.

Conclusions: Given that EHR adoption rates will continue to increase it should be emphasized that successful QI efforts are difficult to achieve with the current state of the technology, especially for smaller practices. So far the onus of improving the functionalities for use in QI efforts has primarily been left to the EHR adopters, who generally lack the resources to develop the software. Policy needs to take this into account and fund not only EHR implementation, but also ensure great improvements are made to core functionalities.

    Cover page: Technical Limitations of Electronic Health Records in Community Health Centers: Implications on Ambulatory Care Quality
    • Article
    • Peer Reviewed
    UC Berkeley Previously Published Works (2015)
    Myelin is essential in vertebrates for the rapid propagation of action potentials, but the molecular mechanisms driving its formation remain largely unknown. Here we show that the initial stage of process extension and axon ensheathment by oligodendrocytes requires dynamic actin filament assembly by the Arp2/3 complex. Unexpectedly, subsequent myelin wrapping coincides with the upregulation of actin disassembly proteins and rapid disassembly of the oligodendrocyte actin cytoskeleton and does not require Arp2/3. Inducing loss of actin filaments drives oligodendrocyte membrane spreading and myelin wrapping in vivo, and the actin disassembly factor gelsolin is required for normal wrapping. We show that myelin basic protein, a protein essential for CNS myelin wrapping whose role has been unclear, is required for actin disassembly, and its loss phenocopies loss of actin disassembly proteins. Together, these findings provide insight into the molecular mechanism of myelin wrapping and identify it as an actin-independent form of mammalian cell motility.
      Cover page: CNS Myelin Wrapping Is Driven by Actin Disassembly
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