RESUMEN
OBJECTIVES: This study aimed to (1) determine the impact of COVID-19 (coronavirus disease 2019) and the corresponding increase in use of telemedicine on volume, efficiency, and burden of electronic health record (EHR) usage by residents and fellows; and (2) to compare these metrics with those of attending physicians. METHODS: We analyzed 11 metrics from Epic's Signal database of outpatient physician user logs for active residents/fellows at our institution across three 1-month time periods: August 2019 (prepandemic/pre-telehealth), May 2020 (mid-pandemic/post-telehealth implementation), and July 2020 (follow-up period) and compared these metrics between trainees and attending physicians. We also assessed how the metrics varied for medical trainees in primary care as compared with subspecialties. RESULTS: Analysis of 141 residents/fellows and 495 attendings showed that after telehealth implementation, overall patient volume, Time in In Basket per day, Time outside of 7 a.m. to 7 p.m., and Time in notes decreased significantly compared with the pre-telehealth period. Female residents, fellows, and attendings had a lower same day note closure rate before and during the post-telehealth implementation period and spent greater time working outside of 7 a.m. to 7 p.m. compared with male residents, fellows, and attendings (p < 0.01) compared with the pre-telehealth period. Attending physicians had a greater patient volume, spent more time, and were more efficient in the EHR compared with trainees (p < 0.01) in both the post-telehealth and follow-up periods as compared with the pre-telehealth period. CONCLUSION: The dramatic change in clinical operations during the pandemic serves as an inflection point to study changes in physician practice patterns in the EHR. We observed that (1) female physicians closed fewer notes the same day and spent more time in the EHR outside of normal working hours compared with male physicians, and (2) attending physicians had higher patient volumes and also higher efficiency in the EHR compared with resident physicians.
Asunto(s)
COVID-19 , Registros Electrónicos de Salud , Internado y Residencia , Telemedicina , Femenino , Humanos , Masculino , COVID-19/epidemiología , Pacientes Ambulatorios , PandemiasRESUMEN
Can the adult brain assimilate a novel, topographically organized, sensory modality into its perceptual repertoire? To test this, we implemented a microstimulation-based neuroprosthesis that rats used to discriminate among infrared (IR) light sources. This system continuously relayed information from four IR sensors that were distributed to provide a panoramic view of IR sources, into primary somatosensory cortex (S1). Rats learned to discriminate the location of IR sources in <4 d. Animals in which IR information was delivered in spatial register with whisker topography learned the task more quickly. Further, in animals that had learned to use the prosthesis, altering the topographic mapping from IR sensor to stimulating electrode had immediate deleterious effects on discrimination performance. Multielectrode recordings revealed that S1 neurons had multimodal (tactile/IR) receptive fields, with clear preferences for those stimuli most likely to be delivered during the task. Neuronal populations predicted, with high accuracy, which stimulation pattern was present in small (75 ms) time windows. Surprisingly, when identical microstimulation patterns were delivered during an unrelated task, cortical activity in S1 was strongly suppressed. Overall, these results show that the adult mammalian neocortex can readily absorb completely new information sources into its representational repertoire, and use this information in the production of adaptive behaviors.