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Design and implementation of electronic health record common data elements for pediatric epilepsy: Foundations for a learning health care system
dc.contributor.authorGrinspan, Zachary M.
dc.contributor.authorPatel, Anup D.
dc.contributor.authorShellhaas, Renée A.
dc.contributor.authorBerg, Anne T.
dc.contributor.authorAxeen, Erika T.
dc.contributor.authorBolton, Jeffrey
dc.contributor.authorClarke, David F.
dc.contributor.authorCoryell, Jason
dc.contributor.authorGaillard, William D.
dc.contributor.authorGoodkin, Howard P.
dc.contributor.authorKoh, Sookyong
dc.contributor.authorKukla, Alison
dc.contributor.authorMbwana, Juma S.
dc.contributor.authorMorgan, Lindsey A.
dc.contributor.authorSinghal, Nilika S.
dc.contributor.authorStorey, Margaret M.
dc.contributor.authorYozawitz, Elissa G.
dc.contributor.authorAbend, Nicholas S.
dc.contributor.authorFitzgerald, Mark P.
dc.contributor.authorFridinger, Sara E.
dc.contributor.authorHelbig, Ingo
dc.contributor.authorMassey, Shavonne L.
dc.contributor.authorPrelack, Marisa S.
dc.contributor.authorBuchhalter, Jeffrey
dc.date.accessioned2021-02-04T21:48:31Z
dc.date.available2022-02-04 16:48:30en
dc.date.available2021-02-04T21:48:31Z
dc.date.issued2021-01
dc.identifier.citationGrinspan, Zachary M.; Patel, Anup D.; Shellhaas, Renée A. ; Berg, Anne T.; Axeen, Erika T.; Bolton, Jeffrey; Clarke, David F.; Coryell, Jason; Gaillard, William D.; Goodkin, Howard P.; Koh, Sookyong; Kukla, Alison; Mbwana, Juma S.; Morgan, Lindsey A.; Singhal, Nilika S.; Storey, Margaret M.; Yozawitz, Elissa G.; Abend, Nicholas S.; Fitzgerald, Mark P.; Fridinger, Sara E.; Helbig, Ingo; Massey, Shavonne L.; Prelack, Marisa S.; Buchhalter, Jeffrey (2021). "Design and implementation of electronic health record common data elements for pediatric epilepsy: Foundations for a learning health care system." Epilepsia (1): 198-216.
dc.identifier.issn0013-9580
dc.identifier.issn1528-1167
dc.identifier.urihttps://hdl.handle.net/2027.42/166156
dc.description.abstractObjectiveCommon data elements (CDEs) are standardized questions and answer choices that allow aggregation, analysis, and comparison of observations from multiple sources. Clinical CDEs are foundational for learning health care systems, a data‐driven approach to health care focused on continuous improvement of outcomes. We aimed to create clinical CDEs for pediatric epilepsy.MethodsA multiple stakeholder group (clinicians, researchers, parents, caregivers, advocates, and electronic health record [EHR] vendors) developed clinical CDEs for routine care of children with epilepsy. Initial drafts drew from clinical epilepsy note templates, CDEs created for clinical research, items in existing registries, consensus documents and guidelines, quality metrics, and outcomes needed for demonstration projects. The CDEs were refined through discussion and field testing. We describe the development process, rationale for CDE selection, findings from piloting, and the CDEs themselves. We also describe early implementation, including experience with EHR systems and compatibility with the International League Against Epilepsy classification of seizure types.ResultsCommon data elements were drafted in August 2017 and finalized in January 2020. Prioritized outcomes included seizure control, seizure freedom, American Academy of Neurology quality measures, presence of common comorbidities, and quality of life. The CDEs were piloted at 224 visits at 10 centers. The final CDEs included 36 questions in nine sections (number of questions): diagnosis (1), seizure frequency (9), quality of life (2), epilepsy history (6), etiology (8), comorbidities (2), treatment (2), process measures (5), and longitudinal history notes (1). Seizures are categorized as generalized tonic‐clonic (regardless of onset), motor, nonmotor, and epileptic spasms. Focality is collected as epilepsy type rather than seizure type. Seizure frequency is measured in nine levels (all used during piloting). The CDEs were implemented in three vendor systems. Early clinical adoption included 1294 encounters at one center.SignificanceWe created, piloted, refined, finalized, and implemented a novel set of clinical CDEs for pediatric epilepsy.
dc.publisherNational Academies Press
dc.publisherWiley Periodicals, Inc.
dc.titleDesign and implementation of electronic health record common data elements for pediatric epilepsy: Foundations for a learning health care system
dc.typeArticle
dc.rights.robotsIndexNoFollow
dc.subject.hlbsecondlevelMedicine (General)
dc.subject.hlbtoplevelHealth Sciences
dc.description.peerreviewedPeer Reviewed
dc.description.bitstreamurlhttp://deepblue.lib.umich.edu/bitstream/2027.42/166156/1/epi16733.pdf
dc.description.bitstreamurlhttp://deepblue.lib.umich.edu/bitstream/2027.42/166156/2/epi16733_am.pdf
dc.identifier.doi10.1111/epi.16733
dc.identifier.doihttps://dx.doi.org/10.7302/79
dc.identifier.sourceEpilepsia
dc.identifier.citedreferencePerucca P, Carter J, Vahle V, Gilliam FG. Adverse antiepileptic drug effects: toward a clinically and neurobiologically relevant taxonomy. Neurology. 2009; 72 ( 14 ): 1223 – 9.
dc.identifier.citedreferenceMc Quaid L, Breen P, Grimson J, Normand C, Dunne M, Delanty N, et al. Socio-technical considerations in epilepsy electronic patient record implementation. Int J Med Informatics. 2010; 79 ( 5 ): 349 – 60.
dc.identifier.citedreferenceFitzsimons M, Dunleavy B, O’Byrne P, Dunne M, Grimson J, Kalra D, et al. Assessing the quality of epilepsy care with an electronic patient record. Seizure. 2013; 22 ( 8 ): 604 – 10.
dc.identifier.citedreferenceDelanty N, White M, Benson K, McCormack M, Heavin S, Comerford E, et al. Development of a genomics module within an epilepsy-specific electronic health record: toward genomic medicine in epilepsy care. Epilepsia. 2019; 60 ( 8 ): 1670 – 7.
dc.identifier.citedreferenceNarayanan J, Dobrin S, Choi J, Rubin S, Pham A, Patel V, et al. Structured clinical documentation in the electronic medical record to improve quality and to support practice-based research in epilepsy. Epilepsia. 2017; 58 ( 1 ): 68 – 76.
dc.identifier.citedreferenceCohen GR, Friedman CP, Ryan AM, Richardson CR, Adler-Milstein J. Variation in physicians’ electronic health record documentation and potential patient harm from that variation. J Gen Intern Med. 2019; 34 ( 11 ): 2355 – 67.
dc.identifier.citedreferenceBruland P, McGilchrist M, Zapletal E, Acosta D, Proeve J, Askin S, et al. Common data elements for secondary use of electronic health record data for clinical trial execution and serious adverse event reporting. BMC Med Res Methodol. 2016; 16 ( 1 ): 159.
dc.identifier.citedreferenceZaharias G. What is narrative-based medicine? Narrative-based medicine 1. Can Fam Physician. 2018; 64 ( 3 ): 176 – 80.
dc.identifier.citedreferenceJoukes E, Abu-Hanna A, Cornet R, de Keizer NF. Time spent on dedicated patient care and documentation tasks before and after the introduction of a structured and standardized electronic health record. Appl Clin Inform. 2018; 9 ( 1 ): 46 – 53.
dc.identifier.citedreferenceGardner RL, Cooper E, Haskell J, Harris DA, Poplau S, Kroth PJ, et al. Physician stress and burnout: the impact of health information technology. J Am Med Inform Assoc. 2019; 26 ( 2 ): 106 – 14.
dc.identifier.citedreferenceHafeez B, Paolicchi J, Pon S, Howell JD, Grinspan ZM. Feasibility of automatic extraction of electronic health data to evaluate a status epilepticus clinical protocol. J Child Neurol. 2016; 31 ( 6 ): 709 – 16.
dc.identifier.citedreferenceGoldenholz DM, Moss R, Jost DA, Crone NE, Krauss G, Picard R, et al. Common data elements for epilepsy mobile health systems. Epilepsia. 2018; 59 ( 5 ): 1020 – 6.
dc.identifier.citedreferenceAncker JS, Kern LM, Abramson E, Kaushal R. The Triangle Model for evaluating the effect of health information technology on healthcare quality and safety. J Am Med Inform Assoc. 2012; 19 ( 1 ): 61 – 5.
dc.identifier.citedreferenceHelbig I, Riggs ER, Barry CA, Klein KM, Dyment D, Thaxton C, et al. The ClinGen Epilepsy Gene Curation Expert Panel—bridging the divide between clinical domain knowledge and formal gene curation criteria. Hum Mutat. 2018; 39 ( 11 ): 1476 – 84.
dc.identifier.citedreferenceBerg AT, Berkovic SF, Brodie MJ, Buchhalter J, Cross JH, van Emde Boas W, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005–2009. Epilepsia. 2010; 51 ( 4 ): 676 – 85.
dc.identifier.citedreferenceLuders H, Akamatsu N, Amina S, Baumgartner C, Benbadis S, Bermeo-Ovalle A, et al. Critique of the 2017 epileptic seizure and epilepsy classifications. Epilepsia. 2019; 60 ( 6 ): 1032 – 9.
dc.identifier.citedreferenceBerg AT. Risk of recurrence after a first unprovoked seizure. Epilepsia. 2008; 49 ( Suppl 1 ): 13 – 8.
dc.identifier.citedreferenceDevinsky O, Cross JH, Wright S. Trial of cannabidiol for drug-resistant seizures in the Dravet syndrome. N Engl J Med. 2017; 377: 699 – 700.
dc.identifier.citedreferenceDevinsky O, Patel AD, Cross JH, Villanueva V, Wirrell EC, Privitera M, et al. Effect of cannabidiol on drop seizures in the Lennox‐Gastaut syndrome. N Engl J Med. 2018; 378: 1888 – 97.
dc.identifier.citedreferenceBerg AT, Rychlik K, Levy SR, Testa FM. Complete remission of childhood-onset epilepsy: stability and prediction over two decades. Brain. 2014; 137: 3213 – 22.
dc.identifier.citedreferenceGlauser TA, Cnaan A, Shinnar S, Hirtz DG, Dlugos D, Masur D, et al. Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy. N Engl J Med. 2010; 362: 790 – 9.
dc.identifier.citedreferenceO’Callaghan FJ, Edwards SW, Alber FD, Hancock E, Johnson AL, Kennedy CR, et al. Safety and effectiveness of hormonal treatment versus hormonal treatment with vigabatrin for infantile spasms (ICISS): a randomised, multicentre, open-label trial. Lancet Neurol. 2017; 16: 33 – 42.
dc.identifier.citedreferenceHussain SA, Shinnar S, Kwong G, Lerner JT, Matsumoto JH, Wu JY, et al. Treatment of infantile spasms with very high dose prednisolone before high dose adrenocorticotropic hormone. Epilepsia. 2014; 55: 103 – 7.
dc.identifier.citedreferenceFountain NB, Van Ness PC, Bennett A, Absher J, Patel AD, Sheth KN, et al. Quality improvement in neurology: epilepsy update quality measurement set. Neurology. 2015; 84: 1483 – 7.
dc.identifier.citedreferenceRamachandranNair R, Jack SM. SUDEP: what do adult patients want to know? Epilepsy Behav. 2016; 64: 195 – 9.
dc.identifier.citedreferenceHo NT, Kroner B, Grinspan Z, Fureman B, Farrell K, Zhang J, et al. Comorbidities of rare epilepsies: results from the rare epilepsy network. J Pediatr. 2018; 203 ( 249–258 ): e245.
dc.identifier.citedreferenceGoodwin SW, Ferro MA, Speechley KN. Development and assessment of the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-16). Epilepsia. 2018; 59: 668 – 78.
dc.identifier.citedreferenceO’Callaghan FJK, Edwards SW, Alber FD, Cortina Borja M, Hancock E, Johnson AL, et al. Vigabatrin with hormonal treatment versus hormonal treatment alone (ICISS) for infantile spasms: 18-month outcomes of an open-label, randomised controlled trial. Lancet Child Adolesc Health. 2018; 2: 715 – 25.
dc.identifier.citedreferenceJain SV, Kothare SV. Sleep and epilepsy. Semin Pediatr Neurol. 2015; 22: 86 – 92.
dc.identifier.citedreferenceGrinspan ZM, Shapiro JS, Abramson EL, Hooker G, Kaushal R, Kern LM. Predicting frequent ED use by people with epilepsy with health information exchange data. Neurology. 2015; 85 ( 12 ): 1031 – 8.
dc.identifier.citedreferenceKeros S, Buraniqi E, Alex B, Antonetty A, Fialho H, Hafeez B, et al. Increasing ketamine use for refractory status epilepticus in US pediatric hospitals. J Child Neurol. 2017; 32: 638 – 46.
dc.identifier.citedreferenceMoura LM, Schwamm E, Moura Junior V, Seitz MP, Hsu J, Cole AJ, et al. Feasibility of the collection of patient‐reported outcomes in an ambulatory neurology clinic. Neurology. 2016; 87: 2435 – 42.
dc.identifier.citedreferenceModi AC, Rausch JR, Glauser TA. Patterns of nonadherence to antiepileptic drug therapy in children with newly diagnosed epilepsy. JAMA. 2011; 305: 1669 – 76.
dc.identifier.citedreferenceBerg AT, Zelko FA, Levy SR, Testa FM. Age at onset of epilepsy, pharmacoresistance, and cognitive outcomes: a prospective cohort study. Neurology. 2012; 79: 1384 – 91.
dc.identifier.citedreferenceWirrell EC, Camfield CS, Camfield PR, Dooley JM, Gordon KE, Smith B. Long-term psychosocial outcome in typical absence epilepsy. Sometimes a wolf in sheeps’ clothing. Arch Pediatr Adolesc Med. 1997; 151: 152 – 8.
dc.identifier.citedreferenceSpindler UP, Hotopp LC, Bach VA, Hornemann F, Syrbe S, Andreas A, et al. Seizure disorders and developmental disorders: impact on life of affected families—a structured interview. Eur J Pediatr. 2017; 176: 1121 – 9.
dc.identifier.citedreferenceBegley C, Shegog R, Liu H, Tatsuoka C, Spruill TM, Friedman D, et al. Correlates of epilepsy self-management in MEW Network participants: from the Centers for Disease Control and Prevention Managing Epilepsy Well Network. Epilepsy Behav. 2018; 85: 243 – 7.
dc.identifier.citedreferenceNabbout R, Andrade DM, Bahi-Buisson N, Cross H, Desquerre I, Dulac O, et al. Outcome of childhood-onset epilepsy from adolescence to adulthood: transition issues. Epilepsy Behav. 2017; 69: 161 – 9.
dc.identifier.citedreferenceBisgaier J, Rhodes KV. Auditing access to specialty care for children with public insurance. N Engl J Med. 2011; 364: 2324 – 33.
dc.identifier.citedreferenceInstitute of Medicine (US) Roundtable on Evidence-Based Medicine, Olsen L, Aisner D, McGinnis JM, eds. The Learning Healthcare System: Workshop Summary. Washington, DC: National Academies Press; 2007.
dc.identifier.citedreferenceLoring DW, Lowenstein DH, Barbaro NM, Fureman BE, Odenkirchen J, Jacobs MP, et al. Common data elements in epilepsy research: development and implementation of the NINDS epilepsy CDE project. Epilepsia. 2011; 52 ( 6 ): 1186 – 91.
dc.identifier.citedreferencePerry MS. Meaningful results in a Jiffy—a PERC of multicenter collaborations. Epilepsy Curr. 2016; 16 ( 5 ): 299 – 301.
dc.identifier.citedreferenceBerg AT, Coryell J, Saneto RP, Grinspan ZM, Alexander JJ, Kekis M, et al. Early-life epilepsies and the emerging role of genetic testing. JAMA Pediatr. 2017; 171 ( 9 ): 863 – 71.
dc.identifier.citedreferenceKnupp KG, Coryell J, Nickels KC, Ryan N, Leister E, Loddenkemper T, et al. Response to treatment in a prospective national infantile spasms cohort. Ann Neurol. 2016; 79 ( 3 ): 475 – 84.
dc.identifier.citedreferenceShellhaas RA, Wusthoff CJ, Tsuchida TN, Glass HC, Chu CJ, Massey SL, et al. Profile of neonatal epilepsies: characteristics of a prospective US cohort. Neurology. 2017; 89 ( 9 ): 893 – 9.
dc.identifier.citedreferenceGainza-Lein M, Sanchez Fernandez I, Jackson M, Abend NS, Arya R, Brenton JN, et al. Association of time to treatment with short-term outcomes for pediatric patients with refractory convulsive status epilepticus. JAMA Neurol. 2018; 75 ( 4 ): 410 – 8.
dc.identifier.citedreferencePatel AD, Baca C, Franklin G, Herman ST, Hughes I, Meunier L, et al. Quality improvement in neurology: epilepsy Quality Measurement Set 2017 update. Neurology. 2018; 91 ( 18 ): 829 – 36.
dc.identifier.citedreferencePatel AD, Berg AT, Billinghurst L, Fain D, Fecske E, Feyma T, et al. Quality improvement in neurology: child neurology quality measure set: executive summary. Neurology. 2018; 90 ( 2 ): 67 – 73.
dc.identifier.citedreferenceWeathers AL, Haq IU, Ficker DM, Ney JP, Meyers SL. Neurology steering board effects change for a major electronic health record vendor. Neurol Clin Pract. 2019; 9 ( 4 ): 360 – 4.
dc.identifier.citedreferenceBoyatzis RE. Transforming Qualitative Information: Thematic Analysis and Code Development. Thousand Oaks, CA: Sage Publications; 1998.
dc.identifier.citedreferencePartnership for Health IT Patient Safety. Health IT safe practices: toolkit for the safe use of copy and paste. ECRI Institute website. Published February 2016. Available at: https://www.ecri.org/Resou​rces/HIT/CP_Toolk​it/Toolk​it_CopyP​aste_final.pdf. Accessed January 21, 2020.
dc.identifier.citedreferenceCramer JA, French J. Quantitative assessment of seizure severity for clinical trials: a review of approaches to seizure components. Epilepsia. 2001; 42 ( 1 ): 119 – 29.
dc.identifier.citedreferenceFisher RS, Cross JH, French JA, Higurashi N, Hirsch E, Jansen FE, et al. Operational classification of seizure types by the International League Against Epilepsy: position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017; 58 ( 4 ): 522 – 30.
dc.identifier.citedreferenceScheffer IE, Berkovic S, Capovilla G, Connolly MB, French J, Guilhoto L, et al. ILAE classification of the epilepsies: position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017; 58 ( 4 ): 512 – 21.
dc.identifier.citedreferenceSaitwal H, Feng X, Walji M, Patel V, Zhang J. Assessing performance of an electronic health record (EHR) using cognitive task analysis. Int J Med Informatics. 2010; 79 ( 7 ): 501 – 6.
dc.identifier.citedreferenceFisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE official report: A practical clinical definition of epilepsy. Epilepsia. 2014; 55 ( 4 ): 475 – 82.
dc.identifier.citedreferenceHarden C, Tomson T, Gloss D, Buchhalter J, Cross JH, Donner E, et al. Practice guideline summary: Sudden unexpected death in epilepsy incidence rates and risk factors: report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2017; 88 ( 17 ): 1674 – 80.
dc.identifier.citedreferenceWirrell EC, Laux L, Donner E, Jette N, Knupp K, Meskis MA, et al. Optimizing the diagnosis and management of Dravet syndrome: recommendations from a North American consensus panel. Pediatr Neurol. 2017; 68 ( 18–34 ): e13.
dc.identifier.citedreferenceBlachut B, Hoppe C, Surges R, Stahl J, Elger CE, Helmstaedter C. Counting seizures: the primary outcome measure in epileptology from the patients’ perspective. Seizure. 2015; 29: 97 – 103.
dc.identifier.citedreferenceHoppe C, Poepel A, Elger CE. Epilepsy: accuracy of patient seizure counts. Arch Neurol. 2007; 64 ( 11 ): 1595 – 9.
dc.identifier.citedreferenceKnupp KG, Leister E, Coryell J, Nickels KC, Ryan N, Juarez-Colunga E, et al. Response to second treatment after initial failed treatment in a multicenter prospective infantile spasms cohort. Epilepsia. 2016; 57 ( 11 ): 1834 – 42.
dc.identifier.citedreferenceShinnar S, Maytal J, Krasnoff L, Moshe SL. Recurrent status epilepticus in children. Ann Neurol. 1992; 31 ( 6 ): 598 – 604.
dc.identifier.citedreferencePrasad M, Krishnan PR, Sequeira R, Al-Roomi K. Anticonvulsant therapy for status epilepticus. Cochrane Database Syst Rev. 2014;( 9 ): CD003723.
dc.identifier.citedreferenceShah P, Storey M, Axeen ET, Patel AD, Shellhaas RA, Grinspan ZM, et al. Pediatric Epilepsy Learning Healthcare System Quality of Life Questions (PELHS-QOL-2), a novel QOL instrument for use in clinical care. Conference abstract. American Epilepsy Society Annual Meeting (AES) 2019; December 6–10, 2019; Baltimore, MD.
dc.identifier.citedreferenceGoodwin SW, Lambrinos AI, Ferro MA, Sabaz M, Speechley KN. Development and assessment of a shortened Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55). Epilepsia. 2015; 56 ( 6 ): 864 – 72.
dc.identifier.citedreferenceMorita DA, Glauser TA, Modi AC. Development and validation of the Pediatric Epilepsy Side Effects Questionnaire. Neurology. 2012; 79 ( 12 ): 1252 – 8.
dc.identifier.citedreferenceCoryell J, Gaillard WD, Shellhaas RA, Grinspan ZM, Wirrell EC, Knupp KG, et al. Neuroimaging of early life epilepsy. Pediatrics. 2018; 142: 3.
dc.identifier.citedreferenceLindy AS, Stosser MB, Butler E, Downtain-Pickersgill C, Shanmugham A, Retterer K, et al. Diagnostic outcomes for genetic testing of 70 genes in 8565 patients with epilepsy and neurodevelopmental disorders. Epilepsia. 2018; 59 ( 5 ): 1062 – 71.
dc.identifier.citedreferenceRamachandran Nair R, Jack SM, Strohm S. SUDEP: to discuss or not? Recommendations from bereaved relatives. Epilepsy Behav. 2016; 56: 20 – 5.
dc.identifier.citedreferenceBerg AT, Goldman S. Getting serious about the early-life epilepsies: lessons from the world of pediatric oncology. Neurology. 2018; 90 ( 18 ): 842 – 8.
dc.identifier.citedreferenceEgberg MD, Kappelman MD, Gulati AS. Improving care in pediatric inflammatory bowel disease. Gastroenterol Clin North Am. 2018; 47 ( 4 ): 909 – 19.
dc.identifier.citedreferenceAnderson JB, Beekman RH 3rd, Kugler JD, Rosenthal GL, Jenkins KJ, Klitzner TS, et al. Improvement in interstage survival in a national pediatric cardiology learning network. Circ Cardiovasc Qual Outcomes. 2015; 8 ( 4 ): 428 – 36.
dc.identifier.citedreferenceBarry MJ, Edgman-Levitan S. Shared decision making—pinnacle of patient‐centered care. N Engl J Med. 2012; 366 ( 9 ): 780 – 1.
dc.identifier.citedreferenceBillingham V. Through the patient’s eyes. Salzburg Global Seminar. Session 356, 1998, as cited in Barry MJ, Edgman-Levitan S, Shared-decision making – the pinnacle of patient‐centered care. N Engl J Med. 2012;366:780–81.
dc.identifier.citedreferenceMbwana JS, Grinspan ZM, Bailey R, Berl M, Buchhalter J, Bumbut A, et al. Using EHRs to advance epilepsy care. Neurol Clin Pract. 2019; 9 ( 1 ): 83 – 8.
dc.working.doi10.7302/79en
dc.owningcollnameInterdisciplinary and Peer-Reviewed


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