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Visser JJ, de Vries M, Kors JA. Assessment of actionable findings in radiology reports. Eur J Radiol 2020; 129:109109. [PMID: 32521309 DOI: 10.1016/j.ejrad.2020.109109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/20/2020] [Accepted: 05/31/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE The American College of Radiology (ACR) Actionable Reporting Work Group defined three categories of imaging findings that require additional, nonroutine communication with the referring physician because of their urgency or unexpectedness. The objective of this study was to determine the prevalence of actionable findings in radiology reports, and to assess how well radiologists agree on the categorisation of actionable findings. METHOD From 124,909 consecutive radiology reports stored in the electronic health record system of a large university hospital, 1000 reports were randomly selected. Two radiologists independently annotated all actionable findings according to the three categories of urgency defined by the ACR Work Group. Annotation differences were resolved in a consensus meeting and a final category was established for each report. Interannotator agreement was measured by accuracy and the kappa coefficient. RESULTS The prevalence of the three categories of actionable findings together was 32.5 %. Of all reports, 10.9 % were from patients seen in the emergency department. Prevalence of actionable findings for these patients (45.9 %) was considerably higher than for patients in routine clinical care (30.9 %). Interannotator agreement scores on the categorisation of actionable findings were 0.812 for accuracy and 0.616 for kappa coefficient. CONCLUSIONS The prevalence of actionable findings in radiology reports is high. The interannotator agreement scores are moderate, indicating that categorisation of actionable findings is a difficult task. To avoid unneeded increase in the workload of radiologists, in particular in routine practice, clinical context may need to be considered in deciding whether a finding is actionable.
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Affiliation(s)
- Jacob J Visser
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Marianne de Vries
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Jan A Kors
- Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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2
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Centonze C, Guzzetti C, Orlando G, Loche S. Adherence to growth hormone (GH) therapy in naïve to treatment GH-deficient children: data of the Italian Cohort from the Easypod Connect Observational Study (ECOS). J Endocrinol Invest 2019; 42:1241-1244. [PMID: 30968283 PMCID: PMC6751271 DOI: 10.1007/s40618-019-01046-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/01/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND With the use of non-objective measurement, adherence to growth hormone (GH) therapy has been reported suboptimal in a large proportion of patients, and poor adherence has been shown to affect short-term growth response in patients receiving GH treatment. OBJECTIVE The Easypod™ electronic device allows objective measurement of adherence. In this study, we report 3-year prospective adherence data of the Italian cohort of naïve GH deficient (GHD) children extrapolated from the Easypod Connect Observational Study (ECOS) database. PATIENTS AND METHODS Seventy-three GHD children naïve to GH treatment were included in the analysis. 22 Italian centers participated in the study. RESULTS Mean adherence rate was consistently above 85% across the 3-year observation period. Particularly, mean adherence was 88.5%, 86.6%, and 85.7% after 1, 2 and 3 years, respectively. Mean (± SD) height-SDS increase after the first year was 0.41 (± 0.38). CONCLUSIONS The majority of naïve GHD children starting GH treatment with Easypod maintained an adherence rate > 85% up to 3 years. Easypod is a useful tool to follow-up patients' adherence allowing timely intervention to improve optimal treatment for these patients.
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Affiliation(s)
- C Centonze
- Medical Affairs Department, Merck Serono S.p.A., Rome, Italy
| | - C Guzzetti
- SSD di Endocrinologia Pediatrica e, Centro Screening Neonatale, Ospedale Pediatrico Miccrocitemico "A. Cao", AO Brotzu, Via Jenner, 09121, Cagliari, Italy
| | - G Orlando
- Medical Affairs Department, Merck Serono S.p.A., Rome, Italy
| | - S Loche
- SSD di Endocrinologia Pediatrica e, Centro Screening Neonatale, Ospedale Pediatrico Miccrocitemico "A. Cao", AO Brotzu, Via Jenner, 09121, Cagliari, Italy.
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Pricci F, Villa M, Maccari F, Agazio E, Rotondi D, Panei P, Roazzi P. The Italian Registry of GH Treatment: electronic Clinical Report Form (e-CRF) and web-based platform for the national database of GH prescriptions. J Endocrinol Invest 2019; 42:769-777. [PMID: 30443857 PMCID: PMC6581935 DOI: 10.1007/s40618-018-0980-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/08/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND In Italy, the utilization and the reimbursement of Growth Hormone (rGH) therapy by the National Health System (Servizio Sanitario Nazionale) are regulated by the "Note #39" included in the "Notes for the use of drugs" by the Italian Medicines Agency (AIFA), which are published in the Official Gazette, thus having the force of law. The "Note #39" establishes the diagnosis for which the reimbursement is granted and confirms the assignment of the national health surveillance on the use of GH therapy to the Italian National Institute of Health, requesting its computerization. AIM The aim of this work was to realize a dedicated electronic Clinical Report Form based on the mandatory data requested by the Note #39 and allowing the online reporting of the rGH prescriptions by the regional accredited centers. RESULTS AND CONCLUSIONS This interface is at the base of the national database of the Italian Registry of GH Treatment, which allows obtaining and managing correct and complete data to provide public health surveillance on GH therapy, both at national and local levels, necessary for policymakers decisions. In addition, this national database could be a useful instrument for improving knowledge about aspects of this treatment still under discussion.
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Affiliation(s)
- F. Pricci
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - M. Villa
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - F. Maccari
- Information Technology Service, Istituto Superiore di Sanità, Rome, Italy
| | - E. Agazio
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - D. Rotondi
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - P. Panei
- Grant Office and Technology Transfer, Istituto Superiore di Sanità, Rome, Italy
| | - P. Roazzi
- Health Technology Assessment, Istituto Superiore di Sanità, Rome, Italy
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McMinn MA, Martikainen P, Gorman E, Rissanen H, Härkänen T, Tolonen H, Leyland AH, Gray L. Validation of non-participation bias methodology based on record-linked Finnish register-based health survey data: a protocol paper. BMJ Open 2019; 9:e026187. [PMID: 30948596 PMCID: PMC6500270 DOI: 10.1136/bmjopen-2018-026187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Decreasing participation levels in health surveys pose a threat to the validity of estimates intended to be representative of their target population. If participants and non-participants differ systematically, the results may be biased. The application of traditional non-response adjustment methods, such as weighting, can fail to correct for such biases, as estimates are typically based on the sociodemographic information available. Therefore, a dedicated methodology to infer on non-participants offers advancement by employing survey data linked to administrative health records, with reference to data on the general population. We aim to validate such a methodology in a register-based setting, where individual-level data on participants and non-participants are available, taking alcohol consumption estimation as the exemplar focus. METHODS AND ANALYSIS We made use of the selected sample of the Health 2000 survey conducted in Finland and a separate register-based sample of the contemporaneous population, with follow-up until 2012. Finland has nationally representative administrative and health registers available for individual-level record linkage to the Health 2000 survey participants and invited non-participants, and the population sample. By comparing the population sample and the participants, synthetic observations representing the non-participants may be generated, as per the developed methodology. We can compare the distribution of the synthetic non-participants with the true distribution from the register data. Multiple imputation was then used to estimate alcohol consumption based on both the actual and synthetic data for non-participants, and the estimates can be compared to evaluate the methodology's performance. ETHICS AND DISSEMINATION Ethical approval and access to the Health 2000 survey data and data from administrative and health registers have been given by the Health 2000 Scientific Advisory Board, Statistics Finland and the National Institute for Health and Welfare. The outputs will include two publications in public health and statistical methodology journals and conference presentations.
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Affiliation(s)
- Megan A McMinn
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Science, University of Helsinki, Helsinki, Finland
| | - Emma Gorman
- Department of Economics, Lancaster University, Lancaster, UK
| | - Harri Rissanen
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Tommi Härkänen
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Tolonen
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Linsay Gray
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Reiner BI. Quantitative Analysis of Uncertainty in Medical Reporting: Part 3: Customizable Education, Decision Support, and Automated Alerts. J Digit Imaging 2018; 31:579-584. [PMID: 29255937 PMCID: PMC6148819 DOI: 10.1007/s10278-017-0042-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
In order to better elucidate and understand the causative factors and clinical implications of uncertainty in medical reporting, one must first create a referenceable database which records a number of standardized metrics related to uncertainty language, clinical context, technology, and provider and patient data. The resulting analytics can in turn be used to create context and user-specific reporting guidelines, real-time decision support, educational resources, and quality assurance measures. If this technology can be directly integrated into reporting technology and workflow, the goal is to proactively improve clinical outcomes at the point of care.
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Affiliation(s)
- Bruce I Reiner
- Department of Radiology, Veterans Affairs Maryland Healthcare System, 10 North Greene Street, Baltimore, MA, 21201, USA.
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Holmgren AJ, Adler-Milstein J, McCullough J. Are all certified EHRs created equal? Assessing the relationship between EHR vendor and hospital meaningful use performance. J Am Med Inform Assoc 2018; 25:654-660. [PMID: 29186508 PMCID: PMC7646986 DOI: 10.1093/jamia/ocx135] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/16/2017] [Accepted: 10/21/2017] [Indexed: 11/15/2022] Open
Abstract
Objective The federal electronic health record (EHR) certification process was intended to ensure a baseline level of system quality and the ability to support meaningful use criteria. We sought to assess whether there was variation across EHR vendors in the degree to which hospitals using products from those vendors were able to achieve high levels of performance on meaningful use criteria. Materials and Methods We created a cross-sectional national hospital sample from the Office of the National Coordinator for Health Information Technology EHR Products Used for Meaningful Use Attestation public use file and the Centers for Medicare & Medicaid Services Medicare EHR Incentive Program Eligible Hospitals public use file. We used regression models to assess the relationship between vendor and hospital performance on 6 Stage 2 Meaningful Use criteria, controlling for hospital characteristics. We also calculated how much variation in performance is explained by vendor choice. Results We found significant associations between specific vendor and level of hospital performance for all 6 meaningful use criteria. Epic was associated with significantly higher performance on 5 of the 6 criteria; relationships for other vendors were mixed, with some associated with significantly worse performance on multiple criteria. EHR vendor choice accounted for between 7% and 34% of performance variation across the 6 criteria. Discussion A nontrivial proportion of variation in hospital meaningful use performance is explained by vendor choice, and certain vendors are more often associated with better meaningful use performance than others. Our results suggest that policy-makers should improve the certification process by including more "real-world" scenario testing and provider feedback or ratings to reduce this variation. Hospitals can use these results to guide interactions with vendors. Conclusion Vendor choice accounts for a meaningful proportion of variation in hospital meaningful use performance, and specific vendors are consistently associated with higher or lower performance across criteria.
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Affiliation(s)
- A Jay Holmgren
- Harvard Business School, Harvard University, Boston, MA 02163, USA
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Abstract
Aims and background False-negative cytological diagnoses represent the critical point of a screening program for early detection of cervical cancer. Computer-assisted reading using neural network technology has been suggested as a possible approach to manage the problem. The study assessed the performance and the cost-outcome ratio of computer-assisted versus conventional manual Pap smear reading. Methods One thousand routine smears, seeded with 81 false-negative smears, were independently interpreted by two readers by conventional and PAPNET-assisted reading. Results of both readings were compared in terms of: a)sensitivity for false-negative smears, b)specificity, and c) cost-outcome (cost per CIN2+ lesion detected). Results PAPNET-assisted reading showed a small increase in sensitivity only for one reader. Including the cost of PAPNET, the cost per detected lesion would be $7,543 and the cost per additional detected lesion would be $25,748. Conclusions The present study provides further evidence that PAPNET-assisted screening may allow the detection of a few extra cases of CIN2+ lesions with respect to conventional reading, though at a very high cost.
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Affiliation(s)
- G M Troni
- Department of Cytopathology, Center for Cancer Study and Prevention, Florence, Italy
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Quantin C, Le Goaster C, Mercier G, Seguret F. [Editorial]. Rev Epidemiol Sante Publique 2018; 66 Suppl 1:S3-S4. [PMID: 29439888 DOI: 10.1016/j.respe.2018.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- C Quantin
- Service de biostatistique et d'information médicale, centre hospitalier universitaire, boulevard Jeanne d'Arc BP 77908, 21079 Dijon cedex, France.
| | - C Le Goaster
- Mission scientifique et internationale, santé publique, France
| | - G Mercier
- Responsable unité de recherche médico-economique, DIM-CHU de Montpellier, France
| | - F Seguret
- Unité d'évaluation et d'études epidémiologiques sur les bases nationales d'activité hospitalière, département d'information médicale-CHU Montpellier, France
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Affiliation(s)
- Vindell Washington
- From Blue Cross & Blue Shield of Louisiana, Baton Rouge (V.W.) and New Orleans (K.D.); Aledade, Bethesda, MD (F.M.); and the Commonwealth Fund, New York (D.B.)
| | - Karen DeSalvo
- From Blue Cross & Blue Shield of Louisiana, Baton Rouge (V.W.) and New Orleans (K.D.); Aledade, Bethesda, MD (F.M.); and the Commonwealth Fund, New York (D.B.)
| | - Farzad Mostashari
- From Blue Cross & Blue Shield of Louisiana, Baton Rouge (V.W.) and New Orleans (K.D.); Aledade, Bethesda, MD (F.M.); and the Commonwealth Fund, New York (D.B.)
| | - David Blumenthal
- From Blue Cross & Blue Shield of Louisiana, Baton Rouge (V.W.) and New Orleans (K.D.); Aledade, Bethesda, MD (F.M.); and the Commonwealth Fund, New York (D.B.)
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10
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Affiliation(s)
- John D Halamka
- From Beth Israel Deaconess Medical Center and Harvard Medical School, Boston (J.D.H.), and the Massachusetts eHealth Collaborative, Waltham (M.T.) - both in Massachusetts
| | - Micky Tripathi
- From Beth Israel Deaconess Medical Center and Harvard Medical School, Boston (J.D.H.), and the Massachusetts eHealth Collaborative, Waltham (M.T.) - both in Massachusetts
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Holmes J, Allen N, Roberts G, Geen J, Williams JD, Phillips AO. Acute kidney injury electronic alerts in primary care - findings from a large population cohort. QJM 2017; 110:577-582. [PMID: 28402560 DOI: 10.1093/qjmed/hcx080] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Electronic reporting of AKI has been used to aid early AKI recognition although its relevance to CA-AKI and primary care has not been described. AIMS We described the characteristics and clinical outcomes of patients with CA-AKI, and AKI identified in primary care (PC-AKI) through AKI e-Alerts. DESIGN A prospective national cohort study was undertaken to collect data on all e-alerts representing adult CA-AKI. METHOD The study utilized the biochemistry based AKI electronic (e)-alert system that is established across the Welsh National Health Service. RESULTS 28.8% of the 22 723 CA-AKI e-alerts were classified as PC-AKI. Ninety-day mortality was 24.0% and lower for PC-AKI vs. non-primary care (non-PC) CA-AKI. Hospitalization was 22.3% for PC-AKI and associated with greater disease severity, higher mortality, but better renal outcomes (non-recovery: 18.1% vs. 21.6%; progression of pre-existing CKD: 40.5% vs. 58.3%). 49.1% of PC-AKI had a repeat test within 7 days, 42.5% between 7 and 90 days, and 8.4% was not repeated within 90 days. There was significantly more non-recovery (24.0% vs. 17.9%) and progression of pre-existing CKD (63.3% vs. 47.0%) in patients with late repeated measurement of renal function compared to those with early repeated measurement of renal function. CONCLUSION The data demonstrate the clinical utility of AKI e-alerts in primary care. We recommend that a clinical review, or referral together with a repeat measurement of renal function within 7 days should be considered an appropriate response to AKI e-alerts in primary care.
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Affiliation(s)
- J Holmes
- Welsh Renal Clinical Network, Cwm Taf University Health Board
| | - N Allen
- Redlands Surgery, Penarth, Cardiff and Vale University Health Board
| | - G Roberts
- Department of Clinical Biochemistry, Hywel Dda University Health Board
| | - J Geen
- Department of Clinical Biochemistry, Cwm Taf University Health Board, Merthyr, UK
- Faculty of Life Sciences and Education, University of South Wales, UK
| | - J D Williams
- Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK
| | - A O Phillips
- Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK
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Trudel MC, Marsan J, Paré G, Raymond L, Ortiz de Guinea A, Maillet É, Micheneau T. Ceiling effect in EMR system assimilation: a multiple case study in primary care family practices. BMC Med Inform Decis Mak 2017; 17:46. [PMID: 28427405 PMCID: PMC5397698 DOI: 10.1186/s12911-017-0445-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 04/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been indisputable growth in adoption of electronic medical record (EMR) systems in the recent years. However, physicians' progress in using these systems has stagnated when measured with maturity scales. While this so-called ceiling effect has been observed and its consequences described in previous studies, there is a paucity of research on the elements that could explain such an outcome. We first suggest that in the context of EMR systems we are in presence of a "tiered ceiling effect" and then we show why such phenomenon occurs. METHODS We conducted in-depth case studies in three primary care medical practices in Canada where physicians had been using EMR systems for 3 years or more. A total of 37 semi-structured interviews were conducted with key informants: family physicians (about half of the interviews), nurses, secretaries, and administrative managers. Additional information was obtained through notes taken during observations of users interacting with their EMR systems and consultation of relevant documents at each site. We used abductive reasoning to infer explanations of the observed phenomenon by going back and forth between the case data and conceptual insights. RESULTS Our analysis shows that a ceiling effect has taken place in the three clinics. We identified a set of conditions preventing the users from overcoming the ceiling. In adopting an EMR system, all three clinics essentially sought improved operational efficiency. This had an influence on the criteria used to assess the systems available on the market and eventually led to the adoption of a system that met the specified criteria without being optimal. Later, training sessions focussed on basic functionalities that minimally disturbed physicians' habits while helping their medical practices become more efficient. Satisfied with the outcome of their system use, physicians were likely to ignore more advanced EMR system functionalities. This was because their knowledge about EMR systems came almost exclusively from a single source of information: their EMR system vendors. This knowledge took the form of interpretations of what the innovation was (know-what), with little consideration of the rationales for innovation adoption (know-why) or hands-on strategies for adopting, implementing and assimilating the innovation in the organization (know-how). CONCLUSIONS This paper provides a holistic view of the technological innovation process in primary care and contends that limited learning, satisficing behaviours and organizational inertia are important factors leading to the ceiling effect frequently experienced in the EMR system assimilation phase.
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Affiliation(s)
- Marie-Claude Trudel
- 0000 0001 0555 9354grid.256696.8Information Technology Department, HEC Montréal, 3000, Chemin de la Côte-Sainte-Catherine, Montréal, Québec H3T 2A7 Canada
| | - Josianne Marsan
- 0000 0004 1936 8390grid.23856.3aUniversité Laval, Québec, Canada
| | - Guy Paré
- 0000 0001 0555 9354grid.256696.8Information Technology Department, HEC Montréal, 3000, Chemin de la Côte-Sainte-Catherine, Montréal, Québec H3T 2A7 Canada
| | - Louis Raymond
- 0000 0001 2197 8284grid.265703.5Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Ana Ortiz de Guinea
- 0000 0001 0555 9354grid.256696.8Information Technology Department, HEC Montréal, 3000, Chemin de la Côte-Sainte-Catherine, Montréal, Québec H3T 2A7 Canada
| | - Éric Maillet
- 0000 0000 9064 6198grid.86715.3dUniversité de Sherbrooke, Longueuil, Canada
| | - Thomas Micheneau
- 0000 0001 0555 9354grid.256696.8Information Technology Department, HEC Montréal, 3000, Chemin de la Côte-Sainte-Catherine, Montréal, Québec H3T 2A7 Canada
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Ni MY, Li TK, Hui RWH, McDowell I, Leung GM. Requesting a unique personal identifier or providing a souvenir incentive did not affect overall consent to health record linkage: evidence from an RCT nested within a cohort. J Clin Epidemiol 2017; 84:142-149. [PMID: 28115256 DOI: 10.1016/j.jclinepi.2017.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 12/15/2016] [Accepted: 01/13/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE It is unclear if unique personal identifiers should be requested from participants for health record linkage: this permits high-quality data linkage but at the potential cost of lower consent rates due to privacy concerns. STUDY DESIGN AND SETTING Drawing from a sampling frame based on the FAMILY Cohort, using a 2 × 2 factorial design, we randomly assigned 1,200 participants to (1) request for Hong Kong Identity Card number (HKID) or no request and (2) receiving a souvenir incentive (valued at USD4) or no incentive. The primary outcome was consent to health record linkage. We also investigated associations between demographics, health status, and postal reminders with consent. RESULTS Overall, we received signed consent forms from 33.3% (95% confidence interval [CI] 30.6-36.0%) of respondents. We did not find an overall effect of requesting HKID (-4.3%, 95% CI -9.8% to 1.2%) or offering souvenir incentives (2.4%, 95% CI -3.1% to 7.9%) on consent to linkage. In subgroup analyses, requesting HKID significantly reduced consent among adults aged 18-44 years (odds ratio [OR] 0.53, 95% CI 0.30-0.94, compared to no request). Souvenir incentives increased consent among women (OR 1.55, 95% CI 1.13-2.11, compared to no souvenirs). CONCLUSIONS Requesting a unique personal identifier or providing a souvenir incentive did not affect overall consent to health record linkage.
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Affiliation(s)
- Michael Y Ni
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 7 Sassoon Road, Hong Kong, China.
| | - Tom K Li
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 7 Sassoon Road, Hong Kong, China
| | - Rex W H Hui
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, 7 Sassoon Road, Hong Kong, China
| | - Ian McDowell
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Canada
| | - Gabriel M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 7 Sassoon Road, Hong Kong, China
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14
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Hill DL, Carroll KW, Dai D, Faerber JA, Dougherty SL, Feudtner C. Identifying Communication-Impaired Pediatric Patients Using Detailed Hospital Administrative Data. Hosp Pediatr 2016; 6:456-467. [PMID: 27381628 DOI: 10.1542/hpeds.2015-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Pediatric inpatients with communication impairment may experience inadequate pain and symptom management. Research regarding potential variation in care among patients with and without communication impairment is hampered because existing pediatric databases do not include information about patient communication ability per se, even though these data sets do contain information about diagnoses and medical interventions that are probably correlated with the probability of communication impairment. Our objective was to develop and evaluate a classification model to identify patients in a large administrative database likely to be communication impaired. METHODS Our sample included 236 hospitalized patients aged ≥12 months whose ability to communicate about pain had been assessed. We randomly split this sample into development (n = 118) and validation (n = 118) sets. A priori, we developed a set of specific diagnoses, technology dependencies, procedures, and medications recorded in the Pediatric Health Information System likely to be strongly associated with communication impairment. We used logistic regression modeling to calculate the probability of communication impairment for each patient in the development set, assessed the model performance, and evaluated the performance of the 11-variable model in the validation set. RESULTS In the validation sample, the classification model showed excellent classification accuracy (area under the receiver operating characteristic curve 0.92; sensitivity 82.6%; 95% confidence interval, 74%-100%; specificity 86.3%; 95% confidence interval, 80%-97%). For the complete sample, the predicted probability of communication impairment demonstrated excellent calibration with the observed communication impairment status. CONCLUSIONS Hospitalized pediatric patients with communication impairment can be accurately identified in a large hospital administrative database.
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Affiliation(s)
- Douglas L Hill
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Karen W Carroll
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Dingwei Dai
- Infomatics, Independence Blue Cross, Philadelphia, Pennsylvania
| | - Jennifer A Faerber
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Susan L Dougherty
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Chris Feudtner
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
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15
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Affiliation(s)
- Zuzanna Czernik
- Hospital Medicine Section, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora
| | - C T Lin
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora
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Bartlett JW, Harel O, Carpenter JR. Asymptotically Unbiased Estimation of Exposure Odds Ratios in Complete Records Logistic Regression. Am J Epidemiol 2015; 182:730-6. [PMID: 26429998 PMCID: PMC4597800 DOI: 10.1093/aje/kwv114] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 04/23/2015] [Indexed: 11/13/2022] Open
Abstract
Missing data are a commonly occurring threat to the validity and efficiency of epidemiologic studies. Perhaps the most common approach to handling missing data is to simply drop those records with 1 or more missing values, in so-called "complete records" or "complete case" analysis. In this paper, we bring together earlier-derived yet perhaps now somewhat neglected results which show that a logistic regression complete records analysis can provide asymptotically unbiased estimates of the association of an exposure of interest with an outcome, adjusted for a number of confounders, under a surprisingly wide range of missing-data assumptions. We give detailed guidance describing how the observed data can be used to judge the plausibility of these assumptions. The results mean that in large epidemiologic studies which are affected by missing data and analyzed by logistic regression, exposure associations may be estimated without bias in a number of settings where researchers might otherwise assume that bias would occur.
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Affiliation(s)
- Jonathan W. Bartlett
- Correspondence to Dr. Jonathan W. Bartlett, Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom (e-mail: )
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Deserno TM, Haak D, Brandenburg V, Deserno V, Classen C, Specht P. Integrated image data and medical record management for rare disease registries. A general framework and its instantiation to theGerman Calciphylaxis Registry. J Digit Imaging 2015; 27:702-13. [PMID: 24865858 DOI: 10.1007/s10278-014-9698-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Especially for investigator-initiated research at universities and academic institutions, Internet-based rare disease registries (RDR) are required that integrate electronic data capture (EDC) with automatic image analysis or manual image annotation. We propose a modular framework merging alpha-numerical and binary data capture. In concordance with the Office of Rare Diseases Research recommendations, a requirement analysis was performed based on several RDR databases currently hosted at Uniklinik RWTH Aachen, Germany. With respect to the study management tool that is already successfully operating at the Clinical Trial Center Aachen, the Google Web Toolkit was chosen with Hibernate and Gilead connecting a MySQL database management system. Image and signal data integration and processing is supported by Apache Commons FileUpload-Library and ImageJ-based Java code, respectively. As a proof of concept, the framework is instantiated to the German Calciphylaxis Registry. The framework is composed of five mandatory core modules: (1) Data Core, (2) EDC, (3) Access Control, (4) Audit Trail, and (5) Terminology as well as six optional modules: (6) Binary Large Object (BLOB), (7) BLOB Analysis, (8) Standard Operation Procedure, (9) Communication, (10) Pseudonymization, and (11) Biorepository. Modules 1-7 are implemented in the German Calciphylaxis Registry. The proposed RDR framework is easily instantiated and directly integrates image management and analysis. As open source software, it may assist improved data collection and analysis of rare diseases in near future.
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Affiliation(s)
- Thomas M Deserno
- Department of Medical Informatics, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52057, Aachen, Germany,
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Siesling S, Louwman WJ, Kwast A, van den Hurk C, O'Callaghan M, Rosso S, Zanetti R, Storm H, Comber H, Steliarova-Foucher E, Coebergh JW. Uses of cancer registries for public health and clinical research in Europe: Results of the European Network of Cancer Registries survey among 161 population-based cancer registries during 2010-2012. Eur J Cancer 2015; 51:1039-49. [PMID: 25131265 DOI: 10.1016/j.ejca.2014.07.016] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 07/02/2014] [Accepted: 07/02/2014] [Indexed: 11/17/2022]
Abstract
AIM To provide insight into cancer registration coverage, data access and use in Europe. This contributes to data and infrastructure harmonisation and will foster a more prominent role of cancer registries (CRs) within public health, clinical policy and cancer research, whether within or outside the European Research Area. METHODS During 2010-12 an extensive survey of cancer registration practices and data use was conducted among 161 population-based CRs across Europe. Responding registries (66%) operated in 33 countries, including 23 with national coverage. RESULTS Population-based oncological surveillance started during the 1940-50s in the northwest of Europe and from the 1970s to 1990s in other regions. The European Union (EU) protection regulations affected data access, especially in Germany and France, but less in the Netherlands or Belgium. Regular reports were produced by CRs on incidence rates (95%), survival (60%) and stage for selected tumours (80%). Evaluation of cancer control and quality of care remained modest except in a few dedicated CRs. Variables evaluated were support of clinical audits, monitoring adherence to clinical guidelines, improvement of cancer care and evaluation of mass cancer screening. Evaluation of diagnostic imaging tools was only occasional. CONCLUSION Most population-based CRs are well equipped for strengthening cancer surveillance across Europe. Data quality and intensity of use depend on the role the cancer registry plays in the politico, oncomedical and public health setting within the country. Standard registration methodology could therefore not be translated to equivalent advances in cancer prevention and mass screening, quality of care, translational research of prognosis and survivorship across Europe. Further European collaboration remains essential to ensure access to data and comparability of the results.
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Affiliation(s)
- S Siesling
- Department of Registration and Research, Comprehensive Cancer Centre the Netherlands, Utrecht, The Netherlands; Department of Health Technology and Services Research, MIRA Institute for Technical Medicine and Biomedical Technology, University of Twente, Enschede, The Netherlands.
| | - W J Louwman
- Research Department, Comprehensive Cancer Centre the Netherlands, location Eindhoven (formerly IKZ), The Netherlands.
| | - A Kwast
- Department of Registration and Research, Comprehensive Cancer Centre the Netherlands, Utrecht, The Netherlands.
| | - C van den Hurk
- Research Department, Comprehensive Cancer Centre the Netherlands, location Eindhoven (formerly IKZ), The Netherlands.
| | | | - S Rosso
- Piedmont Cancer Registry, CPO, Turin, Italy.
| | - R Zanetti
- Piedmont Cancer Registry, CPO, Turin, Italy.
| | - H Storm
- Danish Cancer Society, Copenhagen, Denmark.
| | - H Comber
- National Cancer Registry of Ireland, Cork, Ireland.
| | | | - J W Coebergh
- Research Department, Comprehensive Cancer Centre the Netherlands, location Eindhoven (formerly IKZ), The Netherlands; Department of Public Health, Erasmus MC Rotterdam, The Netherlands.
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19
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Affiliation(s)
- Jenny Woodman
- Research Associate, Population, Policy and Practice, UCL-Institute of Child Health, London
| | | | - Ruth Gilbert
- Professor of Clinical Epidemiology, Population, Policy and Practice, UCL-Institute of Child Health, London
| | - Gene Feder
- Professor of Primary Care, Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol
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Dalton BR, Sabuda DM, Bresee LC, Conly JM. Use of an electronic medication administration record (eMAR) for surveillance of medication omissions: results of a one year study of antimicrobials in the inpatient setting. PLoS One 2015; 10:e0122422. [PMID: 25856373 PMCID: PMC4391922 DOI: 10.1371/journal.pone.0122422] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 02/20/2015] [Indexed: 11/23/2022] Open
Abstract
Introduction Medication administration omissions (MAO) are usually considered medication errors but not all MAO are clinically relevant. We determined the frequency of clinically relevant MAO of antimicrobial drugs in adult hospitals in Calgary, Alberta, Canada based on electronic medication administration record (eMAR). Methods We examined 2011 data from eMAR records on medical wards and developed a reproducible assessment scheme to categorize and determine clinical relevance of MAO. We applied this scheme to records from 2012 in a retrospective cohort study to quantify clinically relevant MAO. Significant predictors of clinically relevant MAO were identified. Results A total of 294,718 dose records were assessed of which 10,282 (3.49%) were for doses not administered. Among these 4903 (1.66% of total); 47.68% of MAO were considered clinically relevant. Significant positive predictors of clinically relevant MAO included inhaled (OR 4.90, 95% CI 3.54-6.94) and liquid oral (OR 1.32, 95% CI 1.18-1.47) route of medication compared to solid oral and irregular dose schedules. Evening nursing shift compared to night shift (OR 0.77 95% CI 0.70-0.85) and parenteral (OR 0.50, 95% CI 0.46-0.54) were negative predictors, The commonest reasons for relevant MAO were patient preference, unspecified reason, administration access issues, drug not available or patient condition. Conclusion Assessment of MAO by review of computer records provides a greater scope and sample size than directly observed medication administration assessments without “observer” effect. We found that MAO of antimicrobials in inpatients were uncommon but were seen more frequently with orally administered antimicrobials which may have significance to antimicrobial stewardship initiatives.
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Affiliation(s)
- Bruce R. Dalton
- Pharmacy Department, Alberta Health Services, Calgary Zone. Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
| | - Deana M. Sabuda
- Pharmacy Department, Alberta Health Services, Calgary Zone. Calgary, Alberta, Canada
| | - Lauren C. Bresee
- Pharmacy Department, Alberta Health Services, Calgary Zone. Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - John M. Conly
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Synder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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21
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O'Riordan M, Doran G, Collins C. Access to diagnostics in primary care and the impact on a primary care led health service. Ir Med J 2015; 108:53-55. [PMID: 25803958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We undertook a postal survey of GPs to establish their current access to radiological and endoscopic tests. More than one fifth of GPs do not have direct access to abdominal (n = 42, 21.4%) or pelvic (n = 49, 24.6%) ultrasound in the public system. Where access is available public patients have an average 14 week waiting period. In stark contrast in the private system virtually all GPs have direct access (n = 159, 99.2% and n = 156, 98.8% respectively for abdominal and pelvic ultrasound) with an average wait of just over four days. Direct access to CT scan in the public system is available to the minority of GPs, e.g. n = 31, 18.4% for chest scan, in the public system; even where available, there is an average 12 week wait for this. In comparison 151 (88.6%) GPs have access to CT chest scanning in the private sector with an average waiting time of 5.4 working days. Such limited access to diagnostics impacts on the delivery of a quality service.
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Carrara G, Scirè CA, Zambon A, Cimmino MA, Cerra C, Caprioli M, Cagnotto G, Nicotra F, Arfè A, Migliazza S, Corrao G, Minisola G, Montecucco C. A validation study of a new classification algorithm to identify rheumatoid arthritis using administrative health databases: case-control and cohort diagnostic accuracy studies. Results from the RECord linkage On Rheumatic Diseases study of the Italian Society for Rheumatology. BMJ Open 2015; 5:e006029. [PMID: 25631308 PMCID: PMC4316439 DOI: 10.1136/bmjopen-2014-006029] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To develop and validate a new algorithm to identify patients with rheumatoid arthritis (RA) and estimate disease prevalence using administrative health databases (AHDs) of the Italian Lombardy region. DESIGN Case-control and cohort diagnostic accuracy study. METHODS In a randomly selected sample of 827 patients drawn from a tertiary rheumatology centre (training set), clinically validated diagnoses were linked to administrative data including diagnostic codes and drug prescriptions. An algorithm in steps of decreasing specificity was developed and its accuracy assessed calculating sensitivity/specificity, positive predictive value (PPV)/negative predictive value, with corresponding CIs. The algorithm was applied to two validating sets: 106 patients from a secondary rheumatology centre and 6087 participants from the primary care. Alternative algorithms were developed to increase PPV at population level. Crude and adjusted prevalence estimates taking into account algorithm misclassification rates were obtained for the Lombardy region. RESULTS The algorithms included: RA certification by a rheumatologist, certification for other autoimmune diseases by specialists, RA code in the hospital discharge form, prescription of disease-modifying antirheumatic drugs and oral glucocorticoids. In the training set, a four-step algorithm identified clinically diagnosed RA cases with a sensitivity of 96.3 (95% CI 93.6 to 98.2) and a specificity of 90.3 (87.4 to 92.7). Both external validations showed highly consistent results. More specific algorithms achieved >80% PPV at the population level. The crude RA prevalence in Lombardy was 0.52%, and estimates adjusted for misclassification ranged from 0.31% (95% CI 0.14% to 0.42%) to 0.37% (0.25% to 0.47%). CONCLUSIONS AHDs are valuable tools for the identification of RA cases at the population level, and allow estimation of disease prevalence and to select retrospective cohorts.
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Affiliation(s)
- Greta Carrara
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Carlo A Scirè
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Antonella Zambon
- Department of Statistics and Quantitative Methods, Section of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Marco A Cimmino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy
| | - Carlo Cerra
- Information System and Management Control, Local Health Authority (ASL), Pavia, Italy
| | - Marta Caprioli
- Department of Medicine, Istituto Clinico Beato Matteo, Vigevano, Italy
| | - Giovanni Cagnotto
- Department of Rheumatology, IRCCS San Matteo Foundation, Pavia, Italy
| | - Federica Nicotra
- Department of Statistics and Quantitative Methods, Section of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Andrea Arfè
- Department of Statistics and Quantitative Methods, Section of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Simona Migliazza
- Information System and Management Control, Local Health Authority (ASL), Pavia, Italy
| | - Giovanni Corrao
- Department of Statistics and Quantitative Methods, Section of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
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Kivekäs E, Kinnunen UM, Haatainen K, Kälviäinen R, Saranto K. Trigger Development for the Improvement of Neurological Patient Care. Stud Health Technol Inform 2015; 216:1116. [PMID: 26262415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
By analyzing medical records, we developed triggers for epilepsy patients' care coordination. Thirteen triggers with potential to affect patient care outcomes and safety were found.
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Affiliation(s)
- Eija Kivekäs
- Research Centre for Comparative Effectiveness and Patient Safety, University of Eastern Finland, Kuopio, Finland
| | - Ulla-Mari Kinnunen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Kaisa Haatainen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Reetta Kälviäinen
- Department of Neurology, University of Eastern Finland, Kuopio, Finland
| | - Kaija Saranto
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
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Hoppszallern S. MOST WIRED Opt In: Creating a community health record. Hosp Health Netw 2015; 89:20. [PMID: 30280829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Ryan MS, Shih SC, Winther CH, Wang JJ. Does it get easier to use an EHR? Report from an urban regional extension center. J Gen Intern Med 2014; 29:1341-8. [PMID: 24841560 PMCID: PMC4175636 DOI: 10.1007/s11606-014-2891-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 03/25/2014] [Accepted: 04/14/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known about whether more experience with an electronic health record (EHR) makes it easier for providers to meaningfully use EHRs. OBJECTIVE To assess whether the length of time that small practice providers have been using the EHR is associated with greater ease in performing meaningful use-related tasks and fewer EHR-related concerns. DESIGN/PARTICIPANTS We administered a web-based survey to 400 small practice providers in medically underserved communities in New York City participating in an EHR implementation and technical assistance project. We used logistic regression to estimate the association between the length of time a provider had been using the EHR (i.e., "live") and the ease of performing meaningful use-related tasks and EHR-related concerns, controlling for provider and practice characteristics. KEY RESULTS Compared to providers who had been live 6 to 12 months, providers who had been live 2 years or longer had 2.02 times greater odds of reporting it was easy to e-prescribe new prescriptions (p < 0.05), 2.12 times greater odds of reporting it was easy to e-prescribe renewal prescriptions (p < 0.05), 2.02 times greater odds of reporting that quality measures were easy to report (p < 0.05), 2.64 times greater odds of reporting it was easy to incorporate lab results as structured data (p < 0.001), and 2.00 times greater odds of reporting it was easy to generate patient lists by condition (p < 0.05). Providers who had been live 2 years or longer had 0.40 times lower odds of reporting financial costs were a concern (p < 0.001), 0.46 times lower odds of reporting that productivity loss was a concern (p < 0.05), 0.54 times lower odds of reporting that EHR unreliability was a concern (p < 0.05), and 0.50 times lower odds of reporting that privacy/security was a concern (p < 0.05). CONCLUSIONS Providers can successfully adjust to the EHR and over time are better able to meaningfully use the EHR.
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Affiliation(s)
- Mandy Smith Ryan
- New York City Department of Health and Mental Hygiene, Primary Care Information Project (PCIP), 42-09 28th Street– CN#52 Gotham Center, Long Island City, NY 11101 USA
| | - Sarah C. Shih
- New York City Department of Health and Mental Hygiene, Primary Care Information Project (PCIP), 42-09 28th Street– CN#52 Gotham Center, Long Island City, NY 11101 USA
| | - Chloe H. Winther
- New York City Department of Health and Mental Hygiene, Primary Care Information Project (PCIP), 42-09 28th Street– CN#52 Gotham Center, Long Island City, NY 11101 USA
| | - Jason J. Wang
- New York City Department of Health and Mental Hygiene, Primary Care Information Project (PCIP), 42-09 28th Street– CN#52 Gotham Center, Long Island City, NY 11101 USA
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Moore CL, Amin J, Gidding HF, Law MG. A new method for assessing how sensitivity and specificity of linkage studies affects estimation. PLoS One 2014; 9:e103690. [PMID: 25068293 PMCID: PMC4113448 DOI: 10.1371/journal.pone.0103690] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 07/04/2014] [Indexed: 01/09/2023] Open
Abstract
Background While the importance of record linkage is widely recognised, few studies have attempted to quantify how linkage errors may have impacted on their own findings and outcomes. Even where authors of linkage studies have attempted to estimate sensitivity and specificity based on subjects with known status, the effects of false negatives and positives on event rates and estimates of effect are not often described. Methods We present quantification of the effect of sensitivity and specificity of the linkage process on event rates and incidence, as well as the resultant effect on relative risks. Formulae to estimate the true number of events and estimated relative risk adjusted for given linkage sensitivity and specificity are then derived and applied to data from a prisoner mortality study. The implications of false positive and false negative matches are also discussed. Discussion Comparisons of the effect of sensitivity and specificity on incidence and relative risks indicate that it is more important for linkages to be highly specific than sensitive, particularly if true incidence rates are low. We would recommend that, where possible, some quantitative estimates of the sensitivity and specificity of the linkage process be performed, allowing the effect of these quantities on observed results to be assessed.
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Affiliation(s)
- Cecilia L. Moore
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
- * E-mail:
| | - Janaki Amin
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
| | - Heather F. Gidding
- School of Public Health & Community Medicine, UNSW Australia, Sydney, New South Wales, Australia
| | - Matthew G. Law
- The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
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Fischer JR. The impact of health care technology on medication safety. S D Med 2014; 67:279-280. [PMID: 25076683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Easier access to lab results. Johns Hopkins Med Lett Health After 50 2014; 29:8. [PMID: 25097948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Weis JM, Levy PC. Copy, paste, and cloned notes in electronic health records: prevalence, benefits, risks, and best practice recommendations. Chest 2014; 145:632-638. [PMID: 24590024 DOI: 10.1378/chest.13-0886] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 07/16/2013] [Indexed: 11/01/2022] Open
Abstract
The modern medical record is not only used by providers to record nuances of patient care, but also is a document that must withstand the scrutiny of insurance payers and legal review. Medical documentation has evolved with the rapid growth in the use of electronic health records (EHRs). The medical software industry has created new tools and more efficient ways to document patient care encounters and record results of diagnostic testing. While these techniques have resulted in efficiencies and improvements in patient care and provider documentation, they have also created a host of new problems, including authorship attribution, data integrity, and regulatory concerns over the accuracy and medical necessity of billed services. Policies to guide provider documentation in EHRs have been developed by institutions and payers with the goal of reducing patient care risks as well as preventing fraud and abuse. In this article, we describe the major content-importing technologies that are commonly used in EHR documentation as well as the benefits and risks associated with their use. We have also reviewed a number of institutional policies and offer some best practice recommendations.
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Strâmbu I. [REGIS--Romanian National Registry for Interstitial Lung Diseases and Sarcoidosis: launch of the website and building-up the database]. Pneumologia 2014; 63:96-99. [PMID: 25241556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
REGIS--Romanian National Registry for Interstitial Lung Diseases and Sarcoidosis: launch of the website and building-up the database Interstitial lung diseases (ILD) comprise about 200 different diseases with low prevalence, some evolving towards irreversible lung fibrosis. The diagnostic of each disease involves complex investigations (high resolution CT scan, broncho-alveolar lavage, complex lung function testing, surgical biopsy), but the main element is the expertise of the clinician and the multidisciplinary diagnostic approach. The creation of a national registry for ILD and sarcoidosis allows putting together in the same database numerous cases, now spread around the country. REGIS is the initiative of a group of physicians from "Marius Nasta" Institute of Pulmonology Bucharest and from the Pulmonology Dept. of "Victor Babes" Infectious Diseases Hospital, Timişoara. REGIS is an online registry, available at www. regis.ro, consisting of several components: 1. The registry per se, in which the accredited physicians will be able to feed information about their patients, by filling-in a questionnaire 2. Educational platform, containing a collection of clinical cases organized according to diagnosis, which is generated anonymously from the data from the registry 3. Patients' page, with information on ILD in general and on the most frequent diseases in the group. Expected results are: increasing the physicians' knowledge on ILDs, informing correctly the patients, bringing up to light new cases previously not diagnosed, building up a database for research (prevalence studies, risk factor studies, selection of patients for clinical trials), creating a base for a future national health programme dedicated to idiopathic pulmonary fibrosis patients, preparing future projects for development of a Romanian centre for lung transplantation.
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Dugas M, Dugas-Breit S. Integrated data management for clinical studies: automatic transformation of data models with semantic annotations for principal investigators, data managers and statisticians. PLoS One 2014; 9:e90492. [PMID: 24587378 PMCID: PMC3938746 DOI: 10.1371/journal.pone.0090492] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 02/03/2014] [Indexed: 11/24/2022] Open
Abstract
Design, execution and analysis of clinical studies involves several stakeholders with different professional backgrounds. Typically, principle investigators are familiar with standard office tools, data managers apply electronic data capture (EDC) systems and statisticians work with statistics software. Case report forms (CRFs) specify the data model of study subjects, evolve over time and consist of hundreds to thousands of data items per study. To avoid erroneous manual transformation work, a converting tool for different representations of study data models was designed. It can convert between office format, EDC and statistics format. In addition, it supports semantic annotations, which enable precise definitions for data items. A reference implementation is available as open source package ODMconverter at http://cran.r-project.org.
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Affiliation(s)
- Martin Dugas
- Institute of Medical Informatics, University of Münster, Münster, Germany
- * E-mail:
| | - Susanne Dugas-Breit
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universitaet, Munich, Germany
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Scott RE, Affleck-Hall LC, Mars M. Refocussing our attention on 'need' in the application of telehealth. Stud Health Technol Inform 2014; 206:78-83. [PMID: 25365674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Given that e-health (including telehealth) is an opportunity cost (i.e., redirecting already scarce healthcare resources away from more traditional healthcare delivery needs), performing needs assessment ensures that investment of resources in e-health is appropriate. Yet the current literature shows research is on clever, narrow, or 'one disease' telehealth applications (e.g., telediabetes; telesurgery), or creation of electronic records (e.g., EHR's; EMRs; HIS's) and accumulation of 'big data' (e.g. biosurveillance). Given the reality of comorbidity, the complexity of telesurgery, and the lack of successful country-wide EHR implementations, are we using our investments in e-health wisely? The requirement for needs assessment to guide selection and implementation of evidence-based and needs-based e-health solutions is seldom adhered to. We must refocus our efforts on more pragmatic needs. Where might insight to evidence-based health needs come from? Using South Africa as an example, this paper highlights several readily available resources, and how they may guide future telehealth implementations in South Africa and elsewhere.
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Affiliation(s)
- Richard E Scott
- Department of Telehealth, University of KwaZulu-Natal, Durban, South Africa
| | | | - Maurice Mars
- Department of Telehealth, University of KwaZulu-Natal, Durban, South Africa
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Pigeot I, Kraywinkel K. [Epidemiological cancer registration in Germany: an impressive research resource]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 57:5-6. [PMID: 24357165 DOI: 10.1007/s00103-013-1885-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- I Pigeot
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS GmbH, Achterstr. 30, 28359, Bremen, Deutschland,
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Kushnir T, Esterson A, Bachner YG. Attitudes of Jewish and Bedouin responders toward family physicians' use of electronic medical records during the medical encounter. Patient Educ Couns 2013; 93:373-380. [PMID: 23916676 DOI: 10.1016/j.pec.2013.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 07/06/2013] [Accepted: 07/08/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Culture is known to impact expectations from medical treatments. The effects of cultural differences on attitudes toward Electronic Medical Records (EMR) have not been investigated. We compared the attitudes of Jewish and Bedouin responders toward EMR's use by family physicians during the medical encounter, and examined the contribution of background variables to these attitudes. METHODS 86 Jewish and 89 Bedouin visitors of patients in a regional Israeli University Medical Center responded to a self-reporting questionnaire with Hebrew and Arabic versions. RESULTS T-tests and a linear regression analysis found that culture did not predict attitudes. Respondents' self-reported health status, Internet and e-mail use, and estimates of their physician's typing speed explained a total of 18.6% of the variance in attitudes (p<0.001). CONCLUSION Bedouins respondents' attitudes toward EMR use were better than expected and similar to those of their Jewish counterparts. The most significant factor influencing respondents' attitudes was the physician's typing speed. PRACTICE IMPLICATIONS (1) Further studies should consider the possible impact of cultural differences between the family physician and the healthcare client on attitudes. (2) Interventions to improve physicians' skill in operating EMRs and typing will potentially have a positive impact on patients' satisfaction with physicians' EMR use.
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Affiliation(s)
- Talma Kushnir
- Department of Public Health, Ben-Gurion University of the Negev, Israel.
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Adler-Milstein J, Cohen GR. Implementing the IT infrastructure for health reform: adoption of health IT among patient-centered medical home practices. AMIA Annu Symp Proc 2013; 2013:11-16. [PMID: 24551318 PMCID: PMC3900118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
While health IT is thought to be critical to the success of new models of care delivery, we know little about the extent to which those pursuing these models are relying on HIT. We studied a large patient-centered medical home (PCMH) demonstration project, a new model of care delivery that has received substantial policy attention, in order to assess which types of HIT were most widely used, and how adoption rates changed over time as PCMH practices matured. We found that clinically-focused HIT tools were both widely adopted, and increasingly adopted, in PCMH practices compared to non-PCMH practices. In contrast, HIT that supports patient-engagement, patient portals and personal health records, was neither in widespread use nor more likely to be adopted over time by PCMH practices compared to other practices. This suggests that these tools may not yet support the types of patient engagement and interactions that PCMH practices seek.
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Affiliation(s)
- Julia Adler-Milstein
- School of Information, University of Michigan, Ann Arbor, MI; ; School of Public Health, University of Michigan, Ann Arbor, MI
| | - Genna R Cohen
- School of Public Health, University of Michigan, Ann Arbor, MI
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Lund A, Joo D, Lewis K, Arikan Y, Grunfeld A. Photodocumentation as an emergency department documentation tool in soft tissue infection: a randomized trial. CAN J EMERG MED 2013; 15:345-52. [PMID: 24176458 DOI: 10.2310/8000.2013.130726] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Current documentation methods for patients with skin and soft tissue infections receiving outpatient parenteral anti-infective therapy (OPAT) include written descriptions and drawings of the infection that may inadequately communicate clinical status. We undertook a study to determine whether photodocumentation (PD) improves the duration of outpatient treatment of skin and soft tissue infections. METHODS A single-blinded, prospective, randomized trial was conducted in the emergency departments of a community hospital and an academic tertiary centre. Participants included consecutive patients age ≥ 14 years presenting with noninvasive skin and soft tissue infections requiring OPAT. Patients in the intervention arm were treated with standard of care plus PD at each emergency physician assessment. Control subjects received care provided at the discretion of the treating physician and non-photographic documentation. The primary outcome was duration of therapy measured in half-days. The required sample size to detect a difference of one half-day was 253 patients per group (α = 0.05). Secondary outcomes included (1) completion and therapeutic failure rates, (2) patient satisfaction, and (3) physician and nurse satisfaction. RESULTS Enrolment was slower and follow-up rates lower than anticipated, and the trial was terminated when funds were exhausted. A total of 468 subjects with similar age and gender characteristics were enrolled, with 244 receiving the intervention and 224 in the control arm. The mean OPAT duration was similar in the two groups (3.6 days v. 3.5 days, p = 0.73). No differences in the rate for completion and therapeutic failure were observed (71% v. 68% and < 1% for both, respectively). Survey response rates varied significantly: patients, 65%; nurses, 17%; and physicians, 87%. Physicians endorsed more comfort with their assessment and OPAT judgment with PD (65% and 64%, respectively). Physicians cited too much time lost with technological challenges, which would affect implementation in a busy ED. CONCLUSIONS PD as an intervention is acceptable to patients and has reasonable endorsement by the majority of physicians. This trial had significant limitations that threatened the integrity of the study, so the results are inconclusive.
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Ross SE, Radcliff TA, LeBlanc WG, Dickinson LM, Libby AM, Nease DE. Effects of health information exchange adoption on ambulatory testing rates. J Am Med Inform Assoc 2013; 20:1137-42. [PMID: 23698257 PMCID: PMC3822119 DOI: 10.1136/amiajnl-2012-001608] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 04/22/2013] [Accepted: 04/27/2013] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine the effects of the adoption of ambulatory electronic health information exchange (HIE) on rates of laboratory and radiology testing and allowable charges. DESIGN Claims data from the dominant health plan in Mesa County, Colorado, from 1 April 2005 to 31 December 2010 were matched to HIE adoption data on the provider level. Using mixed effects regression models with the quarter as the unit of analysis, the effect of HIE adoption on testing rates and associated charges was assessed. RESULTS Claims submitted by 306 providers in 69 practices for 34 818 patients were analyzed. The rate of testing per provider was expressed as tests per 1000 patients per quarter. For primary care providers, the rate of laboratory testing increased over the time span (baseline 1041 tests/1000 patients/quarter, increasing by 13.9 each quarter) and shifted downward with HIE adoption (downward shift of 83, p<0.01). A similar effect was found for specialist providers (baseline 718 tests/1000 patients/quarter, increasing by 19.1 each quarter, with HIE adoption associated with a downward shift of 119, p<0.01). Even so, imputed charges for laboratory tests did not shift downward significantly in either provider group, possibly due to the skewed nature of these data. For radiology testing, HIE adoption was not associated with significant changes in rates or imputed charges in either provider group. CONCLUSIONS Ambulatory HIE adoption is unlikely to produce significant direct savings through reductions in rates of testing. The economic benefits of HIE may reside instead in other downstream outcomes of better informed, higher quality care.
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Affiliation(s)
- Stephen E Ross
- University of Colorado Division of General Internal Medicine, Aurora, Colorado,USA
| | - Tiffany A Radcliff
- Department of Health Policy and Management, Texas A&M School of Rural Public Health, College Station, Texas, USA
- Department of Family Medicine, University of Colorado, Aurora, Colorado, USA
| | - William G LeBlanc
- Department of Family Medicine, University of Colorado, Aurora, Colorado, USA
| | - L Miriam Dickinson
- Department of Family Medicine, University of Colorado, Aurora, Colorado, USA
| | - Anne M Libby
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
| | - Donald E Nease
- Department of Family Medicine, University of Colorado, Aurora, Colorado, USA
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Riedmann EM. Human vaccines & immunotherapeutics: news. Hum Vaccin Immunother 2013; 9:1827-30. [PMID: 24051387 PMCID: PMC3906344 DOI: 10.4161/hv.26237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 08/20/2013] [Indexed: 11/19/2022] Open
Abstract
Vaccinating boys against HPV to reduce cancer rates across the sexes: New melanoma vaccine contains natural product from marine sponges: Impact of Hib conjugate vaccines in developing countries: Electronic Health Records to keep track of immunization status: Pregnant women urged to get whooping cough vaccination: New nano-coating developed to preserve vaccines: Alternative approach to creating a universal flu vaccine: New modular vaccine design: MAPS technology.
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Lichtner V, Venters W, Hibberd R, Cornford T, Barber N. The fungibility of time in claims of efficiency: the case of making transmission of prescriptions electronic in English general practice. Int J Med Inform 2013; 82:1152-70. [PMID: 24008176 DOI: 10.1016/j.ijmedinf.2013.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 07/28/2013] [Accepted: 08/01/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This paper presents a study of the effects of the implementation of the NHS Electronic Prescription Service (EPS) on time spent on repeat prescribing in English general practice. EPS is a new network service for the electronic transmission of primary care prescriptions, principally between GP practices and community pharmacies. This service is promoted on the basis of the importance of safe and timely supply of medicines, and the level of medicines use by many patients with treatable chronic conditions. The service is also based on presumptions of significant time-savings and efficiency gains for general practices and GPs. Our objective was to assess the time-related changes (including time savings) conditioned by digital transmission of prescriptions, specifically for repeat prescribing activity in primary care practices. METHODS As part of the official evaluation of EPS in the English NHS we undertook a qualitative research design with field studies in four of the first GP practices adopting EPS. This research was based on interviews with clinical and administrative staff, and non-participant observation of repeat prescribing related activities. RESULTS We found that the use of EPS reduced turnaround time and conditioned changes in the workflow, with time-savings found mainly in relation to administrative tasks. But the use of this technology also created additional tasks and shifted existing tasks and responsibilities. Thus elimination of tasks did not automatically correspond to potential staff savings or cost savings. Tasks that were eliminated and new tasks that were created were not equivalent in terms of time spent, quality of attention required, and roles involved. CONCLUSIONS The wider claim that healthcare information technology saves time and increases efficiency is often based on assumptions of the fungibility of time and people - i.e. that units of time added or saved on different steps of the workflow can be summed up as if they were all of the same kind, and thus reveal any net efficiency gain. But workflow time savings involve changes in the quality of tasks, redistribution of work and responsibility that mean that time can hardly be added or subtracted to obtain 'efficiency totals'.
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Affiliation(s)
- Valentina Lichtner
- Decision Making Research Group, School of Healthcare, University of Leeds, United Kingdom.
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Kuo KM, Liu CF, Ma CC. An investigation of the effect of nurses' technology readiness on the acceptance of mobile electronic medical record systems. BMC Med Inform Decis Mak 2013; 13:88. [PMID: 23938040 PMCID: PMC3750758 DOI: 10.1186/1472-6947-13-88] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 08/08/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adopting mobile electronic medical record (MEMR) systems is expected to be one of the superior approaches for improving nurses' bedside and point of care services. However, nurses may use the functions for far fewer tasks than the MEMR supports. This may depend on their technological personality associated to MEMR acceptance. The purpose of this study is to investigate nurses' personality traits in regard to technology readiness toward MEMR acceptance. METHODS The study used a self-administered questionnaire to collect 665 valid responses from a large hospital in Taiwan. Structural Equation modeling was utilized to analyze the collected data. RESULTS Of the four personality traits of the technology readiness, the results posit that nurses are optimistic, innovative, secure but uncomfortable about technology. Furthermore, these four personality traits were all proven to have a significant impact on the perceived ease of use of MEMR while the perceived usefulness of MEMR was significantly influenced by the optimism trait only. The results also confirmed the relationships between the perceived components of ease of use, usefulness, and behavioral intention in the Technology Acceptance Model toward MEMR usage. CONCLUSIONS Continuous educational programs can be provided for nurses to enhance their information technology literacy, minimizing their stress and discomfort about information technology. Further, hospital should recruit, either internally or externally, more optimistic nurses as champions of MEMR by leveraging the instrument proposed in this study. Besides, nurses' requirements must be fully understood during the development of MEMR to ensure that MEMR can meet the real needs of nurses. The friendliness of user interfaces of MEMR and the compatibility of nurses' work practices as these will also greatly enhance nurses' willingness to use MEMR. Finally, the effects of technology personality should not be ignored, indicating that hospitals should also include more employees' characteristics beyond socio-demographic profiles in their personnel databases.
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Affiliation(s)
- Kuang-Ming Kuo
- Department of Healthcare Administration, I-Shou University, No.8, Yida Rd. Yanchao District, Kaohsiung City 82445, Taiwan, R.O.C
| | - Chung-Feng Liu
- Department of Information Management, Chia-Nan University of Pharmacy and Science, No.60, Erh-Jen Rd., Sec.1, Jen-Te District, Tainan City 71710, Taiwan, R.O.C
| | - Chen-Chung Ma
- Department of Healthcare Administration, I-Shou University, No.8, Yida Rd. Yanchao District, Kaohsiung City 82445, Taiwan, R.O.C
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McCarthy M. Use of electronic medical records expands in the US, but some hospitals are trailing. BMJ 2013; 347:f4516. [PMID: 23851727 DOI: 10.1136/bmj.f4516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hayes AJ, Davis WA, Davis TM, Clarke PM. Adapting and validating diabetes simulation models across settings: accounting for mortality differences using administrative data. J Diabetes Complications 2013; 27:351-6. [PMID: 23769021 PMCID: PMC9359612 DOI: 10.1016/j.jdiacomp.2012.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 12/06/2012] [Accepted: 12/17/2012] [Indexed: 11/17/2022]
Abstract
AIMS To develop age and sex-specific risk equations for predicting mortality following major complications of diabetes, using a large linked administrative dataset from Western Australia (WA) and to incorporate these into an existing diabetes simulation model. METHODS The study uses linked hospital and mortality records on 13,884 patients following a major diabetes-related complication with a mean (SD) duration of 2.62 (2.25) years. Risk equations for predicting mortality were derived and integrated into the UKPDS Outcomes Model. Estimates of life expectancy and incremental QALYs gained as a result of two theoretical therapies (a reduction of HbA1c of 1%, and reduction of systolic blood pressure of 10 mmHg) were determined using the original and adapted models. RESULTS The two versions of the model generated differences in life expectancy following specific events; however there was little impact of using alternative mortality equations on incremental QALYs gained as a result of reducing HbA(1c) or systolic blood pressure, or on outcomes of life expectancy for a cohort initially free of complications. CONCLUSIONS Mortality following complications varies across diabetic populations and can impact on estimates of life expectancy, but appears to have less impact on incremental benefits of interventions that are commonly used in pharmoeconomic analyses.
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Affiliation(s)
- Alison J Hayes
- Sydney School of Public Health, University of Sydney, Sydney NSW 2006, Australia.
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Chalil Madathil K, Koikkara R, Obeid J, Greenstein JS, Sanderson IC, Fryar K, Moskowitz J, Gramopadhye AK. An investigation of the efficacy of electronic consenting interfaces of research permissions management system in a hospital setting. Int J Med Inform 2013; 82:854-63. [PMID: 23757370 DOI: 10.1016/j.ijmedinf.2013.04.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 04/27/2013] [Accepted: 04/30/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE Ethical and legal requirements for healthcare providers in the United States, stipulate that patients sign a consent form prior to undergoing medical treatment or participating in a research study. Currently, the majority of the hospitals obtain these consents using paper-based forms, which makes patient preference data cumbersome to store, search and retrieve. To address these issues, Health Sciences of South Carolina (HSSC), a collaborative of academic medical institutions and research universities in South Carolina, is developing an electronic consenting system, the Research Permissions Management System (RPMS). This article reports the findings of a study conducted to investigate the efficacy of the two proposed interfaces for this system - an iPad-based and touchscreen-based by comparing them to the paper-based and Topaz-based systems currently in use. METHODS This study involved 50 participants: 10 hospital admission staff and 40 patients. The four systems were compared with respect to the time taken to complete the consenting process, the number of errors made by the patients, the workload experienced by the hospital staff and the subjective ratings of both patients and staff on post-test questionnaires. RESULTS The results from the empirical study indicated no significant differences in the time taken to complete the tasks. More importantly, the participants found the new systems more usable than the conventional methods with the registration staff experiencing the least workload in the iPad and touchscreen-based conditions and the patients experiencing more privacy and control during the consenting process with the proposed electronic systems. In addition, they indicated better comprehension and awareness of what they were signing using the new interfaces. DISCUSSION The results indicate the two methods proposed for capturing patient consents are at least as effective as the conventional methods, and superior in several important respects. While more research is needed, these findings suggest the viability of cautious adoption of electronic consenting systems, especially because these new systems appear to address the challenge of identifying the participants required for the complex research being conducted as the result of advances in the biomedical sciences.
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Affiliation(s)
- Kapil Chalil Madathil
- 110 Freeman Hall, Department of Industrial Engineering, Clemson University, Clemson, SC 29634, United States.
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Kumarapeli P, de Lusignan S. Using the computer in the clinical consultation; setting the stage, reviewing, recording, and taking actions: multi-channel video study. J Am Med Inform Assoc 2013; 20:e67-75. [PMID: 23242763 PMCID: PMC3715353 DOI: 10.1136/amiajnl-2012-001081] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 11/13/2012] [Accepted: 11/17/2012] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Electronic patient record (EPR) systems are widely used. This study explores the context and use of systems to provide insights into improving their use in clinical practice. METHODS We used video to observe 163 consultations by 16 clinicians using four EPR brands. We made a visual study of the consultation room and coded interactions between clinician, patient, and computer. Few patients (6.9%, n=12) declined to participate. RESULTS Patients looked at the computer twice as much (47.6 s vs 20.6 s, p<0.001) when it was within their gaze. A quarter of consultations were interrupted (27.6%, n=45); and in half the clinician left the room (12.3%, n=20). The core consultation takes about 87% of the total session time; 5% of time is spent pre-consultation, reading the record and calling the patient in; and 8% of time is spent post-consultation, largely entering notes. Consultations with more than one person and where prescribing took place were longer (R(2) adj=22.5%, p<0.001). The core consultation can be divided into 61% of direct clinician-patient interaction, of which 15% is examination, 25% computer use with no patient involvement, and 14% simultaneous clinician-computer-patient interplay. The proportions of computer use are similar between consultations (mean=40.6%, SD=13.7%). There was more data coding in problem-orientated EPR systems, though clinicians often used vague codes. CONCLUSIONS The EPR system is used for a consistent proportion of the consultation and should be designed to facilitate multi-tasking. Clinicians who want to promote screen sharing should change their consulting room layout.
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Affiliation(s)
- Pushpa Kumarapeli
- School of Computing and Information Systems, Kingston University–London, Kingston Upon Thames, Surrey, UK
| | - Simon de Lusignan
- Clinical Informatics, Department of Health Care Management and Policy, University of Surrey, Guildford, Surrey, UK
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Colvin L, Slack-Smith L, Stanley FJ, Bower C. Are women with major depression in pregnancy identifiable in population health data? BMC Pregnancy Childbirth 2013; 13:63. [PMID: 23497210 PMCID: PMC3602106 DOI: 10.1186/1471-2393-13-63] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 03/07/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although record linkage of routinely collected health datasets is a valuable research resource, most datasets are established for administrative purposes and not for health outcomes research. In order for meaningful results to be extrapolated to specific populations, the limitations of the data and linkage methodology need to be investigated and clarified. It is the objective of this study to investigate the differences in ascertainment which may arise between a hospital admission dataset and a dispensing claims dataset, using major depression in pregnancy as an example. The safe use of antidepressants in pregnancy is an ongoing issue for clinicians with around 10% of pregnant women suffer from depression. As the birth admission will be the first admission to hospital during their pregnancy for most women, their use of antidepressants, or their depressive condition, may not be revealed to the attending hospital clinicians. This may result in adverse outcomes for the mother and infant. METHODS Population-based de-identified data were provided from the Western Australian Data Linkage System linking the administrative health records of women with a delivery to related records from the Midwives' Notification System, the Hospital Morbidity Data System and the national Pharmaceutical Benefits Scheme dataset. The women with depression during their pregnancy were ascertained in two ways: women with dispensing records relating to dispensed antidepressant medicines with an WHO ATC code to the 3rd level, pharmacological subgroup, 'N06A Antidepressants'; and, women with any hospital admission during pregnancy, including the birth admission, if a comorbidity was recorded relating to depression. RESULTS From 2002 to 2005, there were 96698 births in WA. At least one antidepressant was dispensed to 4485 (4.6%) pregnant women. There were 3010 (3.1%) women with a comorbidity related to depression recorded on their delivery admission, or other admission to hospital during pregnancy. There were a total of 7495 pregnancies identified by either set of records. Using data linkage, we determined that these records represented 6596 individual pregnancies. Only 899 pregnancies were found in both groups (13.6% of all cases). 80% of women dispensed an antidepressant did not have depression recorded as a comorbidity on their hospital records. A simple capture-recapture calculation suggests the prevalence of depression in this population of pregnant women to be around 16%. CONCLUSION No single data source is likely to provide a complete health profile for an individual. For women with depression in pregnancy and dispensed antidepressants, the hospital admission data do not adequately capture all cases.
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Affiliation(s)
- Lyn Colvin
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Australia
- School of Dentistry, The University of Western Australia, Perth, Australia
| | - Linda Slack-Smith
- School of Dentistry, The University of Western Australia, Perth, Australia
| | - Fiona J Stanley
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Australia
| | - Carol Bower
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Australia
- Western Australian Register of Developmental Anomalies, Perth, Australia
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Huang Z, Gan C, Lu X, Huan H. Mining the changes of medical behaviors for clinical pathways. Stud Health Technol Inform 2013; 192:117-121. [PMID: 23920527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In a fast-changing healthcare environment, understanding the changes of medical behaviors in clinical pathways can help hospital managers improve the pathways and make better medical strategies for patient careflow. In this study we propose an approach to detect medical behavior changes between two time periods, by providing a change pattern detection algorithm dividing the discovered change patterns into four categories (i.e., perished patterns, added patterns, unexpected changes, and emerging patterns). The proposed approach is evaluated via real-world data sets extracted from Zhejiang Huzhou Central Hospital of China with regard to the clinical pathway of bronchial lung cancer in 2007-2009 and 2011. The experiment results include three categories of change patterns from the collected data-sets, making a relatively comprehensive cover on the significant changes in clinical pathways, which might be essential from the perspectives of clinical pathway analysis and improvement.
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Affiliation(s)
- Zhengxing Huang
- College of Biomedical Engineering and Instrument Science of Zhejiang University, The Key Laboratory of Biomedical Engineering, Ministry of Education, China
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Verbeke F, Karara G, Nyssen M. Evaluating the impact of ICT-tools on health care delivery in sub-Saharan hospitals. Stud Health Technol Inform 2013; 192:520-523. [PMID: 23920609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This research explores to what extent Information and Communication Technology (ICT)-based information management methods can help to improve efficiency and effectiveness of health services in sub-Saharan hospitals and how clinical information can be made available for secondary use enabling non-redundant reporting of health- and care performance indicators. In the course of a 6 years research effort between 2006 and 2012, it was demonstrated that patient identification, financial management and structured reporting improved dramatically after implementation of well adapted ICT-tools in a set of 19 African health facilities. Real-time financial management metrics helped hospitals to quickly identify fraudulent practices and defective invoicing procedures. Out-patient case load significantly increased compared to the national average, average length of stay has been shortened in 15 of 19 health facilities and global hospital mortality decreased. Hospital workforce-evaluated impact of hospital information system implementation on local working conditions and quality of care was very positive. It was demonstrated that local sub-Saharan health professionals strongly believe in the importance of health information systems.
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Affiliation(s)
- Frank Verbeke
- BISI: Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
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Haarbrandt B, Schwartze J, Gusew N, Seidel C, Haux R. Primary care providers' acceptance of health information exchange utilizing IHE XDS. Stud Health Technol Inform 2013; 190:106-108. [PMID: 23823391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We assessed primary care providers' perception of a health information exchange system (HIE) based on IHE XDS. The HIE will be part of a regional health network in the metropolitan area of Braunschweig, Lower Saxony, Germany. An application enabling access to medical documents in an XDS Affinity Domain was developed. We examined usability and factors related to user acceptance. User perception was probed using system usability scale (SUS) and semi-structured interviews. The evaluation was performed on 7 participants. The SUS showed an above average usability with a median score of 77.5. During interviews, participants submitted suggestions for additional features and improvement of usability. Poor integration of functionality into existing workflows was most frequently criticized. While usability was well perceived by primary care providers, challenges remain in adoption of XDS based IHE. To speed up document access in time-critical domains, we suggest use of complementary methods, enabling directed communication flows.
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Affiliation(s)
- Birger Haarbrandt
- Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig and Hannover Medical School, Germany
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Pottas D, Mostert-Phipps N. Citizens and personal health records - the case of Nelson Mandela Bay. Stud Health Technol Inform 2013; 192:501-504. [PMID: 23920605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This paper explores citizen attitudes towards personal health records. The study was conducted in the Eastern Cape Province of South Africa. A cross-sectional design was used and structured questionnaires administered by data collectors. Most respondents (90%) believed it to be important to extremely important for their healthcare provider to have their complete medical records. Less than half of them (42%), however, believed that the healthcare provider did have their complete medical record available to them. Nevertheless, 69% do not keep a medical record as a way to address this concern. Most of them (84%) were not aware of the existence of electronic tools to capture a personal health record prior to participating in the survey. Concerns relating to the use of online PHRs were identified as privacy (58%), lack of time (27%) and a disinterest in computers (22%). It was found that the existence of a medical chronic condition is a strong predictor of keeping a medical record (albeit mostly in paper-based format).
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Affiliation(s)
- Dalenca Pottas
- School of ICT, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
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Choi M, Lee J, Ahn MJ, Kim Y. Nursing critical patient severity classification system predicts outcomes in patients admitted to surgical intensive care units: use of data from clinical data repository. Stud Health Technol Inform 2013; 192:1063. [PMID: 23920837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
To examine the Critical Patient Severity Classification System (CPSCS) recorded by nurses to predict ICU and hospital lengths of stay and mortality, data were drawn from patients admitted to 2 surgical intensive care units (SICUs) at a university hospital in Seoul, South Korea in 2010. This retrospective study used a large data set retrieved from the Clinical Data Repository System. Among 1432 patients, the mean grade of CPSCS was 4.9 out of 6, which indicated that the subjects had generally severe conditions. The CPSCS was a statistically significant predictor of ICU and hospital LOS and mortality when patients' demographic characteristics were adjusted. In the era of emphasis on using big data, analysis of nursing assessment data should be evaluated to show importance of nursing contribution to predict patients' clinical outcomes.
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Affiliation(s)
- Mona Choi
- College of Nursing, Yonsei University, Seoul, South Korea
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