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Polasek TM. Virtual twin for healthcare management. Front Digit Health 2023; 5:1246659. [PMID: 37781454 PMCID: PMC10540783 DOI: 10.3389/fdgth.2023.1246659] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/01/2023] [Indexed: 10/03/2023] Open
Abstract
Healthcare is increasingly fragmented, resulting in escalating costs, patient dissatisfaction, and sometimes adverse clinical outcomes. Strategies to decrease healthcare fragmentation are therefore attractive from payer and patient perspectives. In this commentary, a patient-centered smart phone application called Virtual Twin for Healthcare Management (VTHM) is proposed, including its organizational layout, basic functionality, and potential clinical applications. The platform features a virtual twin hub that displays the body and its health data. This is a physiologically based human model that is "virtualized" for the patient based on their unique genetic, molecular, physiological, and disease characteristics. The spokes of the system are a full service and interoperable electronic-health record, accessible to healthcare providers with permission on any device with internet access. Theoretical case studies based on real scenarios are presented to show how VTHM could potentially improve patient care and clinical efficiency. Challenges that must be overcome to turn VTHM into reality are also briefly outlined. Notably, the VTHM platform is designed to operationalize current and future precision medicine initiatives, such as access to molecular diagnostic results, pharmacogenomics-guided prescribing, and model-informed precision dosing.
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Affiliation(s)
- Thomas M. Polasek
- Certara, Princeton, NJ, United States
- Centre for Medicines Use and Safety, Monash University, Melbourne, VIC, Australia
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Taylor SE, Joules E, Harding A. Implementation of a pragmatic emergency department patients' own medications (POM) procedure to improve medication safety: An interrupted time series. Australas Emerg Care 2023; 26:271-278. [PMID: 36863966 DOI: 10.1016/j.auec.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Patients' Own Medications (POMs) are useful to inform clinical decision-making, best possible medication history documentation, and ensure timely medication administration. A procedure was developed for managing POMs specifically in the emergency department (ED) and short stay unit. This study evaluated the impact of this procedure on process and patient safety outcomes. METHODS An interrupted time-series was undertaken in a metropolitan ED/short stay unit between November 2017 and September 2021. Pre-implementation and during each of four post-implementation time-periods, data were collected at unannounced times on approximately 100 patients taking medications prior to presentation. Endpoints included proportion of patients with POMs stored in green POMs bags, in standardised locations, and proportion who self-medicated without nurses knowing. RESULTS Following procedure implementation, POMs were stored in standardised locations for 45.9 % of patients. Proportion of patients with POMs stored in green bags increased from 6.9 % to 48.2 % (difference 41.3 %, p < 0.001). Patient self-administration without nurses' knowledge declined from 10.3 % to 2.3 % (difference 8.0 %, p = 0.015). POMs were infrequently left in ED/short stay unit after discharge. CONCLUSIONS The procedure has standardised POMs storage, but room for further improvement remains. Although POMs were not locked away and were readily available to clinicians, patient self-medication without nurses' knowledge declined.
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Affiliation(s)
- Simone E Taylor
- Pharmacy Department, Austin Health, Studley Road, Heidelberg, Victoria, Australia; Emergency Department, Austin Health, Studley Road, Heidelberg, Victoria, Australia.
| | - Emily Joules
- Pharmacy Department, Austin Health, Studley Road, Heidelberg, Victoria, Australia; Emergency Department, Austin Health, Studley Road, Heidelberg, Victoria, Australia; Patient Safety and Clinical Excellence, Austin Health, Studley Road, Heidelberg, Victoria, Australia
| | - Andrew Harding
- Pharmacy Department, Austin Health, Studley Road, Heidelberg, Victoria, Australia; Emergency Department, Austin Health, Studley Road, Heidelberg, Victoria, Australia
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Smith AKJ, Davis MDM, MacGibbon J, Broady TR, Ellard J, Rule J, Cook T, Duck-Chong E, Holt M, Newman CE. Engaging Stigmatised Communities in Australia with Digital Health Systems: Towards Data Justice in Public Health. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2023; 20:1-12. [PMID: 36776992 PMCID: PMC9900552 DOI: 10.1007/s13178-023-00791-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 05/07/2023]
Abstract
Introduction In 2018, following government policy changes to Australia's national electronic health record system, 'My Health Record', consumer advocates-including organisations representing people living with HIV, people who use drugs and sex workers-raised concerns about privacy and data security. Responding to these controversies, this study explores the practical, ethical and political complexities of engaging stigmatised communities with digital health systems. Methods We conducted 16 qualitative semi-structured interviews in 2020 with key informants representing communities who experience stigma, discrimination and marginalisation in Australia. These communities included people living with HIV, sex workers, people who inject drugs, gay and bisexual men and transgender and gender diverse people. We conducted a reflexive thematic analysis. Results Key informants were sceptical of proposed benefits of electronic health records for their communities, and concerned about privacy risks and the potential for discrimination. Meaningful consultation, consent mechanisms and tackling structural stigma were raised as solutions for engaging communities. Conclusions Although communities could benefit from being included in digital health systems, significant cultural, legal and social reforms from government were believed to be necessary to build trust in digital health systems. We argue that these forms of data justice are necessary for effective future systems. Policy Implications Engaging stigmatised communities-including in relation to gender, sexuality, sex work, drug use, HIV-requires a commitment to data justice. The design and implementation of digital health systems requires investment in ongoing and meaningful consultation with communities and representative organisations.
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Affiliation(s)
- Anthony K J Smith
- Centre for Social Research in Health (CSRH), UNSW Sydney, Sydney, Australia
| | - Mark D. M. Davis
- School of Social Sciences, Monash University, Melbourne, Australia
| | - James MacGibbon
- Centre for Social Research in Health (CSRH), UNSW Sydney, Sydney, Australia
| | - Timothy R. Broady
- Centre for Social Research in Health (CSRH), UNSW Sydney, Sydney, Australia
| | - Jeanne Ellard
- Australian Research Centre in Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Australia
| | - John Rule
- National Association of People With HIV Australia, Newtown, Australia
| | - Teddy Cook
- ACON, Surry Hills, Australia
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Martin Holt
- Centre for Social Research in Health (CSRH), UNSW Sydney, Sydney, Australia
| | - Christy E. Newman
- Centre for Social Research in Health (CSRH), UNSW Sydney, Sydney, Australia
- Australian Human Rights Institute, UNSW Sydney, Sydney, Australia
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The effect of My Health Record use in the emergency department on clinician-assessed patient care: results from a survey. BMC Med Inform Decis Mak 2022; 22:178. [PMID: 35791028 PMCID: PMC9255536 DOI: 10.1186/s12911-022-01920-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 07/01/2022] [Indexed: 11/26/2022] Open
Abstract
Background The emergency department has been a major focus for the implementation of Australia’s national electronic health record, known as My Health Record. However, the association between use of My Health Record in the emergency department setting and patient care is largely unknown. The aim of this study was to explore the perspectives of emergency department clinicians regarding My Health Record use frequency, the benefits of My Health Record use (with a focus on patient care) and the barriers to use. Methods All 393 nursing, pharmacy, physician and allied health staff employed within the emergency department at a tertiary metropolitan public hospital in Melbourne were invited to participate in a web-based survey, between 1 May 2021 and 1 December 2021, during the height of the Delta and Omicron Covid-19 outbreaks in Victoria, Australia. Results Overall, the survey response rate was 18% (70/393). Approximately half of the sample indicated My Health Record use in the emergency department (n = 39, 56%, confidence interval [CI] 43–68%). The results showed that users typically only engaged with My Health Record less than once per shift (n = 15, 39%, CI 23–55%). Just over half (n = 19/39, 54%, CI 32–65%) of all participants who use My Health Record agreed they could remember a time when My Health Record had been critical to the care of a patient. Overall, clinicians indicated the biggest barrier preventing their use of My Health Record is that they forget to utilise the system. Conclusion The results suggest that My Health Record has not been adopted as routine practice in the emergency department, by the majority of participants. Close to half of self-identified users of My Health Record do not associate use as being critical to patient care. Instead, My Health Record may only be used in scenarios that clinicians perceive will yield the greatest benefit—which clinicians in this paper suggest is patients with chronic and complex conditions. Further research that explores the predictors to use and consumers most likely to benefit from use is recommended—and strategies to socialise this knowledge and educate clinicians is desperately required. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01920-8.
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Elliott RA, Taylor SE, Koo SM, Nguyen AD, Liu E, Loh G. Accuracy of medication histories derived from an Australian cloud-based repository of prescribed and dispensed medication records. Intern Med J 2022. [PMID: 35719101 DOI: 10.1111/imj.15857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 06/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obtaining accurate medication histories at transitions of care is challenging, but important for patient safety. Prescription exchange services (PES) securely transfer electronic prescription and dispensing records between prescribers and pharmacies; potentially useful data for determining medication histories. AIM To evaluate the accuracy of PES-derived medication histories. METHODS Prospective observational study, at two Australian tertiary-referral health-services. A convenience sample of adult inpatients was recruited. The main outcome measure was: proportion of patients with ≥1 errors in their PES-derived pre-admission medication histories, compared to gold-standard best-possible medication histories, including prescribed and non-prescribed medications, obtained by pharmacists using multiple sources including patient/carer interview. RESULTS 153/154 (99.4%) patients (median age 76years, inter-quartile range [IQR] 64-84years, median 10.0 pre-admission medications, IQR 6.0-14.0) had ≥1 errors in their PES-derived medication history (median 6.0 per patient, IQR 4.0-9.0). Excluding when-required (PRN) medications, 146 (94.8%) patients had a median of 4.0 errors (IQR 2.0-6.0). Omission was the most common error, affecting 549/1648 (33.3%) current medications (median 3.0, IQR 1.0-5.0 per patient); 396 [72.1%] omissions were over-the-counter medicines. Dose-regimen errors affected 276/1099 (25.1%) current medications captured in PES-derived medication histories (median 1.0, IQR 0.0-3.0 per patient). Commission errors (medications in PES-derived histories that weren't current) affected 224/1383 (16.2%) medications (median 1.0, IQR 1.0-2.0 per patient). CONCLUSIONS Medication histories derived solely from a cloud-based medication record repository had a high error rate compared to patients' actual medication use. Like all medication history sources, data from cloud-based repositories need to be verified with additional sources including patients and/or carers. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Rohan A Elliott
- Aged Care and Research, Pharmacy Department, Austin Health, Melbourne
| | - Simone E Taylor
- Emergency Medicine and Research, Pharmacy Department, Austin Health, Melbourne
| | | | | | - Esther Liu
- Pharmacy Department, Peninsula Health, Melbourne
| | - Grace Loh
- Pharmacy Department, Peninsula Health, Melbourne
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Mullins AK, Morris H, Enticott J, Ben-Meir M, Rankin D, Mantripragada K, Skouteris H. Use of My Health Record by Clinicians in the Emergency Department: An Analysis of Log Data. Front Digit Health 2021; 3:725300. [PMID: 34713198 PMCID: PMC8521888 DOI: 10.3389/fdgth.2021.725300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Leverage log data to explore access to My Health Record (MHR), the national electronic health record of Australia, by clinicians in the emergency department. Materials and Methods: A retrospective analysis was conducted using secondary routinely-collected data. Log data pertaining to all patients who presented to the emergency department between 2019 and 2021 of a not-for-profit hospital (that annually observes 23,000 emergency department presentations) were included in this research. Attendance data and human resources data were linked with MHR log data. The primary outcome was a dichotomous variable that indicated whether the MHR of a patient was accessed. Logistic regression facilitated the exploration of factors (user role, day of the week, and month) associated with access. Results: My Health Record was accessed by a pharmacist, doctor, or nurse in 19.60% (n = 9,262) of all emergency department presentations. Access was dominated by pharmacists (18.31%, n = 8,656). All users demonstrated a small, yet significant, increase in access every month (odds ratio = 1.07, 95% Confidence interval: 1.06-1.07, p ≤ 0.001). Discussion: Doctors, pharmacists, and nurses are increasingly accessing MHR. Based on this research, substantially more pharmacists appear to be accessing MHR, compared to other user groups. However, only one in every five patients who present to the emergency department have their MHR accessed, thereby indicating a need to accelerate and encourage the adoption and access of MHR by clinicians.
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Affiliation(s)
- Alexandra K Mullins
- Health and Social Care Unit, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Heather Morris
- Health and Social Care Unit, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Joanne Enticott
- Health and Social Care Unit, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | | | | | | | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia.,Warwick Business School, University of Warwick, Coventry, United Kingdom
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