The impact of medical informatics on patient satisfaction: A USA-based literature review

Associations Between Lean IT Management and Financial Performance in US Hospitals

BACKGROUND AND OBJECTIVES

To understand the relationship between Lean implementation in information technology (IT) departments and hospital performance, particularly with respect to operational and financial outcomes.

METHODS

Primary data were sourced from 1222 hospitals that responded to the National Survey of Lean (NSL)/Transformational Performance Improvement, which was fielded to 4500 general medical-surgical hospitals across the United States. Secondary sources included hospital performance data from the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Medicare & Medicaid Services (CMS). We performed 2 sets of multivariable regressions using data gathered from US hospitals, linked to AHRQ and CMS performance outcomes. We examined 10 different outcomes measuring financial performance, quality of care, and patient experience, and their associations with Lean adoption within hospital IT departments. We then focused only on those hospitals that adopted Lean in IT to identify specific practices associated with performance.

RESULTS

Controlling for other factors, adoption of Lean IT management was associated with lower length of stay ( b = -0.098, P = .018) and inpatient expense per discharge ( b = -0.112, P = .090). Specifically, use of visual management tools (eg, A3 storyboards, status sheets) was associated with lower adjusted inpatient expense per discharge ( b = -0.176, P = .034) and higher earnings before interest, taxes, depreciation, and amortization margin ( b = 0.124, P = .042). Such tools were also associated with hospital participation in bundled payment programs (odds ratio = 2.326; P = .046; 95% confidence interval, 0.979-5.527) and percentage of net revenue paid on a shared risk basis ( b = 0.188, P = .031).

CONCLUSIONS

Lean IT management was associated with positive financial performance, particularly with hospital participation in value-based payment. More detailed study is needed to understand other influential factors and types of work processes, activities, or mechanisms by which high-functioning IT can contribute to financial outcomes.

Climate toxicity: An increasingly relevant clinical issue in Cancer Care

In recent years the terms time and financial toxicities have entered the vocabulary of cancer care. We would like to introduce another toxicity: climate toxicity. Climate toxicity is a double-edge sword in cancer care. Increasing cancer risk by exposure to carcinogens, and consequently increasing treatment requirements leads to ever growing damage to our environment. This article assesses the impact of climate change on patients, the climate toxicity caused by both healthcare workers and healthcare facilities, and suggests actions that may be taken mitigate them.

Tablet in the Consultation Room and Physician Satisfaction

The purpose of the study is to investigate patient-physician interactions during a clinical encounter to ascertain the impact of tablet computing on physician satisfaction during a clinical encounter. This study was conducted at a primary care clinic, and the physicians who participated could use a tablet during their clinical encounters. The authors compared satisfaction between physicians who used the tablet during a clinical encounter and those who did not using data from 122 clinical encounters involving 82 patients. The results indicate that physicians who used the tablet during clinical encounters are more satisfied than those who did not. Additionally, there was a meaning difference in satisfaction between physicians who used the tablet to educate patients and share information than those who did not. HITs have potential benefits, but they also come with risks. To effectively manage the risks and benefits of HITs, healthcare providers should be deliberate and strategic in the implementation of HITs.

Effects of Patient Portal Use on Patient Satisfaction: Survey and Partial Least Squares Analysis

Background

With digital delivery of health care services gaining prominence, patient portals have become a mainstay of many health care organizations. Despite the importance of patient portals, inconclusive data exist regarding the effect of patient portal use on patient satisfaction.

Objective

The aim of this study is to understand the relationship between the postadoptive use of patient portals and patient satisfaction outcomes.

Methods

Postadoptive use of patient portals has a positive relationship with the 3 dimensions of patient satisfaction, mediated by gratification, health self-awareness, and health perceptions. A total of 504 valid patient portal user responses were collected, and partial least squares analysis was performed to analyze the data.

Results

Patient satisfaction was captured using three dimensions: care team interaction, atmosphere, and instruction effectiveness. The results show that postadoptive use of patient portals has a positive influence on all 3 dimensions of patient satisfaction through the mediating variables of gratification, health self-awareness, and health perceptions. Specifically, postadoptive use had significant positive influence on gratification, health self-awareness, and health perceptions. Each of the 3 patient perceptions had significant positive influence on all 3 dimensions of patient satisfaction: care team interaction, atmosphere, and instruction effectiveness. Specifically, our model explained 31.8% of the care team interaction, 40.6% of the atmosphere, and 39.1% of the instruction effectiveness.

Conclusions

Our model shows that patient portal use can influence patient satisfaction through the mediating effects of gratification, health self-awareness, and health perception. Patient satisfaction is an important outcome for health care organizations. Therefore, by promoting effective patient portal use and fostering patient perceptions, health care organizations can improve patient satisfaction.

Orthodontic patients' oral hygiene compliance by utilizing a smartphone application (Brush DJ): a randomized clinical trial

Considering the widespread use of smartphones and their applications (apps), as well as the undeniable role of reminders and apps in behavioral interventions, this study aimed to assess the efficacy of a smartphone app (Brush DJ) for oral hygiene compliance of patients with fixed orthodontic appliances. In this randomized clinical trial, 120 patients between 15 to 25 years who had just started fixed orthodontic treatment were randomly divided into two groups (n = 60). Control patients received conventional oral hygiene instruction, while patients in the intervention group were asked to use the Brush DJ smartphone app, after receiving conventional oral hygiene instruction. The plaque index (PI) and gingival index (GI) were measured at baseline (T0), and at 4 weeks (T1), 8 weeks (T2) and 12 weeks (T3) after the onset of study. A questionnaire was given to all patients to assess the frequency and duration of tooth brushing per day, and the frequency of app usage and reminder noticing in the intervention group. Improvements in PI and GI were noted in the intervention group; while these parameters increased in the control group. Significant differences were noted in PI and GI changes between the two groups (p < 0.001). Brushing frequency and duration were positively correlated with app usage during the follow-up period. Ultimately, we believe that smartphone apps, as motivators and reminders, can greatly help in improving the orthodontic patients’ oral hygiene compliance, especially in adolescents

Perceptions of allied health staff of the implementation of an integrated electronic medical record across regional and metropolitan settings

ObjectiveThe aim of this study was to investigate the perceptions of allied health professionals (AHPs) to implementation of an integrated electronic medical record (EMR) across both regional and metropolitan settings. MethodsThe study was conducted as a cross-sectional electronic survey. AHPs working at three hospital sites within Queensland Health were sent an electronic survey link. Participation was voluntary and recruitment via a snowball sampling technique was encouraged. Responses were analysed descriptively. ResultsIn all, 104 responders completed the survey. Responders were distributed across three sites within the selected health service, with most (75%; n=78) being at the largest site. Physiotherapy accounted for the largest number of responders (22%). Most responders were female (87%; n=90) and between 20 and 40 years of age (68%; n=71). On a scale from 0 (being anxious) to 100 (being excited), at the time EMR implementation was announced, there was a trend towards excitement (mean score 59). The most commonly reported factor hindering EMR implementation was the opportunity to practice with EMR (34%), whereas clinical ‘change champions’ were reported as the most common facilitators (61%). Overall, 60% of responders were very satisfied or satisfied with the EMR, but limited effects on efficiency and patient care were reported. ConclusionsThe results suggest an overall positive response to EMR implementation. Minimal staff reported effects such as stress or anxiety in the workplace related to EMR implementation, and a perception of ‘comfort’ was cited once EMR was part of usual practice. However, responders did not report a significant effect on speed, efficiency or quality of patient care following EMR implementation. What is known about the topic?A growing body of literature exists regarding the perceptions of staff (particularly medical officers) in moving towards EMRs, but there is limited evidence regarding the perceptions of AHPs, and the barriers and facilitators to this change. What does this paper add?This paper presents a novel perspective regarding the perceptions of AHPs regarding the implementation of an EMR and provides a perspective of the barriers and facilitators that supported a smooth transition at three sites. What are the implications for practitioners?Despite being a large-scale service change, the introduction of an EMR did not significantly increase AHPs’ subjective feelings of anxiety. Services considering EMR implementation should invest in the provision of timely information, ‘at-elbow’ support and opportunities to practice the new system.

Patients' experiences of acute deterioration: A scoping review

BACKGROUND

Patient experience is recognised as a means of assessing healthcare delivery with organisations in many countries now gathering patient experience or satisfaction data. It is well documented that the benefits of improving a patients' experience include increased satisfaction, reduced length of stay, improved patient outcomes and reduction of costs. The experience of acute clinical deterioration is unique, extensive and complex as well as being a difficult experience for all involved. However, little is known about this experience from the patient's perspective.

AIM

To explore what is known about the experiences of acute deterioration from the perspective of the patient.

DESIGN

A scoping review of international, peer-reviewed research studies and grey literature published between the years of 2000 and 2018. This review was guided by the three-step search strategy recommended by the Joanna Briggs Institute (JBI).

DATA SOURCES

A range of databases were searched, including CINAHL, Medline, Health Source, Joanna Briggs Institute, PsycINFO, Embase via Ovid, Cochrane library, Ovid Emcare, Scopus as well as grey literature, reference lists and the search engine Google Scholar.

REVIEW METHODS

Joanna Briggs Institute (JBI) scoping review framework was utilised to identify patients' experiences of acute deterioration. Ten databases were searched, and 249 articles were retrieved. After screening the titles and abstracts, 102 articles were assessed in full text for eligibility, and finally 23 articles were further analysed and synthesised using inductive thematic analysis.

RESULTS

19 qualitative studies, three quantitative and one mixed methods study met the inclusion criteria. Seven key themes emerged related to patients' experience of acute deterioration: (1) transformation of perception: memories of factual events; (2) psychological transformation: emotional distress and well-being; (3) physiological transformation: physical distress; (4) facing death; (5) the severity of acute deterioration: from the perspective of the patient; (6) relationship with healthcare professionals and the clinical environment; and (7) the value of relationships: the support of family and friends.

CONCLUSIONS

Participants had considerable recall of their experiences and hospital admissions. The themes highlight the important issues patients face during their own acute physiological deterioration. This review has highlighted that further research is needed to specifically explore the patients' experience of acute deterioration and the emergency management they receive, for example from a hospital's rapid response team (RRT) or medical emergency team (MET).

Primary Care Patients' and Providers' Perspectives about an Online Weight Management Program: a Qualitative Study

BACKGROUND

Primary care providers (PCPs) often take the lead role in caring for patients with overweight and obesity; however, few PCPs counsel patients about weight loss. Online weight management programs that are integrated within primary care may help address this gap in care.

OBJECTIVE

To identify perceptions of and experience with online weight management programs in general and with a proposed online program, to identify barriers to use, and to improve the design and content of our intervention, which included an online program plus population health management (PHM) support from primary care practices.

DESIGN

A mixed qualitative methods study including three patient focus groups and seven semi-structured interviews with healthcare providers.

PARTICIPANTS

A total of 13 adult patients (age range, 20-70) with body mass index (BMI) 27-35 kg/m2 attended the focus groups. In-person semi-structured interviews were conducted with seven healthcare providers (three PCPs, two population health managers, one primary care nurse, and one registered dietitian).

MAIN MEASURES

We developed and used semi-structured focus groups and interview guides. The focus group and interviews were recorded and transcribed. Using grounded theory, we analyzed the transcripts to identify and extract common concepts and themes.

KEY RESULTS

Although patients and healthcare providers expressed positive opinions about online weight management programs, few patients had experience with them, and providers stated that such programs are not being widely implemented in primary care settings. Some participants highlighted the flexibility and low cost as strengths of online weight management tools compared with in-person programs. All participants had favorable opinions about our proposed intervention and were overwhelmingly positive about the combination of an online program and PHM support.

CONCLUSIONS

This study highlights the potential value of online weight management programs and PHM support in primary care.

CLINICAL TRIALS REGISTRATION

NCT02656693.

Improving patient portal enrolment in an academic resident continuity clinic: quality improvement made simple

Electronic health record patient portal usage has been associated with improvement in chronic disease parameters, patient functional status and patient satisfaction. Our institution’s patient portal is a secure, online health management tool that connects patients to portions of their electronic health record.

Our quality improvement project aimed to increase patient portal enrolment significantly in our Internal Medicine resident patient panels.

This study was conducted in a large, multisite health system in Kansas City, Kansas that serves a diverse patient population. Our clinic includes 65 resident patient panels. We followed a subset of 16 resident patient panels in this quality improvement project. A baseline audit showed that 35% of the 1628 patients in these panels were enrolled in the patient portal system. A standardised, nurse-initiated portal sign-up process following patient rooming was implemented. Initial results indicated a 9.6% increase in patient portal sign-up at the end of the first 4-week cycle. We then implemented educational sessions for our clinic nurses as well as attending physicians, and achieved a 15.1% increase from baseline to the end of the second 4-week cycle, resulting in 86 patient portal activations (p<0.01).

Resident physicians worked with clinic nurse partners in two formats for this project. Nurses assigned to patient rooming for residents during the clinic sessions being studied (rooming nurses) initiated the portal sign-up process. Nurses assigned to partner with the resident for longitudinal patient care management, anchor nurses, worked with residents on items such as phone messages or portal messages. Semi-structured interviews of the four anchor nurses aligned with the 16 residents were conducted at the end of the study and revealed that nursing staff perceived increased patient portal activity to be associated with a decrease in nursing workload and an increase in patient engagement.

Use of Expectation Disconfirmation Theory to Test Patient Satisfaction with Asynchronous Telemedicine for Diabetic Retinopathy Detection

OBJECTIVE

The purpose of the study is to extend research on patient satisfaction with telemedicine services by employing the theoretical framework of Expectation Disconfirmation Theory (EDT) for diabetic retinopathy screenings focusing on rural patients.

METHOD

Adult subjects (n=220) with diabetes were recruited from a single family practice office in rural Iowa. Subjects completed a "pre" survey concerning their forward-looking perceptions of telemedicine prior to using telemedicine for detection of diabetic retinopathy and a "post" survey after they received recommendations from the distant ophthalmologists.

RESULTS

All hypotheses of the EDT model were supported. Patient satisfaction is influenced by both patients' expectations (P<.001) and disconfirmation of expectations (P<.001), and patient satisfaction has a positive impact on patient preference for telemedicine services (P<.001). Overall, patients who received telemedicine services were highly satisfied with telemedicine and developed a favorable disposition towards telemedicine services.

CONCLUSIONS

The EDT model is a viable framework to study patient satisfaction of telemedicine services. While previous feasibility studies have shown that telemedicine for diabetic retinopathy screenings yields diagnostic efficacy, this study applies a theoretical framework to demonstrate the viability of telemedicine for diabetic retinopathy screenings in rural areas.

Experiences of adult patients using primary care services in Poland - a cross-sectional study in QUALICOPC study framework

Background

Patients as real healthcare system users are important observers of primary care and are able to provide reliable information about the quality of care. The aim of this study was to explore the patients’ experiences and their level of satisfaction with the process and outcomes of care provided by primary care physicians in Poland and to identify the characteristics of the patients, their physicians, and facilities associated with patient satisfaction.

Methods

The study is based on data from the Polish part of the Quality and Costs of Primary Care in Europe (QUALICOPC) cross-sectional, questionnaire-based study. In Poland, a nationally representative sample of 220 PC physicians and 1980 of their patients were recruited to take part in the study. As a study tool we used 3 out of 4 QUALICOPC questionnaires: “Patient Experience”, “PC Physician” and “Fieldworker” questionnaires.

Results

The areas of the best quality perceived by Polish PC patients are: equity, accessibility of care and quality of service. Coordination and comprehensiveness of care are evaluated relatively worse. The patients’ and their physicians’ characteristics have a limited influence on patient satisfaction and experiences with Polish primary care.

Conclusions

Primary health care in Poland is of good overall quality as perceived by the patients. Study participants were at most satisfied with accessibility and equity of care and less satisfied with coordination and comprehensiveness of care. Longer patient-doctor relationship and older age of patients were found as the most influential determinants of higher satisfaction. However, variables used in this study poorly explain the overall level of satisfaction. Further research is needed to identify the other determinants of patient satisfaction in the Polish population. Rural practices deserve additional attention due to highest proportions of both extremely satisfied and dissatisfied patients.

Electronic supplementary material

The online version of this article (10.1186/s12875-017-0665-6) contains supplementary material, which is available to authorized users.

How does the cellular phone help in epidemiological surveillance? A review of the scientific literature

BACKGROUND

In the field of epidemiological surveillance, no systematic literature review appears to exist of implemented projects using cellular phone technology.

METHOD

We performed a systematic literature review using the Pubmed and Scopus databases to retrieve articles published up to December 2015. We analyzed information reported in these publications according to the mobile health (mHealth) evidence reporting and assessment (mERA) checklist, and complemented this work with specific items related to epidemiology, in order to clarify the types of results reported and summarized in this context.

RESULTS

Thirty-three articles were selected and reviewed. Each article was related to a different project. Two mERA items were systematically and fully reported, while two others were never reported. Three projects were deployed in very specific zones. Most of the projects were implemented in Africa. Infectious diseases were the elements most monitored. Most projects were based on daily data collection and SMS transmission. Economic assessment was limited to SMS, mobile phone, and implementation costs.

DISCUSSION-CONCLUSION

Although suitable for epidemiologic surveillance, the mERA checklist needs further interpretation. The technical and transmission modes of cellular phone use varied greatly from one study to another. No evaluation of the interoperability capabilities of cellular phones with other applications or sub-systems was possible.

The Effect of Electronic Health Record Use and Patient-Centered Communication on Cancer Screening Behavior: An Analysis of the Health Information National Trends Survey

The present study used the 2013 Health Information National Trends Survey (N = 3185) to examine the effects of patient-centered communication (PCC) and the use of electronic health records (EHRs) on the likelihood of patients receiving a recommended screening for cancer (i.e., mammogram, PSA test). Self-determination theory, a framework of self-initiated extrinsic behaviors, was applied to test mediation models of PCC and EHR use, respectively, through patient activation. The results demonstrated that PCC and EHR use predicted cancer screening (mediated through patient activation), but only for women recommended for biannual mammograms. The aforementioned relationship was not found for men who are recommended for prostate cancer screening. PCC and EHRs do appear to facilitate a patient's ability to take care of their own health, but only under certain circumstances. It was additionally found that men were more likely to report higher degrees of physician PCC when their physicians maintained an EHR, whereas women reported no difference. Future research should examine more nuanced personality factors that affect the perception of PCC in the presence of EHRs and the relationship between men's activation and likelihood of receiving a cancer screen.

Information and Communications Technologies Health Projects in Panama: A Systematic Review and their Relation with Public Policies

This paper presents a review about Information and Communications Technologies (ICTs) health projects in Panama. The main contribution is to provide a vision of the situation in Panama, allowing an understanding of the dynamics of health policies and how they have affected the implementation of ICT's Projects to improve the health of Panamanians. We analyze the projects found with ICT's in health of Panama, which allow us to see a perspective of projects information is obtained from 2000 to 2016, however it is important to highlight that there may be other projects that we do not know because we did not find enough information or evidence of the same. That is why this review has interviews with key personnel, who have guided us with the search for information. 56% of technology projects are concentrated in the capital city and only 16% in the province of Chiriquí. 64% of these projects are focused on the development of information systems, mainly focused on electronic patient registration. And 60% refers to projects related to primary health care. The MINSA and CSS both with a 20% participation in ICT project, in addition we can notice the dispersion of projects for hospitals, where each one is developing programs per their needs or priorities. The national information about ICT projects of Health, it has been notorious the state of dispersion and segmented of public health information. We consider that it is a natural consequence of Policy in Panamanian Health System. This situation limits the information retrieval and knowledge of ICT in Health of Panama. To stakeholders, this information is directed so that health policies are designed towards a more effective and integral management, administering the ICT's as tools for the well-being of most the Panamanian population, including indigenous group.

Inpatient Experiences with MyChart Bedside

BACKGROUND

As technology is increasingly being integrated into hospital-based care, it is important to assess patient experiences. The purpose of this project was to conduct an evaluation of inpatient experiences with MyChart^® Bedside.

MATERIALS AND METHODS

A convenience sample of patients (n = 88) were included in this study, who responded to a Web-based self-reported survey that was embedded within the MyChart Bedside application.

RESULTS

The majority of respondents (78%) reported that MyChart Bedside was easy to use. The respondents agreed that MyChart Bedside improved communication with their nurses (74%) and with their physicians (53%), as well as helped them understand their medications (90%) during their inpatient hospitalization.

CONCLUSIONS

The study found that the majority of patients were satisfied with MyChart Bedside, and they reported that it helped them learn more about their medications, as well as communicate with their care team.

Biomedical and Health Informatics Education - the IMIA Years

OBJECTIVE

This paper presents the development of medical informatics education during the years from the establishment of the International Medical Informatics Association (IMIA) until today.

METHOD

A search in the literature was performed using search engines and appropriate keywords as well as a manual selection of papers. The search covered English language papers and was limited to search on papers title and abstract only.

RESULTS

The aggregated papers were analyzed on the basis of the subject area, origin, time span, and curriculum development, and conclusions were drawn.

CONCLUSIONS

From the results, it is evident that IMIA has played a major role in comparing and integrating the Biomedical and Health Informatics educational efforts across the different levels of education and the regional distribution of educators and institutions. A large selection of references is presented facilitating future work on the field of education in biomedical and health informatics.

Developing a mobile application to better inform patients and enable effective consultation in implant dentistry

The field of dentistry lacks satisfactory tools to help visualize planned procedures and their potential results to patients. Dentists struggle to provide an effective image in their patient's mind of the end results of the planned treatment only through verbal explanations. Thus, verbal explanations alone often cannot adequately help the patients make a treatment decision. Inadequate attempts are frequently made by dentists to sketch the procedure for the patient in an effort to depict the treatment. These attempts however require an artistic ability not all dentists have. Real case photographs are sometimes of help in explaining and illustrating treatments. However, particularly in implant cases, real case photographs are often ineffective and inadequate. The purpose of this study is to develop a mobile application with an effective user interface design to support the dentist-patient interaction by providing the patient with illustrative descriptions of the procedures and the end result. Sketching, paper prototyping, and wire framing were carried out with the actual user's participation. Hard and soft dental tissues were modeled using three dimensional (3D) modeling programs and real cases. The application enhances the presentation to the patients of potential implants and implant supported prosthetic treatments with rich 3D illustrative content. The application was evaluated in terms of perceived ease of use and perceived usefulness through an online survey. The application helps improve the information sharing behavior of dentists to enhance the patients' right to make informed decisions. The paper clearly demonstrates the relevance of interactive communication technologies for dentist-patient communication.

Anesthesiologist: the patient's perception

BACKGROUND AND OBJECTIVES

Anesthesia is still a major concern for patients, although the anesthetic complications have decreased significantly. Additionally, the role assigned to the anesthesiologist remains inaccurate. The aim of this study was to evaluate the concerns with anesthesia and assess the patient's knowledge about the anesthesiologist's duties.

METHODS

Prospective study conducted over three months with patients in the preoperative anesthetic visit in a university hospital. Demographic information about the level of education and prior anesthesia was obtained. The knowledge of patients regarding the anesthesiologists' education was evaluated. Patients' concerns and anesthesiologist and surgeon responsibilities were classified with a 5-point scale. The analysis was performed with SPSS 21, and p<0.05 was considered statistically significant.

RESULTS

We included 204 patients, and 135 (66.2%) recognized the anesthesiologist as a specialist physician. Not waking up after surgery and postoperative infection were the main concerns compared to all others (p<0.05). Women expressed more concern than men about not waking up after surgery, nausea and postoperative vomiting, medical problems, and waking up during surgery (p<0.05). Ensure that patients do not wake up during surgery was the anesthesiologist task most recognized, compared to all other (p<0.05). The surgeon was more recognized (p<0.05) than the anesthesiologist in post-operative, antibiotics administration, and blood transfusions pain management.

CONCLUSIONS

Patients need to be informed about the current safety of anesthesia and the anesthesiologist's functions. The patient involvement will demystify some fears and reassure the confidence in the health system.

[Anesthesiologist: the patient's perception]

BACKGROUND AND OBJECTIVES

Anesthesia is still a major concern for patients, although the anesthetic complications have decreased significantly. Additionally, the role assigned to the anesthesiologist remains inaccurate. The aim of this study was to evaluate the concerns with anesthesia and assess the patient's knowledge about the anesthesiologist's duties.

METHODS

Prospective study conducted over three months with patients in the preoperative anesthetic visit in a university hospital. Demographic information about the level of education and prior anesthesia was obtained. The knowledge of patients regarding the anesthesiologists' education was evaluated. Patients' concerns and anesthesiologist and surgeon responsibilities were classified with a 5-point scale. The analysis was performed with SPSS 21, and p<0.05 was considered statistically significant.

RESULTS

We included 204 patients, and 135 (66.2%) recognized the anesthesiologist as a specialist physician. Not waking up after surgery and postoperative infection were the main concerns compared to all others (p<0.05). Women expressed more concern than men about not waking up after surgery, nausea and postoperative vomiting, medical problems, and waking up during surgery (p<0.05). Ensure that patients do not wake up during surgery was the anesthesiologist task most recognized, compared to all other (p<0.05). The surgeon was more recognized (p<0.05) than the anesthesiologist in post-operative, antibiotics administration, and blood transfusions pain management.

CONCLUSIONS

Patients need to be informed about the current safety of anesthesia and the anesthesiologist's functions. The patient involvement will demystify some fears and reassure the confidence in the health system.

Carbon footprint of telemedicine solutions--unexplored opportunity for reducing carbon emissions in the health sector

Background

The healthcare sector is a significant contributor to global carbon emissions, in part due to extensive travelling by patients and health workers.

Objectives

To evaluate the potential of telemedicine services based on videoconferencing technology to reduce travelling and thus carbon emissions in the healthcare sector.

Methods

A life cycle inventory was performed to evaluate the carbon reduction potential of telemedicine activities beyond a reduction in travel related emissions. The study included two rehabilitation units at Umeå University Hospital in Sweden. Carbon emissions generated during telemedicine appointments were compared with care-as-usual scenarios. Upper and lower bound emissions scenarios were created based on different teleconferencing solutions and thresholds for when telemedicine becomes favorable were estimated. Sensitivity analyses were performed to pinpoint the most important contributors to emissions for different set-ups and use cases.

Results

Replacing physical visits with telemedicine appointments resulted in a significant 40–70 times decrease in carbon emissions. Factors such as meeting duration, bandwidth and use rates influence emissions to various extents. According to the lower bound scenario, telemedicine becomes a greener choice at a distance of a few kilometers when the alternative is transport by car.

Conclusions

Telemedicine is a potent carbon reduction strategy in the health sector. But to contribute significantly to climate change mitigation, a paradigm shift might be required where telemedicine is regarded as an essential component of ordinary health care activities and not only considered to be a service to the few who lack access to care due to geography, isolation or other constraints.

Determinants of Patient Satisfaction in Internal Medicine Resident Continuity Clinics: Findings of the Educational Innovations Project Ambulatory Collaborative

BACKGROUND

Many internal medicine programs have reorganized their resident continuity clinics to improve the ambulatory care experience for residents. The effect of this redesign on patient satisfaction is largely unknown.

METHODS

Our multi-institutional, cross-sectional study included 569 internal medicine residents from 11 programs participating in the Educational Innovations Project Ambulatory Collaborative. An 11-item patient satisfaction survey from the Consumer Assessment of Healthcare Providers and Systems was used to assess patient satisfaction, comparing patient satisfaction in traditional models of weekly continuity clinic with 2 new clinic models. We then examined the relationship between patient satisfaction and other practice variables.

RESULTS

Patient satisfaction responses related to resident listening and communication skills, knowledge of medical history, perception of adequate visit time, overall rating, and willingness to refer to family and friends were significantly better in the traditional and block continuity models than the combination model. Higher ambulatory workload was associated with reduced patient perception of respect shown by the physician. The percentage of diabetic patients with glycated hemoglobin < 8% was positively correlated with number of visits, knowledge of medical history, perception of respect, and higher scores for recommending the physician to others. The percentage of diabetic patients with low density lipoprotein < 100 mg/dL was positively correlated with the physician showing respect.

CONCLUSIONS

Patient satisfaction was similar in programs using block design and traditional models for continuity clinic, and both outperformed the combination model programs. There was a delicate balance between workload and patient perception of the physician showing respect. Care outcome measures for diabetic patients were associated with aspects of patient satisfaction.

An improvement in the appointment scheduling in primary health care centers using data mining

An optimal resource management in health care centers implies the use of an appropriate timetabling scheme to schedule appointments. Timetables of health centers are usually divided into time slots whose duration is equal to time required for clinical attendance. However doctors perform a series of tasks that are not always clinical in nature: issuing prescriptions or prescribing sick leave certificates. In this sense the time spent in attending a clinical or an administrative matter is different. This last required less time to attend the patient. This study is focused in the administrative task. A predictive model is generated to provide daily information on how many patients will go to the health center for an administrative issue. The accuracy of the model is less than 4,6 % absolute error and the improvement in scheduling appointments is a time saving of 21,73 %.

An eHealth Intervention for Patients in Rural Areas: Preliminary Findings From a Pilot Feasibility Study

Background

eHealth facilitation of chronic disease management has potential to increase engagement and effectiveness and extend access to care in rural areas.

Objective

The objective of this study was to demonstrate the feasibility and acceptability of an eHealth system for the management of chronic conditions in a rural setting.

Methods

We developed an online management program which incorporated content from the Flinders Chronic Condition Management Program (Flinders Program) and used an existing software platform (goACT), which is accessible by patients and health care workers using either Web-enabled mobile phone or Internet, enabling communication between patients and clinicians. We analyzed the impact of this eHealth system using qualitative and simple quantitative methods.

Results

The eHealth system was piloted with 8 recently hospitalized patients from rural areas, average age 63 (SD 9) years, each with an average of 5 chronic conditions and high level of psychological distress with an average K10 score of 32.20 (SD 5.81). Study participants interacted with the eHealth system. The average number of logins to the eHealth system by the study participants was 26.4 (SD 23.5) over 29 weeks. The login activity was higher early in the week.

Conclusions

The pilot demonstrated the feasibility of implementing and delivering a chronic disease management program using a Web-based patient-clinician application. A qualitative analysis revealed burden of illness and low levels of information technology literacy as barriers to patient engagement.

Patient perceptions of electronic medical records use and ratings of care quality

PURPOSE

Despite considerable potential for improving health care quality, adoption of new technologies, such as electronic medical records (EMRs), requires prudence, to ensure that such tools are designed, implemented, and used meaningfully to facilitate patient-centered communication and care processes, and better health outcomes. The association between patients' perceptions of health care provider use of EMRs and health care quality ratings was assessed.

METHOD

Data from two iterations of the Health Information National Trends Survey, fielded in 2011 and 2012, were pooled for these analyses. The data were collected via mailed questionnaire, using a nationally representative listing of home addresses as the sampling frame (n=7,390). All data were weighted to provide representative estimates of quality of care ratings and physician use of EMR, in the adult US population. Descriptive statistics, t-tests, and multivariable linear regression analyses were conducted.

RESULTS

EMR use was reported significantly more frequently by females, younger age groups, non-Hispanic whites, and those with higher education, higher incomes, health insurance, and a usual source of health care. Respondents who reported physician use of EMRs had significantly higher ratings of care quality (Beta=4.83, standard error [SE]=1.7, P<0.01), controlling for sociodemographic characteristics, usual source of health care, and health insurance status.

CONCLUSION

Nationally representative data suggest that patients' perceptions of EMR use are associated with their perceptions of the quality of the health care they receive.

Patients' involvement in e-health services quality assessment: a system for the automatic interpretation of SMS-based patients' feedback

PURPOSE

Effective communication between patients and health services providers is a key aspect for optimizing and maintaining these services. This work describes a system for the automatic evaluation of users' perception of the quality of SmsCup, a reminder system for outpatient visits based on short message service (SMS). The final purpose is the creation of a closed-loop control system for the outpatient service, where patients' complaints and comments represent a feedback that can be used for a better implementation of the service itself.

METHODS

SmsCup was adopted since about eight years by an Italian healthcare organization, with very good results in reducing the no-show (missing visits) phenomenon. During these years, a number of citizens, even if not required, sent a message back, with comments about the service. The automatic interpretation of the content of those SMS may be useful for monitoring and improving service performances.Yet, due to the complex nature of SMS language, their interpretation represents an ongoing challenge. The proposed system uses conditional random fields as the information extraction method for classifying messages into several semantic categories. The categories refer to appreciation of the service or complaints of various types. Then, the system analyzes the extracted content and provides feedback to the service providers, making them learning and acting on this basis.

RESULTS

At each step, the content of the messages reveals the actual state of the service as well as the efficacy of corrective actions previously undertaken. Our evaluations showed that: (i) the SMS classification system has achieved good overall performance with an average F1-measure and an overall accuracy of about 92%; (ii) the notification of the patients' feedbacks to service providers showed a positive impact on service functioning.

CONCLUSIONS

Our study proposed an interactive patient-centered system for continuous monitoring of the service quality. It has demonstrated the feasibility of a tool for the analysis and notification of the patients' feedback on their service experiences, which would support a more regular access to the service.

Profiling e-health projects in Africa: trends and funding patterns

There is a severe shortage of healthcare provision in Africa. e-Health, the use of Information and Communication Technologies (ICT) to support healthcare, may help to ease this problem. e-Health projects support a wide range of applications ranging from telemedicine to global research collaborations made possible via e-Infrastructures, worldwide systems of integrated advanced high performance networking and computing ICT. To try to understand the state of e-Health in Africa, this paper aims to create a picture and to present an analytical review of some of these initiatives in Africa. A review framework composed of multiple search methods is developed and applied to yield a broad coverage of e-Health projects over the African continent. Seven quantitative analyses on the projects are presented. Major observations include that there is a tendency for e-Health projects to grow in number in some African countries over time; that African countries with larger Gross National Incomes tend to attract more e-Health projects; that e-Health projects in Africa focus on telemedicine, health education and health-related research; that there is a wide range of funding bodies, some of which have a geographical focus, and that the number of m-Health projects has been rising sharply.

Risk Management Information System Architecture for a Hospital Center

In modern day’s institutions, risk management plays a crucial role as it aims to minimize the likelihood of adverse events and contributes to improve the quality of services delivery. In health care, an effective risk management is only possible if supported by information systems that can produce high quality measures and meaningful risk indicators. These indicators will then allow the healthcare organization to self-assess by identifying critical gaps and opportunities for improvement in several frontiers. Such an organizational thrust is not only warranted for competitiveness but also fundamental for the purpose of benchmarking, accreditation and certification. Additionally, monitoring of specific indicators is often required by the tutelage. However, the development of a risk management system can be an arduous process due to the inherent complexity of clinical systems. This paper presents an architecture for the implementation of a risk management information system, using as example the case of CHTMAD, a Portuguese hospital center.