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Noyd DH, Bailey A, Janitz A, Razzaghi T, Bouvette S, Beasley W, Baker A, Chen S, Bard D. Rurality, Cardiovascular Risk Factors, and Early Cardiovascular Disease among Childhood, Adolescent, and Young Adult Cancer Survivors. RESEARCH SQUARE 2024:rs.3.rs-4139837. [PMID: 38645102 PMCID: PMC11030544 DOI: 10.21203/rs.3.rs-4139837/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Background and Aims Cardiovascular risk factors (CVRFs) later in life potentiate risk for late cardiovascular disease (CVD) from cardiotoxic treatment among survivors. This study evaluated the association of baseline CVRFs and CVD in the early survivorship period. Methods This analysis included patients ages 0-29 at initial diagnosis and reported in the institutional cancer registry between 2010 and 2017 (n = 1228). Patients who died within five years (n = 168), those not seen in the oncology clinic (n = 312), and those with CVD within one year of diagnosis (n = 17) were excluded. CVRFs (hypertension, diabetes, dyslipidemia, and obesity) within one year of initial diagnosis, were constructed and extracted from the electronic health record based on discrete observations, ICD9/10 codes, and RxNorm codes for antihypertensives. Results Among survivors (n = 731), 10 incident cases (1.4%) of CVD were observed between one year and five years after the initial diagnosis. Public health insurance (p = 0.04) and late effects risk strata (p = 0.01) were positively associated with CVD. Among survivors with public insurance(n = 495), two additional cases of CVD were identified from claims data with an incidence of 2.4%. Survivors from rural areas had a 4.1 times greater risk of CVD compared with survivors from urban areas (95% CI: 1.1-15.3), despite adjustment for late effects risk strata. Conclusions Clinically computable phenotypes for CVRFs among survivors through informatics methods were feasible. Although CVRFs were not associated with CVD in the early survivorship period, survivors from rural areas were more likely to develop CVD. Implications for Survivors Survivors from non-urban areas and those with public insurance may be particularly vulnerable to CVD.
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Affiliation(s)
- David H Noyd
- Seattle Children's Hospital/University of Washington Department of Pediatrics
| | - Anna Bailey
- The University of Oklahoma Health Sciences Center, Hudson College of Public Health, Department of Biostatistics and Epidemiology
| | - Amanda Janitz
- The University of Oklahoma Health Sciences Center, Hudson College of Public Health, Department of Biostatistics and Epidemiology
| | - Talayeh Razzaghi
- The University of Oklahoma, School of Industrial and Systems Engineering
| | - Sharon Bouvette
- The University of Oklahoma Health Sciences Center, College of Medicine
| | - William Beasley
- The University of Oklahoma Health Sciences Center, College of Medicine
| | - Ashley Baker
- The University of Oklahoma Health Sciences Center, College of Medicine
| | - Sixia Chen
- The University of Oklahoma Health Sciences Center, Hudson College of Public Health, Department of Biostatistics and Epidemiology
| | - David Bard
- The University of Oklahoma Health Sciences Center, College of Medicine
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Naqvi IA, Strobino K, Li H, Schmitt K, Barratt Y, Ferrara SA, Hasni A, Cato KD, Weiner MG, Elkind MSV, Kronish IM, Arcia A. Improving Patient-Reported Outcomes in Stroke Care using Remote Blood Pressure Monitoring and Telehealth. Appl Clin Inform 2023; 14:883-891. [PMID: 37940129 PMCID: PMC10632067 DOI: 10.1055/s-0043-1772679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/13/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Inequities in health care access leads to suboptimal medication adherence and blood pressure (BP) control. Informatics-based approaches may deliver equitable care and enhance self-management. Patient-reported outcomes (PROs) complement clinical measures to assess the impact of illness on patients' well-being in poststroke care. OBJECTIVES The aim of this study was to determine the feasibility of incorporating PROs into Telehealth After Stroke Care (TASC) and to explore the effect of this team-based remote BP monitoring program on psychological distress and quality of life in an underserved urban setting. METHODS Patients discharged home from a Comprehensive Stroke Center were randomized to TASC or usual care for 3 months. They were provided with a BP monitor and a tablet that wirelessly transmitted data to a cloud-based platform, which were integrated with the electronic health record. Participants who did not complete the tablet surveys were contacted via telephone or e-mail. We collected the Patient-Reported Outcomes Measurement Information System Managing Medications and Treatment (PROMIS-MMT), Patient Activation Measure (PAM), Neuro-QOL (Quality of Life in Neurological Disorders) Cognitive Function, Neuro-QOL Depression, and Patient Health Questionnaire-9 (PHQ-9). T-tests and linear regression were used to evaluate the differences in PRO change between the arms. RESULTS Of the 50 participants, two-thirds were Hispanic or non-Hispanic Black individuals. Mechanisms of PRO submission for the arms included tablet (62 vs. 47%), phone (24 vs. 37%), tablet with phone coaching (10 vs. 16%), and e-mail (4 vs. 0%). PHQ-9 depressive scores were nominally lower in TASC at 3 months compared with usual care (2.7 ± 3.6 vs. 4.0 ± 4.1; p = 0.06). No significant differences were observed in PROMIS-MMT, PAM, or Neuro-QoL measures. CONCLUSION Findings suggest the feasibility of collecting PROs through an interactive web-based platform. The team-based remote BP monitoring demonstrated a favorable impact on patients' well-being. Patients equipped with appropriate resources can engage in poststroke self-care to mitigate inequities in health outcomes.
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Affiliation(s)
- Imama A. Naqvi
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, United States
| | - Kevin Strobino
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, United States
| | - Hanlin Li
- NewYork-Presbyterian Hospital, New York, New York, United States
| | - Kevin Schmitt
- NewYork-Presbyterian Hospital, New York, New York, United States
| | - Yuliya Barratt
- NewYork-Presbyterian Hospital, New York, New York, United States
| | - Stephen A. Ferrara
- School of Nursing, Columbia University, New York, New York, United States
| | - Amna Hasni
- Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, United States
| | - Kenrick D. Cato
- Department of Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Mark G. Weiner
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States
| | - Mitchell S. V. Elkind
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, United States
| | - Ian M. Kronish
- Division of Cardiology, Department of Internal Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, United States
| | - Adriana Arcia
- Hahn School of Nursing and Health Science, University of San Diego, San Diego, California, United States
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Song C, Nakayama M. Implementation of a Patient Summary Web Application According to the International Patient Summary and Validation in Common Use Cases in Japan. J Med Syst 2023; 47:100. [PMID: 37740823 PMCID: PMC10517891 DOI: 10.1007/s10916-023-01993-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/07/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND The application of standardized patient summaries would reduce the risk of information overload and related problems for physicians and nurses. Although the International Patient Summary (IPS) standard has been developed, disseminating its applications has challenges, including data conversion of existing systems and development of application matching with common use cases in Japan. This study aimed to develop a patient summary application that summarizes and visualizes patient information accumulated by existing systems. METHODS We converted clinical data from the Standardized Structured Medical Information eXchange version 2 (SS-MIX2) storage at Tohoku University Hospital into the Health Level 7 Fast Healthcare Interoperability Resource (FHIR) repository. Subsequently, we implemented a patient summary web application concerning the IPS and evaluated 12 common use cases of the discharge summary. RESULTS The FHIR resources of seven of the necessary IPS sections were successfully converted from existing SS-MIX2 data. In the main view of the application we developed, all the minimum necessary patient information was summarized and visualized. All types of mandatory or required sections in the IPS and all structured information items of the discharge summary were displayed. Of the discharge summary, 75% of sections and 61.7% of information items were completely displayed, matching 12 common use cases in Japan. CONCLUSIONS We implemented a patient summary application that summarizes and visualizes patient information accumulated by existing systems and is evaluated in common use cases in Japan. Efficient sharing of the minimum necessary patient information for physicians is expected to reduce information overload, workload, and burnout.
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Affiliation(s)
- Chong Song
- Department of Medical Informatics, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Miyagi, Japan
| | - Masaharu Nakayama
- Department of Medical Informatics, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Miyagi, Japan.
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Aniekwe C, Cuffe K, Audu I, Nalda N, Ibezim B, Nnakwe M, Anazodo T, Dada M, Rottinghaus Romano E, Okoye M, Martin M, Shrivastava R. Assessing the effect of electronic health information exchange on the completeness and validity of data for measuring viral load testing turnaround time in Nigeria. Int J Med Inform 2023; 174:105059. [PMID: 37002987 PMCID: PMC11187829 DOI: 10.1016/j.ijmedinf.2023.105059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/13/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Implementation of health information exchange has been shown to result in several benefits which includes the improvement in the completeness and timeliness of data for public health program monitoring and surveillance. OBJECTIVE The objective of this study was to assess the effect of implementing an electronic health information exchange (HIE) on the quality of data available to measure HIV viral load testing turnaround time (TAT) in Nigeria. METHODS We measured viral load data validity and completeness before the implementation of electronic health information exchange, and 6 months after implementation. Records of specimens collected at 30 healthcare facilities and tested in 3 Polymerase Chain Reaction (PCR) labs were analyzed. We define data completeness as the percentage of non-missing values and measured this value by specimens and by data elements in the dataset for calculating TAT. To examine data validity, we classified TAT segments with negative values and date fields that were not in International Organization for Standardization(ISO) standard date format as invalid. Validity was measured by specimens and by each TAT segment. Pearson's chi square was used to assess for improvements in validity and completeness post implementation of HIE. RESULTS 15,226 records of specimens were analyzed at baseline and 18,022 records of specimens analyzed at endline. Data completeness for all specimens recorded increased significantly from 47% before HIE implementation to 67% six months after implementation (p < 0.01). Data validity also increased from 90% before implementation to 91% after implementation (p < 0.01) CONCLUSION: Our study demonstrated evidence of significant improvement in the quality of data available to measure viral load turnaround time with the implementation of HIE.
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Affiliation(s)
- Chinedu Aniekwe
- US Centers for Disease Control and Prevention, Division of Global HIV & TB, Abuja, Nigeria.
| | - Kendra Cuffe
- US Centers for Disease Control and Prevention, Division of Global HIV & TB, Atlanta, USA
| | - Israel Audu
- US Centers for Disease Control and Prevention, Division of Global HIV & TB, Abuja, Nigeria
| | - Nannim Nalda
- US Centers for Disease Control and Prevention, Division of Global HIV & TB, Abuja, Nigeria
| | | | - Michael Nnakwe
- APIN Public Health Initiative in Nigeria, Abuja, Nigeria
| | | | - Mubarak Dada
- APIN Public Health Initiative in Nigeria, Abuja, Nigeria
| | | | - McPaul Okoye
- US Centers for Disease Control and Prevention, Division of Global HIV & TB, Abuja, Nigeria
| | - Monte Martin
- US Centers for Disease Control and Prevention, Division of Global HIV & TB, Atlanta, USA
| | - Ritu Shrivastava
- US Centers for Disease Control and Prevention, Division of Global HIV & TB, Atlanta, USA
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Noyd DH, Janitz A, Baker A, Beasley W, Etzold N, Kendrick D, Oeffinger K. Rural, Large Town, and Urban Differences in Optimal Subspecialty Follow-up and Survivorship Care Plan Documentation among Childhood Cancer Survivors. Cancer Epidemiol Biomarkers Prev 2023; 32:634-641. [PMID: 36827210 PMCID: PMC11082834 DOI: 10.1158/1055-9965.epi-22-0966] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/14/2022] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Children with cancer from rural and nonurban areas face unique challenges. Health equity for this population requires attention to geographic disparities in optimal survivorship-focused care. METHODS The Oklahoma Childhood Cancer Survivor Cohort was based on all patients reported to the institutional cancer registry and ≤ 18 years old at diagnosis between January 1, 2005, and September 24, 2014. Suboptimal follow-up was defined as no completed oncology-related clinic visit five to 7 years after their initial diagnosis (survivors were 7-25 years old at end of the follow-up period). The primary predictor of interest was rurality. RESULTS Ninety-four (21%) of the 449 eligible survivors received suboptimal follow-up. There were significant differences (P = 0.01) as 36% of survivors from large towns (n = 28/78) compared with 21% (n = 20/95) and 17% (n = 46/276) of survivors from small town/isolated rural and urban areas received suboptimal follow-up, respectively. Forty-five percent of adolescents at diagnosis were not seen in the clinic compared with 17% of non-adolescents (P < 0.01). An adjusted risk ratio of 2.2 (95% confidence interval, 1.5, 3.2) was observed for suboptimal follow-up among survivors from large towns, compared with survivors from urban areas. Seventy-three percent of survivors (n = 271/369) had a documented survivorship care plan with similar trends by rurality. CONCLUSIONS Survivors from large towns and those who were adolescents at the time of diagnosis were more likely to receive suboptimal follow-up care compared with survivors from urban areas and those diagnosed younger than thirteen. IMPACT Observed geographic disparities in survivorship care will inform interventions to promote equitable care for survivors from nonurban areas.
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Affiliation(s)
- David H. Noyd
- The University of Oklahoma Health Sciences Center, College of Medicine, Department of Pediatrics
- The University of Oklahoma School of Community Medicine, Department of Medical Informatics
| | - Amanda Janitz
- The University of Oklahoma Health Sciences Center, College of Public Health, Department of Epidemiology and Biostatistics
| | - Ashley Baker
- The University of Oklahoma Health Sciences Center, College of Medicine, Department of Pediatrics
| | - William Beasley
- The University of Oklahoma Health Sciences Center, College of Medicine, Department of Pediatrics
| | - Nancy Etzold
- The University of Oklahoma Health Sciences Center
| | - David Kendrick
- The University of Oklahoma School of Community Medicine, Department of Medical Informatics
| | - Kevin Oeffinger
- Duke University Medical Center, School of Medicine, Department of Medicine
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Sloan-Aagard C, Glenn J, Nañez J, Crawford SB, Currey JC, Hartmann E. The Impact of Community Health Information Exchange Usage on Time to Reutilization of Hospital Services. Ann Fam Med 2023; 21:19-26. [PMID: 36690494 PMCID: PMC9870640 DOI: 10.1370/afm.2903] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/23/2022] [Accepted: 09/12/2022] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Few studies have determined whether clinician usage of a community health information exchange (HIE) directly improves patient care transitions. We hypothesized that lookup in the HIE by primary care physicians of patients recently released from the hospital would increase the time until hospital reuse. METHODS We identified a retrospective cohort of 8,216 hospital inpatients aged over 18 years that were discharged from January 1, 2021 through November 30, 2021 using the Paso del Norte Health Information Exchange, in El Paso County, Texas. All patients had a primary care physician visit within 30 days after hospital discharge, and we identified patients that were looked up in the HIE close to that visit. Of the cohort, 2,627 were rehospitalized and 3,809 visited an emergency department (ED) during the follow-up window. The remaining 1,780 patients were controls. We conducted survival analysis, censoring at the second ED or inpatient visit or end of the study window (January 31, 2022). The model was adjusted by ethnicity, gender, insurance, and age. RESULTS Lookup in the HIE was significantly associated with reducing the likelihood of visiting the ED by 53% and being rehospitalized by 61%. Lookup in the HIE was associated with an increased median time to use of the ED after inpatient discharge from 99 to 238 patient days. Ethnicity, insurance, gender, and age were also significant predictors of hospital reuse. CONCLUSIONS Increased utilization of community HIEs by primary care physicians on behalf of their recently discharged patients may dramatically increase the time until inpatient or ED reuse.
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Affiliation(s)
- Chantel Sloan-Aagard
- Paso del Norte Health Information Exchange, El Paso, Texas
- Department of Public Health, Brigham Young University, Provo, Utah
| | - Jeffrey Glenn
- Department of Public Health, Brigham Young University, Provo, Utah
| | - Juan Nañez
- Paso del Norte Health Information Exchange, El Paso, Texas
| | - Scott B Crawford
- Department of Emergency Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - J C Currey
- Paso del Norte Health Information Exchange, El Paso, Texas
| | - Emily Hartmann
- Paso del Norte Health Information Exchange, El Paso, Texas
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Bloomrosen M, Berner ES. Findings from the 2022 Yearbook Section on Health Information Exchange. Yearb Med Inform 2022; 31:215-218. [PMID: 36463880 PMCID: PMC9719787 DOI: 10.1055/s-0042-1742534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To summarize the recent literature and research and present a selection of the best papers published in 2021 related to health information exchange (HIE). METHODS A systematic review of the literature was performed by the two section editors with the help of a medical librarian. We searched bibliographic databases for HIE-related papers using both MeSH headings and keywords in titles and abstracts. A shortlist of candidate 15 best papers was first selected by section editors before being peer-reviewed by independent external reviewers. RESULTS Major themes of the set of 15 articles included the issues to be addressed in building and maintaining HIEs, HIE implementation barriers and facilitators, and the outcomes of using HIEs. The outcomes of using HIE encompassed the impact on patient care and the ability of HIEs to provide a repository of data for further research. CONCLUSIONS The growth of HIE has followed a course very similar to the growth of electronic health records (EHRs). Initial foci of research included technical issues in the deployment, followed by research on barriers to use. Now that EHRs are more widely implemented and used, the newer research involves the use of the electronic data contained in them. Although HIEs are currently at an earlier stage of maturity and development than EHRs and most of the articles in this review focused on implementation barriers, we have seen the beginning of research on the large amount of longitudinal and diverse data that HIEs can make available. As the implementation and use of HIEs continue to increase and become more widely deployed, we can expect that research about HIE and leveraging HIEs and the data they collect, will continue to increase.
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Affiliation(s)
- Meryl Bloomrosen
- Premier, Inc., Washington, DC, USA,Correspondence to: Meryl Bloomrosen
| | - Eta S. Berner
- Graduate Programs in Health Informatics, Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
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Lech S, Herrmann W, Trautmann S, Schwantes U, Gellert P, Behr J, Buspavanich P. Depression in primary care and the role of evidence-based guidelines: cross-sectional data from primary care physicians in Germany. BMC Health Serv Res 2022; 22:1279. [PMID: 36280876 PMCID: PMC9594952 DOI: 10.1186/s12913-022-08631-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/30/2022] [Indexed: 11/14/2022] Open
Abstract
Background Depression is the most common mental health burden worldwide. Primary care physicians (PCPs) play a key role in the care provision for people with depression. The first objective of the present study was to examine the health care situation of depression in primary care, focusing on the cooperation between PCPs and mental health specialists. Secondly, we aimed at examining the role of the German S3 Guideline for Unipolar Depression in the primary care provision. Methods Data of N = 75 PCPs were analysed from a cross-sectional online survey. Analysis of descriptive information on the current status of primary health care and depression was conducted. Further, to examine factors that are related to the usage of guidelines, multiple regression was performed. Results Only 22.1% of PCPs described the quality of cooperation with ambulatory mental health specialist as good. The most frequent problems in the cooperation were of structural nature (49.3%, long waiting list, few therapy units, as well as barriers in the communication and the information exchange). With regard to the role of the guideline, 65% of PCPs reported never or seldom using the guideline and 31.7% of PCPs perceived the guideline as not useful at all. In addition, perceived usefulness of the S3 guideline was positively associated with the usage of the guideline. Results of the logistic regression revealed a significant association between the usage of the German S3 Guideline for Unipolar Depression and rating of perceived usefulness of the guideline (OR: 4.771; 95% CI: 2.15–10.59; p < 0.001). Conclusion This study highlights the central role of PCPs and demonstrates major barriers in the outpatient health care provision of depression. Present findings suggest a strong need for collaborative health care models to resolve obstacles resulting from fragmented mental health care systems. Finally, reported perceived barriers in the implementation of the German S3 Guideline for Unipolar Depression indicate the urge to involve PCPs in the development of evidence-based guidelines, in order to ensure a successful implementation and usage of guidelines in clinical practice.
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Affiliation(s)
- Sonia Lech
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany ,grid.473452.3Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany ,grid.6363.00000 0001 2218 4662Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Wolfram Herrmann
- grid.6363.00000 0001 2218 4662Institute of General Practice, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sebastian Trautmann
- grid.461732.5ICPP Institute of Clinical Psychology and Psychotherapy, Medical School Hamburg, Hamburg, Germany ,grid.461732.5Department of Psychology, Faculty of Human Sciences, Medical School Hamburg, Hamburg, Germany
| | - Ulrich Schwantes
- grid.473452.3Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Paul Gellert
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Joachim Behr
- grid.473452.3Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany ,Faculty of Health Sciences Brandenburg, Joint Faculty of the University of Potsdam, Brandenburg University of Technology Cottbus-Senftenberg and Brandenburg Medical School, Potsdam, Germany ,grid.6363.00000 0001 2218 4662Research Department of Experimental and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Pichit Buspavanich
- grid.473452.3Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany ,Faculty of Health Sciences Brandenburg, Joint Faculty of the University of Potsdam, Brandenburg University of Technology Cottbus-Senftenberg and Brandenburg Medical School, Potsdam, Germany ,grid.6363.00000 0001 2218 4662Department of Psychiatry and Psychotherapy, Gender Research in Medicine & Institute of Sexology and Sexual Medicine, Charité – Universitätsmedizin Berlin, Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Pfeuffer N, Beyer A, Penndorf P, Leiz M, Radicke F, Hoffmann W, van den Berg N. Evaluation of a Health Information Exchange System for Geriatric Health Care in Rural Areas: Development and Technical Acceptance Study. JMIR Hum Factors 2022; 9:e34568. [PMID: 36107474 PMCID: PMC9523522 DOI: 10.2196/34568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/08/2022] [Accepted: 06/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background Patients of geriatrics are often treated by several health care providers at the same time. The spatial, informational, and organizational separation of these health care providers can hinder the effective treatment of these patients. Objective This study aimed to develop a regional health information exchange (HIE) system to improve HIE in geriatric treatment. This study also evaluated the usability of the regional HIE system and sought to identify barriers to and facilitators of its implementation. Methods The development of the regional HIE system followed the community-based participatory research approach. The primary outcomes were the usability of the regional HIE system, expected implementation barriers and facilitators, and the quality of the developmental process. Data were collected and analyzed using a mixed methods approach. Results A total of 3 focus regions were identified, 22 geriatric health care providers participated in the development of the regional HIE system, and 11 workshops were conducted between October 2019 and September 2020. In total, 12 participants responded to a questionnaire. The main results were that the regional HIE system should support the exchange of assessments, diagnoses, medication, assistive device supply, and social information. The regional HIE system was expected to be able to improve the quality and continuity of care. In total, 5 adoption facilitators were identified. The main points were adaptability of the regional HIE system to local needs, availability to different patient groups and treatment documents, web-based design, trust among the users, and computer literacy. A total of 13 barriers to adoption were identified. The main expected barriers to implementation were lack of resources, interoperability issues, computer illiteracy, lack of trust, privacy concerns, and ease-of-use issues. Conclusions Participating health care professionals shared similar motivations for developing the regional HIE system, including improved quality of care, reduction of unnecessary examinations, and more effective health care provision. An overly complicated registration process for health care professionals and the patients’ free choice of their health care providers hinder the effectiveness of the regional HIE system, resulting in incomplete patient health information. However, the web-based design of the system bridges interoperability problems that exist owing to the different technical and organizational structures of the health care facilities involved. The regional HIE system is better accepted by health care professionals who are already engaged in an interdisciplinary, geriatric-focused network. This might indicate that pre-existing cross-organizational structures and processes are prerequisites for using HIE systems. The participatory design supports the development of technologies that are adaptable to regional needs. Health care providers are interested in participating in the development of an HIE system, but they often lack the required time, knowledge, and resources.
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Affiliation(s)
- Nils Pfeuffer
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Angelika Beyer
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Peter Penndorf
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Maren Leiz
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Franziska Radicke
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Neeltje van den Berg
- Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Ido K, Miyazaki M, Nakayama M. Hemodialysis Record Sharing: Solution for Work Burden Reduction and Disaster Preparedness. JMIR Form Res 2022; 6:e32925. [PMID: 35867394 PMCID: PMC9356332 DOI: 10.2196/32925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 12/02/2022] Open
Abstract
Background After the Great East Japan Earthquake in 2011, backup systems for clinical information were launched in Japan. The system in Miyagi Prefecture called the Miyagi Medical and Welfare Information Network (MMWIN) is used as a health information exchange network to share clinical information among various medical facilities for patients who have opted in. Hospitals and clinics specializing in chronic renal failure require patients’ data and records during hemodialysis to facilitate communication in daily clinical activity and preparedness for disasters. Objective This study aimed to facilitate the sharing of clinical data of patients undergoing hemodialysis among different hemodialysis facilities. Methods We introduced a document-sharing system to make hemodialysis reports available on the MMWIN. We also recruited hospitals and clinics to share the hemodialysis reports of their patients and promoted the development of a network between emergency and dialysis clinics. Results In addition to basic patient information as well as information on diagnosis, prescription, laboratory data, hospitalization, allergy, and image data from different facilities, specific information about hemodialysis is available, as well as a backup of indispensable information in preparation for disasters. As of June 1, 2021, 12 clinics and 10 hospitals of 68 dialysis facilities in Miyagi participated in the MMWIN. The number of patients who underwent hemodialysis in Miyagi increased by more than 40%. Conclusions Our backup system successfully developed a network of hemodialysis facilities. We have accumulated data that are beneficial to prevent the fragmentation of patient information and would be helpful in transferring patients efficiently during unpredictable disasters.
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Affiliation(s)
- Keisuke Ido
- Medical Information Center, Tohoku University Hospital, Sendai, Japan
| | - Mariko Miyazaki
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, Sendai, Japan
| | - Masaharu Nakayama
- Department of Medical Informatics, Tohoku University Graduate School of Medicine, Sendai, Japan
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11
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Williams KS, Grannis SJ. Patient-Centered Data Home: A Path Towards National Interoperability. Front Digit Health 2022; 4:887015. [PMID: 35911616 PMCID: PMC9328272 DOI: 10.3389/fdgth.2022.887015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objective National interoperability is an agenda that has gained momentum in health care. Although several attempts to reach national interoperability, an alerting system through interconnected network of Health Information Exchange (HIE) organizations, Patient-Centered Data Home (PCDH), has seen preliminary success. The aim was to characterize the PCDH initiative through the Indiana Health Information Exchange's participation in the Heartland Region Pilot, which includes HIEs in Indiana, Ohio, Michigan, Kentucky, and Tennessee. Materials and Methods Admission, Discharge, and Transfer (ADT) transactions were collected between December 2016 and December 2017 among the seven HIEs in the Heartland Region. ADTs were parsed and summarized. Overlap analyses and patient matching software were used to characterize the PCDH patients. R software and Microsoft Excel were used to populate descriptive statistics and visualization. Results Approximately 1.5 million ADT transactions were captured. Majority of patients were female, ages 56–75 years, and were outpatient visits. Top noted reasons for visit were labs, screening, and abdominal pain. Based on the overlap analysis, Eastern Tennessee HIE was the only HIE with no duplicate service areas. An estimated 80 percent of the records were able to be matched with other records. Discussion The high volume of exchange in the Heartland Region Pilot established that PCDH is practical and feasible to exchange data. PCDH has the posture to build better comprehensive medical histories and continuity of care in real time. Conclusion The value of the data gained extends beyond clinical practitioners to public health workforce for improved interventions, increased surveillance, and greater awareness of gaps in health for needs assessments. This existing interconnection of HIEs has an opportunity to be a sustainable path toward national interoperability.
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Affiliation(s)
- Karmen S. Williams
- Department of Health Policy and Management, Population Health Informatics, City University of New York, New York, NY, United States
- *Correspondence: Karmen S. Williams
| | - Shaun J. Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, United States
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States
- Indiana University School of Medicine, Indiana University, Indianapolis, IN, United States
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12
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Cifra CL, Tigges CR, Miller SL, Curl N, Monson CD, Dukes KC, Reisinger HS, Pennathur PR, Sittig DF, Singh H. Reporting Outcomes of Pediatric Intensive Care Unit Patients to Referring Physicians via an Electronic Health Record-Based Feedback System. Appl Clin Inform 2022; 13:495-503. [PMID: 35545126 PMCID: PMC9095343 DOI: 10.1055/s-0042-1748147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Many critically ill children are initially evaluated in front-line settings by clinicians with variable pediatric training before they are transferred to a pediatric intensive care unit (PICU). Because clinicians learn from past performance, communicating outcomes of patients back to front-line clinicians who provide pediatric emergency care could be valuable; however, referring clinicians do not consistently receive this important feedback. OBJECTIVES Our aim was to determine the feasibility, usability, and clinical relevance of a semiautomated electronic health record (EHR)-supported system developed at a single institution to deliver timely and relevant PICU patient outcome feedback to referring emergency department (ED) physicians. METHODS Guided by the Health Information Technology Safety Framework, we iteratively designed, implemented, and evaluated a semiautomated electronic feedback system leveraging the EHR in one institution. After conducting interviews and focus groups with stakeholders to understand the PICU-ED health care work system, we designed the EHR-supported feedback system by translating stakeholder, organizational, and usability objectives into feedback process and report requirements. Over 6 months, we completed three cycles of implementation and evaluation, wherein we analyzed EHR access logs, reviewed feedback reports sent, performed usability testing, and conducted physician interviews to determine the system's feasibility, usability, and clinical relevance. RESULTS The EHR-supported feedback process is feasible with timely delivery and receipt of feedback reports. Usability testing revealed excellent Systems Usability Scale scores. According to physicians, the process was well-integrated into their clinical workflows and conferred minimal additional workload. Physicians also indicated that delivering and receiving consistent feedback was relevant to their clinical practice. CONCLUSION An EHR-supported system to deliver timely and relevant PICU patient outcome feedback to referring ED physicians was feasible, usable, and important to physicians. Future work is needed to evaluate impact on clinical practice and patient outcomes and to investigate applicability to other clinical settings involved in similar care transitions.
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Affiliation(s)
- Christina L Cifra
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
| | - Cody R Tigges
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
| | - Sarah L Miller
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
| | - Nathaniel Curl
- Emergency Medicine, UnityPoint Health-Trinity Medical Center, Rock Island, Illinois, United States
| | - Christopher D Monson
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
| | - Kimberly C Dukes
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa, United States.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
| | - Heather S Reisinger
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa, United States.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States.,Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa, United States
| | - Priyadarshini R Pennathur
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States.,Department of Industrial and Systems Engineering, College of Engineering, University of Iowa, Iowa City, Iowa, United States
| | - Dean F Sittig
- School of Biomedical Informatics, Center for Healthcare Quality and Safety, University of Texas Health Science Center, Houston, Texas, United States
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, United States
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13
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Desai MD, Tootooni MS, Bobay KL. Can Prehospital Data Improve Early Identification of Sepsis in Emergency Department? An Integrative Review of Machine Learning Approaches. Appl Clin Inform 2022; 13:189-202. [PMID: 35108741 PMCID: PMC8810268 DOI: 10.1055/s-0042-1742369] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Sepsis is associated with high mortality, especially during the novel coronavirus disease 2019 (COVID-19) pandemic. Along with high monetary health care costs for sepsis treatment, there is a lasting impact on lives of sepsis survivors and their caregivers. Early identification is necessary to reduce the negative impact of sepsis and to improve patient outcomes. Prehospital data are among the earliest information collected by health care systems. Using these untapped sources of data in machine learning (ML)-based approaches can identify patients with sepsis earlier in emergency department (ED). OBJECTIVES This integrative literature review aims to discuss the importance of utilizing prehospital data elements in ED, summarize their current use in developing ML-based prediction models, and specifically identify those data elements that can potentially contribute to early identification of sepsis in ED when used in ML-based approaches. METHOD Literature search strategy includes following two separate searches: (1) use of prehospital data in ML models in ED; and (2) ML models that are developed specifically to predict/detect sepsis in ED. In total, 24 articles are used in this review. RESULTS A summary of prehospital data used to identify time-sensitive conditions earlier in ED is provided. Literature related to use of ML models for early identification of sepsis in ED is limited and no studies were found related to ML models using prehospital data in prediction/early identification of sepsis in ED. Among those using ED data, ML models outperform traditional statistical models. In addition, the use of the free-text elements and natural language processing (NLP) methods could result in better prediction of sepsis in ED. CONCLUSION This study reviews the use of prehospital data in early decision-making in ED and suggests that researchers utilize such data elements for prediction/early identification of sepsis in ML-based approaches.
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Affiliation(s)
- Manushi D. Desai
- Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, Illinois, United States
| | - Mohammad S. Tootooni
- Department of Health Informatics and Data Science, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, United States
| | - Kathleen L. Bobay
- Department of Health Informatics and Data Science, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, United States,Address for correspondence Kathleen L. Bobay, PhD, RN, FAAN Department of Health Informatics and Data Science, Parkinson School of Health Sciences and Public Health, Marcella Niehoff School of Nursing, Loyola University Chicago2160 South First Avenue, Maywood, IL 60153United States
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14
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Fujii S, Nonaka S, Nakayama M. Use of Medical Information and Digital Services for Self-Empowerment before, during, and after a Major Disaster. TOHOKU J EXP MED 2021; 255:183-194. [PMID: 34853210 DOI: 10.1620/tjem.255.183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Disaster response procedures have been developed and improved following the Great East Japan Earthquake. Innovative services have also been created through digital transformation, including an acceleration and deepening of artificial intelligence technology. Things that were once technically impossible are now possible. These innovative technologies will spread across various fields, and disaster response will not be an exception. The Ministry of Health, Labour and Welfare is promoting the use of personal health records in a way that effectively supports the management of treatments by using data from wearable devices and specific applications. During the COVID-19 pandemic, the trade-off between protecting personal information and enabling social benefits, such as in the use of digital tracking, and infodemics, including misinformation, have become new social challenges. Reviewing past disaster preparedness and the services and value provided by digital transformation indicates what new disaster preparedness should be. Digital transformation does not require literacy (ability to collect, analyze, and use information) but competence (beneficial behavioral traits derived from experience). Understanding behavior through data and enabling rational behavior are crucial. By increasing human productivity, we can save time and improve self- and mutual-help in times of disaster. Medical information and digital services must be properly used in normal times. A society that uses such services will be more disaster resilient.
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Affiliation(s)
- Susumu Fujii
- Disaster Medical Informatics Lab, International Research Institute of Disaster Science (IRIDeS), Tohoku University
| | - Sayuri Nonaka
- Disaster Medical Informatics Lab, International Research Institute of Disaster Science (IRIDeS), Tohoku University
| | - Masaharu Nakayama
- Disaster Medical Informatics Lab, International Research Institute of Disaster Science (IRIDeS), Tohoku University.,Department of Medical Informatics, Tohoku University School of Medicine
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