Clinical information systems for primary care: more than just an electronic medical record

Health technology tools used to increase physical activity and improve cardiovascular parameters in older adults: A review

INTRODUCTION

Ageing is a period of physical and psychological changes. Inactivity is one of the biggest problems among the older adult population increasing the risk of sarcopenia and chronic diseases. Physical activity is an effective intervention to improve health outcomes. In recent years, there has been an increase in the use of technology, with health technology tools (ICT) appearing as an intervention to increase physical activity and improve associated health problems.

OBJECTIVE

In this review, we evaluated the effectiveness of health technology to increase physical activity and to improve cardiovascular parameters in older adults.

METHODOLOGY

Studies with a great variety of health technology tools to increase physical activity levels, and that evaluated the effect of that increase on cardiovascular parameters were included by searching the main databases.

RESULTS

Eleven studies reporting the use of a variety of ICT tools were included in this review. Despite these differences, the effectiveness of health technology tool interventions has been demonstrated in increasing physical activity and reducing cardiovascular parameters.

DISCUSSION

The lack of adherence of older adults to health technology would be a disadvantage, but it has been shown that younger older adults are more familiar with health technology tools and the number using them is increasing.

CONCLUSION

Health technology tools show effectiveness in increasing physical activity in older adults and improving cardiovascular parameters.

Health information technologies in geriatrics and gerontology: a mixed systematic review

OBJECTIVE

To review, categorize, and synthesize findings from the literature about the application of health information technologies in geriatrics and gerontology (GGHIT).

MATERIALS AND METHODS

This mixed-method systematic review is based on a comprehensive search of Medline, Embase, PsychInfo and ABI/Inform Global. Study selection and coding were performed independently by two researchers and were followed by a narrative synthesis. To move beyond a simple description of the technologies, we employed and adapted the diffusion of innovation theory (DOI).

RESULTS

112 papers were included. Analysis revealed five main types of GGHIT: (1) telecare technologies (representing half of the studies); (2) electronic health records; (3) decision support systems; (4) web-based packages for patients and/or family caregivers; and (5) assistive information technologies. On aggregate, the most consistent finding proves to be the positive outcomes of GGHIT in terms of clinical processes. Although less frequently studied, positive impacts were found on patients' health, productivity, efficiency and costs, clinicians' satisfaction, patients' satisfaction and patients' empowerment.

DISCUSSION

Further efforts should focus on improving the characteristics of such technologies in terms of compatibility and simplicity. Implementation strategies also should be improved as trialability and observability are insufficient.

CONCLUSIONS

Our results will help organizations in making decisions regarding the choice, planning and diffusion of GGHIT implemented for the care of older adults.

Nurse led electronic toxicity scoring in head and neck radiotherapy

PURPOSE OF THE STUDY

In order to improve 'adherence' to a course of treatment for head and neck radiotherapy, patients need to be managed frequently. In order to achieve this in a busy clinical environment streamlined electronic tools must be utilised. By providing nursing teams with the capacity to conduct electronic toxicity scoring on a bi-weekly basis, adherence can be improved and closer attention paid to head and neck radiotherapy toxicities.

METHODS AND MATERIALS

A convenience sample of 20 patients undergoing head and neck radiotherapy was analysed. Each of these patients had electronic toxicity data recorded on a bi-weekly basis for dysphagia, mucositis, skin reaction and weight loss. This information was then extracted from the ARIA™ patient information system and analysed. Additionally the time taken for the nursing team to undertake each patient review was also extracted from ARIA™.

RESULTS

The efficiencies offered by an electronic medical record allow comprehensive toxicity data to be recorded and analysed effortlessly. The average time taken to review these patients on a bi-weekly basis was 6.97 min and contained on average 60 words of toxicity description and action.

CONCLUSION

Electronic toxicity scoring offers many advantages to the radiation oncology nurse, increased efficiency allows more frequent patient interaction which will in turn aid adherence. In order to better manage the treatment course of head and neck radiotherapy patients, nurses must be provided with streamlined and efficient electronic means of recording data. In this way it is possible to review head and neck radiotherapy patients bi-weekly.

The patient care notebook: from pilot phase to successful hospitalwide dissemination

BACKGROUND

A patient care notebook that patients take with them to different care settings improved disharge planning and patient education during a pilot find, organize, clarify, understand, select-plan, do, check, act (FOCUS-PDCA) project on a 15-bed rehabilitation unit. The 296-bed rehabilitation hospital expanded the notebook's use to all hospital programs through a second PDCA cycle. ADAPTING THE NOTEBOOK: The three-ring binder notebook sections were modified from the pilot notebook to three sections standardized for all programs. Materials included information about hospital services and patients' rights and medical information about future appointments, specific diagnostic information, home medications and exercises, and equipment and home modifications. Staff were educated about the notebook through in-services and an educational video.

RESULTS

When patients and their families who were discharged with home services were contacted, more than two-thirds reported that the notebooks were useful and easy to use. As staff became more familiar with the notebook, 75% or more reported that the notebooks were useful and easy to use and improved the discharge process. The notebooks were still used two years after their introduction.

DISCUSSION

An innovative and helpful new care process, the patient care notebook can improve a rehabilitation hospital's patient education and discharge planning processes. It represents a better practice in health care provider/patient communication.

Impact of an Electronic Chart on the Staff Workload in a Radiation Oncology Department

BACKGROUND

In order to improve the efficiency of patient care, we developed an electronic medical record system, named the Comprehensive Radiation Oncology Management System (C-ROMS). C-ROMS was used together with a commercial record-and-verify system, LANTIS (Siemens Medical Systems Inc., Concord, CA, USA). The impact of the C-ROMS/LANTIS system on the staff workload in the Radiation Oncology Department was quantified and evaluated.

METHODS

Thirty-four breast cancer patients were divided into two groups based on the method of the charting and the delivery of radiation treatment. The paper chart and manual treatment were used for one group, and the C-ROMS/LANTIS for the other. For each group of patients, the workload per patient for each staff group in the department-nursing/clerical staff, simulation staff, dosimetry/physics staff and technologist staff-was measured and compared.

RESULTS

The average total staff workload with the C-ROMS/LANTIS system was 28.2% less than that with the paper chart/manual treatment method. The workloads for nursing/clerical staff, simulation staff and technologist staff were reduced by 85.7, 61.2 and 20.6%, respectively. The workload for dosimetry/physics staff was increased by 28.4%.

CONCLUSION

The C-ROMS/LANTIS system significantly decreased the averaged total staff workload, and thus increased the efficiency of patient care.