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Ming DY, Wong W, Jones KA, Antonelli RC, Gujral N, Gonzales S, Rogers U, Ratliff W, Shah N, King HA. Feasibility of Implementation of a Mobile Digital Personal Health Record to Coordinate Care for Children and Youth With Special Health Care Needs in Primary Care: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e46847. [PMID: 37728977 PMCID: PMC10551780 DOI: 10.2196/46847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Electronic health record (EHR)-integrated digital personal health records (PHRs) via Fast Healthcare Interoperability Resources (FHIR) are promising digital health tools to support care coordination (CC) for children and youth with special health care needs but remain widely unadopted; as their adoption grows, mixed methods and implementation research could guide real-world implementation and evaluation. OBJECTIVE This study (1) evaluates the feasibility of an FHIR-enabled digital PHR app for CC for children and youth with special health care needs, (2) characterizes determinants of implementation, and (3) explores associations between adoption and patient- or family-reported outcomes. METHODS This nonrandomized, single-arm, prospective feasibility trial will test an FHIR-enabled digital PHR app's use among families of children and youth with special health care needs in primary care settings. Key app features are FHIR-enabled access to structured data from the child's medical record, families' abilities to longitudinally track patient- or family-centered care goals, and sharing progress toward care goals with the child's primary care provider via a clinician dashboard. We shall enroll 40 parents or caregivers of children and youth with special health care needs to use the app for 6 months. Inclusion criteria for children and youth with special health care needs are age 0-16 years; primary care at a participating site; complex needs benefiting from CC; high hospitalization risk in the next 6 months; English speaking; having requisite technology at home (internet access, Apple iOS mobile device); and an active web-based EHR patient portal account to which a parent or caregiver has full proxy access. Digital prescriptions will be used to disseminate study recruitment materials directly to eligible participants via their existing EHR patient portal accounts. We will apply an intervention mixed methods design to link quantitative and qualitative (semistructured interviews and family engagement panels with parents of children and youth with special health care needs) data and characterize implementation determinants. Two CC frameworks (Pediatric Care Coordination Framework; Patient-Centered Medical Home) and 2 evaluation frameworks (Consolidated Framework for Implementation Research; Technology Acceptance Model) provide theoretical foundations for this study. RESULTS Participant recruitment began in fall 2022, before which we identified >300 potentially eligible patients in EHR data. A family engagement panel in fall 2021 generated formative feedback from family partners. Integrated analysis of pretrial quantitative and qualitative data informed family-centered enhancements to study procedures. CONCLUSIONS Our findings will inform how to integrate an FHIR-enabled digital PHR app for children and youth with special health care needs into clinical care. Mixed methods and implementation research will help strengthen implementation in diverse clinical settings. The study is positioned to advance knowledge of how to use digital health innovations for improving care and outcomes for children and youth with special health care needs and their families. TRIAL REGISTRATION ClinicalTrials.gov NCT05513235; https://clinicaltrials.gov/study/NCT05513235. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46847.
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Affiliation(s)
- David Y Ming
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Willis Wong
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Richard C Antonelli
- Department of Pediatrics, Boston Children's Hospital, Harvard School of Medicine, Boston, MA, United States
| | - Nitin Gujral
- Innovation and Digital Health Accelerator, Boston Children's Hospital, Boston, MA, United States
| | - Sarah Gonzales
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Ursula Rogers
- AI Health, Duke University School of Medicine, Durham, NC, United States
| | - William Ratliff
- Duke Institute for Health Innovation, Duke University School of Medicine, Durham, NC, United States
| | - Nirmish Shah
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Heather A King
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veteran Affairs Health Care System, Durham, NC, United States
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2
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Pachamanova D, Glover W, Li Z, Docktor M, Gujral N. Identifying Patterns in Administrative Tasks through Structural Topic Modeling: A Study of Task Definitions, Prevalence, and Shifts in a Mental Health Practice's Operations during the COVID-19 Pandemic. J Am Med Inform Assoc 2021; 28:2707-2715. [PMID: 34390582 DOI: 10.1093/jamia/ocab185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/12/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This case study illustrates the use of natural language processing for identifying administrative task categories, prevalence and shifts necessitated by a major event (the COVID-19 pandemic) from user-generated data stored as free text in a task management system for a multi-site mental health practice with 40 clinicians and 13 administrative staff members. METHODS Structural topic modeling was applied on 7,079 task sequences from 13 administrative users of a HIPAA-compliant task management platform. Context was obtained through interviews with an expert panel. RESULTS 10 task definitions spanning three major categories were identified, and their prevalence estimated. Significant shifts in task prevalence due to the pandemic were detected for tasks like billing inquiries to insurers, appointment cancellations, patient balances and new patient follow-up. CONCLUSIONS Structural topic modeling effectively detects task categories, prevalence, and shifts, providing opportunities for healthcare providers to reconsider staff roles and to optimize workflows and resource allocation.
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Affiliation(s)
- Dessislava Pachamanova
- Professor and Zwerling Family Endowed Research Scholar, Mathematics & Science Division, Babson College, Wellesley, MA, USA.,Research Affiliate, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Wiljeana Glover
- Stephen C. and Carmella R Kletjian Foundation Distinguished Professor of Global Healthcare Entrepreneurship, Operations and Information Management Division, Babson College, Wellesley, MA, USA
| | - Zhi Li
- Lecturer, Operations and Information Management Division, Babson College, Wellesley, MA, USA
| | - Michael Docktor
- Attending, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Nitin Gujral
- Chief Technology Officer, Dock Health, Boston, MA, USA
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Li J, Hojlo MA, Chennuri S, Gujral N, Paterson HL, Shefchek KA, Genetti CA, Cohn EL, Sewalk KC, Garvey EA, Buttermore ED, Anderson NC, Beggs AH, Agrawal PB, Brownstein JS, Haendel MA, Holm IA, Gonzalez-Heydrich J, Brownstein CA. Underrepresentation of Phenotypic Variability of 16p13.11 Microduplication Syndrome Assessed With an Online Self-Phenotyping Tool (Phenotypr): Cohort Study. J Med Internet Res 2021; 23:e21023. [PMID: 33724192 PMCID: PMC8074853 DOI: 10.2196/21023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/26/2020] [Accepted: 01/16/2021] [Indexed: 12/24/2022] Open
Abstract
Background 16p13.11 microduplication syndrome has a variable presentation and is characterized primarily by neurodevelopmental and physical phenotypes resulting from copy number variation at chromosome 16p13.11. Given its variability, there may be features that have not yet been reported. The goal of this study was to use a patient “self-phenotyping” survey to collect data directly from patients to further characterize the phenotypes of 16p13.11 microduplication syndrome. Objective This study aimed to (1) discover self-identified phenotypes in 16p13.11 microduplication syndrome that have been underrepresented in the scientific literature and (2) demonstrate that self-phenotyping tools are valuable sources of data for the medical and scientific communities. Methods As part of a large study to compare and evaluate patient self-phenotyping surveys, an online survey tool, Phenotypr, was developed for patients with rare disorders to self-report phenotypes. Participants with 16p13.11 microduplication syndrome were recruited through the Boston Children's Hospital 16p13.11 Registry. Either the caregiver, parent, or legal guardian of an affected child or the affected person (if aged 18 years or above) completed the survey. Results were securely transferred to a Research Electronic Data Capture database and aggregated for analysis. Results A total of 19 participants enrolled in the study. Notably, among the 19 participants, aggression and anxiety were mentioned by 3 (16%) and 4 (21%) participants, respectively, which is an increase over the numbers in previously published literature. Additionally, among the 19 participants, 3 (16%) had asthma and 2 (11%) had other immunological disorders, both of which have not been previously described in the syndrome. Conclusions Several phenotypes might be underrepresented in the previous 16p13.11 microduplication literature, and new possible phenotypes have been identified. Whenever possible, patients should continue to be referenced as a source of complete phenotyping data on their condition. Self-phenotyping may lead to a better understanding of the prevalence of phenotypes in genetic disorders and may identify previously unreported phenotypes.
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Affiliation(s)
- Jianqiao Li
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, United States.,The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, MA, United States
| | - Margaret A Hojlo
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, United States.,Tommy Fuss Center for Neuropsychiatric Disease Research, Boston Children's Hospital, Boston, MA, United States
| | - Sampath Chennuri
- Innovation and Digital Health Accelerator, Boston Children's Hospital, Boston, MA, United States
| | - Nitin Gujral
- Innovation and Digital Health Accelerator, Boston Children's Hospital, Boston, MA, United States
| | - Heather L Paterson
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, United States.,The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, MA, United States
| | - Kent A Shefchek
- Department of Environmental and Molecular Toxicology, Oregon State University, Corvallis, OR, United States
| | - Casie A Genetti
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, United States.,The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, MA, United States
| | - Emily L Cohn
- Innovation and Digital Health Accelerator, Boston Children's Hospital, Boston, MA, United States
| | - Kara C Sewalk
- Computational Epidemiology Group, Boston Children's Hospital, Boston, MA, United States
| | - Emily A Garvey
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, United States.,Tommy Fuss Center for Neuropsychiatric Disease Research, Boston Children's Hospital, Boston, MA, United States
| | - Elizabeth D Buttermore
- Human Neuron Core, Translational Neuroscience Center, Boston Children's Hospital, Boston, MA, United States
| | - Nickesha C Anderson
- Department of Neurology, Boston Children's Hospital, Boston, MA, United States
| | - Alan H Beggs
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, United States.,The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Pankaj B Agrawal
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, United States.,The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States.,Division of Newborn Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - John S Brownstein
- Innovation and Digital Health Accelerator, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Melissa A Haendel
- Center for Health Artificial Intelligence, University of Colorado Anschutz, Aurora, CO, United States
| | - Ingrid A Holm
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, United States.,The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Joseph Gonzalez-Heydrich
- The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, MA, United States.,Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, United States.,Tommy Fuss Center for Neuropsychiatric Disease Research, Boston Children's Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Catherine A Brownstein
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA, United States.,The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, MA, United States.,Tommy Fuss Center for Neuropsychiatric Disease Research, Boston Children's Hospital, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
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Yarahuan JK, Hunter B, Nadar D, Gujral N, Fine AM, Flett K. 1147. Improving Accessibility and Antibiotic Prescribing with an Enhanced Digital Antibiogram. Open Forum Infect Dis 2019. [PMCID: PMC6809329 DOI: 10.1093/ofid/ofz360.1011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Institutional antibiograms play a key role in antimicrobial stewardship and may provide a venue for clinical decision support. Our institution recently transitioned our paper antibiogram to an enhanced digital antibiogram with antibiotic recommendations for common pediatric infections. The objectives of this study were (1) to improve the accessibility of our institutional antibiogram through a digital platform and (2) to improve trainee confidence when selecting empiric antibiotics by integrating clinical decision support. Methods The digital antibiogram was developed and evaluated at a tertiary children’s hospital. The tool was developed iteratively over one year by our innovation and digital health accelerator with recommendations for empiric antibiotic selection provided by experts in pediatric infectious diseases (see Figure 1 for example). Usability pilot testing was performed with a group of ordering providers and the tool was released internally in October 2018. A paired pre- and post- implementation survey evaluated residents’ perceptions of the accessibility of the paper vs. digital antibiogram and their confidence when selecting empiric antibiotics. Data were analyzed by Fisher exact test. Results During the 3 months after release, the digital antibiogram was accessed 1014 times with similar proportions of views for susceptibility data, dosing, and empiric antibiotic recommendations. Of the 31 pediatric residents who responded to both pre- and post- implementation surveys, only 59% had access to a copy of the paper antibiogram. Following release of the digital antibiogram, residents referred to antibiotic susceptibilities more frequently (P < 0.05, Figure 2) and were more frequently more confident when selecting the correct antibiotic dose (P < 0.01, Figure 3). See Figure 4 for dosing recommendation example. Conclusion Providing antibiotic susceptibility and dosing recommendations digitally improved accessibility and resident confidence during antibiotic prescribing. Our digital tool provides a successful platform for displaying the antibiotic data and recommendations that enable appropriate antibiotic use. ![]()
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Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - Brandon Hunter
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Devin Nadar
- Boston Children’s Hospital, Jamaica Plain, Massachusetts
| | | | - Andrew M Fine
- Boston Children’s Hospital, Jamaica Plain, Massachusetts
| | - Kelly Flett
- Affiliation Novant Health Eastover Pediatrics, Charlotte, North Carolina
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Wilder JL, Nadar D, Gujral N, Ortiz B, Stevens R, Holder-Niles F, Lee J, Gaffin JM. Pediatrician Attitudes toward Digital Voice Assistant Technology Use in Clinical Practice. Appl Clin Inform 2019; 10:286-294. [PMID: 31042806 DOI: 10.1055/s-0039-1687863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Digital voice assistant technology provides unique opportunities to enhance clinical practice. We aimed to understand factors influencing pediatric providers' current and potential use of this technology in clinical practice. METHODS We surveyed pediatric providers regarding current use and interest in voice technology in the workplace. Regression analyses evaluated provider characteristics associated with voice technology use. Among respondents not interested in voice technology, we elicited individual concerns. RESULTS Among 114 respondents, 19 (16.7%) indicated current use of voice technology in clinical practice, and 51 (44.7%) indicated use of voice technology for nonclinical purposes. Fifty-four (47.4%) reported willingness to try digital voice assistant technology in the clinical setting. Providers who had longer clinic visits (odds ratio [OR], 3.11, 95% confidence interval [CI], 1.04, 9.33, p = 0.04), fewer patient encounters per day (p = 0.02), and worked in hospital-based practices (OR, 2.95, 95% CI, 1.08, 8.07, p = 0.03) were more likely to currently use voice technology in the office. Younger providers (p = 0.02) and those confident in the accuracy of voice technology (OR, 3.05, 95% CI, 1.38, 6.74, p = 0.005) were more willing to trial digital voice assistants in the clinical setting. Among respondents unwilling or unsure about trying voice assistant technology, the most common reasons elicited were concerns related to its accuracy (35%), efficiency (33%), and privacy (28%). CONCLUSION This national survey evaluating use and attitudes toward digital voice assistant technology by pediatric providers found that while only one-eighth of pediatric providers currently use digital voice assistant technology in the clinical setting, almost half are interested in trying it in the future. Younger provider age and confidence in the accuracy of voice technology are associated with provider interest in using voice technology in the clinical setting. Future development of voice technology for clinical use will need to consider accuracy of information, efficiency of use, and patient privacy for successful integration into the workplace.
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Affiliation(s)
- Jayme L Wilder
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States.,Harvard Medical School, Harvard University, Boston, Massachusetts, United States
| | - Devin Nadar
- Innovation & Digital Health Accelerator, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Nitin Gujral
- Innovation & Digital Health Accelerator, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Benjamin Ortiz
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, United States
| | - Robert Stevens
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, United States
| | - Faye Holder-Niles
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States.,Harvard Medical School, Harvard University, Boston, Massachusetts, United States
| | - John Lee
- Harvard Medical School, Harvard University, Boston, Massachusetts, United States.,Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Jonathan M Gaffin
- Harvard Medical School, Harvard University, Boston, Massachusetts, United States.,Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts, United States
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Rehm KP, Brittan MS, Stephens JR, Mummidi P, Steiner MJ, Gay JC, Ayubi SA, Gujral N, Mittal V, Dunn K, Chiang V, Hall M, Blaine K, O'Neill M, McBride S, Rogers J, Berry JG. Issues Identified by Postdischarge Contact after Pediatric Hospitalization: A Multisite Study. J Hosp Med 2018; 13:236-242. [PMID: 29394301 DOI: 10.12788/jhm.2934] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Many hospitals are considering contacting hospitalized patients soon after discharge to help with issues that arise. OBJECTIVE To (1) describe the prevalence of contactidentified postdischarge issues (PDI) and (2) assess characteristics of children with the highest likelihood of having a PDI. DESIGN, SETTING, PATIENTS A retrospective analysis of hospital-initiated follow-up contact for 12,986 children discharged from January 2012 to July 2015 from 4 US children's hospitals. Contact was made within 14 days of discharge by hospital staff via telephone call, text message, or e-mail. Standardized questions were asked about issues with medications, appointments, and other PDIs. For each hospital, patient characteristics were compared with the likelihood of PDI by using logistic regression. RESULTS Median (interquartile range) age of children at admission was 4.0 years (0-11); 59.9% were nonHispanic white, and 51.0% used Medicaid. The most common reasons for admission were bronchiolitis (6.3%), pneumonia (6.2%), asthma (5.1%), and seizure (4.9%). Twenty-five percent of hospitalized children (n=3263) reported a PDI at contact (hospital range: 16.0%-62.8%). Most (76.3%) PDIs were related to follow-up appointments (eg, difficulty getting one); 20.8% of PDIs were related to medications (eg, problems filling a prescription). Patient characteristics associated with the likelihood of PDI varied across hospitals. Older age (age 10-18 years vs <1 year) was significantly (P<.001) associated with an increased likelihood of PDI in 3 of 4 hospitals. CONCLUSIONS PDIs were identified often through hospital-initiated follow-up contact. Most PDIs were related to appointments. Hospitals caring for children may find this information useful as they strive to optimize their processes for follow-up contact after discharge.
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Affiliation(s)
- Kris P Rehm
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Mark S Brittan
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John R Stephens
- North Carolina Children's Hospital, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Pradeep Mummidi
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Michael J Steiner
- North Carolina Children's Hospital, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - James C Gay
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Nitin Gujral
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Vandna Mittal
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kelly Dunn
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Vincent Chiang
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Matt Hall
- Children's Hospital Association, Overland Park, Kansas, USA
| | - Kevin Blaine
- Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Sarah McBride
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jayne Rogers
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jay G Berry
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Al Ayubi SU, Pelletier A, Sunthara G, Gujral N, Mittal V, Bourgeois FC. A Mobile App Development Guideline for Hospital Settings: Maximizing the Use of and Minimizing the Security Risks of "Bring Your Own Devices" Policies. JMIR Mhealth Uhealth 2016; 4:e50. [PMID: 27169345 PMCID: PMC4880739 DOI: 10.2196/mhealth.4424] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 10/16/2015] [Accepted: 01/19/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hospitals today are introducing new mobile apps to improve patient care and workflow processes. Mobile device adoption by hospitals fits with present day technology behavior; however, requires a deeper look into hospital device policies and the impact on patients, staff, and technology development. Should hospitals spend thousands to millions of dollars to equip all personnel with a mobile device that is only used in a hospital environment? Allowing health care professionals to use personal mobile devices at work, known as bring-your-own-device (BYOD), has the potential to support both the hospital and its employees to deliver effective and efficient care. OBJECTIVE The objectives of this research were to create a mobile app development guideline for a BYOD hospital environment, apply the guideline to the development of an in-house mobile app called TaskList, pilot the TaskList app within Boston Children's Hospital (BCH), and refine the guideline based on the app pilot. TaskList is an Apple operating system (iOS)-based app designed for medical residents to monitor, create, capture, and share daily collaborative tasks associated with patients. METHODS To create the BYOD guidelines, we developed TaskList that required the use of mobile devices among medical resident. The TaskList app was designed in four phases: (1) mobile app guideline development, (2) requirements gathering and developing of TaskList fitting the guideline, (3) deployment of TaskList using BYOD with end-users, and (4) refinement of the guideline based on the TaskList pilot. Phase 1 included understanding the existing hospital BYOD policies and conducting Web searches to find best practices in software development for a BYOD environment. Phase 1 also included gathering subject matter input from the Information Services Department (ISD) at BCH. Phase 2 involved the collaboration between the Innovation Acceleration Program at BCH, the ISD Department and the TaskList Clinical team in understanding what features should be built into the app. Phase 3 involved deployment of TaskList on a clinical floor at BCH. Lastly, Phase 4 gathered the lessons learned from the pilot to refine the guideline. RESULTS Fourteen practical recommendations were identified to create the BCH Mobile Application Development Guideline to safeguard custom applications in hospital BYOD settings. The recommendations were grouped into four categories: (1) authentication and authorization, (2) data management, (3) safeguarding app environment, and (4) remote enforcement. Following the guideline, the TaskList app was developed and then was piloted with an inpatient ward team. CONCLUSIONS The Mobile Application Development guideline was created and used in the development of TaskList. The guideline is intended for use by developers when addressing integration with hospital information systems, deploying apps in BYOD health care settings, and meeting compliance standards, such as Health Insurance Portability and Accountability Act (HIPAA) regulations.
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Affiliation(s)
- Soleh U Al Ayubi
- Innovation & Digital Health Accelerator, Boston Children's Hospital, Boston, MA, United States.
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Jensen G, Friedenberg F, Levine G, Zaeri N, Braitman LE, Tran HD, Gujral N, Proenza J. Accuracy and clinical utility of the mini-dose 14C-urea breath test in the evaluation of Helicobacter pylori infection. Nucl Med Commun 1998; 19:771-5. [PMID: 9751931 DOI: 10.1097/00006231-199808000-00007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to evaluate the accuracy of the 14C-urea breath test by comparing the results to those obtained by endoscopy with mucosal biopsy. We also examined the value of the breath test result obtained prior to endoscopy in predicting peptic ulcer disease. Forty-two individuals underwent the 14C-urea breath test. Collections of expired C02 were analysed using a liquid scintillation counter. All individuals then underwent endoscopy with biopsy. Biopsy material was evaluated by the rapid urease method and by histology for the presence of H. pylori. Our results demonstrated that the 14C-urea breath test was 100% sensitive and specific when compared to the rapid urease test as the 'gold standard' for the detection of H. pylori. In comparison to pathology, the sensitivity remained 100% and the specificity was 89%. The results of the 14C-urea breath test had a poor predictive value for the determination of peptic ulcer disease. We conclude that the 14C-urea breath test can be easily performed at any medical facility equipped with a liquid scintillation counter and can accurately detect H. pylori. A negative breath test result could not exclude the presence of peptic ulcer disease.
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Affiliation(s)
- G Jensen
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA
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9
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Friedenberg F, Jensen G, Gujral N, Braitman LE, Levine GM. Serum albumin is predictive of 30-day survival after percutaneous endoscopic gastrostomy. JPEN J Parenter Enteral Nutr 1997; 21:72-4. [PMID: 9084008 DOI: 10.1177/014860719702100272] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) tubes have been used since 1980 in patients who require prolonged enteral feeding. PURPOSE To identify factors associated with poor survival (defined as survival < 30 days) post-PEG. METHODS We assessed a cohort of 64 patients consecutively referred for a percutaneous endoscopic gastrostomy tube in a single, tertiary care hospital. Prior to PEG tube placement, we evaluated relevant clinical variables in each patient to determine their effect on 30-day mortality. RESULTS Of the cohort, 43 of 64 (67.2%) survived at least 30 days after tube placement. One death was attributable to tube placement. Bivariate analyses showed that 30-day survival correlated directly with serum albumin (r = .253; p = .049) and inversely with creatinine (r = -0.255; p = .042). Using multivariable logistic regression analysis, only albumin was identified as an independent predictor of 30-day survival (p = .044). Eighty-three percent of patients with a serum albumin > or = 3.0 g/dL survived 30 days compared with 58% with an albumin < 3.0, a difference of 25% (95% CI, -2% to 54%; p = .07). CONCLUSIONS In conclusion, serum albumin appears to be a predictor of early survival in individuals undergoing percutaneous endoscopic gastrostomy tube placement.
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Affiliation(s)
- F Friedenberg
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania 19141, USA
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Affiliation(s)
- N Gujral
- Division of Gastroenterology, Albert Einstein Medical Center, Philadelphia, Pennsylvania 19141, USA
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Abstract
Two patients developed unusual causes of severe gastrointestinal hemorrhage associated with anticardiolipin antibodies. One patient bled from small bowel ischemia and mesenteric thrombosis. Another patient bled massively from an ulcer of the descending duodenum which was refractory to standard antiulcer therapy. Ischemia may have contributed to the atypical ulcer presentation in this second patient, which included atypical ulcer location, ulcer refractoriness to standard peptic ulcer therapy, and severe recurrent hemorrhage. In five previously reported cases intestinal infarction associated with anticardiolipin antibodies presented, as it usually presents in patients without anticardiolipin antibodies, as an acute abdomen without acute gastrointestinal bleeding. The current study demonstrates that intestinal ischemia due to thrombosis is in the differential diagnosis of gastrointestinal bleeding in the anticardiolipin antibody syndrome.
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Affiliation(s)
- M S Cappell
- Department of Medicine, UMDNJ-Robert Wood Johnson (formerly Rutgers) Medical School, New Brunswick, New Jersey 08903
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