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Parekh P, Wheless H, Freglette C, French J, Morrison C, Pellinen J. Learning difficulties often not documented in newly diagnosed focal epilepsy. Epilepsy Behav 2024; 156:109837. [PMID: 38759428 DOI: 10.1016/j.yebeh.2024.109837] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVE A previous investigation of people with newly diagnosed focal epilepsy participating in the Human Epilepsy Project 1 (HEP1) revealed an association between learning difficulties and structural brain differences, suggesting an underlying relationship prior to seizure onset. To investigate physicians' practices of documentation learning difficulties during clinical encounters, we conducted a review of initial epileptologist encounter notes from HEP1 participants who self-reported early life learning difficulties separately as part of study enrollment. METHODS HEP1 enrolled 67 North American participants between June 2012 and November 2017 who self-reported one or more difficulties with learning (i.e., having repeated grade, receiving learning support/remediation, and/or formal diagnosis of a learning disability) prior to epilepsy diagnosis as part of the study enrollment. The epileptologist's initial encounter note was then reviewed in detail for each of these participants. Documentation of learning issues and specific diagnoses of learning disabilities was compared to participant characteristics. Regression analysis was used to test for any independent associations between participant characteristics and physician documentation of learning difficulties. RESULTS There were significant independent relationships between age, sex, and physician documentation of learning difficulties. On average, participants ages 22 and younger were 12.12 times more likely to have their learning difficulties documented compared to those 23 years and older (95 % CI: 2.226 to 66.02, p = 0.004). Additionally, male participants had 7.2 times greater odds of having their learning difficulty documented compared to female participants (95 % CI: 1.538 to 33.717, p = 0.012). There were no significant independent associations between race, language, employment, or geographical region. SIGNIFICANCE These findings highlight disparities in physician documentation for people with newly diagnosed focal epilepsy and a history of learning difficulties. In the HEP1 cohort, physicians were more likely to document learning difficulties in males and in younger individuals. Systematic practice standards are important for reducing healthcare disparities across populations, improving clinical care to individuals, as well as enabling more accurate retrospective study of clinical phenomenon.
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Affiliation(s)
- Pia Parekh
- New York University School of Medicine and NYU Langone Health, New York, NY, USA
| | - Hannah Wheless
- New York University School of Medicine and NYU Langone Health, New York, NY, USA
| | - Cameryn Freglette
- New York University School of Medicine and NYU Langone Health, New York, NY, USA
| | - Jacqueline French
- New York University School of Medicine and NYU Langone Health, New York, NY, USA
| | - Chris Morrison
- New York University School of Medicine and NYU Langone Health, New York, NY, USA
| | - Jacob Pellinen
- Department of Neurology, University of Colorado, Aurora, CO, USA.
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Thielmann RR, Hoving C, Cals JW, Crutzen R. Patient online access to medical records in general practice: Perceived effects after one year follow-up. Patient Educ Couns 2024; 125:108309. [PMID: 38705022 DOI: 10.1016/j.pec.2024.108309] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 03/29/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE Online access to medical records is expected to foster patient empowerment and patient-centred healthcare. However, data on actual experienced effects remain limited. We aimed to examine the development of effects patients perceive from online access. METHODS A nationwide online survey (N = 1769) evaluated Dutch patients' use of online access and beliefs about its effects on 16 outcomes at baseline and one-year follow-up. Analyses of Variance (ANOVA) were used to examine within-person belief changes across three user groups: patients who 1) used online access before the study, 2) started use during the study, and 3) did not use it at all. RESULTS There was a small decline in five beliefs around online access facilitating patient empowerment and participation in participants who started using online access during the study compared to at least one other user group. Most changes in beliefs did not differ between groups. CONCLUSION No evidence of benefits from online access was found. The findings might indicate inadequacies in the current system of online access. Possibly, the benefits of online access are contingent upon portal improvements and changes in documentation practices. PRACTICE IMPLICATION Records need to be easily accessible and comprehensible for patients. Consultation practices should enable patient participation.
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Affiliation(s)
| | - Ciska Hoving
- Department of Health Promotion, Maastricht University, the Netherlands
| | - Jochen Wl Cals
- Department of Family Medicine, Maastricht University, the Netherlands
| | - Rik Crutzen
- Department of Health Promotion, Maastricht University, the Netherlands
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Ha T, Kang S, Yeo NY, Kim TH, Kim WJ, Yi BK, Jang JW, Park SW. Status of MyHealthWay and Suggestions for Widespread Implementation, Emphasizing the Utilization and Practical Use of Personal Medical Data. Healthc Inform Res 2024; 30:103-112. [PMID: 38755101 PMCID: PMC11098772 DOI: 10.4258/hir.2024.30.2.103] [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: 01/19/2024] [Revised: 04/21/2024] [Accepted: 04/24/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVES In the Fourth Industrial Revolution, there is a focus on managing diverse medical data to improve healthcare and prevent disease. The challenges include tracking detailed medical records across multiple institutions and the necessity of linking domestic public medical entities for efficient data sharing. This study explores MyHealthWay, a Korean healthcare platform designed to facilitate the integration and transfer of medical data from various sources, examining its development, importance, and legal implications. METHODS To evaluate the management status and utilization of MyHealthWay, we analyzed data types, security, legal issues, domestic versus international issues, and infrastructure. Additionally, we discussed challenges such as resource and infrastructure constraints, regulatory hurdles, and future considerations for data management. RESULTS The secure sharing of medical information via MyHealthWay can reduce the distance between patients and healthcare facilities, fostering personalized care and self-management of health. However, this approach faces legal challenges, particularly relating to data standardization and access to personal health information. Legal challenges in data standardization and access, particularly for secondary uses such as research, necessitate improved regulations. There is a crucial need for detailed governmental guidelines and clear data ownership standards at institutional levels. CONCLUSIONS This report highlights the role of Korea's MyHealthWay, which was launched in 2023, in transforming healthcare through systematic data integration. Challenges include data privacy and legal complexities, and there is a need for data standardization and individual empowerment in health data management within a systematic medical big data framework.
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Affiliation(s)
- Taejun Ha
- Department of Biomedical Research Institute, Kangwon National University Hospital, Chuncheon,
Korea
| | - Seonguk Kang
- Department of Biomedical Research Institute, Kangwon National University Hospital, Chuncheon,
Korea
- Department of Convergence Security, Kangwon National University, Chuncheon,
Korea
| | - Na Young Yeo
- Department of Medical Bigdata Convergence, Kangwon National University, Chuncheon,
Korea
| | - Tae-Hoon Kim
- University-Industry Cooperation Foundation, Kangwon National University, Chuncheon,
Korea
| | - Woo Jin Kim
- Department of Convergence Security, Kangwon National University, Chuncheon,
Korea
- Department of Medical Informatics, Kangwon National University School of Medicine, Chuncheon,
Korea
- Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon,
Korea
| | - Byoung-Kee Yi
- Department of Artificial Intelligence Convergence, Kangwon National University, Chuncheon,
Korea
| | - Jae-Won Jang
- Department of Convergence Security, Kangwon National University, Chuncheon,
Korea
- Department of Medical Bigdata Convergence, Kangwon National University, Chuncheon,
Korea
- Department of Medical Informatics, Kangwon National University School of Medicine, Chuncheon,
Korea
- Department of Neurology, Kangwon National University Hospital, Chuncheon,
Korea
| | - Sang Won Park
- Department of Medical Informatics, Kangwon National University School of Medicine, Chuncheon,
Korea
- Institute of Medical Science, Kangwon National University School of Medicine, Chuncheon,
Korea
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Amoateng CNA, Achampong EK. Impact of the Lightwave Health Information Management Software on the Dimensions of Quality of Healthcare Data. Healthc Inform Res 2024; 30:35-41. [PMID: 38359847 PMCID: PMC10879824 DOI: 10.4258/hir.2024.30.1.35] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 01/01/2024] [Accepted: 01/13/2024] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVES The use of technology in healthcare to manage patient records, guide diagnosis, and make referrals is termed electronic healthcare. An electronic health record system called Lightwave Health Information Management System (LHIMS) was implemented in 2018 at Cape Coast Teaching Hospital (CCTH). This study evaluated the impact of LHIMS on the quality of healthcare data at CCTH, focusing on the extent to which its use has enhanced the main dimensions of data quality. METHODS Structured questionnaires were administered to doctors at CCTH to enquire about their opinions about the present state of LHIMS as measured against the parameters of interest in this study, mainly the dimensions of quality healthcare data and the specific issues plaguing the system as reported by respondents. RESULTS Most doctors found LHIMS convenient to use, mainly because it made access to patient records easier and had to some extent improved the dimensions of quality healthcare data, except for comprehensiveness, at CCTH. Major challenges that impeded the smooth running of the system were erratic power supply, inadequate logistics and technological drive, and poor internet connectivity. CONCLUSIONS LHIMS must be upgraded to include more decision support systems and additional add-ons such as patients' radiological reports, and laboratory results must be readily available on LHIMS to make patient health data more comprehensive.
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Affiliation(s)
| | - Emmanuel Kusi Achampong
- Department of Medical Education and IT, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast,
Ghana
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Blok GCGH, Berger MY, Ahmeti AB, Holtman GA. What is important to the GP in recognizing acute appendicitis in children: a delphi study. BMC Prim Care 2023; 24:217. [PMID: 37872491 PMCID: PMC10591392 DOI: 10.1186/s12875-023-02167-6] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/30/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND For diagnostic research on appendicitis in registration data, insight is needed in the way GPs generate medical records. We aimed to reach a consensus on the features that GPs consider important in the consultation and medical records when evaluating a child with suspected appendicitis. METHODS We performed a three-round Delphi study among Dutch GPs selected by purposive sampling. An initial feature list was created based on a literature search and features in the relevant Dutch guideline. Finally, using a vignette describing a child who needed later reassessment, we asked participants to complete an online questionnaire about which consultation features should be addressed and recorded. RESULTS A literature review and Dutch guideline yielded 95 consultation features. All three rounds were completed by 22 GPs, with the final consensus list containing 26 symptoms, 29 physical assessments and signs, 2 additional tests, and 8 further actions (including safety-netting, i.e., informing the patient about when to contact the GP again). Of these, participants reached consensus that 37 should be actively addressed and that 20 need to be recorded if findings are negative. CONCLUSIONS GPs agreed that negative findings do not need to be recorded for most features and that records should include the prognostic and safety-netting advice given. The results have implications in three main domains: for research, that negative findings are likely to be missing; for medicolegal purposes, that documentation cannot be expected to be complete; and for clinical practice, that safety-netting advice should be given and documented.
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Affiliation(s)
- Guus C G H Blok
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, Groningen, 9700 AD, The Netherlands
| | - Marjolein Y Berger
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, Groningen, 9700 AD, The Netherlands
| | - Arjan B Ahmeti
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, Groningen, 9700 AD, The Netherlands
| | - Gea A Holtman
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, Groningen, 9700 AD, The Netherlands.
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Choi J, Park H, Chie EK, Choi SW, Lee HY, Yoo S, Kim BJ, Ryu B. Current Status and Key Issues of Data Management in Tertiary Hospitals: A Case Study of Seoul National University Hospital. Healthc Inform Res 2023; 29:209-217. [PMID: 37591676 PMCID: PMC10440204 DOI: 10.4258/hir.2023.29.3.209] [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: 06/09/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVES In the era of the Fourth Industrial Revolution, where an ecosystem is being developed to enhance the quality of healthcare services by applying information and communication technologies, systematic and sustainable data management is essential for medical institutions. In this study, we assessed the data management status and emerging concerns of three medical institutions, while also examining future directions for seamless data management. METHODS To evaluate the data management status, we examined data types, capacities, infrastructure, backup methods, and related organizations. We also discussed challenges, such as resource and infrastructure issues, problems related to government regulations, and considerations for future data management. RESULTS Hospitals are grappling with the increasing data storage space and a shortage of management personnel due to costs and project termination, which necessitates countermeasures and support. Data management regulations on the destruction or maintenance of medical records are needed, and institutional consideration for secondary utilization such as long-term treatment or research is required. Government-level guidelines for facilitating hospital data sharing and mobile patient services should be developed. Additionally, hospital executives at the organizational level need to make efforts to facilitate the clinical validation of artificial intelligence software. CONCLUSIONS This analysis of the current status and emerging issues of data management reveals potential solutions and sets the stage for future organizational and policy directions. If medical big data is systematically managed, accumulated over time, and strategically monetized, it has the potential to create new value.
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Affiliation(s)
- Jinwook Choi
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul,
Korea
| | - Hyeryun Park
- Interdisciplinary Program for Bioengineering, Graduate School, Seoul National University, Seoul,
Korea
| | - Eui Kyu Chie
- Office of Hospital Information, Seoul National University Hospital, Seoul,
Korea
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul,
Korea
| | - Sae Won Choi
- Office of Hospital Information, Seoul National University Hospital, Seoul,
Korea
| | - Ho-Young Lee
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam,
Korea
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Sooyoung Yoo
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Byoung Jae Kim
- Information Systems and Technology, Seoul Metropolitan Government-Seoul National University Hospital Boramae Medical Center, Seoul,
Korea
| | - Borim Ryu
- Center for Data Science, Biomedical Research Institute, Seoul Metropolitan Government-Seoul National University Hospital Boramae Medical Center, Seoul,
Korea
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Choy J, Pourkazemi F, Anderson C, Bogaardt H. Dosages of Swallowing Exercises Prescribed in Stroke Rehabilitation: A Medical Record Audit. Dysphagia 2023; 38:686-699. [PMID: 35951119 PMCID: PMC10006267 DOI: 10.1007/s00455-022-10500-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 07/13/2022] [Indexed: 01/19/2023]
Abstract
This study investigated how swallowing exercise dosage is recorded, and what swallowing exercise dosages are reported in a stroke rehabilitation setting. We additionally explored the relation between mean daily swallowing repetitions and likelihood of improvement in functional swallowing status and considered how swallowing exercise dosages in practice compared to evidence-based principles of neural plasticity and strength training. We audited medical records for 42 patients with post-stroke dysphagia admitted to an inpatient rehabilitation unit over 18 months. Data were collected on participant characteristics, swallowing exercises and dosages, and clinical outcomes. The relation between dosage and outcomes was investigated using logistic regression analysis. On average, patients were seen for a median of 2.4 swallowing intervention sessions per week (IQR: 1.7) over 21 days (IQR: 16) and received a median 44.5 swallowing exercise repetitions per session (IQR: 39.6). Results indicated variable reporting of swallowing exercise dosages. Frequency, intervention duration, exercise type, and number of repetitions were routinely recorded in medical records, while intensity, session length, content, and adherence to home exercise programs were not. Frequency of swallowing intervention was lower in practice compared to research studies, and swallowing exercises did not follow specificity or progressive resistance principles. Likelihood of improvement in swallowing status was partially explained by age (B = -.015, p = .007) but not by mean daily swallowing exercise repetitions. This study illustrates dosages of swallowing exercises used in clinical practice. Results highlight the need for improved consideration and reporting of dosage, and application of evidence-based principles to swallowing exercise dosages.
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Affiliation(s)
- Jacinda Choy
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia.
- HammondCare Braeside Hospital, 340 Prairie Vale Road, Prairiewood, NSW, 2176, Australia.
| | - Fereshteh Pourkazemi
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Caitlin Anderson
- HammondCare Braeside Hospital, 340 Prairie Vale Road, Prairiewood, NSW, 2176, Australia
| | - Hans Bogaardt
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, SA, 5005, Australia
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Jean-Baptiste L, Mouazer A, Sedki K, Tsopra R. Translating the Observational Medical Outcomes Partnership - Common Data Model (OMOP-CDM) Electronic Health Records to an OWL Ontology. Stud Health Technol Inform 2022; 290:76-80. [PMID: 35672974 DOI: 10.3233/shti220035] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The heterogeneity of electronic health records model is a major problem: it is necessary to gather data from various models for clinical research, but also for clinical decision support. The Observational Medical Outcomes Partnership - Common Data Model (OMOP-CDM) has emerged as a standard model for structuring health records populated from various other sources. This model is proposed as a relational database schema. However, in the field of decision support, formal ontologies are commonly used. In this paper, we propose a translation of OMOP-CDM into an ontology, and we explore the utility of the semantic web for structuring EHR in a clinical decision support perspective, and the use of the SPARQL language for querying health records. The resulting ontology is available online.
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Affiliation(s)
- Lamy Jean-Baptiste
- Université Sorbonne Paris Nord, LIMICS, Sorbonne Université, INSERM, UMR 1142, F-93000, Bobigny, France
| | - Abdelmalek Mouazer
- Université Sorbonne Paris Nord, LIMICS, Sorbonne Université, INSERM, UMR 1142, F-93000, Bobigny, France
| | - Karima Sedki
- Université Sorbonne Paris Nord, LIMICS, Sorbonne Université, INSERM, UMR 1142, F-93000, Bobigny, France
| | - Rosy Tsopra
- INSERM, Université de Paris, Sorbonne Université, Centre de Recherche des Cordeliers, Information Sciences to support Personalized Medicine, F-75006 Paris, France
- Department of Medical Informatics, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
- INRIA Paris, 75012 Paris, France
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Fridriksdottir KK, Gunnlaugsdottir J, Haraldsdóttir RK. [ Medical records at the National Hospital of Iceland: Present status and future prospects]. LAEKNABLADID 2021; 107:331-6. [PMID: 34161293 DOI: 10.17992/lbl.2021.0708.644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION The aim of the research was to examine the status of medical records at the National Hospital in Iceland. The aim was, furthermore, to examine the policy making regarding records among managers and other employees. A research such as this has not been undertaken previously. It provides new knowledge regarding the systematic management of medical records. The academic value of the research is the discovery of how sensitive records are being managed from a legal standpoint as well as information security. The practical value of the research is that its findings can be used as a status evaluation of ongoing assignments and plans within the National Hospital. SUBSTANCE Qualitative research methods were used for the collection and analysis of the data supported by triangulation and grounded theory. Available written material was examined, interviews were conducted, and participant observations took place. Finally, a focus group was formed. Although the conclusions cannot be generalized, they do provide important indications regarding the state of records management, as a level of saturation was reached in the data collection, and it was deemed unlikely that additional data would have added information of significant value. RESULTS The findings of the research show that important work has been undertaken to form and implement a policy regarding information and access to records in accordance with law, regulations and international standards. It is obvious that the managers have set themselves ambitious goals in this respect. Moreover, an international certification has been obtained within the health and information technology department regarding information security. CONCLUSIONS The main problem seems to be twofold: First, a clarification of the administration and responsibility of health records is needed, and second that the hospital has not succeeded in securing enough funds in order to pursue established policies in an effective manner. It was revealed that top management support needs to be strengthened; training and education need improvement and the awareness of hospital staff of their responsibility regarding the security of medical records must be emphasized.
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Valim AP, Franciscatto ME, Gomes E, Santos EM. [Reply to: Early Detection of COVID-19 in Portugal: Use of Clinical Records]. ACTA MEDICA PORT 2021; 34:404. [PMID: 34253285 DOI: 10.20344/amp.16241] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Ana Paula Valim
- Universidade do Sul de Santa Catarina. Tubarão. Santa Catarina. Brazil
| | | | - Elonir Gomes
- Departamento de Educação. Universidade do Sul de Santa Catarina. Tubarão. Santa Catarina. Brazil
| | - Eliane Mazzuco Santos
- Departamento de Saúde Coletiva. Universidade do Sul de Santa Catarina. Tubarão. Santa Catarina. Brazil
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Moreira JL, Barletta PHAAS, Baucia JA. Morbidity and Mortality in Patients Undergoing Mitral Valve Replacement at a Cardiovascular Surgery Referral Service: a Retrospective Analysis. Braz J Cardiovasc Surg 2021; 36:183-191. [PMID: 33355785 PMCID: PMC8163271 DOI: 10.21470/1678-9741-2019-0440] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction We aimed to identify predictors of morbidity and mortality in patients undergoing isolated mitral valve replacement. Methods This is a retrospective cohort study with 164 patients who underwent isolated mitral valve replacement at a referral hospital for cardiovascular diseases, which were performed from January 2011 to December 2016. Data were obtained from medical records, including preoperative, intraoperative, and postoperative information. Statistical analysis was performed to calculate odds ratio (OR), unpaired Student's t-test, and binary logistic regression. P-values < 0.05 were considered significant. Results A total of 69.5% (n=114) of the patients had a diagnosis of rheumatic disease prior to surgery. Mortality rate was 6.7% (n=11). The most observed complication was the occurrence of postoperative arrhythmias (19.5%). On average, patients remained 5.34 days in the intensive care unit. There was a statistically significant enhanced risk of death among patients with previous diagnosis of endocarditis (OR 5.22, 95% confidence interval [CI] 1,368-19,915; P=0.008), reduced ejection fraction (EF) (< 50%) (OR 9.46, 95% CI 2,61-34,35; P<0.001), and mitral regurgitation (MR) (OR 7.7, 95% CI 1.576-37.545; P=0.004). Patients who died were older than those who survived surgery (P<0.001) and had lower preoperative serum hemoglobin levels (P=0.018). Logistic regression showed age and reduced EF at preoperative evaluation as predictors of death. Conclusion Older age, reduced serum hemoglobin levels, preoperative diagnosis of endocarditis, reduced EF, and MR were associated with postoperative mortality. Age and reduced EF were predictors of death.
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Affiliation(s)
| | | | - José Augusto Baucia
- Department of Anesthesiology and Surgery, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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De Sá J, Ferreira J, Macedo A. [Development and Implementation of a Patient Registry: The Experience of a Multiple Sclerosis Center in Portugal]. ACTA MEDICA PORT 2021; 35:328-335. [PMID: 33459588 DOI: 10.20344/amp.13933] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/21/2020] [Accepted: 08/10/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Patient registries allow better evaluations of therapeutic outcomes and support personalized health care in several conditions. This study aimed to implement a local registry in a multiple sclerosis center in Portugal, in order to carry out a critical analysis of its development stages, and to perform an initial analysis of the included patients. MATERIAL AND METHODS The establishment of the registry was divided in two phases - development (creation of the online platform for data entry) and implementation (recruitment of patients and retrospective and prospective collection of available information). A demographic and clinical analysis of patients was performed. RESULTS Neurologists and study coordinators participated in the project, accounting for a total of 1050 hours of work in the implementation phase. Amongst the 498 multiple sclerosis patients included, 72.9% were female and relapsing-remitting multiple sclerosis was the most common subtype of the disease. The most frequently prescribed drugs at diagnosis were beta interferons. Missing data in electronic health records were detected concerning the progression of disability and diagnostic tests. DISCUSSION The difficulties encountered could be mitigated by defining minimum elements to be included in patient records and by implementing more minimalist registries. This could reduce the time spent by healthcare professionals in collecting information, thus optimizing costs, and allowing the focus to be placed on personalized healthcare by taking advantage of the registry and its associated tools. CONCLUSION Despite the amount of data collected within the scope of this study, several difficulties affected the implementation and maintenance of the registry, which could be overcome by improving future strategies.
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Affiliation(s)
- João De Sá
- Serviço de Neurologia. Hospital de Santa Maria. Centro Hospitalar Universitário de Lisboa Norte. Lisboa; Departamento de Neurologia. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - João Ferreira
- Serviço de Neurologia. Hospital de Santa Maria. Centro Hospitalar Universitário de Lisboa Norte. Lisboa. Portugal
| | - Ana Macedo
- Keypoint - Consultoria Científica Lda. Algés. Portugal
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Sultana M, Hossain A, Laila F, Taher KA, Islam MN. Towards developing a secure medical image sharing system based on zero trust principles and blockchain technology. BMC Med Inform Decis Mak 2020; 20:256. [PMID: 33028318 PMCID: PMC7542122 DOI: 10.1186/s12911-020-01275-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background Data security has been a critical topic of research and discussion since the onset of data sharing in e-health systems. Although digitalization of data has increased efficiency and speed, it has also made data vulnerable to cyber attacks. Medical records in particular seem to be the regular victims of hackers. Several data breach incidents throughout history have warranted the invention of security measures against these threats. Although various security procedures like firewalls, virtual private networks, encryption, etc are present, a mix of these approaches are required for maximum security in medical image and data sharing. Methods Relatively new, blockchain has become an effective tool for safeguarding sensitive information. However, to ensure overall protection of medical data (images), security measures have to be taken at each step, from the beginning, during and even after transmission of medical images which is ensured by zero trust security model. In this research, a number of studies that deal with these two concepts were studied and a decentralized and trustless framework was proposed by combining these two concepts for secured medical data and image transfer and storage. Results Research output suggested blockchain technology ensures data integrity by maintaining an audit trail of every transaction while zero trust principles make sure the medical data is encrypted and only authenticated users and devices interact with the network. Thus the proposed model solves a lot of vulnerabilities related to data security. Conclusions A system to combat medical/health data vulnerabilities has been proposed. The system makes use of the immutability of blockchain, the additional security of zero trust principles, and the scalability of off chain data storage using Inter Planetary File Systems (IPFS). The adoption of this system suggests to enhance the security of medical or health data transmission.
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Affiliation(s)
- Maliha Sultana
- Department of Computer Science Engineering, Military Institute of Science and Technology, Mirpur Cantonment, Dhaka, 1216, Bangladesh
| | - Afrida Hossain
- Department of Computer Science Engineering, Military Institute of Science and Technology, Mirpur Cantonment, Dhaka, 1216, Bangladesh
| | - Fabiha Laila
- Department of Computer Science Engineering, Military Institute of Science and Technology, Mirpur Cantonment, Dhaka, 1216, Bangladesh
| | - Kazi Abu Taher
- Department of Information and Communication Technology, Bangladesh University of Professionals, Mirpur Cantonment, Dhaka, 1216, Bangladesh
| | - Muhammad Nazrul Islam
- Department of Computer Science Engineering, Military Institute of Science and Technology, Mirpur Cantonment, Dhaka, 1216, Bangladesh.
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Abstract
Objectives The study aimed to determine the incidence of healthcare-associated infections (HAI) and their sites in a cardiac surgery service, as well as to determine if gender and age were risk factors for infection and to quantify mortality and increase in the hospital length of stay (LOS) due to HAI. Methods Medical records of patients who underwent cardiac surgery from January 2012 to January 2018 were retrospectively analyzed. Data on age, gender, mortality, occurrence of HAI during hospitalization, and LOS were collected. Continuous variables were analyzed using Student's t-test, while categorical variables were compared using Fisher's exact test or chi-square test. Results Among the 195 patients available, the HAI rate in our service was 22.6%, with female gender being a risk factor for infections (odds ratio [OR]=2.23; P=0.015). Age was also a significant risk factor for infections, with a difference in the mean age between the group with and without infection (P=0.02). The occurrence of an infectious process increased the LOS in 14 days (P<0.001) and resulted in higher mortality rates (P=0.112). A patient who has HAI was approximately 19 times more likely to remain hospitalized for more than nine days (P<0.001). Conclusion Age and gender were risk factors for the development of HAI and the occurrence of an infectious process during hospitalization significantly increases the LOS. These findings may guide future actions aimed at reducing the impact of HAI on the health system.
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Affiliation(s)
| | | | - Leonardo Andrade Mulinari
- Universidade Federal do Paraná Hospital de Clínicas Department of Surgery Brazil Department of Thoracic and Cardiovascular Surgery, Department of Surgery, Hospital de Clínicas, Universidade Federal do Paraná, Brazil
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15
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Laville SM, Gras-Champel V, Moragny J, Metzger M, Jacquelinet C, Combe C, Fouque D, Laville M, Frimat L, Robinson BM, Stengel B, Massy ZA, Liabeuf S. Adverse Drug Reactions in Patients with CKD. Clin J Am Soc Nephrol 2020; 15:1090-1102. [PMID: 32611662 PMCID: PMC7409761 DOI: 10.2215/cjn.01030120] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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: 01/24/2019] [Accepted: 05/13/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Little is known about the burden of adverse drug reactions in CKD. We estimated the incidence of overall and serious adverse drug reactions and assessed the probability of causation, preventability, and factors associated with adverse drug reactions in patients seen by nephrologists. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The Chronic Kidney Disease-Renal Epidemiology and Information Network cohort included 3033 outpatients (65% men) with CKD and eGFR<60 ml/min per 1.73 m2, with follow-up for 2 years. Adverse drug reactions were identified from hospitalization reports, medical records, and participant interviews and finally assessed for causality, preventability, and immediate therapeutic management by experts in pharmacology. RESULTS Median (interquartile range) age was 69 (60-76) years old; 55% had eGFR≥30 ml/min per 1.73 m2, and 45% had eGFR<30 ml/min per 1.73 m2. Participants were prescribed a median (range) of eight (five to ten) drugs. Over 2 years, 536 patients had 751 adverse drug reactions, 150 (in 125 participants) classified as serious, for rates of 14.4 (95% confidence interval, 12.6 to 16.5) and 2.7 (95% confidence interval, 1.7 to 4.3) per 100 person-years, respectively. Among the serious adverse drug reactions, 32% were considered preventable or potentially preventable; 16 caused death, directly or indirectly. Renin-angiotensin system inhibitors (15%), antithrombotic agents (14%), and diuretics (10%) were the drugs to which the most adverse drug reactions were imputed, but antithrombotic agents caused 34% of serious adverse drug reactions. The drug was discontinued in 71% of cases, at least temporarily. Adjusted hazard ratios for serious adverse drug reaction were significantly higher in patients with eGFR<30 versus ≥30 ml/min per 1.73 m2 (1.8; 95% confidence interval, 1.3 to 2.6), in those prescribed more than ten versus less than five medications (2.4; 95% confidence interval, 1.1 to 5.2), or in those with poor versus good adherence (1.6; 95% confidence interval, 1.4 to 2.4). CONCLUSIONS Adverse drug reactions are common and sometimes serious in patients with CKD. Many serious adverse drug reactions may be preventable. Some specific pharmacologic classes, particularly antithrombotic agents, are at risk of serious adverse drug reactions. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN), NCT03381950.
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Affiliation(s)
- Solène M Laville
- Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, National Institute of Health and Medical Research, Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Villejuif, France
| | | | - Julien Moragny
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France
| | - Marie Metzger
- Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, National Institute of Health and Medical Research, Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Villejuif, France
| | - Christian Jacquelinet
- Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, National Institute of Health and Medical Research, Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Villejuif, France.,Renal Epidemiology and Information Network Registry, Biomedicine Agency, Saint Denis, France
| | - Christian Combe
- Department of Nephrology Transplantation Dialysis, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,Inserm Unit 1026, University of Bordeaux Segalen, Bordeaux, France
| | - Denis Fouque
- Nephrology Department, Centre Hospitalier Lyon Sud, Université de Lyon, Carmen, Pierre-Bénite, France
| | - Maurice Laville
- Nephrology Department, Centre Hospitalier Lyon Sud, Université de Lyon, Carmen, Pierre-Bénite, France
| | - Luc Frimat
- Nephrology Department, Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France.,Lorraine University, APEMAC, Vandoeuvre-lès-Nancy, France
| | | | - Bénédicte Stengel
- Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, National Institute of Health and Medical Research, Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Villejuif, France
| | - Ziad A Massy
- Paris-Saclay University, Versailles Saint-Quentin-en-Yvelines University, National Institute of Health and Medical Research, Center for research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Villejuif, France.,Division of Nephrology, Ambroise Paré University Hospital, Assistance publique - Hôpitaux de Paris, Boulogne-Billancourt/Paris, France
| | - Sophie Liabeuf
- Department of Clinical Pharmacology, Amiens University Hospital, Amiens, France.,MP3CV Laboratory, EA7517, University of Picardie Jules Verne, Amiens, France
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16
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Prata Ribeiro H, Ponte A, Robalo Cordeiro F, Vieira F. [The New General Data Protection Regulation and Its Implications Regarding Clinical Information Requests to Healthcare Professionals]. ACTA MEDICA PORT 2020; 33:221-224. [PMID: 32238234 DOI: 10.20344/amp.13162] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/20/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Henrique Prata Ribeiro
- Hospital Júlio de Matos. Centro Hospitalar Psiquiátrico de Lisboa. Lisboa. Clínica Universitária de Psiquiatria e Psicologia Médica. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Deputado da iniciativa Health Parliament Portugal 2020. Lisboa. Portugal
| | - André Ponte
- Hospital Júlio de Matos. Centro Hospitalar Psiquiátrico de Lisboa. Lisboa. Clínica Universitária de Psiquiatria e Psicologia Médica. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | | | - Fernando Vieira
- Hospital Júlio de Matos. Centro Hospitalar Psiquiátrico de Lisboa. Lisboa. Portugal
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17
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Akkaya G, Bilen Ç, Tuncer ON, Ayık MF, Atay Y. Long-Term Assessment of Left Ventricular Ejection Fraction and Mitral Regurgitation Following Takeuchi Repair. Braz J Cardiovasc Surg 2019; 34:687-693. [PMID: 31364346 PMCID: PMC6894018 DOI: 10.21470/1678-9741-2018-0376] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the early operative outcomes and to compare the left ventricle and mitral valve functions after initial Takeuchi repair in patients with anomalous left coronary arising from pulmonary artery (ALCAPA). METHODS Fourteen patients (5 males, 9 females; mean age 4.3 years, ranging from 25 days to 34 years) who were operated for ALCAPA between 2007 and 2018 were included in this study. Data were evaluated retrospectively based on our medical records. RESULTS Hospital mortality rate was 7.1% (n=1). Thirteen surviving patients were kept in follow-up mean 4.3±3.05 years. When compared to preoperative measurements, both left ventricular ejection fraction (LVEF), (P=0.007) and mitral regurgitation (MR) (P=0.001) significantly improved before discharge. Moreover, LVEF values were improved in the late follow-up, considering early postoperative outcomes, and this alteration was significant (P=0.014). Nevertheless, alteration in the degree of MR among patients did not differ in the long-term follow-up (P=0.180). There was no late-term mortality or need for reoperation among patients. CONCLUSION Although some centers prefer to direct implantation in ALCAPA, Takeuchi procedure can be accepted as a reliable method that provides satisfactory long-term results, considering that it aids to improve left ventricle ejection fraction and reduced mitral valve regurgitation.
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Affiliation(s)
- Gökmen Akkaya
- Ege University School of Medicine Department of Cardiovascular Surgery Izmir Turkey Department of Cardiovascular Surgery,Ege University School of Medicine, Izmir, Turkey
| | - Çağatay Bilen
- Ege University School of Medicine Department of Cardiovascular Surgery Izmir Turkey Department of Cardiovascular Surgery,Ege University School of Medicine, Izmir, Turkey
| | - Osman Nuri Tuncer
- Ege University School of Medicine Department of Cardiovascular Surgery Izmir Turkey Department of Cardiovascular Surgery,Ege University School of Medicine, Izmir, Turkey
| | - Mehmet Fatih Ayık
- Ege University School of Medicine Department of Cardiovascular Surgery Izmir Turkey Department of Cardiovascular Surgery,Ege University School of Medicine, Izmir, Turkey
| | - Yüksel Atay
- Ege University School of Medicine Department of Cardiovascular Surgery Izmir Turkey Department of Cardiovascular Surgery,Ege University School of Medicine, Izmir, Turkey
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18
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Dima A, Allemann S, Dediu D. AdhereR: An Open Science Approach to Estimating Adherence to Medications Using Electronic Healthcare Databases. Stud Health Technol Inform 2019; 264:1451-1452. [PMID: 31438176 DOI: 10.3233/shti190479] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Adherence to medications is a key performance indicator and behavioral outcome in healthcare. Electronic healthcare databases represent rich data sources for estimating adherence in both research and practice. To build a solid evidence base for adherence management across clinical settings, it is necessary to standardize adherence estimation and facilitate its appropriate use. We present the recent development and oportunities offered by AdhereR, an R package for visualisation of medication histories and computation of adherence.
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Affiliation(s)
- Alexandra Dima
- EA 7425 Health Services and Performance Research, Université Claude Bernard Lyon 1, Lyon, France
| | - Samuel Allemann
- EA 7425 Health Services and Performance Research, Université Claude Bernard Lyon 1, Lyon, France.,Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
| | - Dan Dediu
- Laboratoire Dynamique du Langage, Université Lumière Lyon 2, Lyon, France
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19
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Fujita K, Sugiyama O, Hiragi S, Okamoto K, Takemura T, Kuroda T. Analysis for the Annual Text Amount of Electronic Medical Records. Stud Health Technol Inform 2019; 264:1662-1663. [PMID: 31438281 DOI: 10.3233/shti190585] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The amount of text of electronic medical records and its changes over time are not clear. In designing an electronic medical records system, prediction of the amount of text is important. We analyzed the number of characters described in the electronic medical records. As a result, it became clear that the annual text quantity of electronic medical records follows the lognormal distribution, and also the amount has been increasing year by year.
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Affiliation(s)
- Kenichiro Fujita
- Division of Medical Informatics and Administration Planning, Kyoto University Hospital, Kyoto, Japan
- Graduate School of Applied Informatics, University of Hyogo, Kobe, Japan
| | - Osamu Sugiyama
- Division of Medical Informatics and Administration Planning, Kyoto University Hospital, Kyoto, Japan
| | - Shusuke Hiragi
- Division of Medical Informatics and Administration Planning, Kyoto University Hospital, Kyoto, Japan
| | - Kazuya Okamoto
- Division of Medical Informatics and Administration Planning, Kyoto University Hospital, Kyoto, Japan
| | - Tadamasa Takemura
- Graduate School of Applied Informatics, University of Hyogo, Kobe, Japan
| | - Tomohiro Kuroda
- Division of Medical Informatics and Administration Planning, Kyoto University Hospital, Kyoto, Japan
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20
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Khattak FK, Jeblee S, Crampton N, Mamdani M, Rudzicz F. AutoScribe: Extracting Clinically Pertinent Information from Patient-Clinician Dialogues. Stud Health Technol Inform 2019; 264:1512-1513. [PMID: 31438207 DOI: 10.3233/shti190510] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We present AutoScribe, a system for automatically extracting pertinent medical information from dialogues between clinicians and patients. AutoScribe parses the dialogue and extracts entities such as medications and symptoms, using context to predict which entities are relevant, and automatically generates a patient note and primary diagnosis.
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Affiliation(s)
- Faiza Khan Khattak
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada.,Vector Institute for Artificial Intelligence, Toronto, Ontario, Canada
| | - Serena Jeblee
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada.,Vector Institute for Artificial Intelligence, Toronto, Ontario, Canada
| | - Noah Crampton
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Frank Rudzicz
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada.,Vector Institute for Artificial Intelligence, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.,Surgical Safety Technologies Inc, Toronto, Ontario, Canada
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21
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Abstract
My Health Record (MyHR) is Australia's national personally-controlled electronic health record. Initially established in 2012, it moved from an opt-in to an opt-out system in 2018. This paper considers the privacy aspects of MyHR shared health summary. Drawing on Nissenbaum's theory of privacy as contextual integrity, we argue that the shift in the event-specific nature of information sharing leads to MyHR breaching contextual integrity. As per Nissenbaum's decision heuristic for contextual integrity, we evaluate this breach through a reflection on the changing nature of health care, including patient empowerment, and the greater complexity of care. It is evident that more needs to be known about the benefits of shared health summaries, as well as the actual use of MyHR by clinicians and patients. Though we focus on MyHR, this evaluation has broader applicability to other national electronic health records and electronic shared health summaries.
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Affiliation(s)
- Timothy Kariotis
- School of Computing and Information Systems, University of Melbourne, Australia
| | - Megan Prictor
- Melbourne Law School, University of Melbourne, Australia
| | - Shanton Chang
- School of Computing and Information Systems, University of Melbourne, Australia
| | - Kathleen Gray
- Health and Biomedical Informatics Centre, University of Melbourne, Australia
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22
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Roth CP, Coulter ID, Kraus LS, Ryan GW, Jacob G, Marks JS, Hurwitz EL, Vernon H, Shekelle PG, Herman PM. Researching the Appropriateness of Care in the Complementary and Integrative Health Professions Part 5: Using Patient Records: Selection, Protection, and Abstraction. J Manipulative Physiol Ther 2019; 42:327-334. [PMID: 31257004 DOI: 10.1016/j.jmpt.2019.02.008] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 01/23/2019] [Accepted: 02/07/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this paper is to describe the 4-step process (consent, selection, protection, and abstraction) of acquiring a large sample of chiropractic patient records from multiple practices and subsequent data abstraction. METHODS From April 2017 to December 2017, RAND acquired patient records from 99 chiropractic practices across the United States. The records included patients enrolled in a survey e-study (prospective sample) and a random sample of all clinic patients (retrospective sample) with chronic back or neck pain. Clinic staff were trained to collect the sample, scan, and transfer the records. We designed an online data collection tool for abstraction. Protocols were instituted to protect patient confidentiality. Doctors of chiropractic were selected and trained as abstractors, and a system was established to monitor data collection. RESULTS In compliance with data protection protocols, 3603 patient records were scanned, including 1475 in the prospective sample and 2128 in the random sample. A total of 1716 patients (prospective sample) consented to having their records scanned, but only 1475 could be retrieved. Of records scanned, 19% were unusable owing to illegibility, no care during the period of interest, or poor scanning. The abstractor interrater reliability for appropriateness of care decisions was fair to moderate (κ .38-.48). CONCLUSION The acquisition, handling, and abstraction of a large sample of chiropractic records was a complex task with challenges that necessitated adapting planned approaches. Of the records abstracted, many revealed incomplete provider documentation regarding the details of and rationale for care. Better documentation and more standardized record keeping would facilitate future research using patient records.
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Affiliation(s)
- Carol P Roth
- RAND Corporation, Health, Santa Monica, California
| | | | - Lisa S Kraus
- RAND Corporation, Health, Santa Monica, California
| | - Gery W Ryan
- RAND Corporation, Health, Santa Monica, California
| | - Gary Jacob
- RAND Corporation, Health, Santa Monica, California
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23
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Butcher L. A Mismatch Made in America. Manag Care 2019; 28:37-39. [PMID: 31188099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
When patients and their medical records are out of whack, it causes harm and wastes money. It gets worse when organizations try to share patient records. Even if two facilities share the same EHR system, match rates may be as low as 50%. Privacy concerns makes this problem difficult to fix.
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24
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Guimarães R, Guimarães M, Sousa N, Ferreira A. [Medical Student Secrecy, its Link to the Duty of Confidentiality and the Right to Access and Reuse Health Information]. ACTA MEDICA PORT 2019; 32:11-13. [PMID: 30753797 DOI: 10.20344/amp.10958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/30/2018] [Indexed: 11/20/2022]
Abstract
The authors address the legal void that exists regarding medical student access to clinical records and health information that local healthcare organizations hold under legal and institutional custody. They develop a legal thesis that configures the creation of medical student professional secrecy and its connection with the duty of confidentiality as assumptions that underlie the medical student's right to access and reuse health information. Medical students have the legitimacy to access health information and clinical records, as they bear an unequivocal informational, legitimate, constitutionally protected and sufficiently relevant need. They conclude that the legislature must work together with universities and hospital institutions to legally establish the concept of Medical Student Professional Secrecy, its link to the duty of confidentiality and the right of the medical student to access and reuse health information. Furthermore, it must do so in a specific legal act and in the precise terms of the text approved unanimously by the Council of Portuguese Medical Schools, by the National Council of Medical Ethics and Deontology, by the National Council of the Portuguese Medical Association and by its President.
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Affiliation(s)
- Rui Guimarães
- MEDCIDS - Department of Community Medicine, Health Information and Decision. Faculty of Medicine. University of Porto. Porto; Departament of Urology. University Hospital Center of São João. Porto; CISPFEM - Department of Public Health and Forensic Sciences and Medical Education. Faculty of Medicine. University of Porto. Porto. Portugal
| | - Miguel Guimarães
- Departament of Urology. University Hospital Center of São João. Porto. President. Portuguese Medical Association. Lisboa. Portugal
| | - Nuno Sousa
- President. School of Medicine. University of Minho. Braga. Director. Clinical Academic Center (2CA). Braga. Portugal
| | - Amélia Ferreira
- CISPFEM - Department of Public Health and Forensic Sciences and Medical Education. Faculty of Medicine. University of Porto. Porto. Dean. Faculty of Medicine. University of Porto. Porto. Coordinator. Council of Portuguese Medical Schools. Porto. Portugal
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25
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Al-Mahrezi A, Baddar S, Al-Siyabi S, Al-Kindi S, Al-Zakwani I, Al-Rawas O. Asthma Clinics in Primary Healthcare Centres in Oman: Do they make a difference? Sultan Qaboos Univ Med J 2018; 18:e137-e142. [PMID: 30210841 DOI: 10.18295/squmj.2018.18.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/07/2018] [Accepted: 03/25/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives This study aimed to determine the effect of newly established asthma clinics (ACs) on asthma management at primary healthcare centres (PHCs) in Oman. Methods This retrospective cross-sectional study was conducted between June 2011 and May 2012 in seven PHCs in the Seeb wilayat of Muscat, Oman. All ≥6-year-old asthmatic patients visiting these PHCs during the study period were included. Electronic medical records were reviewed to determine which clinical assessment and management components had been documented. Results A total of 452 asthmatic patients were included in the study. The mean age was 35 ± 21 years old (range: 6-95 years) and the majority (57%) were female. In total, 288 (64%) cases were managed at ACs and 164 (36%) were managed at general clinics (GCs). Significant differences were noted in the documentation of cases managed at ACs compared to those at GCs, including history-taking information regarding signs and symptoms (91% versus 19%; P <0.001), trigger factors (79% versus 16%; P <0.001) and a history of atopy (81% versus 17%; P <0.001), smoking (61% versus 7%; P <0.001), asthma exacerbations (73% versus 10%; P <0.001) or previous admissions (63% versus 10%; P <0.001). Furthermore, prescription rates of inhaled corticosteroids (72% versus 61%; P = 0.021) and short-acting β-agonists (93% versus 82%; P = 0.001) were significantly higher at ACs compared to GCs. Conclusion Overall, the findings indicated that ACs have had a positive impact on asthma management at the studied PHCs.
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Affiliation(s)
- Abdulaziz Al-Mahrezi
- Department of Family Medicine & Public Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sawsan Baddar
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sheikha Al-Siyabi
- Directorate General of Primary Health Care, Ministry of Health, Muscat, Oman
| | - Safaa Al-Kindi
- Directorate General of Primary Health Care, Ministry of Health, Muscat, Oman
| | - Ibrahim Al-Zakwani
- Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Omar Al-Rawas
- Department of Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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Jasinski MJ, Lumley MA, Soman S, Yee J, Ketterer MW. Family Consultation to Reduce Early Hospital Readmissions among Patients with End Stage Kidney Disease: A Randomized Controlled Trial. Clin J Am Soc Nephrol 2018; 13:850-857. [PMID: 29636355 PMCID: PMC5989676 DOI: 10.2215/cjn.08450817] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 03/22/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The US Centers for Medicare and Medicaid Services have mandated reducing early (30-day) hospital readmissions to improve patient care and reduce costs. Patients with ESKD have elevated early readmission rates, due in part to complex medical regimens but also cognitive impairment, literacy difficulties, low social support, and mood problems. We developed a brief family consultation intervention to address these risk factors and tested whether it would reduce early readmissions. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS One hundred twenty hospitalized adults with ESKD (mean age=58 years; 50% men; 86% black, 14% white) were recruited from an urban, inpatient nephrology unit. Patients were randomized to the family consultation (n=60) or treatment-as-usual control (n=60) condition. Family consultations, conducted before discharge at bedside or via telephone, educated the family about the patient's cognitive and behavioral risk factors for readmission, particularly cognitive impairment, and how to compensate for them. Blinded medical record reviews were conducted 30 days later to determine readmission status (primary outcome) and any hospital return visit (readmission, emergency department, or observation; secondary outcome). Logistic regressions tested the effects of the consultation versus control on these outcomes. RESULTS Primary analyses were intent-to-treat. The risk of a 30-day readmission after family consultation (n=12, 20%) was 0.54 compared with treatment-as-usual controls (n=19, 32%), although this effect was not statistically significant (odds ratio, 0.54; 95% confidence interval, 0.23 to 1.24; P=0.15). A similar magnitude, nonsignificant result was observed for any 30-day hospital return visit: family consultation (n=19, 32%) versus controls (n=28, 47%; odds ratio, 0.53; 95% confidence interval, 0.25 to 1.1; P=0.09). Per protocol analyses (excluding three patients who did not receive the assigned consultation) revealed similar results. CONCLUSIONS A brief consultation with family members about the patient's cognitive and psychosocial risk factors had no significant effect on 30-day hospital readmission in patients with ESKD.
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Affiliation(s)
- Matthew J. Jasinski
- Department of Psychology, Wayne State University, Detroit, Michigan; and Departments of
| | - Mark A. Lumley
- Department of Psychology, Wayne State University, Detroit, Michigan; and Departments of
| | | | | | - Mark W. Ketterer
- Psychiatry, Henry Ford Hospital, Henry Ford Health System, Detroit, Michigan
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Mashoufi M, Ayatollahi H, Khorasani-Zavareh D. A Review of Data Quality Assessment in Emergency Medical Services. Open Med Inform J 2018; 12:19-32. [PMID: 29997708 PMCID: PMC5997849 DOI: 10.2174/1874431101812010019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/22/2018] [Accepted: 05/15/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Data quality is an important issue in emergency medicine. The unique characteristics of emergency care services, such as high turn-over and the speed of work may increase the possibility of making errors in the related settings. Therefore, regular data quality assessment is necessary to avoid the consequences of low quality data. This study aimed to identify the main dimensions of data quality which had been assessed, the assessment approaches, and generally, the status of data quality in the emergency medical services. METHODS The review was conducted in 2016. Related articles were identified by searching databases, including Scopus, Science Direct, PubMed and Web of Science. All of the review and research papers related to data quality assessment in the emergency care services and published between 2000 and 2015 (n=34) were included in the study. RESULTS The findings showed that the five dimensions of data quality; namely, data completeness, accuracy, consistency, accessibility, and timeliness had been investigated in the field of emergency medical services. Regarding the assessment methods, quantitative research methods were used more than the qualitative or the mixed methods. Overall, the results of these studies showed that data completeness and data accuracy requires more attention to be improved. CONCLUSION In the future studies, choosing a clear and a consistent definition of data quality is required. Moreover, the use of qualitative research methods or the mixed methods is suggested, as data users' perspectives can provide a broader picture of the reasons for poor quality data.
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Affiliation(s)
- Mehrnaz Mashoufi
- PhD Student of Health Information Management, School of Health Management and Information Sciences, Tehran Iran University of Medical Sciences, Tehran, Iran
| | - Haleh Ayatollahi
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Davoud Khorasani-Zavareh
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Health in Disaster and Emergency, School of HSE, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Aggarwal A, Garhwal S, Kumar A. HEDEA: A Python Tool for Extracting and Analysing Semi-structured Information from Medical Records. Healthc Inform Res 2018; 24:148-153. [PMID: 29770248 PMCID: PMC5944189 DOI: 10.4258/hir.2018.24.2.148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 01/14/2018] [Accepted: 01/24/2018] [Indexed: 11/23/2022] Open
Abstract
Objectives One of the most important functions for a medical practitioner while treating a patient is to study the patient's complete medical history by going through all records, from test results to doctor's notes. With the increasing use of technology in medicine, these records are mostly digital, alleviating the problem of looking through a stack of papers, which are easily misplaced, but some of these are in an unstructured form. Large parts of clinical reports are in written text form and are tedious to use directly without appropriate pre-processing. In medical research, such health records may be a good, convenient source of medical data; however, lack of structure means that the data is unfit for statistical evaluation. In this paper, we introduce a system to extract, store, retrieve, and analyse information from health records, with a focus on the Indian healthcare scene. Methods A Python-based tool, Healthcare Data Extraction and Analysis (HEDEA), has been designed to extract structured information from various medical records using a regular expression-based approach. Results The HEDEA system is working, covering a large set of formats, to extract and analyse health information. Conclusions This tool can be used to generate analysis report and charts using the central database. This information is only provided after prior approval has been received from the patient for medical research purposes.
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Affiliation(s)
- Anshul Aggarwal
- Department of Computer Science and Engineering, Thapar Institute of Engineering and Technology, Patiala, India
| | - Sunita Garhwal
- Department of Computer Science and Engineering, Thapar Institute of Engineering and Technology, Patiala, India
| | - Ajay Kumar
- Department of Computer Science and Engineering, Thapar Institute of Engineering and Technology, Patiala, India
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Affiliation(s)
- Bryan M Tucker
- Department of Internal Medicine, Section on Nephrology; Wake Forest School of Medicine, Winston-Salem, North Carolina
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30
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Ceusters W, Blaisure J. Caveats for the Use of the Active Problem List as Ground Truth for Decision Support. Stud Health Technol Inform 2018; 255:10-14. [PMID: 30306897] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Diagnoses recorded on the problem list are increasingly being used for decision support applications. To obtain insight in the adequacy of the clinical user interface to capture what the clinician has in mind, and to reconstruct the clinical reality of the patient, we analyzed in the database of an EHR system the transactions that resulted from managing the problem list. Our findings indicate (1) that caution is required when using the evolution of the problem list for determining comorbidity or ongoing disease, and (2) that similarities or differences in problem list annotation sequences do not always correspond with similarities resp. differences in disease courses. It is to be investigated whether automatically identifiable subsets of problem list evolution patterns exist from which ground truth reliably can be inferred or whether clinicians need more education in how problem list user interfaces should be used to avoid erroneous interpretations by clinical decision support applications.
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Affiliation(s)
- Werner Ceusters
- Department of Biomedical Informatics, University at Buffalo, Buffalo, NY, USA
| | - Jonathan Blaisure
- Department of Biomedical Informatics, University at Buffalo, Buffalo, NY, USA
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Elder NC, Imhoff R, Chubinski J, Jacobson CJ Jr, Pallerla H, Saric P, Rotenberg V, Vonder Meulen MB, Leonard AC, Carrozza M, Regan S. Congruence of Patient Self-Rating of Health with Family Physician Ratings. J Am Board Fam Med 2017; 30:196-204. [PMID: 28379826 DOI: 10.3122/jabfm.2017.02.160243] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/08/2016] [Accepted: 11/14/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND A single self-rated health (SRH) question is associated with health outcomes, but agreement between SRH and physician-rated patient health (PRPH) has been poorly studied. We studied patient and physician reasoning for health ratings and the role played by patient lifestyle and objective health measures in the congruence between SRH and PRPH. METHODS Surveys of established family medicine patients and their physicians, and medical record review at 4 offices. Patients and physicians rated patient health on a 5-point scale and gave reasons for the rating and suggestions for improving health. Patients' and physicians' reasons for ratings and improvement suggestions were coded into taxonomies developed from the data. Bivariate relationships between the variables and the difference between SRH and PRPH were examined and all single predictors of the difference were entered into a multivariable regression model. RESULTS Surveys were completed by 506 patients and 33 physicians. SRH and PRPH ratings matched exactly for 38% of the patient-physician dyads. Variables associated with SRH being lower than PRPH were higher patient body mass index (P = .01), seeing the physician previously (P = .04), older age, (P < .001), and a higher comorbidity score (P = .001). Only 25.7% of the dyad reasons for health status rating and 24.1% of needed improvements matched, and these matches were unrelated to SRH/PRPH agreement. Physicians focused on disease in their reasoning for most patients, whereas patients with excellent or very good SRH focused on feeling well. CONCLUSIONS Patients' and physicians' beliefs about patient health frequently lack agreement, confirming the need for shared decision making with patients.
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Hovenga E, Grain H. Connecting PHRs and EHRs for a Sustainable National Health System. Stud Health Technol Inform 2017; 245:1228. [PMID: 29295315] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An EHR for integrated care (IEHR) is defined by the International Organization for Standardization (ISO) [1]: "…a repository of information regarding the health status of a subject of care, in computer processable form, stored and transmitted securely, and accessible by multiple authorised users, having a standardized or commonly agreed logical information model that is independent of EHR systems and whose primary purpose is the support of continuing, efficient and quality integrated health care. It contains information which is retrospective, concurrent and prospective." We need to differentiate between EMR/EHR and the lifelong PHR in terms of type of data storage, sharing and use [2-3].
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Affiliation(s)
- Evelyn Hovenga
- eHealth Education Pty Ltd, East Melbourne, Victoria, Australia
| | - Heather Grain
- eHealth Education Pty Ltd, East Melbourne, Victoria, Australia
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Brammen D, Dewenter H, Thiemann V, Majeed RW, Xu T, Heitmann KU, Walcher F, Thun S, Röhrig R. Disseminating a Standard for Medical Records in Emergency Departments Among Different Software Vendors Using HL7 CDA. Stud Health Technol Inform 2017; 243:132-136. [PMID: 28883186] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A standardized medical record for the emergency department (GEDMR) was released in Germany, but only sparsely and randomly implemented by emergency department (ED) electronic health record (EHR) vendors. A reason for this may be a lacking common language between the medical and the Health Information Technology (HIT) domain. HL7 clinical document architecture (CDA) may leverage this communication gap. This paper reports on the effects of a professional medical association record standard on EHR vendors and the German ED-EHR market. Standard records and data standards are developed and published by different institutions either on governmental, healthcare agency or medical association level. There are some standard records, especially by US cardiology associations, transformed into HL7 C-CDA. GEDMR was modeled as HL7 CDA with the use of interoperable terminologies like LOINC and SNOMED CT. Being part of an emergency department data registry development project, local deployment at 15 project hospitals receiving sufficient funding was performed. Two major ED-EHR vendors adapted GEDMR within their product including CDA export. 106,868 CDAs were produced in six hospitals until now. Four local implementations with four different ED-EHRs were developed, producing 42,256 CDAs. Five additional vendors are adapting or developing an ED-EHR. The GEDMR-CDA implementation guide with funding for implementation in project hospitals had a significant impact on the German ED-EHR market. Within two years after release, a broadening and increasingly self-enforcing support by German ED-EHR vendors is notable.
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Affiliation(s)
- Dominik Brammen
- Department of Trauma Surgery, Otto-von-Guericke-University Magdeburg, Germany
| | - Heike Dewenter
- Hochschule Niederrhein, University of Applied Sciences, Krefeld, Germany
| | - Volker Thiemann
- Department of Medical Informatics, Carl von Ossietzky University Oldenburg, Germany
| | - Raphael W Majeed
- Department of Medical Informatics, Carl von Ossietzky University Oldenburg, Germany
| | - Tingyan Xu
- Department of Medical Informatics, Carl von Ossietzky University Oldenburg, Germany
| | | | - Felix Walcher
- Department of Trauma Surgery, Otto-von-Guericke-University Magdeburg, Germany
| | - Sylvia Thun
- Hochschule Niederrhein, University of Applied Sciences, Krefeld, Germany
| | - Rainer Röhrig
- Department of Medical Informatics, Carl von Ossietzky University Oldenburg, Germany
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Márquez Fosser S, Gaiera A, Otero C, Benitez S, Luna D, Quiroz F. Automatic Loading of Problems Using a Comorbidities Subset: One Step to Organize and Maintain the Patient's Problem List. Stud Health Technol Inform 2017; 245:1358. [PMID: 29295437] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An accurate and updated problems' list is critical in a problem-oriented Electronic Health Record (EHR). The lack of organization and maintenance of the problems limits its value. Certain problems have a larger effect on the clinical evolution of the patient, these are known as Comorbidities. The aim of this paper is to evaluate the impact of the automatic loading of comorbidities in the organization and maintenance of inpatient problems' list using a comorbidities subset.
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Affiliation(s)
| | - Alejandro Gaiera
- Departamento de Informática en Salud, Hospital Italiano de Buenos Aires
| | - Carlos Otero
- Departamento de Informática en Salud, Hospital Italiano de Buenos Aires
| | - Sonia Benitez
- Departamento de Informática en Salud, Hospital Italiano de Buenos Aires
| | - Daniel Luna
- Departamento de Informática en Salud, Hospital Italiano de Buenos Aires
| | - Fernán Quiroz
- Departamento de Informática en Salud, Hospital Italiano de Buenos Aires
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Feely MA, Hildebrandt D, Edakkanambeth Varayil J, Mueller PS. Prevalence and Contents of Advance Directives of Patients with ESRD Receiving Dialysis. Clin J Am Soc Nephrol 2016; 11:2204-2209. [PMID: 27856490 PMCID: PMC5142080 DOI: 10.2215/cjn.12131115] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 07/26/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES ESRD requiring dialysis is associated with increased morbidity and mortality rates, including increased rates of cognitive impairment, compared with the general population. About one quarter of patients receiving dialysis choose to discontinue dialysis at the end of life. Advance directives are intended to give providers and surrogates instruction on managing medical decision making, including end of life situations. The prevalence of advance directives is low among patients receiving dialysis. Little is known about the contents of advance directives among these patients with advance directives. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We retrospectively reviewed the medical records of all patients receiving maintenance in-center hemodialysis at a tertiary academic medical center between January 1, 2007 and January 1, 2012. We collected demographic data, the prevalence of advance directives, and a content analysis of these advance directives. We specifically examined the advance directives for instructions on management of interventions at end of life, including dialysis. RESULTS Among 808 patients (mean age of 68.6 years old; men =61.2%), 49% had advance directives, of which only 10.6% mentioned dialysis and only 3% specifically addressed dialysis management at end of life. Patients who had advance directives were more likely to be older (74.5 versus 65.4 years old; P<0.001) and have died during the study period (64.4% versus 46.6%; P<0.001) than patients who did not have advance directives. Notably, for patients receiving dialysis who had advance directives, more of the advance directives addressed cardiopulmonary resuscitation (44.2%), mechanical ventilation (37.1%), artificial nutrition and hydration (34.3%), and pain management (43.4%) than dialysis (10.6%). CONCLUSIONS Although one-half of the patients receiving dialysis in our study had advance directives, end of life management of dialysis was rarely addressed. Future research should focus on improving discernment and documentation of end of life values, goals, and preferences, such as dialysis-specific advance directives, among these patients.
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Affiliation(s)
- Molly A. Feely
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; and
| | | | | | - Paul S. Mueller
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; and
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Macías Saint-Gerons D, de la Fuente Honrubia C, de Andrés Trelles F, Catalá-López FCL. [Future Perspective of Pharmacoepidemiology in the "Big Data Era" and the Growth of Information Sources]. Rev Esp Salud Publica 2016; 90:e1-e7. [PMID: 27905352] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 11/29/2016] [Indexed: 06/06/2023] Open
Abstract
The arrival of new drug into the market requires many years of previous research along with the need of continuous evaluation throughout the lifetime of the drug. This warrants pharmacoepidemiological research which may be defined as the study of the use and the effects of drugs in large populations. Nowadays this type of research seems more feasible thanks to the massive expansion of the information sources and data (e.g: clinical patient registries, electronic medical records). However there is a risk of information overload, fragmented evidence and given the enthusiasm aroused by the "Big Data", it must be emphasized that its nature is mainly observational, and therefore subject to bias and confusion. The application of epidemiological methods in this scenario seems essential for any analysis. In short, the management and use of these data sources to generate useful information expansion is the next challenge for the application of research methods in modern pharmacoepidemiology.
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Affiliation(s)
- Diego Macías Saint-Gerons
- División de Farmacoepidemiología y Farmacovigilancia. Agencia Española de Medicamentos y Productos Sanitarios (AEMPS). Madrid.
| | - César de la Fuente Honrubia
- Área de Estabilidad Presupuestaria. Subdirección General de Análisis Presupuestario y Organización Institucional del Sector Público Autonómico. Secretaría General de Coordinación Autonómica y Local. Ministerio de Hacienda y Administraciones Públicas. Madrid. España
| | | | - Ferrán Catalá-López Catalá-López
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI). Ottawa. Ontario. Canadá
- Fundación Instituto de Investigación en Servicios de Salud. Valencia. España
- Departamento de Medicina. Universidad de Valencia/Instituto de Investigación Sanitaria INCLIVA y CIBERSAM. Valencia. España
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Heiden-Rootes KM, Salas J, Scherrer JF, Schneider FD, Smith CW. Comparison of Medical Diagnoses among Same-Sex and Opposite-Sex-Partnered Patients. J Am Board Fam Med 2016; 29:688-93. [PMID: 28076251 DOI: 10.3122/jabfm.2016.06.160047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/26/2016] [Accepted: 05/02/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Health disparities for gay and lesbian individuals are well documented in survey research. However, a limitation throughout the existing literature is the reliance on self-reported health conditions. This study used medical record diagnoses for gay and lesbian patients seen in primary care clinics. METHODS This study used medical records of primary care patients (n = 31,569) seen at Midwestern, university-affiliated primary care clinics. First, all records with information about the sexual partnering of the patient were identified (n = 13,509). Then, opposite-sex-partnered and same-sex-partnered (SSP) patients were compared for prevalence of common chronic conditions and clinic utilization. RESULTS Only 44.20% of medical records included information about patients' sexual partners. Both male and female SSP patients were more likely to be lower socioeconomic status, be a current or former smoker, and be diagnosed with substance abuse/dependence and depression. CONCLUSIONS The findings suggest the need for more consistent screening of the sexual partnering of patients for identifying patients who are at greater risk of poorer health outcomes. However, identifying the sexual partnering of patients may not occur systematically in primary care, and there may be a lack of disclosure by SSP patients to their physicians given the social stigma about same-sex relationships.
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Tuot DS, Zhu Y, Velasquez A, Espinoza J, Mendez CD, Banerjee T, Hsu CY, Powe NR. Variation in Patients' Awareness of CKD according to How They Are Asked. Clin J Am Soc Nephrol 2016; 11:1566-1573. [PMID: 27340288 PMCID: PMC5012470 DOI: 10.2215/cjn.00490116] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/06/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Awareness of CKD is necessary for patient engagement and adherence to medical regimens. Having an accurate tool to assess awareness is important. Use of the National Health and Nutrition Examination Survey (NHANES) CKD awareness question "Have you ever been told by a doctor or other health professional that you had weak or failing kidneys (excluding kidney stones, bladder infections, or incontinence)?" produces surprisingly low measures of CKD awareness. We sought to compare the sensitivity and specificity of different questions ascertaining awareness of CKD and other health conditions. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Between August of 2011 and August of 2014, an in-person questionnaire was administered to 220 adults with CKD, diabetes, hypertension, or hyperlipidemia who received primary care in a public health care delivery system to ascertain awareness of each condition. CKD awareness was measured using the NHANES question, and other questions, asking if patients knew about their "kidney disease", "protein in the urine", "kidney problem", or "kidney damage." Demographic data were self-reported; health literacy was measured. The sensitivity and specificity of each question was calculated using the medical record as the gold standard. RESULTS In this diverse population (9.6% white, 40.6% black, 36.5% Hispanic, 12.3% Asian), the mean age was 58 years, 30% had a non-English language preference, and 45% had low health literacy. Eighty percent of participants had CKD, with a mean eGFR of 47.2 ml/min per 1.73 m(2). The sensitivities of each CKD awareness question were: 26.4% for "kidney damage", 27.7% for "kidney disease", 33.2% for "weak or failing kidneys", 39.8% for "protein in the urine", and 40.1% for "kidney problem." Specificities ranged from 82.2% to 97.6%. The best two-question combination yielded a sensitivity of 53.1% and a specificity of 83.3%. This was lower than awareness of hypertension (90.1%) or diabetes (91.8%). CONCLUSIONS CKD awareness is low compared with other chronic diseases regardless of how it is ascertained. Nevertheless, more sensitive questions to ascertain CKD awareness suggest current under-ascertainment.
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Affiliation(s)
| | - Yunnuo Zhu
- Center for Vulnerable Populations, and
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | | | | | | | - Tanushree Banerjee
- Center for Vulnerable Populations, and
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | | | - Neil R. Powe
- Center for Vulnerable Populations, and
- Department of Medicine, University of California, San Francisco, San Francisco, California
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Abstract
Because they do not rank highly in the hierarchy of evidence and are not frequently cited, case reports describing the clinical circumstances of single patients are seldom published by medical journals. However, many clinicians argue that case reports have significant educational value, advance medical knowledge, and complement evidence-based medicine. Over the last several years, a vast number (∼160) of new peer-reviewed journals have emerged that focus on publishing case reports. These journals are typically open access and have relatively high acceptance rates. However, approximately half of the publishers of case reports journals engage in questionable or "predatory" publishing practices. Authors of case reports may benefit from greater awareness of these new publication venues as well as an ability to discriminate between reputable and non-reputable journal publishers.
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Abstract
BACKGROUND Death of a baby in-utero is a very devastating event to the mother and the family. Most stillbirths occur during labor and birth with other deaths occurring during the antenatal period. Millions of families experience stillbirths, yet these deaths remain uncounted, and policies have not been clearly stipulated to address this issue. The aim of the study was to identify the possible causes of stillbirths as recorded in the medical records. METHODS A retrospective study looking at medical records of women who experienced stillbirths between 1(st) January 2009 and 31(st) December 2013 at Nyeri Provincial General Hospital, Kenya. The hospital records containing cases of stillbirths were retrieved and data abstraction forms were used to collect data and information. RESULTS Both fresh and macerated stillbirths were equally common. The stillbirth rate was 12.2 per 1,000 births. There was significant association between stillbirths and the clients who were referred and reason for referral, (p=0.029) and (p=0.005), respectively. The number of ANC visits during pregnancy was also significant (p=0.05). Mode of delivery and the reason for cesarean section were significantly associated with stillbirths, (p=0.003) and (p=0.032), respectively. The type of labor and delivery complications experienced was associated with stillbirths (p= 0.022). CONCLUSION AND GLOBAL HEALTH IMPLICATIONS There were several factors associated with stillbirths thus efforts should be made to establish approaches aimed at prevention. Addressing the causes of stillbirths will contribute to reduction of perinatal mortality.
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Affiliation(s)
- Joyce J Cheptum
- Dedan Kimathi University of Technology, School of Health Sciences, Department of Nursing, P.O Box 657-10100, Nyeri, KENYA
| | - Nelly Muiruri
- Nyeri Provincial General Hospital, P.O Box 27-10100, Nyeri, KENYA
| | - Ernest Mutua
- Dedan Kimathi University of Technology, School of Health Sciences, Department of Nursing, P.O Box 657-10100, Nyeri, KENYA
| | - Moses Gitonga
- Dedan Kimathi University of Technology, School of Health Sciences, Department of Nursing, P.O Box 657-10100, Nyeri, KENYA
| | - Mwangi Juma
- Nyeri Provincial General Hospital, P.O Box 27-10100, Nyeri, KENYA
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Pocetta G, Votino A, Biribanti A, Rossi A. Recording Non Communicable Chronic Diseases at Risk Behaviours in General Practice. A qualitative study using the PRECEDE-PROCEED Model. Ann Ig 2015; 27:554-61. [PMID: 26152542 DOI: 10.7416/ai.2015.2047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Full, accurate registration of behavioral risk factors in patients is essential for good quality preventive action in General Practice. In addition, the GP's records are useful for epidemiological surveillance of risk behavior and assessment of preventive actions in the community and also for the accurate Case Management in the Continuity of Care perspective. Up to date, very little research has been carried out in Italy in this area. METHODS The PRECEDE-PROCEED model was used to analyze data of a semi-structured interview of purposively selected Italian GPs. PRECEDE, the diagnostic component of the model, was used to highlight factors that affected their recording of behavioral risk lifestyles. The PRECEDE framework distinguishes three categories of factors influencing behavior: Predisposing (wanting to do), Reinforcing Factors (rewards for doing) and Enabling Factors (being able to do) 2. RESULTS The Predisposing Factors were identified as the GPs' positive attitude to writing up structured, systematic records of patient data and the low attitude towards registration of the behavioural risk factors with respect to clinical data. Enabling Factors were: the high load of paperwork; the requirement for quantitative registration of certain factors; the software information structure which limited recording of some risk behaviors. Reinforcing Factors were the GPs perception that patients were reluctant to providing data on their behavior and that they as GPs did not have enough incentives for this work; current local epidemiology selectively focused physicians' attention on recording behaviours related to prevalent diseases. CONCLUSIONS It has been possible to identify ways to improve the quality of GPs records of behavioral risk factors in patients: 1)equipping computer systems with detection procedures to guide GP recordings : 2) training to improve the GP's awareness and attitude and 3) incentives that are not only financial but also linked to professional development.
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Affiliation(s)
- Giancarlo Pocetta
- Department of Experimental Medicine, Research Centre for Health Promotion and Health Education, University of Perugia, Italy
| | - Antonio Votino
- Department of Experimental Medicine, Research Centre for Health Promotion and Health Education, University of Perugia, Italy
| | - Alessia Biribanti
- Department of Experimental Medicine, Research Centre for Health Promotion and Health Education, University of Perugia, Italy
| | - Alessandro Rossi
- Italian College of General Practice and Primary Care, Florence, Italy
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Ajami S, Ketabi S, Torabiyan F. Performance improvement indicators of the Medical Records Department and Information Technology (IT) in hospitals. Pak J Med Sci 2015; 31:717-20. [PMID: 26150874 PMCID: PMC4485301 DOI: 10.12669/pjms.313.8005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 02/19/2015] [Accepted: 03/17/2015] [Indexed: 11/16/2022] Open
Abstract
Medical Record Department (MRD) has a vital role in making short and long term plans to improve health system services. The aim of this study was to describe performance improvement indicators of hospital MRD and information technology (IT).
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Affiliation(s)
- Sima Ajami
- Sima Ajami, Ph.D. Professor, Department of Health Information Technology, School of Medical Management and Information Sciences, Isfahan University of Medical Sciences, Hezarjerib Avenue, Isfahan, Iran
| | - Saedeh Ketabi
- Saedeh Ketabi, Ph.D. Associate Professor, Dept. of Management, School of Administrative Sciences and Economics, University of Isfahan, Isfahan, Iran
| | - Fatemeh Torabiyan
- Fatemeh Torabiyan, Master student of Health Information Technology, Isfahan University of Medical Sciences, Hezarjerib Avenue, Isfahan, Iran
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Moon S, McInnes B, Melton GB. Challenges and practical approaches with word sense disambiguation of acronyms and abbreviations in the clinical domain. Healthc Inform Res 2015; 21:35-42. [PMID: 25705556 PMCID: PMC4330198 DOI: 10.4258/hir.2015.21.1.35] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 01/19/2015] [Indexed: 11/24/2022] Open
Abstract
Objectives Although acronyms and abbreviations in clinical text are used widely on a daily basis, relatively little research has focused upon word sense disambiguation (WSD) of acronyms and abbreviations in the healthcare domain. Since clinical notes have distinctive characteristics, it is unclear whether techniques effective for acronym and abbreviation WSD from biomedical literature are sufficient. Methods The authors discuss feature selection for automated techniques and challenges with WSD of acronyms and abbreviations in the clinical domain. Results There are significant challenges associated with the informal nature of clinical text, such as typographical errors and incomplete sentences; difficulty with insufficient clinical resources, such as clinical sense inventories; and obstacles with privacy and security for conducting research with clinical text. Although we anticipated that using sophisticated techniques, such as biomedical terminologies, semantic types, part-of-speech, and language modeling, would be needed for feature selection with automated machine learning approaches, we found instead that simple techniques, such as bag-of-words, were quite effective in many cases. Factors, such as majority sense prevalence and the degree of separateness between sense meanings, were also important considerations. Conclusions The first lesson is that a comprehensive understanding of the unique characteristics of clinical text is important for automatic acronym and abbreviation WSD. The second lesson learned is that investigators may find that using simple approaches is an effective starting point for these tasks. Finally, similar to other WSD tasks, an understanding of baseline majority sense rates and separateness between senses is important. Further studies and practical solutions are needed to better address these issues.
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Affiliation(s)
- Sungrim Moon
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Bridget McInnes
- Department of Computer Science, Virginia Commonwealth University, Richmond, VA, USA
| | - Genevieve B Melton
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA. ; Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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Oluoch T, Katana A, Ssempijja V, Kwaro D, Langat P, Kimanga D, Okeyo N, Abu-Hanna A, de Keizer N. Electronic medical record systems are associated with appropriate placement of HIV patients on antiretroviral therapy in rural health facilities in Kenya: a retrospective pre-post study. J Am Med Inform Assoc 2014; 21:1009-14. [PMID: 24914014 PMCID: PMC4215039 DOI: 10.1136/amiajnl-2013-002447] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 04/14/2014] [Accepted: 05/14/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVE There is little evidence that electronic medical record (EMR) use is associated with better compliance with clinical guidelines on initiation of antiretroviral therapy (ART) among ART-eligible HIV patients. We assessed the effect of transitioning from paper-based to an EMR-based system on appropriate placement on ART among eligible patients. METHODS We conducted a retrospective, pre-post EMR study among patients enrolled in HIV care and eligible for ART at 17 rural Kenyan clinics and compared the: (1) proportion of patients eligible for ART based on CD4 count or WHO staging who initiate therapy; (2) time from eligibility for ART to ART initiation; (3) time from ART initiation to first CD4 test. RESULTS 7298 patients were eligible for ART; 54.8% (n=3998) were enrolled in HIV care using a paper-based system while 45.2% (n=3300) were enrolled after the implementation of the EMR. EMR was independently associated with a 22% increase in the odds of initiating ART among eligible patients (adjusted OR (aOR) 1.22, 95% CI 1.12 to 1.33). The proportion of ART-eligible patients not receiving ART was 20.3% and 15.1% for paper and EMR, respectively (χ(2)=33.5, p<0.01). Median time from ART eligibility to ART initiation was 29.1 days (IQR: 14.1-62.1) for paper compared to 27 days (IQR: 12.9-50.1) for EMR. CONCLUSIONS EMRs can improve quality of HIV care through appropriate placement of ART-eligible patients on treatment in resource limited settings. However, other non-EMR factors influence timely initiation of ART.
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Affiliation(s)
- Tom Oluoch
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention,Nairobi, Kenya
| | - Abraham Katana
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention,Nairobi, Kenya
| | - Victor Ssempijja
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention,Nairobi, Kenya
| | - Daniel Kwaro
- Kenya Medical Research Institute, CDC Collaborative Program, Kisumu, Kenya
| | - Patrick Langat
- Kenya Medical Research Institute, CDC Collaborative Program, Kisumu, Kenya
| | - Davies Kimanga
- Ministry of Health, National AIDS and STI Control Program, Nairobi, Kenya
| | - Nicky Okeyo
- Kenya Medical Research Institute, CDC Collaborative Program, Kisumu, Kenya
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicolette de Keizer
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Abstract
During patient care rounds with the medical team, pharmacy students have made positive contributions for the benefit of the patient. However, very little has been documented regarding the impact these future healthcare professionals are making while on clinical rotations. The objective of this study was to assess the impact that clinical interventions made by 6th year pharmacy students had on overall patient outcome. Using a special program for a personal digital assistant (PDA), the students daily recorded the pharmacotherapeutic interventions they made. The interventions ranged from dosage adjustments to providing drug information. Data was collected over a 12-week period from various hospitals and clinics in the Jacksonville, Florida area. In total, there were 89 pharmaceutical interventions performed and recorded by the students. Fifty interventions involved drug modification and fifty-four interventions were in regards to drug information and consulting. Of the drug information and consulting interventions, 15 were drug modification. This study shows the impact pharmacy students make in identifying, recommending, and documenting clinical pharmacotherapeutic interventions. Similar to pharmacists, pharmacy students can also have a positive contribution towards patient care.
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Affiliation(s)
- Elicia D King
- College of Pharmacy and Pharmaceutical Sciences, Florida Agricultural and Mechanical University . Jacksonville, FL ( USA )
| | - Mamie A Wilson
- College of Pharmacy and Pharmaceutical Sciences, Florida Agricultural and Mechanical University . Jacksonville, FL ( USA )
| | - Linh Van
- College of Pharmacy and Pharmaceutical Sciences, Florida Agricultural and Mechanical University . Jacksonville, FL ( USA )
| | - Frank S Emanuel
- Division Director and Assistant Professor of Pharmacy Practice. College of Pharmacy and Pharmaceutical Sciences, Florida Agricultural and Mechanical University . Jacksonville, FL ( USA )
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Crook M, Ajdukovic M, Angley C, Soulsby N, Doecke C, Stupans I, Angley M. Eliciting comprehensive medication histories in the emergency department: the role of the pharmacist. Pharm Pract (Granada) 2014; 5:78-84. [PMID: 25214922 PMCID: PMC4155155 DOI: 10.4321/s1886-36552007000200005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The Australian Pharmaceutical Advisory Committee guidelines call for a detailed medication history to be taken at the first point of admission to hospital. Accurate medication histories are vital in optimising health outcomes and have been shown to reduce mortality rates. This study aimed to examine the accuracy of medication histories taken in the Emergency Department of the Royal Adelaide Hospital. Medication histories recorded by medical staff were compared to those elicited by a pharmacy researcher. The study, conducted over a six-week period, included 100 patients over the age of 70, who took five or more regular medications, had three or more clinical co-morbidities and/or had been discharged from hospital in three months prior to the study. Following patient interviews, the researcher contacted the patient's pharmacist and GP for confirmation and completion of the medication history. Out of the 1152 medications recorded as being used by the 100 patients, discrepancies were found for 966 medications (83.9%). There were 563 (48.9%) complete omissions of medications. The most common discrepancies were incomplete or omitted dosage and frequency information. Discrepancies were mostly medications that treated dermatological and ear, nose and throat disorders but approximately 29% were used to treat cardiovascular disorders. This study provides support for the presence of an Emergency Department pharmacist who can compile a comprehensive and accurate medication history to enhance medication management along the continuum of care. It is recommended that the patient's community pharmacy and GP be contacted for clarification and confirmation of the medication history.
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Affiliation(s)
- Meredith Crook
- School of Pharmacy and Medical Sciences, University of South Australia . Adelaide ( Australia )
| | - Maya Ajdukovic
- School of Pharmacy and Medical Sciences, University of South Australia . Adelaide ( Australia )
| | | | - Natalie Soulsby
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia . Adelaide ( Australia )
| | - Christopher Doecke
- Director of Pharmacy Services, Royal Adelaide Hospital and School of Pharmacy and Medical Sciences, University of South Australia . Adelaide ( Australia )
| | - Ieva Stupans
- Dean Teaching and Learning, Division of Health Sciences, University of South Australia . Adelaide ( Australia )
| | - Manya Angley
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia . Adelaide ( Australia )
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Ajdukovic M, Crook M, Angley C, Stupans I, Soulsby N, Doecke C, Anderson B, Angley M. Pharmacist elicited medication histories in the Emergency Department: Identifying patient groups at risk of medication misadventure. Pharm Pract (Granada) 2014; 5:162-8. [PMID: 25170353 PMCID: PMC4147795 DOI: 10.4321/s1886-36552007000400004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The Australian Pharmaceutical Advisory Committee guidelines call for a detailed medication history to be taken at the first point of admission to an Emergency Department (ED). The elderly, in particular those residing in Residential Aged Care Facilities and those with a non-English speaking background, have been identified as patient groups vulnerable to medication misadventure.
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Affiliation(s)
- Maja Ajdukovic
- School of Pharmacy and Medical Sciences, University of South Australia . Adelaide, Australia
| | - Meredith Crook
- School of Pharmacy and Medical Sciences, University of South Australia . Adelaide, Australia
| | - Christopher Angley
- Senior Consultant in Emergency Medicine, Emergency Department, Royal Adelaide Hospital. Adelaide, Australia
| | - Ieva Stupans
- Division of Health Sciences, University of South Australia . Adelaide, Australia
| | - Natalie Soulsby
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia . Adelaide, Australia
| | - Christopher Doecke
- Director of Pharmacy Services, Royal Adelaide Hospital and School of Pharmacy and Medical Sciences, University of South Australia . Adelaide, Australia
| | - Barbara Anderson
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia . Adelaide, Australia
| | - Manya Angley
- Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia . Adelaide, Australia
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Kwon Y, Kang K, Bae C, Chung HJ, Kim JH. Lifelog agent for human activity pattern analysis on health avatar platform. Healthc Inform Res 2014; 20:69-75. [PMID: 24627821 PMCID: PMC3950268 DOI: 10.4258/hir.2014.20.1.69] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/22/2014] [Accepted: 01/23/2014] [Indexed: 11/23/2022] Open
Abstract
Objectives To provide accurate personalized medical care, it is necessary to gather individual-related data or contextual information regarding the target person. Nowadays a large number of people possess smartphones, which enables sensors in the smartphones to be used for lifelogging. The objective of the study is to analyze human activity pattern by using lifelog agent cooperating with the Health Avatar platform. Methods Using the lifelog measured by accelerometer and gyroscope in a smartphone at a 50 Hz rate, the agent reveals how long the user walks, runs, sits, stands, and lies down, and this information is summarized by hours. The summaries are sent to the Health Avatar platform and finally are written in the Continuity of Care Record (CCR) format. Results The lifelog agent is successfully operated with the Health Avatar platform. In addition, we implement an application that displays the user's activity patterns in a graph and calculates the metabolic equivalent of task based calorie burned by hour or by day using the lifelog of the CCR form to show that the lifelog can be used as medical records. Conclusions The agent shows how lifelogs are analyzed and summarized to help activity recognition. We believe that our agent demonstrates a way of incorporating lifelogs into medical care and a way of exploiting lifelogs in a medical format.
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Affiliation(s)
- Yongjin Kwon
- Human Computing Research Section, SW · Content Research Laboratory, Electronics and Telecommunications Research Institute, Daejeon, Korea
| | - Kyuchang Kang
- Human Computing Research Section, SW · Content Research Laboratory, Electronics and Telecommunications Research Institute, Daejeon, Korea
| | - Changseok Bae
- Human Computing Research Section, SW · Content Research Laboratory, Electronics and Telecommunications Research Institute, Daejeon, Korea
| | - Hee-Joon Chung
- Seoul National University Biomedical Informatics, Division of Biomedical Informatics, Seoul National University College of Medicine, Seoul, Korea
| | - Ju Han Kim
- Seoul National University Biomedical Informatics, Division of Biomedical Informatics, Seoul National University College of Medicine, Seoul, Korea
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Ehteshami A, Sadoughi F, Saeedbakhsh S, Isfahani MK. Assessment of Medical Records Module of Health Information System According to ISO 9241-10. Acta Inform Med 2013; 21:36-41. [PMID: 23572860 PMCID: PMC3612430 DOI: 10.5455/aim.2012.21.36-41] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 02/20/2013] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Hospital managers and personnel need to Hospital Information System (HIS) to increase the efficiency and effectiveness in their organization. Accurate, appropriate, precise, timely, valid information, and Suitable Information system for their tasks is required and the basis for decision making in various levels of the hospital management, since, this study was conducted to Assess of Selected HIS in Isfahan University of Medical Science Hospitals According to ISO 9241-10. METHODS This paper obtained from an applied, descriptive cross sectional study, in which the medical records module of IUMS selected HIS in Isfahan University of Medical Science affiliated seven hospitals were assessed with ISO 9241-10 questionnaire contained 7 principles and 74 items. The obtained data were analyzed with SPSS software and descriptive statistics were used to examine measures of central tendencies. RESULTS THE ANALYSIS OF DATA REVEALED THE FOLLOWING ABOUT THE SOFTWARE: Suitability for user tasks, self descriptiveness, controllability by user, Conformity with user expectations, error tolerance, suitability for individualization, and suitability for user learning, respectively, was 68, 67, 70, 74, 69, 53, and 68 percent. Total compliance with ISO 9241-10 was 67 percent. CONCLUSION Information is the basis for policy and decision making in various levels of the hospital management. Consequently, it seems that HIS developers should decrease HIS errors and increase its suitability for tasks, self descriptiveness, controllability, conformity with user expectations, error tolerance, suitability for individualization, suitability for user learning.
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Affiliation(s)
- Asghar Ehteshami
- Department of Health Information Technology Management, School of Health Management and Information Sciences, Isfahan University of Medical Sciences , Isfahan, Iran
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Abstract
OBJECTIVE To identify the temporal relations between clinical events and temporal expressions in clinical reports, as defined in the i2b2/VA 2012 challenge. DESIGN To detect clinical events, we used rules and Conditional Random Fields. We built Random Forest models to identify event modality and polarity. To identify temporal expressions we built on the HeidelTime system. To detect temporal relations, we systematically studied their breakdown into distinct situations; we designed an oracle method to determine the most prominent situations and the most suitable associated classifiers, and combined their results. RESULTS We achieved F-measures of 0.8307 for event identification, based on rules, and 0.8385 for temporal expression identification. In the temporal relation task, we identified nine main situations in three groups, experimentally confirming shared intuitions: within-sentence relations, section-related time, and across-sentence relations. Logistic regression and Naïve Bayes performed best on the first and third groups, and decision trees on the second. We reached a 0.6231 global F-measure, improving by 7.5 points our official submission. CONCLUSIONS Carefully hand-crafted rules obtained good results for the detection of events and temporal expressions, while a combination of classifiers improved temporal link prediction. The characterization of the oracle recall of situations allowed us to point at directions where further work would be most useful for temporal relation detection: within-sentence relations and linking History of Present Illness events to the admission date. We suggest that the systematic situation breakdown proposed in this paper could also help improve other systems addressing this task.
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