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Applied Clinical Informatics

Peter L Elkin, Daniel R Schlegel, Michael Anderson, Jordan Komm, Gregoire Ficheur, Leslie Bisson
Evoking strength is one of the important contributions of the field of Biomedical Informatics to the discipline of Artificial Intelligence. The University at Buffalo's Orthopedics Department wanted to create an expert system to assist patients with self-diagnosis of knee problems and to thereby facilitate referral to the right orthopedic subspecialist. They had two independent sports medicine physicians review 469 cases. A board-certified orthopedic sports medicine practitioner, L.B., reviewed any disagreements until a gold standard diagnosis was reached...
April 2018: Applied Clinical Informatics
John D D'Amore, Chun Li, Laura McCrary, Jonathan M Niloff, Dean F Sittig, Allison B McCoy, Adam Wright
BACKGROUND:  Value-based payment for care requires the consistent, objective calculation of care quality. Previous initiatives to calculate ambulatory quality measures have relied on billing data or individual electronic health records (EHRs) to calculate and report performance. New methods for quality measure calculation promoted by federal regulations allow qualified clinical data registries to report quality outcomes based on data aggregated across facilities and EHRs using interoperability standards...
April 2018: Applied Clinical Informatics
Stacy D O'Connor, Ramin Khorasani, Stephen M Pochebit, Ronilda Lacson, Katherine P Andriole, Anuj K Dalal
BACKGROUND:  Failure of timely test result follow-up has consequences including delayed diagnosis and treatment, added costs, and potential patient harm. Closed-loop communication is key to ensure clinically significant test results (CSTRs) are acknowledged and acted upon appropriately. A previous implementation of the Alert Notification of Critical Results (ANCR) system to facilitate closed-loop communication of imaging CSTRs yielded improved communication of critical radiology results and enhanced adherence to institutional CSTR policies...
April 2018: Applied Clinical Informatics
Torbjørn Torsvik, Børge Lillebo, Morten Hertzum
BACKGROUND:  Electronic health records may present laboratory test results in a variety of ways. Little is known about how the usefulness of different visualizations of laboratory test results is influenced by the complex and varied process of clinical decision making. OBJECTIVE:  The purpose of this study was to investigate how clinicians access and utilize laboratory test results when caring for patients with chronic illness. METHODS:  We interviewed 10 attending physicians about how they access and assess laboratory tests when following up patients with chronic illness...
April 2018: Applied Clinical Informatics
Kea Turner, Chelsea Renfro, Stefanie Ferreri, Kim Roberts, Trista Pfeiffenberger, Christopher M Shea
OBJECTIVE:  Community pharmacists' role in clinical care is expanding in the United States and information systems are needed that extend beyond a dispensing workflow. As pharmacies adopt new systems, implementation support will be needed. This study identifies the barriers and facilitators experienced by community pharmacies in implementing a Web-based medication management application and describes the implementation strategies used to support these pharmacies. METHODS:  Semistructured interviews were conducted with 28 program and research staff that provides support to community pharmacies participating in a statewide pharmacy network...
April 2018: Applied Clinical Informatics
Eric Zapletal, Jean-Emmanuel Bibault, Philippe Giraud, Anita Burgun
BACKGROUND:  Clinical data warehouses are now widely used to foster clinical and translational research and the Informatics for Integrating Biology and the Bedside (i2b2) platform has become a de facto standard for storing clinical data in many projects. However, to design predictive models and assist in personalized treatment planning in cancer or radiation oncology, all available patient data need to be integrated into i2b2, including radiation therapy data that are currently not addressed in many existing i2b2 sites...
April 2018: Applied Clinical Informatics
Sara J Deakyne Davies, Robert W Grundmeier, Diego A Campos, Katie L Hayes, Jamie Bell, Evaline A Alessandrini, Lalit Bajaj, James M Chamberlain, Marc H Gorelick, Rene Enriquez, T Charles Casper, Beth Scheid, Marlena Kittick, J Michael Dean, Elizabeth R Alpern
BACKGROUND:  Electronic health record (EHR)-based registries allow for robust data to be derived directly from the patient clinical record and can provide important information about processes of care delivery and patient health outcomes. METHODS:  A data dictionary, and subsequent data model, were developed describing EHR data sources to include all processes of care within the emergency department (ED). ED visit data were deidentified and XML files were created and submitted to a central data coordinating center for inclusion in the registry...
April 2018: Applied Clinical Informatics
Birgit Prodinger, Paul Rastall, Dipak Kalra, Darren Wooldridge, Iain Carpenter
OBJECTIVE:  Specifying the content in electronic health records (EHRs) through standardized headings based on international reference classifications will facilitate their semantic interoperability. The objective of this study was to specify potential chapter headings for EHRs aligned with the World Health Organization's (WHO) International Classification of Functioning, Disability, and Health (ICF) based on the perspectives of people living with chronic health conditions, carers, and professionals...
April 2018: Applied Clinical Informatics
Saif Khairat, Gary Burke, Heather Archambault, Todd Schwartz, James Larson, Raj M Ratwani
OBJECTIVE:  The purpose of this study was to further explore the effect of EHRs on emergency department (ED) attending and resident physicians' perceived workload, satisfaction, and productivity through the completion of six EHR patient scenarios combined with workload, productivity, and satisfaction surveys. METHODS:  To examine EHR usability, we used a live observational design combined with post observation surveys conducted over 3 days, observing emergency physicians' interactions with the EHR during a 1-hour period...
April 2018: Applied Clinical Informatics
Tobias Hodgson, Farah Magrabi, Enrico Coiera
OBJECTIVE:  To conduct a replication study to validate previously identified significant risks and inefficiencies associated with the use of speech recognition (SR) for documentation within an electronic health record (EHR) system. METHODS:  Thirty-five emergency department clinicians undertook randomly allocated clinical documentation tasks using keyboard and mouse (KBM) or SR using a commercial EHR system. The experiment design, setting, and tasks (E2) replicated an earlier study (E1), while technical integration issues that may have led to poorer SR performance were addressed...
April 2018: Applied Clinical Informatics
Joshua C Smith, Qingxia Chen, Joshua C Denny, Dan M Roden, Kevin B Johnson, Randolph A Miller
BACKGROUND:  Often unrecognized by providers, adverse drug reactions (ADRs) diminish patients' quality of life, cause preventable admissions and emergency department visits, and increase health care costs. OBJECTIVE:  This article evaluates whether an automated system, the Adverse Drug Effect Recognizer (ADER), could assist clinicians in detecting and addressing inpatients' ongoing preadmission ADRs. METHODS:  ADER uses natural language processing to extract patients' medications, findings, and past diagnoses from admission notes...
April 2018: Applied Clinical Informatics
Brittany Couture, Elizabeth Lilley, Frank Chang, Ann DeBord Smith, Jessica Cleveland, Awatef Ergai, Zachary Katsulis, James Benneyan, Esteban Gershanik, David W Bates, Sarah A Collins
INTRODUCTION:  Developing an optimized and user-friendly mHealth application for patients and family members in the hospital environment presents unique challenges given the diverse patient population and patients' various states of well-being. OBJECTIVE:  This article describes user-centered design methods and results for developing the patient and family facing user interface and functionality of MySafeCare, a safety reporting tool for hospitalized patients and their family members...
April 2018: Applied Clinical Informatics
Blake J Lesselroth, Kathleen Adams, Victoria L Church, Stephanie Tallett, Yelizaveta Russ, Jack Wiedrick, Christopher Forsberg, David A Dorr
BACKGROUND:  The Veterans Affairs Portland Healthcare System developed a medication history collection software that displays prescription names and medication images. OBJECTIVE:  This article measures the frequency of medication discrepancy reporting using the medication history collection software and compares with the frequency of reporting using a paper-based process. This article also determines the accuracy of each method by comparing both strategies to a best possible medication history...
April 2018: Applied Clinical Informatics
Quan Wei, Karen L Courtney
OBJECTIVE:  Long-term care (LTC), residential care requiring 24-hour nursing services, plays an important role in the health care service delivery system. The purpose of this study was to identify the needed clinical information and information flow to support LTC Registered Nurses (RNs) in care collaboration and clinical decision making. METHODS:  This descriptive qualitative study combines direct observations and semistructured interviews, conducted at Alberta's LTC facilities between May 2014 and August 2015...
April 2018: Applied Clinical Informatics
Christine A Rehr, Adrian Wong, Diane L Seger, David W Bates
OBJECTIVE:  This article aims to understand provider behavior around the use of the override reason "Inaccurate warning," specifically whether it is an effective way of identifying unhelpful medication alerts. MATERIALS AND METHODS:  We analyzed alert overrides that occurred in the intensive care units (ICUs) of a major academic medical center between June and November 2016, focused on the following high-significance alert types: dose, drug-allergy alerts, and drug-drug interactions (DDI)...
April 2018: Applied Clinical Informatics
Mark V Mai, Brooke T Luo, Evan W Orenstein, Anthony A Luberti
Opportunities for education in clinical informatics exist throughout the spectrum of formal education extending from high school to postgraduate training. However, physicians in residency represent an underdeveloped source of potential informaticians. Despite the rapid growth of accredited fellowship programs since clinical informatics became a board-eligible subspecialty in 2011, few resident physicians are aware of their role at the intersection of clinical medicine and health information technology or associated opportunities...
April 2018: Applied Clinical Informatics
Mustafa Ozkaynak, Danny T Y Wu, Katia Hannah, Peter S Dayan, Rakesh D Mistry
BACKGROUND:  Clinical decision support (CDS) embedded into the electronic health record (EHR), is a potentially powerful tool for institution of antimicrobial stewardship programs (ASPs) in emergency departments (EDs). However, design and implementation of CDS systems should be informed by the existing workflow to ensure its congruence with ED practice, which is characterized by erratic workflow, intermittent computer interactions, and variable timing of antibiotic prescription. OBJECTIVE:  This article aims to characterize ED workflow for four provider types, to guide future design and implementation of an ED-based ASP using the EHR...
April 2018: Applied Clinical Informatics
Hamed Nadri, Bahlol Rahimi, Hadi Lotfnezhad Afshar, Mahnaz Samadbeik, Ali Garavand
OBJECTIVE:  Regardless of the acceptance of users, information and communication systems can be considered as a health intervention designed to improve the care delivered to patients. This study aimed to determine the adoption and use of the extended Technology Acceptance Model (TAM2) by the users of hospital information system (HIS) in paraclinical departments including laboratory, radiology, and nutrition and to investigate the key factors of adoption and use of these systems. MATERIALS AND METHODS:  A standard questionnaire was used to collect the data from nearly 253 users of these systems in paraclinical departments of eight university hospitals in two different cities of Iran...
April 2018: Applied Clinical Informatics
James Todd, Brent Richards, Bruce James Vanstone, Adrian Gepp
BACKGROUND:  Various tasks within health care processes are repetitive and time-consuming, requiring personnel who could be better utilized elsewhere. The task of assigning clinical urgency categories to internal patient referrals is one such case of a time-consuming process, which may be amenable to automation through the application of text mining and natural language processing (NLP) techniques. OBJECTIVE:  This article aims to trial and evaluate a pilot study for the first component of the task-determining reasons for referrals...
January 2018: Applied Clinical Informatics
Priscila Alves Maranhão, Gustavo Marísio Bacelar-Silva, Duarte Nuno Gonçalves Ferreira, Conceição Calhau, Pedro Vieira-Marques, Ricardo João Cruz-Correia
BACKGROUND:  The traditional concept of personalized nutrition is based on adapting diets according to individual needs and preferences. Discussions about personalized nutrition have been on since the Human Genome Project, which has sequenced the human genome. Thenceforth, topics such as nutrigenomics have been assessed to help in better understanding the genetic variation influence on the dietary response and association between nutrients and gene expression. Hence, some challenges impaired the understanding about the nowadays important clinical data and about clinical data assumed to be important in the future...
January 2018: Applied Clinical Informatics
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