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Applied Clinical Informatics

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https://www.readbyqxmd.com/read/30304745/factors-influencing-sustained-engagement-with-ecg-self-monitoring-perspectives-from-patients-and-health-care-providers
#1
Meghan Reading, Dawon Baik, Melissa Beauchemin, Kathleen T Hickey, Jacqueline A Merrill
BACKGROUND:  Patient-generated health data (PGHD) collected digitally with mobile health (mHealth) technology has garnered recent excitement for its potential to improve precision management of chronic conditions such as atrial fibrillation (AF), a common cardiac arrhythmia. However, sustained engagement is a major barrier to collection of PGHD. Little is known about barriers to sustained engagement or strategies to intervene upon engagement through application design. OBJECTIVE:  This article investigates individual patient differences in sustained engagement among individuals with a history of AF who are self-monitoring using mHealth technology...
October 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/30282094/the-use-of-health-information-exchange-to-augment-patient-handoff-in-long-term-care-a-systematic-review
#2
Clemens Scott Kruse, Gabriella Marquez, Daniel Nelson, Olivia Palomares
BACKGROUND:  Legislation aimed at increasing the use of a health information exchange (HIE) in healthcare has excluded long-term care facilities, resulting in a vulnerable patient population that can benefit from the improvement of communication and reduction of waste. OBJECTIVE:  The purpose of this review is to provide a framework for future research by identifying themes in the long-term care information technology sector that could function to enable the adoption and use of HIE mechanisms for patient handoff between long-term care facilities and other levels of care to increase communication between providers, shorten length of stay, reduce 60-day readmissions, and increase patient safety...
October 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/30257260/automated-versus-manual-data-extraction-of-the-padua-prediction-score-for-venous-thromboembolism-risk-in-hospitalized-older-adults
#3
Juliessa M Pavon, Richard J Sloane, Carl F Pieper, Cathleen S Colón-Emeric, Harvey J Cohen, David Gallagher, Miriam C Morey, Midori McCarty, Thomas L Ortel, Susan N Hastings
OBJECTIVE:  Venous thromboembolism (VTE) prophylaxis is an important consideration for hospitalized older adults, and the Padua Prediction Score (PPS) is a risk prediction tool used to prioritize patient selection. We developed an automated PPS (APPS) algorithm using electronic health record (EHR) data. This study examines the accuracy of APPS and its individual components versus manual data extraction. METHODS:  This is a retrospective cohort study of hospitalized general internal medicine patients, aged 70 and over...
July 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/30231259/integrated-electronic-discharge-summaries-experience-of-a-tertiary-pediatric-institution
#4
Daryl R Cheng, Merav L Katz, Mike South
OBJECTIVE:  Succinct and timely discharge summaries (DSs) facilitate ongoing care for patients discharged from acute care settings. Many institutions have introduced electronic DS (eDS) templates to improve quality and timeliness of clinical correspondence. However, significant intrahospital and intraunit variability and application exists. A review of the literature and guidelines revealed 13 key elements that should be included in a best practice DS. This was compared against our pediatric institution's eDS template-housed within an integrated electronic medical record (EMR) and used across most inpatient hospital units...
July 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/30208497/emergency-physicians-perceived-influence-of-ehr-use-on-clinical-workflow-and-performance-metrics
#5
Courtney A Denton, Hiral C Soni, Thomas G Kannampallil, Anna Serrichio, Jason S Shapiro, Stephen J Traub, Vimla L Patel
OBJECTIVE:  Over the last decade, electronic health records (EHRs) have shaped clinical practice. In this article, we investigated the perceived effects of EHR use on clinical workflow and meaningful use (MU) performance metrics. MATERIALS AND METHODS:  Semistructured interviews were conducted with 20 ( n  = 20) physicians at two urban emergency departments. Interview questions focused on time spent on EHR use, changes in clinical practices with EHR use, and the effect of MU performance metrics on clinical workflow...
July 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/30208496/a-heuristic-evaluation-to-assess-use-of-after-visit-summaries-for-supporting-continuity-of-care
#6
Patrice Tremoulet, Ramya Krishnan, Dean Karavite, Naveen Muthu, Susan Harkness Regli, Amy Will, Jeremy Michel
BACKGROUND:  Outpatient providers often do not receive discharge summaries from acute care providers prior to follow-up visits. These outpatient providers may use the after-visit summaries (AVS) that are given to patients to obtain clinical information. It is unclear how effectively AVS support care coordination between clinicians. OBJECTIVES:  Goals for this effort include: (1) developing usability heuristics that may be applied both for assessment and to guide generation of medical documents in general, (2) conducting a heuristic evaluation to assess the use of AVS for communication between clinicians, and (3) providing recommendations for generating AVS that effectively support both patient/caregiver use and care coordination...
July 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/30184560/a-brief-survey-on-six-basic-and-reduced-ehealth-indicators-in-seven-countries-in-2017
#7
Reinhold Haux, Elske Ammenwerth, Sabine Koch, Christoph U Lehmann, Hyeoun-Ae Park, Kaija Saranto, C P Wong
BACKGROUND:  Holistic, ubiquitous support of patient-centered health care (eHealth) at all health care institutions and in patients' homes through information processing is increasingly supplementing institution-centered care. While eHealth indicators may measure the transition from institution-centered (e.g., hospital-centered) information processing to patient-centered information processing, collecting relevant and timely data for such indicators has been difficult. OBJECTIVES:  This article aims to design some basic eHealth indicators, which are easily collected and measure how well information processing supports holistic patient-centered health care, and to evaluate penetrance of patient-centered health as measured by the indicators internationally via an expert survey...
July 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/30184559/applying-the-re-aim-framework-for-the-evaluation-of-a-clinical-decision-support-tool-for-pediatric-head-trauma-a-mixed-methods-study
#8
Ruth M Masterson Creber, Peter S Dayan, Nathan Kuppermann, Dustin W Ballard, Leah Tzimenatos, Evaline Alessandrini, Rakesh D Mistry, Jeffrey Hoffman, David R Vinson, Suzanne Bakken
BACKGROUND:  The overuse of cranial computed tomography (CT) to diagnose potential traumatic brain injuries (TBIs) exposes children with minor blunt head trauma to unnecessary ionizing radiation. The Pediatric Emergency Care Applied Research Network and the Clinical Research on Emergency Services and Treatments Network implemented TBI prediction rules via electronic health record (EHR) clinical decision support (CDS) to decrease use of CTs in children with minor blunt head trauma. OBJECTIVE:  This article aims to facilitate implementation and dissemination of a CDS alert into emergency departments around the country...
July 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/30157500/numeracy-and-understanding-of-quantitative-aspects-of-predictive-models-a-pilot-study
#9
Gary E Weissman, Kuldeep N Yadav, Vanessa Madden, Katherine R Courtright, Joanna L Hart, David A Asch, Marilyn M Schapira, Scott D Halpern
BACKGROUND:  The assessment of user preferences for performance characteristics of patient-oriented clinical prediction models is lacking. It is unknown if complex statistical aspects of prediction models are readily understandable by a general audience. OBJECTIVE:  A pilot study was conducted among nonclinical audiences to determine the feasibility of interpreting statistical concepts that describe the performance of prediction models. METHODS:  We conducted a cross-sectional electronic survey using the Amazon Mechanical Turk platform...
July 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/30157499/snomed-ct-concept-hierarchies-for-sharing-definitions-of-clinical-conditions-using-electronic-health-record-data
#10
Duwayne L Willett, Vaishnavi Kannan, Ling Chu, Joel R Buchanan, Ferdinand T Velasco, John D Clark, Jason S Fish, Adolfo R Ortuzar, Josh E Youngblood, Deepa G Bhat, Mujeeb A Basit
BACKGROUND:  Defining clinical conditions from electronic health record (EHR) data underpins population health activities, clinical decision support, and analytics. In an EHR, defining a condition commonly employs a diagnosis value set or "grouper." For constructing value sets, Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT) offers high clinical fidelity, a hierarchical ontology, and wide implementation in EHRs as the standard interoperability vocabulary for problems...
July 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/30134474/mapping-the-flow-of-pediatric-trauma-patients-using-process-mining
#11
Ashimiyu B Durojaiye, Nicolette M McGeorge, Lisa L Puett, Dylan Stewart, James C Fackler, Peter L T Hoonakker, Harold P Lehmann, Ayse P Gurses
BACKGROUND:  Inhospital pediatric trauma care typically spans multiple locations, which influences the use of resources, that could be improved by gaining a better understanding of the inhospital flow of patients and identifying opportunities for improvement. OBJECTIVES:  To describe a process mining approach for mapping the inhospital flow of pediatric trauma patients, to identify and characterize the major patient pathways and care transitions, and to identify opportunities for patient flow and triage improvement...
July 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/30134473/feasibility-of-electronic-health-record-based-triggers-in-detecting-dental-adverse-events
#12
Elsbeth Kalenderian, Enihomo Obadan-Udoh, Alfa Yansane, Karla Kent, Nutan B Hebballi, Veronique Delattre, Krisna Kumar Kookal, Oluwabunmi Tokede, Joel White, Muhammad F Walji
BACKGROUND:  We can now quantify and characterize the harm patients suffer in the dental chair by mining data from electronic health records (EHRs). Most dental institutions currently deploy a random audit of charts using locally developed definitions to identify such patient safety incidents. Instead, selection of patient charts using triggers and assessment through calibrated reviewers may more efficiently identify dental adverse events (AEs). OBJECTIVE:  Our goal was to develop and test EHR-based triggers at four academic institutions and find dental AEs, defined as moderate or severe physical harm due to dental treatment...
July 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/30112742/adoption-of-electronic-dental-records-examining-the-influence-of-practice-characteristics-on-adoption-in-one-state
#13
Zain Chauhan, Mohammad Samarah, Kim M Unertl, Martha W Jones
OBJECTIVE:  Compared with medicine, less research has focused on adoption rates and factors contributing to the adoption of electronic dental records (EDRs) and certified electronic health records (EHRs) in the field of dentistry. We ran two multivariate models on EDR adoption and certification-capable EHR adoption to determine environmental and organizational factors associated with adoption. METHODS:  We conducted telephone survey of a 10-item questionnaire using disproportionate stratified sampling procedure of 149 dental clinics in Tennessee in 2017 measuring adoption of dental information technology (IT) (EDRs and certification-capable EHRs) and practice characteristics, including region, rurality, specialty, and practice size...
July 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/30112741/a-systematic-review-of-the-technology-acceptance-model-in-health-informatics
#14
Bahlol Rahimi, Hamed Nadri, Hadi Lotfnezhad Afshar, Toomas Timpka
BACKGROUND:  One common model utilized to understand clinical staff and patients' technology adoption is the technology acceptance model (TAM). OBJECTIVE:  This article reviews published research on TAM use in health information systems development and implementation with regard to application areas and model extensions after its initial introduction. METHOD:  An electronic literature search supplemented by citation searching was conducted on February 2017 of the Web of Science, PubMed, and Scopus databases, yielding a total of 492 references...
July 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/30089333/common-consumer-health-related-needs-in-the-pediatric-hospital-setting-lessons-from-an-engagement-consultation-service
#15
Daniel J Lee, Robert Cronin, Jamie Robinson, Shilo Anders, Kim Unertl, Katherine Kelly, Heather Hankins, Ryan Skeens, Gretchen P Jackson
BACKGROUND:  Informed and engaged parents may influence outcomes for childhood illness. Understanding the needs of the caregivers of pediatric patients is a critical first step in promoting engagement in their child's care. In 2014, we developed an Engagement Consultation Service at the Monroe Carell Jr. Children's Hospital at Vanderbilt. This service determines the health-related needs of the caregivers of hospitalized children and makes educational or technology recommendations to meet those needs and support engagement...
July 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/30089332/going-mobile-resident-physicians-assessment-of-the-impact-of-tablet-computers-on-clinical-tasks-job-satisfaction-and-quality-of-care
#16
Megan Sweeney, Kaavya Paruchuri, Saul N Weingart
BACKGROUND: There are few published studies of the use of portable or handheld computers in health care, but these devices have the potential to transform multiple aspects of clinical teaching and practice. OBJECTIVE:  This article assesses resident physicians' perceptions and experiences with tablet computers before and after the introduction of these devices. METHODS:  We surveyed 49 resident physicians from 8 neurology, surgery, and internal medicine clinical services before and after the introduction of tablet computers at a 415-bed Boston teaching hospital...
July 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/30068013/design-and-implementation-of-a-pediatric-icu-acuity-scoring-tool-as-clinical-decision-support
#17
Eric Shelov, Naveen Muthu, Heather Wolfe, Danielle Traynor, Nancy Craig, Christopher Bonafide, Vinay Nadkarni, Daniela Davis, Maya Dewan
BACKGROUND AND OBJECTIVE:  Pediatric in-hospital cardiac arrest most commonly occurs in the pediatric intensive care unit (PICU) and is frequently preceded by early warning signs of clinical deterioration. In this study, we describe the implementation and evaluation of criteria to identify high-risk patients from a paper-based checklist into a clinical decision support (CDS) tool in the electronic health record (EHR). MATERIALS AND METHODS:  The validated paper-based tool was first adapted by PICU clinicians and clinical informaticians and then integrated into clinical workflow following best practices for CDS design...
July 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/30068012/leveraging-patient-reported-outcomes-using-data-visualization
#18
Lisa V Grossman, Steven K Feiner, Elliot G Mitchell, Ruth M Masterson Creber
BACKGROUND:  Health care organizations increasingly use patient-reported outcomes (PROs) to capture patients' health status. Although federal policy mandates PRO collection, the challenge remains to better engage patients in PRO surveys, and ensure patients comprehend the surveys and their results. OBJECTIVE:  This article identifies the design requirements for an interface that assists patients with PRO survey completion and interpretation, and then builds and evaluates the interface...
July 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/30045386/training-to-optimize-collaborative-use-of-an-inpatient-portal
#19
Jennifer L Hefner, Cynthia J Sieck, Ann Scheck McAlearney
BACKGROUND:  Inpatient portals are an emerging technology that can facilitate collaborative interactions between patients and care teams, but little is known about how organizations attempt to implement and facilitate inpatient portal use for their providers. METHODS:  We held in-person, semistructured interviews with care team members and information technology (IT) staff and conducted rigorous thematic analysis of transcripts. RESULTS:  Interviews with 220 care team members and 4 IT staff identified 3 new areas of training needed to optimize inpatient portal implementation and use that extend beyond training to use other technologies: (1) teaching staff to train patients about tool use; (2) training about how to promote tool use to patients; and (3) training about optimal use of secure messaging...
July 2018: Applied Clinical Informatics
https://www.readbyqxmd.com/read/30045385/simple-workflow-changes-enable-effective-patient-identity-matching-in-poison-control
#20
Mollie R Cummins, Pallavi Ranade-Kharkar, Cody Johansen, Heather Bennett, Shelley Gabriel, Barbara I Crouch, Guilherme Del Fiol, Matt Hoffman
BACKGROUND:  U.S. poison control centers pose a special case for patient identity matching because they collect only minimal patient identifying information. METHODS:  In early 2017, the Utah Poison Control Center (Utah PCC) initiated participation in regional health information exchange by sending Health Level Seven Consolidated Clinical Document Architecture (C-CDA) documents to the Utah Health Information Network and Intermountain Healthcare. To increase the documentation of patient identifiers by the Utah PCC, we (1) adapted documentation practices to enable more complete and consistent documentation, and (2) implemented staff training to improve collection of identifiers...
July 2018: Applied Clinical Informatics
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