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Applied Clinical Informatics

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https://www.readbyqxmd.com/read/27901174/metrics-for-electronic-nursing-record-based-narratives-cross-sectional-analysis
#1
Kidong Kim, Suyeon Jeong, Kyogu Lee, Hyeoun-Ae Park, Yul Ha Min, Joo Yun Lee, Yekyung Kim, Sooyoung Yoo, Gippeum Doh, Soyeon Ahn
OBJECTIVES: We aimed to determine the characteristics of quantitative metrics for nursing narratives documented in electronic nursing records and their association with hospital admission traits and diagnoses in a large data set not limited to specific patient events or hypotheses. METHODS: We collected 135,406,873 electronic, structured coded nursing narratives from 231,494 hospital admissions of patients discharged between 2008 and 2012 at a tertiary teaching institution that routinely uses an electronic health records system...
November 30, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27878205/iterative-development-and-evaluation-of-a-pharmacogenomic-guided-clinical-decision-support-system-for-warfarin-dosing
#2
Brittany L Melton, Alan J Zillich, Jason Saleem, Alissa L Russ, James E Tisdale, Brian R Overholser
OBJECTIVE: Pharmacogenomic-guided dosing has the potential to improve patient outcomes but its implementation has been met with clinical challenges. Our objective was to develop and evaluate a clinical decision support system (CDSS) for pharmacogenomic-guided warfarin dosing designed for physicians and pharmacists. METHODS: Twelve physicians and pharmacists completed 6 prescribing tasks using simulated patient scenarios in two iterations (development and validation phases) of a newly developed pharmacogenomic-driven CDSS prototype...
November 23, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27847961/mind-the-gap-a-systematic-review-to-identify-usability-and-safety-challenges-and-practices-during-electronic-health-record-implementation
#3
Raj Ratwani, Terry Fairbanks, Erica Savage, Katie Adams, Michael Wittie, Edna Boone, Andrew Hayden, Janey Barnes, Zach Hettinger, Andrew Gettinger
OBJECTIVE: Decisions made during electronic health record (EHR) implementations profoundly affect usability and safety. This study aims to identify gaps between the current literature and key stakeholders' perceptions of usability and safety practices and the challenges encountered during the implementation of EHRs. MATERIALS AND METHODS: Two approaches were used: a literature review and interviews with key stakeholders. We performed a systematic review of the literature to identify usability and safety challenges and best practices during implementation...
November 16, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27826610/identification-of-long-bone-fractures-in-radiology-reports-using-natural-language-processing-to-support-healthcare-quality-improvement
#4
Robert W Grundmeier, Aaron J Masino, T Charles Casper, Jonathan M Dean, Jamie Bell, Rene Enriquez, Sara Deakyne, James M Chamberlain, Elizabeth R Alpern
BACKGROUND: Important information to support healthcare quality improvement is often recorded in free text documents such as radiology reports. Natural language processing (NLP) methods may help extract this information, but these methods have rarely been applied outside the research laboratories where they were developed. OBJECTIVE: To implement and validate NLP tools to identify long bone fractures for pediatric emergency medicine quality improvement. METHODS: Using freely available statistical software packages, we implemented NLP methods to identify long bone fractures from radiology reports...
November 9, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27803949/usability-and-workflow-evaluation-of-rheumatic-disease-activity-ready-a-mobile-application-for-rheumatology-patients-and-providers
#5
Po-Yin Yen, Barbara Lara, Marcelo Lopetegui, Aseem Bharat, Stacy Ardoin, Bernadette Johnson, Puneet Mathur, Peter J Embi, Jeffrey R Curtis
BACKGROUND: RhEumAtic Disease activitY (READY) is a mobile health (mHealth) application that aims to create a shared platform integrating data from both patients and physicians, with a particular emphasis on arthritis disease activity. METHODS: We made READY available on an iPad and pilot implemented it at a rheumatology outpatient clinic. We conducted 1) a usability evaluation study to explore patients' and physicians' interactions with READY, and 2) a time motion study (TMS) to observe the clinical workflow before and after the implementation...
November 2, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27803948/telemedicine-for-developing-countries-a-survey-and-some-design-issues
#6
Carlo Combi, Gabriele Pozzani, Giuseppe Pozzi
BACKGROUND: Developing countries need telemedicine applications that help in many situations, when physicians are a small number with respect to the population, when specialized physicians are not available, when patients and physicians in rural villages need assistance in the delivery of health care. Moreover, the requirements of telemedicine applications for developing countries are somewhat more demanding than for developed countries. Indeed, further social, organizational, and technical aspects need to be considered for successful telemedicine applications in developing countries...
November 2, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27786335/how-physician-perspectives-on-e-prescribing-evolve-over-time-a-case-study-following-the-transition-between-ehrs-in-an-outpatient-clinic
#7
Erika L Abramson, Vaishali Patel, Elizabeth R Pfoh, Rainu Kaushal
BACKGROUND: Physicians are expending tremendous resources transitioning to new electronic health records (EHRs), with electronic prescribing as a key functionality of most systems. Physician dissatisfaction post-transition can be quite marked, especially initially. However, little is known about how physicians' experiences using new EHRs for e-prescribing evolve over time. We previously published a qualitative case study about the early physician experience transitioning from an older to a newer, more robust EHR, in the outpatient setting, focusing on their perceptions of the electronic prescribing functionality...
October 26, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27781238/improving-individual-acceptance-of-health-clouds-through-confidentiality-assurance
#8
Tatiana Ermakova, Benjamin Fabian, Rüdiger Zarnekow
BACKGROUND: Cloud computing promises to essentially improve healthcare delivery performance. However, shifting sensitive medical records to third-party cloud providers could create an adoption hurdle because of security and privacy concerns. OBJECTIVES: This study examines the effect of confidentiality assurance in a cloud-computing environment on individuals' willingness to accept the infrastructure for inter-organizational sharing of medical data. METHODS: We empirically investigate our research question by a survey with over 260 full responses...
October 26, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27757472/evaluation-of-a-pilot-asthma-care-program-for-electronic-communication-between-school-health-and-a-healthcare-system-s-electronic-medical-record
#9
Kelly W Reeves, Yhenneko Taylor, Hazel Tapp, Thomas Ludden, Lindsay E Shade, Beth Burton, Cheryl Courtlandt, Michael Dulin
OBJECTIVE: Asthma is a common childhood chronic lung disease affecting greater than 10% of children in the United States. School nurses are in a unique position to close gaps in care. Indeed, effective asthma management is more likely to result when providers, family, and schools work together to optimize the patient's treatment plan. Currently, effective communication between schools and healthcare systems through electronic medical record (EMR) systems remains a challenge. The goal of this feasibility pilot was to link the school-based care team with primary care providers in the healthcare system network via electronic communication through the EMR, on behalf of pediatric asthma patients who had been hospitalized for an asthma exacerbation...
October 19, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27757471/appointment-lead-time-policy-development-to-improve-patient-access-to-care
#10
Yu-Li Huang, Sarah M Bach
BACKGROUND: Patient access to care has been a known and continuing struggle for many health care providers. In spite of appointment lead time policies set by government or clinics, the problem persists. Justification for how lead time policies are determined is lacking. OBJECTIVES: This paper proposed a data-driven approach for how to best set feasible appointment target lead times given a clinic's capacity and appointment requests. METHODS: The proposed approach reallocates patient visits to minimize the deviation between actual appointment lead time and a feasible target lead time...
October 19, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27730249/patient-perceptions-of-wearable-face-mounted-computing-technology-and-the-effect-on-the-doctor-patient-relationship
#11
Micah T Prochaska, Valerie G Press, David O Meltzer, Vineet M Arora
BACKGROUND: Wearable face-mounted computers such as Google Glass™ , Microsoft HoloLens™, and Oculus' Rift(®), are increasingly being tested in hospital care. These devices challenge social etiquette, raise privacy issues, and may disrupt the intimacy of the doctor patient relationship. We aimed to determine patients' perception of and their privacy concerns with an archetype of wearable face-mounted computer devices, Google Glass. METHODS: Hospitalized inpatients were asked about their familiarity with Glass, how comfortable they would be and if they would be concerned about privacy if their physician wore Glass, if the use of Glass would affect their trust in their physician, and if they would want their physician to wear Glass if it improved their care...
October 12, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27730248/a-two-year-longitudinal-assessment-of-ophthalmologists-perceptions-after-implementing-an-electronic-health-record-system
#12
Joshua R Ehrlich, Monica Michelotti, Taylor S Blachley, Kai Zheng, Mick P Couper, Grant M Greenberg, Sharon Kileny, Greta L Branford, David A Hanauer, Jennifer S Weizer
OBJECTIVES: To understand the attitudes and perceptions of ophthalmologists toward an electronic health record (EHR) system, before and after its clinical implementation. METHODS: Ophthalmologists at a single large academic ophthalmology department were surveyed longitudinally before and after implementation of a new EHR system. The survey measured ophthalmologists' attitudes toward implementation of a new EHR. Questions focused on satisfaction, efficiency, and documentation...
October 12, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27704138/toward-designing-information-display-to-support-critical-care-a-qualitative-contextual-evaluation-and-visioning-effort
#13
Melanie C Wright, Sherry Dunbar, Brekk C Macpherson, Eugene W Moretti, Guillherme Del Fiol, Jean Bolte, Jeffrey M Taekman, Noa Segall
OBJECTIVES: Electronic health information overload makes it difficult for providers to quickly find and interpret information to support care decisions. The purpose of this study was to better understand how clinicians use information in critical care to support the design of improved presentation of electronic health information. METHODS: We conducted a contextual analysis and visioning project. We used an eye-tracker to record 20 clinicians' information use activities in critical care settings...
October 5, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27679839/social-networking-services-based-communicative-care-for-patients-with-diabetes-mellitus-in-korea
#14
Hun-Sung Kim, Yoo Jin Jeong, Sun Jung Baik, So Jung Yang, Tong Min Kim, Hyunah Kim, Hyunyong Lee, Seung-Hwan Lee, Jae Hyoung Cho, In-Young Choi, Kun-Ho Yoon
OBJECTIVES: Social networking services (SNS)-based online communities are good examples of improving quality of care by incorporating information technology into medicine. Therefore, we created an SNS-based community care webpage for communication among patients with diabetes mellitus (DM). We aimed to identify what diabetic patients wanted to know and were interested in by analyzing their posts and classified content in which users were interested. METHODS: As opposed to the existing physician-focused health information websites, we built a patient-focused experience exchange website, "I love insulin (http://www...
September 28, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27652375/optimizing-clinical-decision-support-in-the-electronic-health-record-clinical-characteristics-associated-with-the-use-of-a-decision-tool-for-disposition-of-ed-patients-with-pulmonary-embolism
#15
Dustin W Ballard, Ridhima Vemula, Uli K Chettipally, Mamata V Kene, Dustin G Mark, Andrew K Elms, James S Lin, Mary E Reed, Jie Huang, Adina S Rauchwerger, David R Vinson
OBJECTIVE: Adoption of clinical decision support (CDS) tools by clinicians is often limited by workflow barriers. We sought to assess characteristics associated with clinician use of an electronic health record-embedded clinical decision support system (CDSS). METHODS: In a prospective study on emergency department (ED) activation of a CDSS tool across 14 hospitals between 9/1/14 to 4/30/15, the CDSS was deployed at 10 active sites with an on-site champion, education sessions, iterative feedback, and up to 3 gift cards/clinician as an incentive...
September 21, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27652374/practical-considerations-for-implementing-genomic-information-resources-experiences-from-emerge-and-cser
#16
Luke V Rasmussen, Casey L Overby, John Connolly, Christopher G Chute, Joshua C Denny, Robert Freimuth, Andrea L Hartzler, Ingrid A Holm, Shannon Manzi, Jyotishman Pathak, Peggy L Peissig, Maureen Smith, Marc S Williams, Brian H Shirts, Elena M Stoffel, Peter Tarczy-Hornoch, Carolyn R Rohrer Vitek, Wendy A Wolf, Justin Starren
OBJECTIVES: To understand opinions and perceptions on the state of information resources specifically targeted to genomics, and approaches to delivery in clinical practice. METHODS: We conducted a survey of genomic content use and its clinical delivery from representatives across eight institutions in the electronic Medical Records and Genomics (eMERGE) network and two institutions in the Clinical Sequencing Exploratory Research (CSER) consortium in 2014. RESULTS: Eleven responses representing distinct projects across ten sites showed heterogeneity in how content is being delivered, with provider-facing content primarily delivered via the electronic health record (EHR) (n=10), and paper/pamphlets as the leading mode for patient-facing content (n=9)...
September 21, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27623763/healthcare-applications-of-smart-watches-a-systematic-review
#17
Tsung-Chien Lu, Chia-Ming Fu, Matthew Huei-Ming Ma, Cheng-Chung Fang, Anne M Turner
OBJECTIVE: The aim of this systematic review is to synthesize research studies involving the use of smart watch devices for healthcare. MATERIALS AND METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was chosen as the systematic review methodology. We searched PubMed, CINAHL Plus, EMBASE, ACM, and IEEE Xplore. In order to include ongoing clinical trials, we also searched ClinicalTrials.gov. Two investigators evaluated the retrieved articles for inclusion...
September 14, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27602412/the-hidden-lives-of-nurses-cognitive-artifacts
#18
Jacquelyn W Blaz, Alexa K Doig, Kristin G Cloyes, Nancy Staggers
BACKGROUND: Standardizing nursing handoffs at shift change is recommended to improve communication, with electronic tools as the primary approach. However, nurses continue to rely on personally created paper-based cognitive artifacts - their "paper brains" - to support handoffs, indicating a deficiency in available electronic versions. OBJECTIVE: The purpose of this qualitative study was to develop a deep understanding of nurses' paper-based cognitive artifacts in the context of a cancer specialty hospital...
September 7, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27580980/meta-generalis-a-novel-method-for-structuring-information-from-radiology-reports
#19
Flavio Barbosa, Agma Jucci Traina, Valdair Francisco Muglia
BACKGROUND: A structured report for imaging exams aims at increasing the precision in information retrieval and communication between physicians. However, it is more concise than free text and may limit specialists' descriptions of important findings not covered by pre-defined structures. A computational ontological structure derived from free texts designed by specialists may be a solution for this problem. Therefore, the goal of our study was to develop a methodology for structuring information in radiology reports covering specifications required for the Brazilian Portuguese language, including the terminology to be used...
August 24, 2016: Applied Clinical Informatics
https://www.readbyqxmd.com/read/27530268/the-use-of-evidence-based-problem-oriented-templates-as-a-clinical-decision-support-in-an-inpatient-electronic-health-record-system
#20
Raj Mehta, Nila S Radhakrishnan, Carrie D Warring, Ankur Jain, Jorge Fuentes, Angela Dolganiuc, Laura S Lourdes, John Busigin, Robert R Leverence
BACKGROUND: The integration of clinical decision support (CDS) in documentation practices remains limited due to obstacles in provider workflows and design restrictions in electronic health records (EHRs). The use of electronic problem-oriented templates (POTs) as a CDS has been previously discussed but not widely studied. OBJECTIVE: We evaluated the voluntary use of evidence-based POTs as a CDS on documentation practices. METHODS: This was a randomized cohort (before and after) study of Hospitalist Attendings in an Academic Medical Center using EPIC EHRs...
August 17, 2016: Applied Clinical Informatics
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