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Applied Clinical Informatics

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
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
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
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
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
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
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
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 Two investigators evaluated the retrieved articles for inclusion...
September 14, 2016: Applied Clinical Informatics
Laura Fanucchi, Donglin Yan, Rosemarie L Conigliaro
BACKGROUND: Communication errors are identified as a root cause contributing to a majority of sentinel events. The clinical note is a cornerstone of physician communication, yet there are few published interventions on teaching note writing in the electronic health record (EHR). This is a prospective, two-site, quality improvement project to assess and improve the quality of clinical documentation in the EHR using a validated assessment tool. METHODS: Internal Medicine (IM) residents at the University of Kentucky College of Medicine (UK) and Montefiore Medical Center/Albert Einstein College of Medicine (MMC) received one of two interventions during an inpatient ward month: either a lecture, or a lecture and individual feedback on progress notes...
July 6, 2016: Applied Clinical Informatics
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...
2016: Applied Clinical Informatics
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)...
2016: Applied Clinical Informatics
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...
2016: Applied Clinical Informatics
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...
2016: Applied Clinical Informatics
Bret S E Heale, Casey Lynnette Overby, Guilherme Del Fiol, Wendy S Rubinstein, Donna R Maglott, Tristan H Nelson, Aleksandar Milosavljevic, Christa L Martin, Scott R Goehringer, Robert Freimuth, Marc S Williams
BACKGROUND: The Clinical Genome Resource (ClinGen) Electronic Health Record (EHR) Workgroup aims to integrate ClinGen resources with EHRs. A promising option to enable this integration is through the Health Level Seven (HL7) Infobutton Standard. EHR systems that are certified according to the US Meaningful Use program provide HL7-compliant infobutton capabilities, which can be leveraged to support clinical decision-making in genomics. OBJECTIVES: To integrate genomic knowledge resources using the HL7 infobutton standard...
2016: Applied Clinical Informatics
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...
2016: Applied Clinical Informatics
Neha Patel, James E Siegler, Nathaniel Stromberg, Neil Ravitz, C William Hanson
BACKGROUND: In hospitals, effective and efficient communication among care providers is critical to the provision of high-quality patient care. Yet, major problems impede communications including the frequent use of interruptive and one-way communication paradigms. This is especially frustrating for frontline providers given the dynamic nature of hospital care teams in an environment that is in constant flux. METHODS: We conducted a pre-post evaluation of a commercially available secured messaging mobile application on 4 hospital units at a single institution for over one year...
2016: Applied Clinical Informatics
Ayan Nasir, Varadraj Gurupur, Xinliang Liu
BACKGROUND: There is a need to develop a tool that will measure data completeness of patient records using sophisticated statistical metrics. Patient data integrity is important in providing timely and appropriate care. Completeness is an important step, with an emphasis on understanding the complex relationships between data fields and their relative importance in delivering care. This tool will not only help understand where data problems are but also help uncover the underlying issues behind them...
2016: Applied Clinical Informatics
Carolyn L Turvey, Dawn M Klein, Matthew Witry, J Stacey Klutts, Elaine L Hill, Bruce Alexander, Kim M Nazi
OBJECTIVES: Consumer-mediated health information exchange (HIE) is one of the three types of HIE designated by the Office of the National Coordinator. HIE is intended to improve the quality of care while reducing cost, yet empirical support for this claim is mixed. Future research should identify the contexts whereby HIE is most effective. METHODS: This study was conducted as a pilot two-arm randomized controlled trial. In the intervention arm, 27 veterans were taught how to generate a Continuity of Care Document (CCD) within the Blue Button feature of their VA patient portal and were then asked to share it with their community non-VA provider...
2016: Applied Clinical Informatics
Kavita Radhakrishnan, Karen A Monsen, Sung-Heui Bae, Wenhui Zhang
BACKGROUND: Visualization can reduce the cognitive load of information, allowing users to easily interpret and assess large amounts of data. The purpose of our study was to examine home health data using visual analysis techniques to discover clinically salient associations between patient characteristics with problem-oriented health outcomes of older adult home health patients during the home health service period. METHODS: Knowledge, Behavior and Status ratings at discharge as well as change from admission to discharge that was coded using the Omaha System was collected from a dataset on 988 de-identified patient data from 15 home health agencies...
2016: Applied Clinical Informatics
Erin A Vogel, Sarah J Billups, Sheryl J Herner, Thomas Delate
OBJECTIVE: The purpose of this study was to compare the effectiveness of an outpatient renal dose adjustment alert via a computerized provider order entry (CPOE) clinical decision support system (CDSS) versus a CDSS with alerts made to dispensing pharmacists. METHODS: This was a retrospective analysis of patients with renal impairment and 30 medications that are contraindicated or require dose-adjustment in such patients. The primary outcome was the rate of renal dosing errors for study medications that were dispensed between August and December 2013, when a pharmacist-based CDSS was in place, versus August through December 2014, when a prescriber-based CDSS was in place...
2016: Applied Clinical Informatics
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