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https://www.readbyqxmd.com/read/29769151/real-time-automated-detection-of-ventilator-associated-events-avoiding-missed-detections-misclassifications-and-false-detections-due-to-human-error
#1
Erica S Shenoy, Eric S Rosenthal, Yu-Ping Shao, Siddharth Biswal, Manohar Ghanta, Erin E Ryan, Dolores Suslak, Nancy Swanson, Valdery Moura Junior, David C Hooper, M Brandon Westover
OBJECTIVETo validate a system to detect ventilator associated events (VAEs) autonomously and in real time.DESIGNRetrospective review of ventilated patients using a secure informatics platform to identify VAEs (ie, automated surveillance) compared to surveillance by infection control (IC) staff (ie, manual surveillance), including development and validation cohorts.SETTINGThe Massachusetts General Hospital, a tertiary-care academic health center, during January-March 2015 (development cohort) and January-March 2016 (validation cohort)...
May 17, 2018: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/29768667/analyzing-self-controlled-case-series-data-when-case-confirmation-rates-are-estimated-from-an-internal-validation-sample
#2
Stanley Xu, Christina L Clarke, Sophia R Newcomer, Matthew F Daley, Jason M Glanz
Vaccine safety studies are often electronic health record (EHR)-based observational studies. These studies often face significant methodological challenges, including confounding and misclassification of adverse event. Vaccine safety researchers use self-controlled case series (SCCS) study design to handle confounding effect and employ medical chart review to ascertain cases that are identified using EHR data. However, for common adverse events, limited resources often make it impossible to adjudicate all adverse events observed in electronic data...
May 16, 2018: Biometrical Journal. Biometrische Zeitschrift
https://www.readbyqxmd.com/read/29768634/perceived-burden-of-ehrs-on-physicians-at-different-stages-of-their-career
#3
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
https://www.readbyqxmd.com/read/29768633/evaluating-the-efficiency-and-safety-of-speech-recognition-within-a-commercial-electronic-health-record-system-a-replication-study
#4
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
https://www.readbyqxmd.com/read/29766520/the-role-of-electronic-health-records-in-clinical-reasoning
#5
REVIEW
Markus Berndt, Martin R Fischer
Electronic health records (eHRs) play an increasingly important role in documentation and exchange of information in multi-and interdisciplinary patient care. Although eHRs are associated with mixed evidence in terms of effectiveness, they are undeniably the health record form of the future. This poses several learning opportunities and challenges for medical education. This review aims to connect the concept of eHRs to key competencies of physicians and elaborates current learning science perspectives on diagnostic and clinical reasoning based on a theoretical framework of scientific reasoning and argumentation...
May 16, 2018: Annals of the New York Academy of Sciences
https://www.readbyqxmd.com/read/29766382/reduced-effectiveness-of-interruptive-drug-drug-interaction-alerts-after-conversion-to-a-commercial-electronic-health-record
#6
Adam Wright, Skye Aaron, Diane L Seger, Lipika Samal, Gordon D Schiff, David W Bates
BACKGROUND: Drug-drug interaction (DDI) alerts in electronic health records (EHRs) can help prevent adverse drug events, but such alerts are frequently overridden, raising concerns about their clinical usefulness and contribution to alert fatigue. OBJECTIVE: To study the effect of conversion to a commercial EHR on DDI alert and acceptance rates. DESIGN: Two before-and-after studies. PARTICIPANTS: 3277 clinicians who received a DDI alert in the outpatient setting...
May 15, 2018: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/29759257/developing-a-medical-scribe-program-at-an-academic-hospital-the-hennepin-county-medical-center-experience
#7
Marc L Martel, Brian H Imdieke, Kayla M Holm, Sara Poplau, William G Heegaard, Jon L Pryor, Mark Linzer
BACKGROUND: Medical scribes are frequently incorporated into the patient care model to improve provider efficiency and enable providers to refocus their attention to the patient rather than the electronic health record (EHR). The medical scribe program was based on four pillars (objectives): (1) provider satisfaction, (2) standardized documentation, (3) documentation components for risk adjustment, and (4) revenue enhancement. METHODS: The medical scribe program was deployed in nine non-resident-supported clinics (internal medicine, ophthalmology, orthopedics, hematology/oncology, urology), with the medical scribes (who have no clinical duties) supporting both physicians and advanced practice providers (nurse practitioners and physician assistants)...
May 2018: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/29759054/successfully-navigating-multiple-electronic-health-records-when-using-telepsychiatry-the-nc-step-experience
#8
Sy Atezaz Saeed
Telepsychiatry is a viable option for providing psychiatric care to those who are currently underserved or who lack access to services, but barriers to its widespread utilization remain. Use of different electronic health record systems (EHRs) by various health care systems is one such barrier. Utilization of different EHRs makes it difficult for providers to review patient data and to document clinical encounters. This column describes a Web portal developed by the North Carolina Statewide Telepsychiatry Program that connects participating hospital emergency departments and remote psychiatric providers, allowing them to share secure electronic health information regarding patient encounters across different EHRs...
May 15, 2018: Psychiatric Services: a Journal of the American Psychiatric Association
https://www.readbyqxmd.com/read/29758342/next-generation-sequencing-in-drug-development-target-identification-and-genetically-stratified-clinical-trials
#9
REVIEW
Abolfazl Doostparast Torshizi, Kai Wang
Next-generation sequencing (NGS) enabled high-throughput analysis of genotype-phenotype relationships on human populations, ushering in a new era of genetics-informed drug development. The year 2017 was remarkable, with the first FDA-approved gene therapy for cancer (Kymriah™) and for inherited diseases (LUXTURNA™), the first multiplex NGS panel for companion diagnostics (MSK-IMPACT™) and the first drug targeting a genetic signature rather than a disease (Keytruda® ). We envision that population-scale NGS with paired electronic health records (EHRs) will become a routine measure in the drug development process for the identification of novel drug targets, and that genetically stratified clinical trials could be widely adopted to improve power in precision-medicine-guided drug development...
May 11, 2018: Drug Discovery Today
https://www.readbyqxmd.com/read/29756524/chest-pain-atherosclerotic-cardiovascular-disease-risk-and-cardiology-referral-in-primary-care
#10
Vishaal Buch, Hayley Ralph, Joanne Salas, Paul J Hauptman, Dawn Davis, Jeffrey F Scherrer
BACKGROUND: The atherosclerotic cardiovascular disease (ASCVD) 10-year risk estimate is recommended by cardiologists for determining risk of a cardiac event. However, the majority of patients presenting to primary care with chest pain have noncardiac etiologies. Therefore, we determined if high versus low ASCVD risk was associated with primary care physicians' referral to cardiology in patients with and without chest pain. METHODS: Deidentified electronic health record (EHR) data was obtained from 5795 patients treated in academic primary care clinics from 2008 to 2015...
January 2018: Journal of Primary Care & Community Health
https://www.readbyqxmd.com/read/29756355/development-and-validation-of-a-high-quality-composite-real-world-mortality-endpoint
#11
Melissa D Curtis, Sandra D Griffith, Melisa Tucker, Michael D Taylor, William B Capra, Gillis Carrigan, Ben Holzman, Aracelis Z Torres, Paul You, Brandon Arnieri, Amy P Abernethy
OBJECTIVE: To create a high-quality electronic health record (EHR)-derived mortality dataset for retrospective and prospective real-world evidence generation. DATA SOURCES/STUDY SETTING: Oncology EHR data, supplemented with external commercial and US Social Security Death Index data, benchmarked to the National Death Index (NDI). STUDY DESIGN: We developed a recent, linkable, high-quality mortality variable amalgamated from multiple data sources to supplement EHR data, benchmarked against the highest completeness U...
May 14, 2018: Health Services Research
https://www.readbyqxmd.com/read/29755826/pharmacovigilance-via-baseline-regularization-with-large-scale-longitudinal-observational-data
#12
Zhaobin Kuang, Peggy Peissig, Vítor Santos Costa, Richard Maclin, David Page
Several prominent public health hazards [29] that occurred at the beginning of this century due to adverse drug events (ADEs) have raised international awareness of governments and industries about pharmacovigilance (PhV) [6,7], the science and activities to monitor and prevent adverse events caused by pharmaceutical products after they are introduced to the market. A major data source for PhV is large-scale longitudinal observational databases (LODs) [6] such as electronic health records (EHRs) and medical insurance claim databases...
August 2017: KDD: Proceedings
https://www.readbyqxmd.com/read/29753874/simulation-of-patient-flow-in-multiple-healthcare-units-using-process-and-data-mining-techniques-for-model-identification
#13
Sergey V Kovalchuk, Anastasia A Funkner, Oleg G Metsker, Aleksey N Yakovlev
INTRODUCTION: An approach to building a hybrid simulation of patient flow is introduced with a combination of data-driven methods for automation of model identification. The approach is described with a conceptual framework and basic methods for combination of different techniques. The implementation of the proposed approach for simulation of the acute coronary syndrome (ACS) was developed and used in an experimental study. METHODS: A combination of data, text, process mining techniques, and machine learning approaches for the analysis of electronic health records (EHRs) with discrete-event simulation (DES) and queueing theory for the simulation of patient flow was proposed...
May 10, 2018: Journal of Biomedical Informatics
https://www.readbyqxmd.com/read/29752835/documentation-of-psychotropic-prn-medication-administration-an-evaluation-of-electronic-health-records-compared-with-paper-charts-and-verbal-reports
#14
Krystle Martin, Elke Ham, Zoe Hilton
AIMS AND OBJECTIVES: To describe the documentation of pro re nata (PRN) medication for anxiety, and to compare documentation at two hospitals providing similar psychiatric services, one that used paper charts and another that used an electronic health record (EHR). We also assessed congruence between nursing documentation and verbal reports from staff about the PRN administration process. BACKGROUND: The ability to accurately document patients' symptoms and the care given is considered a core competency of the nursing profession (Wilkinson, 2007); however, researchers have found poor concordance between nursing notes and verbal reports or observations of events (e...
May 12, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29752205/evaluation-of-the-frequency-of-dispensing-electronically-discontinued-medications-and-associated-outcomes
#15
Erin J Copi, Lindsey R Kelley, Kaleigh K Fisher
OBJECTIVES: To determine if outpatient pharmacies of an academic medical center inadvertently dispense discontinued medications and, if so, if these inadvertently dispensed prescriptions contribute to subsequent hospital admissions and patient harm. METHODS: This was a single-center retrospective chart review. Prescription billing data were analyzed for electronic prescriptions for hypotensives, hypoglycemics, anticoagulants, antiplatelets, and statins picked up from 3 outpatient pharmacies within the health system over a period of 1 year...
May 8, 2018: Journal of the American Pharmacists Association: JAPhA
https://www.readbyqxmd.com/read/29751829/querying-archetype-based-ehrs-by-search-ontology-based-xpath-engineering
#16
Stefan Kropf, Alexandr Uciteli, Katrin Schierle, Peter Krücken, Kerstin Denecke, Heinrich Herre
BACKGROUND: Legacy data and new structured data can be stored in a standardized format as XML-based EHRs on XML databases. Querying documents on these databases is crucial for answering research questions. Instead of using free text searches, that lead to false positive results, the precision can be increased by constraining the search to certain parts of documents. METHODS: A search ontology-based specification of queries on XML documents defines search concepts and relates them to parts in the XML document structure...
May 11, 2018: Journal of Biomedical Semantics
https://www.readbyqxmd.com/read/29751746/validating-the-use-of-veterans-affairs-tobacco-health-factors-for-assessing-change-in-smoking-status-accuracy-availability-and-approach
#17
Anne C Melzer, Erika A Pinsker, Barbara Clothier, Siamak Noorbaloochi, Diana J Burgess, Elisheva R Danan, Steven S Fu
BACKGROUND: Accurate smoking status is key for research purposes, but can be costly and difficult to measure. Within the Veteran's Health Administration (VA), smoking status is recorded as part of routine care as "health factors" (HF)-fields that researchers can query through the electronic health record (EHR). Many researchers are interested in using these fields to track changes in smoking status over time, however the validity of this measure for assessing change is unknown...
May 11, 2018: BMC Medical Research Methodology
https://www.readbyqxmd.com/read/29748851/a-platform-for-innovation-and-standards-evaluation-a-case-study-from-the-openmrs-open-source-radiology-information-system
#18
Judy W Gichoya, Marc Kohli, Larry Ivange, Teri S Schmidt, Saptarshi Purkayastha
Open-source development can provide a platform for innovation by seeking feedback from community members as well as providing tools and infrastructure to test new standards. Vendors of proprietary systems may delay adoption of new standards until there are sufficient incentives such as legal mandates or financial incentives to encourage/mandate adoption. Moreover, open-source systems in healthcare have been widely adopted in low- and middle-income countries and can be used to bridge gaps that exist in global health radiology...
May 10, 2018: Journal of Digital Imaging: the Official Journal of the Society for Computer Applications in Radiology
https://www.readbyqxmd.com/read/29747644/electronic-health-record-tools-to-assist-with-children-s-insurance-coverage-a-mixed-methods-study
#19
Jennifer E DeVoe, Megan Hoopes, Christine A Nelson, Deborah J Cohen, Aleksandra Sumic, Jennifer Hall, Heather Angier, Miguel Marino, Jean P O'Malley, Rachel Gold
BACKGROUND: Children with health insurance have increased access to healthcare and receive higher quality care. However, despite recent initiatives expanding children's coverage, many remain uninsured. New technologies present opportunities for helping clinics provide enrollment support for patients. We developed and tested electronic health record (EHR)-based tools to help clinics provide children's insurance assistance. METHODS: We used mixed methods to understand tool adoption, and to assess impact of tool use on insurance coverage, healthcare utilization, and receipt of recommended care...
May 10, 2018: BMC Health Services Research
https://www.readbyqxmd.com/read/29746339/comorbidities-in-childhood-celiac-disease-a-phenome-wide-association-study-using-the-electronic-health-record
#20
Ariana Prinzbach, Soheil Moosavinasab, Steve Rust, Brendan Boyle, John A Barnard, Yungui Huang, Simon Lin
OBJECTIVES: Celiac disease (CD) is associated with a variety of extraintestinal autoimmune and inflammatory findings that manifest clinically as symptoms and comorbidities. Understanding these comorbidities may improve identification of the disease and prevent sequelae. In this study, we use an unbiased electronic health record (EHR)-based Phenome Wide Association Study (PheWAS) method to confirm known comorbidities, discover novel associations and enhance characterization of the clinical presentation of CD in children...
May 9, 2018: Journal of Pediatric Gastroenterology and Nutrition
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