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https://www.readbyqxmd.com/read/28729232/development-feasibility-and-small-scale-implementation-of-a-web-based-prognostic-tool-surveillance-epidemiology-and-end-results-cancer-survival-calculator
#1
Michelle Henton, Bridget Gaglio, Laurie Cynkin, Eric J Feuer, Borsika A Rabin
BACKGROUND: Population datasets and the Internet are playing an ever-growing role in the way cancer information is made available to providers, patients, and their caregivers. The Surveillance, Epidemiology, and End Results Cancer Survival Calculator (SEER*CSC) is a Web-based cancer prognostic tool that uses SEER data, a large population dataset, to provide physicians with highly valid, evidence-based prognostic estimates for increasing shared decision-making and improving patient-provider communication of complex health information...
July 20, 2017: JMIR Cancer
https://www.readbyqxmd.com/read/28726458/getting-started-reply-to-condon-et-al-2017-and-rossiter-2017
#2
Karen A Matthews, Nancy E Adler, Christopher B Forrest, William W Stead
Condon, Weston, and Hill (2017) and Rossiter (2017) expressed concerns about the recommended panel of psychosocial vital signs that should be included in electronic health records (EHRs). Condon et al. (2017) would prefer a broader array of measures and Rossiter (2017) a set of optimal measures based on consensus. Our task was to identify a core set of measures to be used now in all EHRs based on usefulness and low burden. We anticipate that with new evidence, changing needs, and greater input from stakeholders, the recommended measures will be elaborated or modified...
July 2017: American Psychologist
https://www.readbyqxmd.com/read/28724368/utilizing-patient-data-from-the-veterans-administration-electronic-health-record-to-support-web-based-clinical-decision-support-informatics-challenges-and-issues-from-three-clinical-domains
#3
Nallakkandi Rajeevan, Kristina M Niehoff, Peter Charpentier, Forrest L Levin, Amy Justice, Cynthia A Brandt, Terri R Fried, Perry L Miller
BACKGROUND: The US Veterans Administration (VA) has developed a robust and mature computational infrastructure in support of its electronic health record (EHR). Web technology offers a powerful set of tools for structuring clinical decision support (CDS) around clinical care. This paper describes informatics challenges and design issues that were confronted in the process of building three Web-based CDS systems in the context of the VA EHR. METHODS: Over the course of several years, we implemented three Web-based CDS systems that extract patient data from the VA EHR environment to provide patient-specific CDS...
July 19, 2017: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/28723587/evaluation-of-an-electronic-clinical-decision-support-tool-for-incident-elevated-bp-in-adolescents
#4
Elyse Olshen Kharbanda, Stephen E Asche, Alan Sinaiko, James D Nordin, Heidi L Ekstrom, Patricia Fontaine, Steven P Dehmer, Nancy E Sherwood, Patrick J O'Connor
OBJECTIVE: To evaluate, among adolescents 10-17 years with an incident hypertensive BP (≥95(th) percentile) at a primary care visit, whether TeenBP, a novel electronic health record (EHR) linked clinical decision support tool (CDS), improved recognition of elevated BP and return for follow-up BP evaluation. METHODS: We conducted a pragmatic cluster randomized trial in 20 primary care clinics in a large Midwestern medical group. Ten clinics received the TeenBP CDS, including an alert to remeasure a hypertensive BP at that visit, an alert that a hypertensive BP should be repeated in 1-3 weeks and patient-specific order sets...
July 16, 2017: Academic Pediatrics
https://www.readbyqxmd.com/read/28723312/alcohol-marijuana-and-opioid-use-disorders-5-year-patterns-and-characteristics-of-emergency-department-encounters
#5
Amber L Bahorik, Derek D Satre, Andrea H Kline-Simon, Constance M Weisner, Kelly C Young-Wolff, Cynthia I Campbell
BACKGROUND: Changes in substance use patterns stemming from opioid misuse, ongoing drinking problems, and marijuana legalization may result in new populations of patients with substance use disorders (SUDs) using emergency department (ED) resources. This study examined ED admission trends in a large sample of patients with alcohol, marijuana, and opioid use disorder in an integrated health system. METHODS: In a retrospective design, electronic health record (EHR) data identified patients with ≥ 1 of three common SUDs in 2010 (n = 17,574; alcohol, marijuana, or opioid use disorder) and patients without SUD (n = 17,574)...
July 19, 2017: Substance Abuse
https://www.readbyqxmd.com/read/28720625/developing-electronic-health-record-ehr-strategies-related-to-health-center-patients-social-determinants-of-health
#6
Rachel Gold, Erika Cottrell, Arwen Bunce, Mary Middendorf, Celine Hollombe, Stuart Cowburn, Peter Mahr, Gerardo Melgar
BACKGROUND: "Social determinants of heath" (SDHs) are nonclinical factors that profoundly affect health. Helping community health centers (CHCs) document patients' SDH data in electronic health records (EHRs) could yield substantial health benefits, but little has been reported about CHCs' development of EHR-based tools for SDH data collection and presentation. METHODS: We worked with 27 diverse CHC stakeholders to develop strategies for optimizing SDH data collection and presentation in their EHR, and approaches for integrating SDH data collection and the use of those data (eg, through referrals to community resources) into CHC workflows...
July 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28720032/electronic-immunization-alerts-and-spillover-effects-on-other-preventive-care
#7
Julia M Kim, Maria Rivera, Nichole Persing, David G Bundy, Kevin J Psoter, Sharon R Ghazarian, Marlene R Miller, Barry S Solomon
The impact of electronic health record (EHR) immunization clinical alert systems on the delivery of other preventive services remains unknown. We assessed for spillover effects of an EHR immunization alert on delivery of 6 other preventive services, in children 18 to 30 months of age needing immunizations. We conducted a secondary data analysis, with additional primary data collection, of a randomized, historically controlled trial to improve immunization rates with EHR alerts, in an urban, primary care clinic...
August 2017: Clinical Pediatrics
https://www.readbyqxmd.com/read/28716376/improving-the-safety-of-health-information-technology-requires-shared-responsibility-it-is-time-we-all-step-up
#8
Dean F Sittig, Elisabeth Belmont, Hardeep Singh
In 2011, an Institute of Medicine report on health information technology (IT) and patient safety highlighted that building health-IT for safer use is a shared responsibility between key stakeholders including: "vendors, care providers, healthcare organizations, health-IT departments, and public and private agencies". Use of electronic health records (EHRs) involves all these stakeholders, but they often have conflicting priorities and requirements. Since 2011, the concept of shared responsibility has gained little traction and EHR developers and users continue to attribute the substantial, long list of problems to each other...
July 14, 2017: Healthcare
https://www.readbyqxmd.com/read/28714196/impact-of-an-electronic-health-record-alert-in-primary-care-on-increasing-hepatitis-c-screening-and-curative-treatment-for-baby-boomers
#9
Monica A Konerman, Mary Thomson, Kristen Gray, Meghan Moore, Hetal Choxi, Elizabeth Seif, Anna Sf Lok
Despite effective treatment for chronic hepatitis C (CHC), deficiencies in diagnosis and access preclude disease elimination. Screening of baby boomers remains low. The aims of this study were to assess the impact of an electronic health record (EHR) based prompt on HCV screening rates in baby boomers in primary care, and access to specialty care and treatment among those newly diagnosed. We implemented an EHR based "Best Practice Advisory" (BPA) that prompted primary care providers (PCPs) to perform HCV screening for patients seen in primary care clinic: 1) born between 1945-1965; 2) lacked a prior diagnosis of HCV infection; and 3) lacked prior documented anti-HCV testing...
July 17, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/28711345/working-at-the-intersection-of-context-culture-and-technology-provider-perspectives-on-antimicrobial-stewardship-in-the-emergency-department-using-electronic-health-record-clinical-decision-support
#10
Phillip Chung, Jean Scandlyn, Peter S Dayan, Rakesh D Mistry
BACKGROUND: Antibiotic stewardship programs (ASPs) have not been fully developed for the emergency department (ED), in part the result of the barriers characteristic of this setting. Electronic health record-based clinical decision support (EHR CDS) represents a promising strategy to implement ASPs in the ED. We aimed to determine the cultural beliefs and structural barriers and facilitators to implementation of antimicrobial stewardship in the pediatric ED using EHR CDS. METHODS: Interviews and focus groups were conducted with hospital and ED leadership, attending ED physicians, nurse practitioners, physician assistants, and residents at a single health system in Colorado...
July 12, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28710055/what-patients-value-about-reading-visit-notes-a-qualitative-inquiry-of-patient-experiences-with-their-health-information
#11
Macda Gerard, Alan Fossa, Patricia H Folcarelli, Jan Walker, Sigall K Bell
BACKGROUND: Patients are increasingly asking for their health data. Yet, little is known about what motivates patients to engage with the electronic health record (EHR). Furthermore, quality-focused mechanisms for patients to comment about their records are lacking. OBJECTIVE: We aimed to learn more about patient experiences with reading and providing feedback on their visit notes. METHODS: We developed a patient feedback tool linked to OpenNotes as part of a pilot quality improvement initiative focused on patient engagement...
July 14, 2017: Journal of Medical Internet Research
https://www.readbyqxmd.com/read/28709453/validation-of-multisource-electronic-health-record-data-an-application-to-blood-transfusion-data
#12
Loan R van Hoeven, Martine C de Bruijne, Peter F Kemper, Maria M W Koopman, Jan M M Rondeel, Anja Leyte, Hendrik Koffijberg, Mart P Janssen, Kit C B Roes
BACKGROUND: Although data from electronic health records (EHR) are often used for research purposes, systematic validation of these data prior to their use is not standard practice. Existing validation frameworks discuss validity concepts without translating these into practical implementation steps or addressing the potential influence of linking multiple sources. Therefore we developed a practical approach for validating routinely collected data from multiple sources and to apply it to a blood transfusion data warehouse to evaluate the usability in practice...
July 14, 2017: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/28708848/predicting-all-cause-risk-of-30-day-hospital-readmission-using-artificial-neural-networks
#13
Mehdi Jamei, Aleksandr Nisnevich, Everett Wetchler, Sylvia Sudat, Eric Liu
Avoidable hospital readmissions not only contribute to the high costs of healthcare in the US, but also have an impact on the quality of care for patients. Large scale adoption of Electronic Health Records (EHR) has created the opportunity to proactively identify patients with high risk of hospital readmission, and apply effective interventions to mitigate that risk. To that end, in the past, numerous machine-learning models have been employed to predict the risk of 30-day hospital readmission. However, the need for an accurate and real-time predictive model, suitable for hospital setting applications still exists...
2017: PloS One
https://www.readbyqxmd.com/read/28699944/improving-the-readability-of-pediatric-hospital-medicine-discharge-instructions
#14
Ndidi Unaka, Angela Statile, Karen Jerardi, Devesh Dahale, Joan Morris, Brianna Liberio, Ashley Jenkins, Blair Simpson, Randi Mullaney, Jodi Kelley, Michelle Durling, Jennifer Shafer, Patrick Brady
BACKGROUND: Readable discharge instructions may help caregivers understand and implement care plans following hospitalization. Many caregivers of hospitalized children, however, have limited literacy. We aimed to increase the percentage of discharge instructions written at 7th grade level or lower for hospital medicine patients from 13% to 80% in 6 months. METHODS: Quality improvement efforts targeted a 42-bed unit at the community satellite of our large, urban academic hospital...
July 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28699564/detecting-clinically-relevant-new-information-in-clinical-notes-across-specialties-and-settings
#15
Rui Zhang, Serguei V S Pakhomov, Elliot G Arsoniadis, Janet T Lee, Yan Wang, Genevieve B Melton
BACKGROUND: Automated methods for identifying clinically relevant new versus redundant information in electronic health record (EHR) clinical notes is useful for clinicians and researchers involved in patient care and clinical research, respectively. We evaluated methods to automatically identify clinically relevant new information in clinical notes, and compared the quantity of redundant information across specialties and clinical settings. METHODS: Statistical language models augmented with semantic similarity measures were evaluated as a means to detect and quantify clinically relevant new and redundant information over longitudinal clinical notes for a given patient...
July 5, 2017: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/28699545/predictive-models-for-pressure-ulcers-from-intensive-care-unit-electronic-health-records-using-bayesian-networks
#16
Pacharmon Kaewprag, Cheryl Newton, Brenda Vermillion, Sookyung Hyun, Kun Huang, Raghu Machiraju
BACKGROUND: We develop predictive models enabling clinicians to better understand and explore patient clinical data along with risk factors for pressure ulcers in intensive care unit patients from electronic health record data. Identifying accurate risk factors of pressure ulcers is essential to determining appropriate prevention strategies; in this work we examine medication, diagnosis, and traditional Braden pressure ulcer assessment scale measurements as patient features. In order to predict pressure ulcer incidence and better understand the structure of related risk factors, we construct Bayesian networks from patient features...
July 5, 2017: BMC Medical Informatics and Decision Making
https://www.readbyqxmd.com/read/28697871/patterns-of-antimicrobial-agent-prescription-in-a-sentinel-population-of-canine-and-feline-veterinary-practices-in-the-united-kingdom
#17
D A Singleton, F Sánchez-Vizcaíno, S Dawson, P H Jones, P J M Noble, G L Pinchbeck, N J Williams, A D Radford
Antimicrobial resistance is an increasingly important global health threat and the use of antimicrobial agents is a key risk factor in its development. This study describes antimicrobial agent prescription (AAP) patterns over a 2year period using electronic health records (EHRs) from booked consultations in a network of 457 sentinel veterinary premises in the United Kingdom. A semi-automated classification methodology was used to map practitioner defined product codes in 918,333 EHRs from 413,870 dogs and 352,730 EHRs from 200,541 cats, including 289,789 AAPs...
June 2017: Veterinary Journal
https://www.readbyqxmd.com/read/28696480/a-picture-is-worth-1-000-words-the-use-of-clinical-images-in-electronic-medical-records
#18
Angela C Ai, Francine L Maloney, Thu-Trang Hickman, Allison R Wilcox, Harley Ramelson, Adam Wright
OBJECTIVE: To understand how clinicians utilize image uploading tools in a home grown electronic health records (EHR) system. METHODS: A content analysis of patient notes containing non-radiological images from the EHR was conducted. Images from 4,000 random notes from July 1, 2009 - June 30, 2010 were reviewed and manually coded. Codes were assigned to four properties of the image: (1) image type, (2) role of image uploader (e.g. MD, NP, PA, RN), (3) practice type (e...
July 12, 2017: Applied Clinical Informatics
https://www.readbyqxmd.com/read/28696416/cytochrome-p450-interactions-are-common-and-consequential-in-massachusetts-hospital-discharges
#19
T H McCoy, V M Castro, A Cagan, L Snapper, A Roberson, R H Perlis
Despite the recognition that drug-drug interactions contribute substantially to preventable health-care costs, the prevalence of such interactions related to the cytochrome P450 system in clinical practice remains poorly characterized. This study drew retrospective hospital discharge cohorts from a large health claims data set and a large health system data set. For every hospital discharge, frequency of co-occurrence of substrates and inducers or inhibitors at cytochrome P450 2D6, 2C19, 3A4 and 1A2 were determined...
July 11, 2017: Pharmacogenomics Journal
https://www.readbyqxmd.com/read/28693480/utility-preserving-anonymization-for-health-data-publishing
#20
Hyukki Lee, Soohyung Kim, Jong Wook Kim, Yon Dohn Chung
BACKGROUND: Publishing raw electronic health records (EHRs) may be considered as a breach of the privacy of individuals because they usually contain sensitive information. A common practice for the privacy-preserving data publishing is to anonymize the data before publishing, and thus satisfy privacy models such as k-anonymity. Among various anonymization techniques, generalization is the most commonly used in medical/health data processing. Generalization inevitably causes information loss, and thus, various methods have been proposed to reduce information loss...
July 11, 2017: BMC Medical Informatics and Decision Making
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