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https://www.readbyqxmd.com/read/28212287/big-data-analytics-for-genomic-medicine
#1
REVIEW
Karen Y He, Dongliang Ge, Max M He
Genomic medicine attempts to build individualized strategies for diagnostic or therapeutic decision-making by utilizing patients' genomic information. Big Data analytics uncovers hidden patterns, unknown correlations, and other insights through examining large-scale various data sets. While integration and manipulation of diverse genomic data and comprehensive electronic health records (EHRs) on a Big Data infrastructure exhibit challenges, they also provide a feasible opportunity to develop an efficient and effective approach to identify clinically actionable genetic variants for individualized diagnosis and therapy...
February 15, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28197420/the-challenges-of-electronic-health-records-and-diabetes-electronic-prescribing-implications-for-safety-net-care-for-diverse-populations
#2
REVIEW
Neda Ratanawongsa, Lenny L S Chan, Michelle M Fouts, Elizabeth J Murphy
Widespread electronic health record (EHR) implementation creates new challenges in the diabetes care of complex and diverse populations, including safe medication prescribing for patients with limited health literacy and limited English proficiency. This review highlights how the EHR electronic prescribing transformation has affected diabetes care for vulnerable patients and offers recommendations for improving patient safety through EHR electronic prescribing design, implementation, policy, and research. Specifically, we present evidence for (1) the adoption of RxNorm; (2) standardized naming and picklist options for high alert medications such as insulin; (3) the widespread implementation of universal medication schedule and language-concordant labels, with the expansion of electronic prescription 140-character limit; (4) enhanced bidirectional communication with pharmacy partners; and (5) informatics and implementation research in safety net healthcare systems to examine how EHR tools and practices affect diverse vulnerable populations...
2017: Journal of Diabetes Research
https://www.readbyqxmd.com/read/28194729/design-and-implementation-of-decision-support-for-tobacco-dependence-treatment-in-an-inpatient-electronic-medical-record-a-randomized-trial
#3
Steven L Bernstein, June Rosner, Michelle DeWitt, Jeanette Tetrault, Allen L Hsiao, James Dziura, Scott Sussman, Patrick O'Connor, Benjamin Toll
: Tobacco dependence treatment for hospitalized smokers results in long-term cessation if treatment continues at least 30 days post-discharge. Health information technology may facilitate ongoing tobacco dependence treatment after hospital discharge. To describe the use and impact of a new decision support tool and order set for inpatient physicians, addressing tobacco dependence treatment for hospitalized smokers, embedded in an electronic health record (EHR). In a cluster-randomized trial, 254 physicians were randomized (1:1) to either receive or not receive the decision support tool and order set, which were embedded in the Epic (Madison, WI) EHR used at 2 hospitals in a single city...
February 13, 2017: Translational Behavioral Medicine
https://www.readbyqxmd.com/read/28186074/adoption-of-electronic-health-record-system-in-community-based-physiotherapy-clinics-a-pilot-case-study
#4
Alan Yung
QUESTION: Can community-based physiotherapists adopt and use a nationally integrated electronic health record (NEHR) system? DESIGN: Observation and semi-structured interviews in two community-based physiotherapy clinics in Sydney, Australia. PARTICIPANTS: Two physiotherapy practice managers who were also practising physiotherapists. INTERVENTION: The implementation of a nationally integrated EHR system in physiotherapy...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28186040/low-cost-rapid-usability-testing-its-application-in-both-product-development-and-system-implementation
#5
Andre Kushniruk, Elizabeth Borycki
In recent years there has been considerable discussion around the need for certification and regulation of healthcare information technology (IT). In particular, the usability of the products being developed needs to be evaluated. This has included the application of standards designed to ensure the process of system development is user-centered and takes usability into consideration while a product is being developed. In addition to this, in healthcare, organizations in the United States and Europe have also addressed the need and requirement for product certification...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28186034/better-data-quality-for-better-healthcare-research-results-a-case-study
#6
Robert Hart, Mu-Hsing Kuo
Electronic Health Records (EHRs) have been identified as a key tool to collect data for healthcare research. However, EHR data must be of sufficient quality to support quality research results. Island Health, BC, Canada has invested and continues to invest in the development of solutions to address the quality of its EHR data and support high quality healthcare studies. This paper examines Island Health's data quality engine, its development and its successful implementation.
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28186031/the-use-of-case-studies-in-systems-implementations-within-health-care-settings-a-scoping-review
#7
Rav Gill, Elizabeth M Borycki
There is little evidence available in the research literature as to how to undertake an implementation process that ensures electronic medical record (EMR)/electronic health record (EHR) implementation success (i.e. high levels of clinician adoption). The research literature has documented the presence of a direct relationship between how systems are implemented and their level of adoption by clinicians after implementation. In order to develop recommendations for systems implementation to enhance the level of clinician adoption and to ensure EHR/EMR success, researchers need to analyze implementation failures (i...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28186029/the-cost-of-quality-in-diabetes
#8
Ahmad Ghany, Karim Keshavjee
The adoption and use of Electronic Medical Records (EMRs) and Electronic Health Records (EHRs) is continuing to rise in North America. These systems contain data of varying degrees of quality, including poor quality or "dirty" data. Data entered into EMRs need to be clean or of high quality for them to be useful for a variety of reasons, including quality improvement, clinical decision support, population management, research and system management. There are two potential solutions to obtaining clean data from EMRs: data discipline and data cleansing...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28186017/storing-and-querying-longitudinal-data-sets-in-an-open-source-ehr
#9
John Chelsom, Naveed Dogar
The cityEHR is an example of an open source EHR system which stores clinical data as collections of XML documents. The records gathered in routine clinical care are a rich source of longitudinal data for use in clinical studies. We describe how the standard language XQuery can be used to identify cohorts of patients, matching specified criteria. We discuss methods for ensuring good data quality and the issues in implementing XML queries on longitudinal data sets.
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28183354/protocol-for-the-analysis-of-a-natural-experiment-on-the-impact-of-the-affordable-care-act-on-diabetes-care-in-community-health-centers
#10
Nathalie Huguet, Heather Angier, Miguel Marino, K John McConnell, Megan J Hoopes, Jean P O'Malley, Lewis A Raynor, Sonja Likumahuwa-Ackman, Heather Holderness, Jennifer E DeVoe
BACKGROUND: It is hypothesized that Affordable Care Act (ACA) Medicaid expansions could substantially improve access to health insurance and healthcare services for patients at risk for diabetes mellitus (DM), with pre-DM, or already diagnosed with DM. The ACA called for every state to expand Medicaid coverage by 2014. In a 2012 legal challenge, the US Supreme Court ruled that states were not required to implement Medicaid expansions. This 'natural experiment' presents a unique opportunity to learn whether and to what extent Medicaid expansion can affect healthcare access and services for patients with DM risk, pre-DM, or DM...
February 10, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28173888/current-state-of-antimicrobial-stewardship-in-children-s-hospital-emergency-departments
#11
Rakesh D Mistry, Jason G Newland, Jeffrey S Gerber, Adam L Hersh, Larissa May, Sarah M Perman, Nathan Kuppermann, Peter S Dayan
BACKGROUND Antimicrobial stewardship programs (ASPs) effectively optimize antibiotic use for inpatients; however, the extent of emergency department (ED) involvement in ASPs has not been described. OBJECTIVE To determine current ED involvement in children's hospital ASPs and to assess beliefs and preferred methods of implementation for ED-based ASPs. METHODS A cross-sectional survey of 37 children's hospitals participating in the Sharing Antimicrobial Resistance Practices collaboration was conducted. Surveys were distributed to ASP leaders and ED medical directors at each institution...
February 8, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28163715/primary-care-provider-perceptions-of-colorectal-cancer-screening-barriers-implications-for-designing-quality-improvement-interventions
#12
Jennifer M Weiss, Perry J Pickhardt, Jessica R Schumacher, Aaron Potvien, David H Kim, Patrick R Pfau, Elizabeth A Jacobs, Maureen A Smith
Aims. Colorectal cancer (CRC) screening is underutilized. Increasing CRC screening rates requires interventions targeting multiple barriers at each level of the healthcare organization (patient, provider, and system). We examined groups of primary care providers (PCPs) based on perceptions of screening barriers and the relationship to CRC screening rates to inform approaches for conducting barrier assessments prior to designing and implementing quality improvement interventions. Methods. We conducted a retrospective cohort study linking EHR and survey data...
2017: Gastroenterology Research and Practice
https://www.readbyqxmd.com/read/28157382/electronic-health-record-ehr-organizational-change-explaining-resistance-through-profession-organizational-experience-and-ehr-communication-quality
#13
Ashley K Barrett
The American Recovery and Reinvestment Act passed by the U.S. government in 2009 mandates that all healthcare organizations adopt a certified electronic health record (EHR) system by 2015. Failure to comply will result in Medicare reimbursement penalties, which steadily increase with each year of delinquency. There are several repercussions of this seemingly top-down, rule-bound organizational change-one of which is employee resistance. Given the penalties for violating EHR meaningful use standards are ongoing, resistance to this mandate presents a serious issue for healthcare organizations...
February 3, 2017: Health Communication
https://www.readbyqxmd.com/read/28156482/implementing-an-emergency-department-emr-trigger-tool-for-palliative-medicine-consultation-and-its-effect-on-length-of-stay-and-health-care-costs-a-retrospective-study
#14
Felix Rivera, Wendy Edwards
: 167 Background: Several studies have shown that palliative medicine consultation can improve multiple patient-centered outcomes, especially when provided early. Our goal is to show that our electronic health record (EHR) trigger tool is a cost-effective way for hospitals to identify patients who may benefit from early consultation, improving outcomes such as hospital length of stay and facilitating appropriate disposition for patients with metastatic cancer. METHODS: Retrospective chart review of 721 patients at an urban community hospital who were identified by a trigger system integrated into the Emergency Department (ED) EHR...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152956/implementing-value-based-cancer-care-a-multidisciplinary-approach-to-defining-breast-cancer-outcomes
#15
Tinisha L Mayo, Tracy E Spinks, Seohyun Lee, Carlos Hernando Barcenas, Benjamin D Smith, Sharon Hermes Giordano, Rosa F Hwang, Richard A Ehlers, Jesse C Selber, Ronald Stewart Walters, Debu Tripathy, Kelly Hunt, Thomas A Buchholz, Thomas W Feeley, Henry Mark Kuerer
: 16 Background: Value in healthcare (patient-centered outcomes achieved per dollar spent) unifies performance improvement goals with health outcomes of importance to patients. We describe the process through which value-based measures for breast cancer patients and dynamic capture of these metrics via our new electronic health record (EHR) were developed at our institution. METHODS: A review of the breast cancer literature was conducted on treatment options as well as expected outcomes and potential treatment complications...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152947/measuring-value-in-bundled-payments-for-head-and-neck-cancer
#16
Tracy E Spinks, Alexis B Guzman, Randal S Weber, Ehab Y Hanna, Amy Clark Hessel, Beth Michelle Beadle, Kate A Hutcheson, James Incalcaterra, Nancy M Wood, Delrose Jones, Thomas W Feeley
: 11 Background: Value, defined as outcomes relative to costs, cannot be improved without rigorous long-term measurement. To assess value within a bundled payment pilot for head and neck cancer, we aim to generate timely, patient-centered outcomes and robust, near-real time financial tracking (Porter and Teisberg, Redefining health care. Creating value-based competition on results; Harvard Business School Press, 2006). METHODS: Clinical and quality experts created an outcome measure set for head and neck cancer, using a three-tiered outcomes hierarchy from Michael Porter of Harvard Business School as a framework...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152928/integration-of-a-clinical-pathways-software-into-an-ehr-in-a-large-multisite-hospital-affiliated-community-oncology-setting
#17
Thomas James Saphner, Jacob C Frick, Carol Huibregtse, Gail S Stiemke
: 129 Background: Via Oncology (Via) is a decision support tool that integrates patient information, their disease, and goals of care to develop a treatment algorithm. Via prioritizes treatments by efficacy first, toxicity second, and cost third. The recommended regimen is offered to the doctor and patient who may accept it or choose an off pathway treatment. The pathways are updated quarterly and are expected to speed the integration of new treatments into practice, standardize therapy, improve quality, and decrease cost...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152912/an-electronic-intervention-to-improve-structured-cancer-stage-data-capture
#18
Kim Framski, Patricia Lazette, Teresita Vega, Rogerio Lilenbaum
: 151 Background: Cancer Staging is critical for prognosticating, treatment planning, outcomes analysis, registry reporting and clinical trial eligibility determination. Oncology EHRs have structured staging modules but use by physicians is inconsistent. Typically, stage is entered as unstructured free text in clinical notes and cannot be used for reporting. Instead, institutions depend the tumor registry (TR) which typically lag 6 months behind. Our Cancer Committee determined that real-time capture of structured cancer staging was an imperative...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152887/utilizing-a-case-management-system-to-reduce-the-response-time-for-symptom-management-calls-in-a-high-volume-practice
#19
Larry Edward Bilbrey
: 170 Background: A five physician, three nurse practitioner,community oncology clinic experiences high call volumes (average 352 daily), many of which are related to side-effects of chemo/biotherapy and health related issues. A study was completed to decrease the time for a patient symptom management call to be addressed and concluded. METHODS: Initial primary data were collected over a four month period (April-August 2015) using the phone system and the Electronic Health Record (EHR) reporting capabilities, by cross-referencing the caller-ID data with the EHR patient demographics data; only documented symptom management calls within the EHR were included...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152862/effect-on-clinical-trial-participation-by-integration-of-a-clinical-pathway-program-into-an-electronic-health-record-ehr
#20
Thomas James Saphner
: 167 Background: Patient enrollment to clinical trials is lower than desired. Even large organizations with extensive research support services have many barriers to recruitment and poor rates of enrollment. Barriers to clinical trial participation can be physician related, system related, or patient related. Physician related issues are the largest barrier to patient accrual. Physicians are often not aware that a trial may be available for a patient. While all initial patients are manually screened in our system, screening for subsequent lines of therapy are not...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
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