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  Subjects -> MEDICAL SCIENCES (Total: 8036 journals)
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MEDICAL SCIENCES (2127 journals)                  1 2 3 4 5 6 7 8 | Last

Showing 1 - 200 of 3562 Journals sorted alphabetically
16 de Abril     Open Access  
3D Printing in Medicine     Open Access   (Followers: 2)
AADE in Practice     Hybrid Journal   (Followers: 5)
ABCS Health Sciences     Open Access   (Followers: 4)
Abia State University Medical Students' Association Journal     Full-text available via subscription  
ACIMED     Open Access   (Followers: 1)
ACS Medicinal Chemistry Letters     Hybrid Journal   (Followers: 44)
Acta Bio Medica     Full-text available via subscription   (Followers: 2)
Acta Bioethica     Open Access  
Acta Bioquimica Clinica Latinoamericana     Open Access   (Followers: 1)
Acta Científica Estudiantil     Open Access  
Acta Facultatis Medicae Naissensis     Open Access  
Acta Informatica Medica     Open Access   (Followers: 1)
Acta Medica (Hradec Králové)     Open Access  
Acta Medica Bulgarica     Open Access  
Acta Medica Colombiana     Open Access   (Followers: 1)
Acta Médica Costarricense     Open Access   (Followers: 2)
Acta Medica Indonesiana     Open Access  
Acta Medica International     Open Access  
Acta medica Lituanica     Open Access  
Acta Medica Marisiensis     Open Access  
Acta Medica Martiniana     Open Access  
Acta Medica Nagasakiensia     Open Access   (Followers: 1)
Acta Medica Peruana     Open Access   (Followers: 2)
Acta Médica Portuguesa     Open Access  
Acta Medica Saliniana     Open Access  
Acta Scientiarum. Health Sciences     Open Access   (Followers: 1)
Acupuncture & Electro-Therapeutics Research     Full-text available via subscription   (Followers: 6)
Acupuncture and Natural Medicine     Open Access  
Addiction Science & Clinical Practice     Open Access   (Followers: 8)
Addictive Behaviors Reports     Open Access   (Followers: 9)
Adıyaman Üniversitesi Sağlık Bilimleri Dergisi / Health Sciences Journal of Adıyaman University     Open Access  
Adnan Menderes Üniversitesi Sağlık Bilimleri Fakültesi Dergisi     Open Access  
Advanced Biomedical Research     Open Access  
Advanced Health Care Technologies     Open Access   (Followers: 4)
Advanced Science, Engineering and Medicine     Partially Free   (Followers: 8)
Advances in Bioscience and Clinical Medicine     Open Access   (Followers: 6)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26)
Advances in Life Course Research     Hybrid Journal   (Followers: 8)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Medical Education and Practice     Open Access   (Followers: 29)
Advances in Medical Ethics     Open Access  
Advances in Medical Research     Open Access  
Advances in Medical Sciences     Hybrid Journal   (Followers: 7)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Medicine     Open Access   (Followers: 3)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4)
Advances in Molecular Oncology     Open Access   (Followers: 2)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7)
Advances in Parkinson's Disease     Open Access  
Advances in Phytomedicine     Full-text available via subscription  
Advances in Preventive Medicine     Open Access   (Followers: 6)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20)
Advances in Regenerative Medicine     Open Access   (Followers: 3)
Advances in Skeletal Muscle Function Assessment     Open Access  
Advances in Therapy     Hybrid Journal   (Followers: 5)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 5)
Advances in Wound Care     Hybrid Journal   (Followers: 11)
Aerospace Medicine and Human Performance     Full-text available via subscription   (Followers: 12)
African Health Sciences     Open Access   (Followers: 3)
African Journal of Biomedical Research     Open Access   (Followers: 1)
African Journal of Clinical and Experimental Microbiology     Open Access   (Followers: 2)
African Journal of Laboratory Medicine     Open Access   (Followers: 2)
African Journal of Medical and Health Sciences     Open Access   (Followers: 2)
African Journal of Trauma     Open Access   (Followers: 1)
Afrimedic Journal     Open Access   (Followers: 2)
Aggiornamenti CIO     Hybrid Journal   (Followers: 1)
AIDS Research and Human Retroviruses     Hybrid Journal   (Followers: 9)
AJOB Primary Research     Partially Free   (Followers: 3)
AJSP: Reviews & Reports     Hybrid Journal  
Aktuelle Ernährungsmedizin     Hybrid Journal   (Followers: 4)
Al-Azhar Assiut Medical Journal     Open Access  
Alexandria Journal of Medicine     Open Access   (Followers: 1)
Allgemeine Homöopathische Zeitung     Hybrid Journal   (Followers: 3)
Alpha Omegan     Full-text available via subscription  
ALTEX : Alternatives to Animal Experimentation     Open Access   (Followers: 3)
Althea Medical Journal     Open Access  
American Journal of Biomedical Engineering     Open Access   (Followers: 13)
American Journal of Biomedical Research     Open Access   (Followers: 2)
American Journal of Biomedicine     Full-text available via subscription   (Followers: 7)
American Journal of Chinese Medicine, The     Hybrid Journal   (Followers: 4)
American Journal of Clinical Medicine Research     Open Access   (Followers: 7)
American Journal of Family Therapy     Hybrid Journal   (Followers: 11)
American Journal of Law & Medicine     Full-text available via subscription   (Followers: 11)
American Journal of Lifestyle Medicine     Hybrid Journal   (Followers: 5)
American Journal of Managed Care     Full-text available via subscription   (Followers: 11)
American Journal of Medical Case Reports     Open Access   (Followers: 1)
American Journal of Medical Sciences and Medicine     Open Access   (Followers: 4)
American Journal of Medicine     Hybrid Journal   (Followers: 48)
American Journal of Medicine and Medical Sciences     Open Access   (Followers: 1)
American Journal of Medicine Studies     Open Access   (Followers: 1)
American Journal of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American Journal of the Medical Sciences     Hybrid Journal   (Followers: 12)
American Journal on Addictions     Hybrid Journal   (Followers: 9)
American medical news     Free   (Followers: 3)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 5)
Amyloid: The Journal of Protein Folding Disorders     Hybrid Journal   (Followers: 5)
Anales de la Facultad de Medicina     Open Access  
Anales de la Facultad de Medicina, Universidad de la República, Uruguay     Open Access  
Anales del Sistema Sanitario de Navarra     Open Access   (Followers: 1)
Analgesia & Resuscitation : Current Research     Hybrid Journal   (Followers: 6)
Anatolian Clinic the Journal of Medical Sciences     Open Access  
Anatomica Medical Journal     Open Access  
Anatomical Science International     Hybrid Journal   (Followers: 3)
Anatomical Sciences Education     Hybrid Journal   (Followers: 1)
Anatomy     Open Access   (Followers: 1)
Anatomy Research International     Open Access   (Followers: 2)
Angewandte Schmerztherapie und Palliativmedizin     Hybrid Journal  
Angiogenesis     Hybrid Journal   (Followers: 3)
Ankara Medical Journal     Open Access   (Followers: 2)
Ankara Üniversitesi Tıp Fakültesi Mecmuası     Open Access  
Annales de Pathologie     Full-text available via subscription  
Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale     Full-text available via subscription   (Followers: 3)
Annals of African Medicine     Open Access   (Followers: 2)
Annals of Anatomy - Anatomischer Anzeiger     Hybrid Journal   (Followers: 2)
Annals of Bioanthropology     Open Access   (Followers: 4)
Annals of Biomedical Engineering     Hybrid Journal   (Followers: 17)
Annals of Biomedical Sciences     Full-text available via subscription   (Followers: 3)
Annals of Clinical Hypertension     Open Access  
Annals of Clinical Microbiology and Antimicrobials     Open Access   (Followers: 12)
Annals of Family Medicine     Open Access   (Followers: 14)
Annals of Health Research     Open Access  
Annals of Ibadan Postgraduate Medicine     Open Access  
Annals of Medical and Health Sciences Research     Open Access   (Followers: 7)
Annals of Medicine     Hybrid Journal   (Followers: 12)
Annals of Medicine and Surgery     Open Access   (Followers: 7)
Annals of Microbiology     Hybrid Journal   (Followers: 11)
Annals of Nigerian Medicine     Open Access   (Followers: 1)
Annals of Rehabilitation Medicine     Open Access  
Annals of Saudi Medicine     Open Access  
Annals of the New York Academy of Sciences     Hybrid Journal   (Followers: 5)
Annals of The Royal College of Surgeons of England     Full-text available via subscription   (Followers: 3)
Annual Reports in Medicinal Chemistry     Full-text available via subscription   (Followers: 7)
Annual Reports on NMR Spectroscopy     Full-text available via subscription   (Followers: 5)
Annual Review of Medicine     Full-text available via subscription   (Followers: 16)
Anthropological Review     Open Access   (Followers: 23)
Anthropologie et santé     Open Access   (Followers: 5)
Antibiotics     Open Access   (Followers: 9)
Antibodies     Open Access   (Followers: 2)
Antibody Technology Journal     Open Access   (Followers: 1)
Antibody Therapeutics     Open Access  
Anuradhapura Medical Journal     Open Access  
Anwer Khan Modern Medical College Journal     Open Access   (Followers: 2)
Apmis     Hybrid Journal   (Followers: 1)
Apparence(s)     Open Access   (Followers: 1)
Applied Clinical Informatics     Hybrid Journal   (Followers: 3)
Applied Clinical Research, Clinical Trials and Regulatory Affairs     Hybrid Journal  
Applied Medical Informatics     Open Access   (Followers: 12)
Arab Journal of Nephrology and Transplantation     Open Access   (Followers: 1)
Archive of Clinical Medicine     Open Access   (Followers: 1)
Archive of Community Health     Open Access   (Followers: 1)
Archives Medical Review Journal / Arşiv Kaynak Tarama Dergisi     Open Access  
Archives of Asthma, Allergy and Immunology     Open Access  
Archives of Medical and Biomedical Research     Open Access   (Followers: 3)
Archives of Medical Laboratory Sciences     Open Access   (Followers: 1)
Archives of Medicine and Health Sciences     Open Access   (Followers: 3)
Archives of Medicine and Surgery     Open Access  
Archives of Trauma Research     Open Access   (Followers: 3)
Archivos de Medicina (Manizales)     Open Access  
ArgoSpine News & Journal     Hybrid Journal  
Arquivos Brasileiros de Oftalmologia     Open Access   (Followers: 1)
Arquivos de Ciências da Saúde     Open Access  
Arquivos de Medicina     Open Access  
Ars Medica : Revista de Ciencias Médicas     Open Access  
ARS Medica Tomitana     Open Access   (Followers: 1)
Art Therapy: Journal of the American Art Therapy Association     Full-text available via subscription   (Followers: 15)
Arterial Hypertension     Open Access   (Followers: 1)
Artificial Intelligence in Medicine     Hybrid Journal   (Followers: 14)
Artificial Organs     Hybrid Journal   (Followers: 1)
ASHA Leader     Open Access  
Asia Pacific Family Medicine     Open Access   (Followers: 1)
Asia Pacific Journal of Clinical Nutrition     Full-text available via subscription   (Followers: 11)
Asia Pacific Journal of Clinical Trials : Nervous System Diseases     Open Access  
Asian Bioethics Review     Full-text available via subscription   (Followers: 3)
Asian Biomedicine     Open Access   (Followers: 2)
Asian Journal of Cell Biology     Open Access   (Followers: 5)
Asian Journal of Health     Open Access   (Followers: 3)
Asian Journal of Medical and Biological Research     Open Access   (Followers: 4)
Asian Journal of Medical and Pharmaceutical Researches     Open Access   (Followers: 1)
Asian Journal of Medical Sciences     Open Access   (Followers: 2)
Asian Journal of Scientific Research     Open Access   (Followers: 3)
Asian Journal of Transfusion Science     Open Access   (Followers: 1)
Asian Medicine     Hybrid Journal   (Followers: 5)
Asian Pacific Journal of Cancer Prevention     Open Access  
ASPIRATOR : Journal of Vector-borne Disease Studies     Open Access  
Astrocyte     Open Access  
Atención Familiar     Open Access  
Atención Primaria     Open Access   (Followers: 1)
Atti della Accademia Peloritana dei Pericolanti - Classe di Scienze Medico-Biologiche     Open Access  
Audiology - Communication Research     Open Access   (Followers: 10)
Auris Nasus Larynx     Full-text available via subscription  
Australian Coeliac     Full-text available via subscription   (Followers: 1)
Australian Family Physician     Full-text available via subscription   (Followers: 3)
Australian Journal of Medical Science     Full-text available via subscription   (Followers: 1)
Autopsy and Case Reports     Open Access  
Avicenna     Open Access   (Followers: 3)
Avicenna Journal of Clinical Medicine     Open Access  
Avicenna Journal of Medicine     Open Access   (Followers: 1)
Bangabandhu Sheikh Mujib Medical University Journal     Open Access   (Followers: 1)

        1 2 3 4 5 6 7 8 | Last

Similar Journals
Journal Cover
Applied Clinical Informatics
Journal Prestige (SJR): 0.624
Citation Impact (citeScore): 1
Number of Followers: 3  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1869-0327
Published by Thieme Publishing Group Homepage  [238 journals]
  • Common Laboratory Results Frequently Misunderstood by a Sample of
           Mechanical Turk Users
    • Authors: Qureshi; Nabeel, Mehrotra, Ateev, Rudin, Robert S., Fischer, Shira H.
      Pages: 175 - 179
      Abstract: Objectives More patients are receiving their test results via patient portals. Given test results are written using medical jargon, there has been concern that patients may misinterpret these results. Using sample colonoscopy and Pap smear results, our objective was to assess how frequently people can identify the correct diagnosis and when a patient should follow up with a provider. Methods We used Mechanical Turk—a crowdsourcing tool run by Amazon that enables easy and fast gathering of users to perform tasks like answering questions or identifying objects—to survey individuals who were shown six sample test results (three colonoscopy, three Pap smear) ranging in complexity. For each case, respondents answered multiple choice questions on the correct diagnosis and recommended return time. Results Among the three colonoscopy cases (n = 642) and three Pap smear cases (n = 642), 63% (95% confidence interval [CI]: 60–67%) and 53% (95% CI: 49–57%) of the respondents chose the correct diagnosis, respectively. For the most complex colonoscopy and Pap smear cases, only 29% (95% CI: 23–35%) and 9% (95% CI: 5–13%) chose the correct diagnosis. Conclusion People frequently misinterpret colonoscopy and Pap smear test results. Greater emphasis needs to be placed on assisting patients in interpretation.
      Citation: Appl Clin Inform 2019; 10: 175-179
      PubDate: 2019-03-13T00:00:00+0100
      DOI: 10.1055/s-0039-1679960
      Issue No: Vol. 10, No. 02 (2019)
       
  • Effect of Sociodemographic Factors on Uptake of a Patient-Facing
           Information Technology Family Health History Risk Assessment Platform
    • Authors: Wu; R. Ryanne, Myers, Rachel A., Buchanan, Adam H., Dimmock, David, Fulda, Kimberly G., Haller, Irina V., Haga, Susanne B., Harry, Melissa L., McCarty, Catherine, Neuner, Joan, Rakhra-Burris, Teji, Sperber, Nina, Voils, Corrine I., Ginsburg, Geoffrey S., Orlando, Lori A.
      Pages: 180 - 188
      Abstract: Objective Investigate sociodemographic differences in the use of a patient-facing family health history (FHH)-based risk assessment platform. Methods In this large multisite trial with a diverse patient population, we evaluated the relationship between sociodemographic factors and FHH health risk assessment uptake using an information technology (IT) platform. The entire study was administered online, including consent, baseline survey, and risk assessment completion. We used multivariate logistic regression to model effect of sociodemographic factors on study progression. Quality of FHH data entered as defined as relatives: (1) with age of onset reported on relevant conditions; (2) if deceased, with cause of death and (3) age of death reported; and (4) percentage of relatives with medical history marked as unknown was analyzed using grouped logistic fixed effect regression. Results A total of 2,514 participants consented with a mean age of 57 and 10.4% minority. Multivariate modeling showed that progression through study stages was more likely for younger (p-value = 0.005), more educated (p-value = 0.004), non-Asian (p-value = 0.009), and female (p-value = 0.005) participants. Those with lower health literacy or information-seeking confidence were also less likely to complete the study. Most significant drop-out occurred during the risk assessment completion phase. Overall, quality of FHH data entered was high with condition's age of onset reported 87.85%, relative's cause of death 85.55% and age of death 93.76%, and relative's medical history marked as unknown 19.75% of the time. Conclusion A demographically diverse population was able to complete an IT-based risk assessment but there were differences in attrition by sociodemographic factors. More attention should be given to ensure end-user functionality of health IT and leverage electronic medical records to lessen patient burden.
      Citation: Appl Clin Inform 2019; 10: 180-188
      PubDate: 2019-03-13T00:00:00+0100
      DOI: 10.1055/s-0039-1679926
      Issue No: Vol. 10, No. 02 (2019)
       
  • Can Automated Retrieval of Data from Emergency Department Physician Notes
           Enhance the Imaging Order Entry Process'
    • Authors: Rousseau; Justin F., Ip, Ivan K., Raja, Ali S., Valtchinov, Vladimir I., Cochon, Laila, Schuur, Jeremiah D., Khorasani, Ramin
      Pages: 189 - 198
      Abstract: Background When a paucity of clinical information is communicated from ordering physicians to radiologists at the time of radiology order entry, suboptimal imaging interpretations and patient care may result. Objectives Compare documentation of relevant clinical information in electronic health record (EHR) provider note to computed tomography (CT) order requisition, prior to ordering of head CT for emergency department (ED) patients presenting with headache. Methods In this institutional review board-approved retrospective observational study performed between April 1, 2013 and September 30, 2014 at an adult quaternary academic hospital, we reviewed data from 666 consecutive ED encounters for patients with headaches who received head CT. The primary outcome was the number of concept unique identifiers (CUIs) relating to headache extracted via ontology-based natural language processing from the history of present illness (HPI) section in ED notes compared with the number of concepts obtained from the imaging order requisition. Results Our analysis was conducted on cases where the HPI note section was completed prior to image order entry, which occurred in 23.1% (154/666) of encounters. For these 154 encounters, the number of CUIs specific to headache per note extracted from the HPI (median = 3, interquartile range [IQR]: 2–4) was significantly greater than the number of CUIs per encounter obtained from the imaging order requisition (median = 1, IQR: 1–2; Wilcoxon signed rank p 
      Citation: Appl Clin Inform 2019; 10: 189-198
      PubDate: 2019-03-20T00:00:00+0100
      DOI: 10.1055/s-0039-1679927
      Issue No: Vol. 10, No. 02 (2019)
       
  • Impact of Electronic versus Paper-Based Recording before EHR
           Implementation on Health Care Professionals' Perceptions of EHR Use, Data
           Quality, and Data Reuse
    • Authors: Joukes; Erik, de Keizer, Nicolette F., de Bruijne, Martine C., Abu-Hanna, Ameen, Cornet, Ronald
      Pages: 199 - 209
      Abstract: Background The implementation of an electronic health record (EHR) with structured and standardized recording of patient data can improve data quality and reusability. Whether and how users perceive these advantages may depend on the preimplementation situation. Objective To determine whether the influence of implementing a structured and standardized EHR on perceived EHR use, data quality, and data reuse differed for users working with paper-based records versus a legacy EHR before implementation. Methods We used an electronic questionnaire to measure users' perception before implementation (2014), expected change, and perceived change after implementation (2016) on three themes. We included all health care professionals in two university hospitals in the Netherlands. Before jointly implementing the same structured and standardized EHR, one hospital used paper-based records and the other a legacy EHR. We compared perceptions before and after implementation for both centers. Additionally, we compared expected benefit with perceived benefit. Results We received 7,611 responses (4,537 before and 3,074 after implementation) of which 5,707 (75%) were from professionals reading and recording patient data. A total of 975 (13%) professionals responded to both before and after implementation questionnaires. In the formerly paper-based center staff perceived improvement in all themes after implementation. The legacy EHR center experienced deterioration of perceived EHR use and data reuse, and only one improvement in EHR use. In both centers, for half of the aspects at least 45% of responders experienced results worse than expected preimplementation. Conclusion Our results indicate that the preimplementation recording practice impacts the perceived effect of the implementation of a structured and standardized EHR. For almost half of the respondents the new EHR did not meet their expectations. Especially legacy EHR centers need to investigate the expectations as these might be different and less clear cut than those in paper-based centers. These expectations need to be addressed appropriately to achieve a successful implementation.
      Citation: Appl Clin Inform 2019; 10: 199-209
      PubDate: 2019-03-20T00:00:00+0100
      DOI: 10.1055/s-0039-1681054
      Issue No: Vol. 10, No. 02 (2019)
       
  • Safeuristics! Do Heuristic Evaluation Violation Severity Ratings Correlate
           with Patient Safety Severity Ratings for a Native Electronic Health Record
           Mobile Application'
    • Authors: Kennedy; Brandan, Kerns, Ellen, Chan, Y. Raymond, Chaparro, Barbara S., Fouquet, Sarah D.
      Pages: 210 - 218
      Abstract: Objective Usability of electronic health records (EHRs) remains challenging, and poor EHR design has patient safety implications. Heuristic evaluation detects usability issues that can be classified by severity. The National Institute of Standards and Technology provides a safety scale for EHR usability. Our objectives were to investigate the relationship between heuristic severity ratings and safety scale ratings in an effort to analyze EHR safety. Materials and Methods Heuristic evaluation was conducted on seven common mobile EHR tasks, revealing 58 heuristic violations and 28 unique usability issues. Each usability issue was independently scored for severity by trained hospitalists and a Human Factors researcher and for safety severity by two physician informaticists and two clinical safety professionals. Results Results demonstrated a positive correlation between heuristic severity and safety severity ratings. Regression analysis demonstrated that 49% of safety risk variability by clinical safety professionals (r = 0.70; n = 28) and 42% of safety risk variability by clinical informatics specialists (r = 0.65; n = 28) was explained by usability severity scoring of problems outlined by heuristic evaluation. Higher severity ratings of the usability issues were associated with increased perceptions of patient safety risk. Discussion This study demonstrated the use of heuristic evaluation as a technique to quickly identify usability problems in an EHR that could lead to safety issues. Detection of higher severity ratings could help prioritize failures in EHR design that more urgently require design changes. This approach is a cost-effective technique for improving usability while impacting patient safety. Conclusion Results from this study demonstrate the efficacy of the heuristic evaluation technique to identify usability problems that impact safety of the EHR. Also, the use of interdisciplinary teams for evaluation should be considered for severity assessment.
      Citation: Appl Clin Inform 2019; 10: 210-218
      PubDate: 2019-03-27T00:00:00+0100
      DOI: 10.1055/s-0039-1681073
      Issue No: Vol. 10, No. 02 (2019)
       
  • An openEHR Approach to Detailed Clinical Model Development: Tobacco
           Smoking Summary Archetype as a Case Study
    • Authors: Wei; Ping-Cheng, Atalag, Koray, Day, Karen
      Pages: 219 - 228
      Abstract: Background Data modeling for electronic health records (EHRs) is complex, requiring technological and cognitive sophistication. The openEHR approach leverages the tacit knowledge of domain experts made explicit in a model development process aiming at interoperability and data reuse. Objective The purpose of our research was to explore the process that enabled the aggregation of the tacit knowledge of domain experts in an explicit form using the Clinical Knowledge Manager (CKM) platform and associated assets. The Tobacco Smoking Summary archetype is used to illustrate this. Methods Three methods were used to triangulate findings: (1) observation of CKM discussions by crowdsourced domain experts in two reviews, (2) observation of editor discussions and decision-making, and (3) interviews with eight domain experts. CKM discussions were analyzed for content and editor discussions for decision-making, and interviews were thematically analyzed to explore in depth the explication of tacit knowledge. Results The Detailed Clinical Model (DCM) process consists of a set of reviews by domain experts, with each review followed by editorial discussions and decision-making until an agreement is reached among reviewers and editors that the DCM is publishable. Interviews revealed three themes: (1) data interoperability and reusability, (2) accurate capture of patient data, and (3) challenges of sharing tacit knowledge. Discussion The openEHR approach to developing an open standard revealed a complex set of conditions for a successful interoperable archetype, such as leadership, maximal dataset, crowdsourced domain expertise and tacit knowledge made explicit, editorial vision, and model-driven software. Aggregated tacit knowledge that is explicated into a DCM enables the ability to collect accurate data and plan for the future. Conclusion The process based on the CKM platform enables domain experts and stakeholders to be heard and to contribute to mutually designed standards that align local protocols and agendas to international interoperability requirements.
      Citation: Appl Clin Inform 2019; 10: 219-228
      PubDate: 2019-03-27T00:00:00+0100
      DOI: 10.1055/s-0039-1681074
      Issue No: Vol. 10, No. 02 (2019)
       
  • Comparison of Antibiotic Dosing Before and After Implementation of an
           Electronic Order Set
    • Authors: Nichols; Kristen R., Petschke, Allison L., Webber, Emily C., Knoderer, Chad A.
      Pages: 229 - 236
      Abstract: Background To maximize resources, the antimicrobial stewardship program at a pediatric tertiary care hospital made pediatric dosing specific guidance within the electronic health record available to all hospitals within the health system. Objective The objective of this study was to compare the appropriateness of antibiotic dosing before and after the implementation of an electronic intravenous (IV) antibiotic order set. Methods This was a retrospective cohort study evaluating orders from patients younger than 18 years who received cefepime, piperacillin–tazobactam, tobramycin, or gentamicin at 12 health-system hospitals. Antibiotic dosing regimens and order set use were evaluated in patients who received the specified antibiotics during the 6-month time frame prior to and following electronic order set availability at each hospital. Results In the before and after implementation periods, 360 and 387 total antibiotic orders were included, respectively. Most orders were gentamicin (55.8% in the before implementation period and 54.5% in the after implementation period) followed by piperacillin-tazobactam (22.5% in the before period and 22.2% in the after period). Overall, 663 orders were classified as appropriate (88.8%). Appropriateness was similar in the before or after implementation periods (87.8 vs. 89.7%, p = 0.415). There was a significant difference in appropriateness if a blank order versus the electronic IV antibiotic order set was used (82.8 vs. 90.5%; p = 0.024). Conclusion No difference in antibiotic appropriateness overall was found in the before and after implementation periods. However, when specifically compared with the appropriateness of dosing when blank order forms were used, dosing was more appropriate when electronic antibiotic order sets were used.
      Citation: Appl Clin Inform 2019; 10: 229-236
      PubDate: 2019-04-03T00:00:00+01:00
      DOI: 10.1055/s-0039-1683877
      Issue No: Vol. 10, No. 02 (2019)
       
  • Assessing the Safety of Custom Web-Based Clinical Decision Support Systems
           in Electronic Health Records: A Case Study
    • Authors: Thayer; Jeritt G., Miller, Jeffrey M., Fiks, Alexander G., Tague, Linda, Grundmeier, Robert W.
      Pages: 237 - 246
      Abstract: Background With the widespread adoption of vendor-supplied electronic health record (EHR) systems, clinical decision support (CDS) customization efforts beyond those anticipated by the vendor may require the use of technologies external to the EHR such as web services. Pursuing such customizations, however, is not without risk. Validating the expected behavior of a customized CDS system in the high-volume, complex environment of the live EHR is a challenging problem. Objective This article identifies technology failures that impacted clinical care related to web service-based advanced custom CDS systems embedded in the complex sociotechnical context of a production EHR. Methods In an academic health system’s primary care network, we performed an inventory of incidents between January 1, 2008 and December 31, 2016 related to a customized CDS system and performed a targeted review of changes in the CDS source code. Additional feedback on the root cause of individual incidents was obtained through interviews with members of the CDS project teams. Results We identified five CDS malfunctions that impaired clinical workflow. The mechanisms for these failures are mapped to four characteristics of well-behaved applications: (1) system integrity; (2) data integrity; (3) reliability; and (4) scalability. Over the 9-year period, two malfunctions of the customized CDS significantly impaired clinical workflow for a total of 5 hours. Lesser impacts—loss of individual features with straightforward workarounds—arose from three malfunctions, which affected users on 53 days. Discussion Advanced customization of EHRs for the purpose of CDS can present significant risks to clinical workflow. Conclusion This case study highlights that advanced customization of CDS within a commercial EHR may support care for complex patient populations, but ongoing monitoring and support is required to ensure its safe use.
      Citation: Appl Clin Inform 2019; 10: 237-246
      PubDate: 2019-04-03T00:00:00+01:00
      DOI: 10.1055/s-0039-1683985
      Issue No: Vol. 10, No. 02 (2019)
       
  • Electronic Health Record Documentation Patterns of Recorded Primary Care
           Visits Focused on Complex Communication: A Qualitative Study
    • Authors: Prater; Laura, Sanchez, Anthony, Modan, Gabriella, Burgess, Jennifer, Frier, Kim, Richards, Nathan, Bose-Brill, Seuli
      Pages: 247 - 253
      Abstract: Background In a time-constrained clinical environment, physicians cannot feasibly document all aspects of an office visit in the electronic health record (EHR). This is especially true for patients with multiple chronic conditions requiring complex clinical reasoning. It is unclear how physicians prioritize the documentation of health information in the EHR. Objective The goal of this study is to examine documentation tradeoffs made by physicians when caring for complex patients by comparing the content of office visit conversations with resulting EHR documentation. Methods We used grounded theory method of qualitative analysis to assess emergent themes in the transcripts of 10 office visits, and then compared the themes to documentation in the EHR. Differences between discussion and subsequent documentation of social and emotional health topics and each of the other key categories were compared using the Wilcoxon signed-rank test. Results The categories that emerged included “chronic conditions,” “acute/new problems,” “disease prevention,” and “social and emotional health.” We found that when social and emotional topics were discussed in the office visit, it was documented in the medical record only 30.6% of the time. Chronic conditions, acute/new problems, and disease prevention were documented in the EHR between 87.5 and 91.7% of the time after discussion. The differences between discussion and documentation of social and emotional topics were significantly greater than the differences for chronic conditions, acute/new problems, and disease prevention (all p 
      Citation: Appl Clin Inform 2019; 10: 247-253
      PubDate: 2019-04-10T00:00:00+01:00
      DOI: 10.1055/s-0039-1683986
      Issue No: Vol. 10, No. 02 (2019)
       
  • Early Adopters of Patient-Generated Health Data Upload in an Electronic
           Patient Portal
    • Authors: Ancker; Jessica S., Mauer, Elizabeth, Kalish, Robin B., Vest, Joshua R., Gossey, J. Travis
      Pages: 254 - 260
      Abstract: Background and Objective Patient-generated health data (PGHD) may help providers monitor patient status between clinical visits. Our objective was to describe our medical center's early experience with an electronic flowsheet allowing patients to upload self-monitored blood glucose to their provider's electronic health record (EHR). Methods An academic multispecialty practice enabled the portal-linked PGHD tool in 2012. We conducted a retrospective observational study of adult ambulatory patients using this tool between 2012 and 2016, comparing clinical and demographic characteristics of data uploaders with those of a group of patients with diabetes diagnoses and patient portal accounts seen by the same health care providers. Results Over four years, 16 providers chose to use the tool, and 53 adult patients used it to upload three or more blood glucose values within any 9-month period. Of these patients, 23 were pregnant women and 30 were nonpregnant adults with diabetes. Uploaders had more encounters and portal log-ins than comparison patients but did not differ in socioeconomic status. Among the chronic disease patients, uploaders' mean hemoglobin A1c and body mass index (BMI) both dropped significantly in the months after upload. Conclusion Despite the potential value of PGHD in health care, the rate of adoption of a tool allowing patients to upload PGHD to their provider's EHR has been slow. Among chronic disease patients, PGHD upload was associated with improvements in blood glucose control and BMI, but it is possible that the changes were because of increased motivation or intensive changes in medical management.
      Citation: Appl Clin Inform 2019; 10: 254-260
      PubDate: 2019-04-10T00:00:00+01:00
      DOI: 10.1055/s-0039-1683987
      Issue No: Vol. 10, No. 02 (2019)
       
  • Evaluating the Effect of Monitoring through Telephone (Tele-Monitoring) on
           Self-Care Behaviors and Readmission of Patients with Heart Failure after
           Discharge
    • Authors: Negarandeh; Reza, Zolfaghari, Mitra, Bashi, Nazli, Kiarsi, Maryam
      Pages: 261 - 268
      Abstract: Background Heart failure is one of the serious cardiovascular diseases, which poses a global pandemic and places a heavy burden on health care systems worldwide. The incidence of this disease in Iran is higher than in other Asian countries. To reduce patients' complications, readmission rates, and health care expenditures, it is necessary to design interventions, which are culturally appropriate and based on community needs. Methods In 2016, a randomized clinical trial (IRCT2017010731804N1) was initiated to compare tailored tele-monitoring intervention with usual care. In total, 80 patients completed the study after a follow-up period of 8 weeks. The primary end point was heart failure self-care, which was measured using the Iranian version of the European Heart Failure self-care questionnaire. Secondary end points were heart failure related readmission rates. Results The mean scores for self-care behaviors of the two groups showed significant difference at the baseline (p = 0.045). The results of the analysis of covariance that was used to control the differences in the pretest scores of self-care behaviors showed that the difference between both groups after the intervention was still significant (p 
      Citation: Appl Clin Inform 2019; 10: 261-268
      PubDate: 2019-04-17T00:00:00+01:00
      DOI: 10.1055/s-0039-1685167
      Issue No: Vol. 10, No. 02 (2019)
       
  • How to Check the Reliability of Artificial Intelligence
           Solutions—Ensuring Client Expectations are Met
    • Appl Clin Inform 2019; 10: 269-271
      DOI: 10.1055/s-0039-1685220



      Georg Thieme Verlag KG Stuttgart · New York

      Artikel in Thieme eJournals:
      Inhaltsverzeichnis     Volltext

      Appl Clin Inform 2019; 10: 269-2712019-04-17T00:00:00+01:00
      Issue No: Vol. 10, No. 02 (2019)
       
  • Quality Informatics: The Convergence of Healthcare Data, Analytics, and
           Clinical Excellence
    • Appl Clin Inform 2019; 10: 272-277
      DOI: 10.1055/s-0039-1685221



      Georg Thieme Verlag KG Stuttgart · New York

      Artikel in Thieme eJournals:
      Inhaltsverzeichnis     Volltext

      Appl Clin Inform 2019; 10: 272-2772019-04-24T00:00:00+01:00
      Issue No: Vol. 10, No. 02 (2019)
       
  • Composer—Visual Cohort Analysis of Patient Outcomes
    • Authors: Rogers; Jen, Spina, Nicholas, Neese, Ashley, Hess, Rachel, Brodke, Darrel, Lex, Alexander
      Pages: 278 - 285
      Abstract: Objective Visual cohort analysis utilizing electronic health record data has become an important tool in clinical assessment of patient outcomes. In this article, we introduce Composer, a visual analysis tool for orthopedic surgeons to compare changes in physical functions of a patient cohort following various spinal procedures. The goal of our project is to help researchers analyze outcomes of procedures and facilitate informed decision-making about treatment options between patient and clinician. Methods In collaboration with orthopedic surgeons and researchers, we defined domain-specific user requirements to inform the design. We developed the tool in an iterative process with our collaborators to develop and refine functionality. With Composer, analysts can dynamically define a patient cohort using demographic information, clinical parameters, and events in patient medical histories and then analyze patient-reported outcome scores for the cohort over time, as well as compare it to other cohorts. Using Composer's current iteration, we provide a usage scenario for use of the tool in a clinical setting. Conclusion We have developed a prototype cohort analysis tool to help clinicians assess patient treatment options by analyzing prior cases with similar characteristics. Although Composer was designed using patient data specific to orthopedic research, we believe the tool is generalizable to other healthcare domains. A long-term goal for Composer is to develop the application into a shared decision-making tool that allows translation of comparison and analysis from a clinician-facing interface into visual representations to communicate treatment options to patients.
      Citation: Appl Clin Inform 2019; 10: 278-285
      PubDate: 2019-04-24T00:00:00+01:00
      DOI: 10.1055/s-0039-1687862
      Issue No: Vol. 10, No. 02 (2019)
       
  • Pediatrician Attitudes toward Digital Voice Assistant Technology Use in
           Clinical Practice
    • Authors: Wilder; Jayme L., Nadar, Devin, Gujral, Nitin, Ortiz, Benjamin, Stevens, Robert, Holder-Niles, Faye, Lee, John, Gaffin, Jonathan M.
      Pages: 286 - 294
      Abstract: Objective Digital voice assistant technology provides unique opportunities to enhance clinical practice. We aimed to understand factors influencing pediatric providers' current and potential use of this technology in clinical practice. Methods We surveyed pediatric providers regarding current use and interest in voice technology in the workplace. Regression analyses evaluated provider characteristics associated with voice technology use. Among respondents not interested in voice technology, we elicited individual concerns. Results Among 114 respondents, 19 (16.7%) indicated current use of voice technology in clinical practice, and 51 (44.7%) indicated use of voice technology for nonclinical purposes. Fifty-four (47.4%) reported willingness to try digital voice assistant technology in the clinical setting. Providers who had longer clinic visits (odds ratio [OR], 3.11, 95% confidence interval [CI], 1.04, 9.33, p = 0.04), fewer patient encounters per day (p = 0.02), and worked in hospital-based practices (OR, 2.95, 95% CI, 1.08, 8.07, p = 0.03) were more likely to currently use voice technology in the office. Younger providers (p = 0.02) and those confident in the accuracy of voice technology (OR, 3.05, 95% CI, 1.38, 6.74, p = 0.005) were more willing to trial digital voice assistants in the clinical setting. Among respondents unwilling or unsure about trying voice assistant technology, the most common reasons elicited were concerns related to its accuracy (35%), efficiency (33%), and privacy (28%). Conclusion This national survey evaluating use and attitudes toward digital voice assistant technology by pediatric providers found that while only one-eighth of pediatric providers currently use digital voice assistant technology in the clinical setting, almost half are interested in trying it in the future. Younger provider age and confidence in the accuracy of voice technology are associated with provider interest in using voice technology in the clinical setting. Future development of voice technology for clinical use will need to consider accuracy of information, efficiency of use, and patient privacy for successful integration into the workplace.
      Citation: Appl Clin Inform 2019; 10: 286-294
      PubDate: 2019-05-01T00:00:00+01:00
      DOI: 10.1055/s-0039-1687863
      Issue No: Vol. 10, No. 02 (2019)
       
  • Diffusing an Innovation: Clinician Perceptions of Continuous Predictive
           Analytics Monitoring in Intensive Care
    • Authors: Kitzmiller; Rebecca R., Vaughan, Ashley, Skeeles-Worley, Angela, Keim-Malpass, Jessica, Yap, Tracey L., Lindberg, Curt, Kennerly, Susan, Mitchell, Claire, Tai, Robert, Sullivan, Brynne A., Anderson, Ruth, Moorman, Joseph R.
      Pages: 295 - 306
      Abstract: Background The purpose of this article is to describe neonatal intensive care unit clinician perceptions of a continuous predictive analytics technology and how those perceptions influenced clinician adoption. Adopting and integrating new technology into care is notoriously slow and difficult; realizing expected gains remain a challenge. Methods Semistructured interviews from a cross-section of neonatal physicians (n = 14) and nurses (n = 8) from a single U.S. medical center were collected 18 months following the conclusion of the predictive monitoring technology randomized control trial. Following qualitative descriptive analysis, innovation attributes from Diffusion of Innovation Theory-guided thematic development. Results Results suggest that the combination of physical location as well as lack of integration into work flow or methods of using data in care decisionmaking may have delayed clinicians from routinely paying attention to the data. Once data were routinely collected, documented, and reported during patient rounds and patient handoffs, clinicians came to view data as another vital sign. Through clinicians' observation of senior physicians and nurses, and ongoing dialogue about data trends and patient status, clinicians learned how to integrate these data in care decision making (e.g., differential diagnosis) and came to value the technology as beneficial to care delivery. Discussion The use of newly created predictive technologies that provide early warning of illness may require implementation strategies that acknowledge the risk–benefit of treatment clinicians must balance and take advantage of existing clinician training methods.
      Citation: Appl Clin Inform 2019; 10: 295-306
      PubDate: 2019-05-01T00:00:00+01:00
      DOI: 10.1055/s-0039-1688478
      Issue No: Vol. 10, No. 02 (2019)
       
  • Creation of a Multicenter Pediatric Inpatient Data Repository Derived from
           Electronic Health Records
    • Authors: Hornik; Christoph P., Atz, Andrew M., Bendel, Catherine, Chan, Francis, Downes, Kevin, Grundmeier, Robert, Fogel, Ben, Gipson, Debbie, Laughon, Matthew, Miller, Michael, Smith, Michael, Livingston, Chad, Kluchar, Cindy, Heath, Anne, Jarrett, Chanda, McKerlie, Brian, Patel, Hetalkumar, Hunter, Christina
      Pages: 307 - 315
      Abstract: Background Integration of electronic health records (EHRs) data across sites and access to that data remain limited. Objective We developed an EHR-based pediatric inpatient repository using nine U.S. centers from the National Institute of Child Health and Human Development Pediatric Trials Network. Methods A data model encompassing 147 mandatory and 99 optional elements was developed to provide an EHR data extract of all inpatient encounters from patients
      Citation: Appl Clin Inform 2019; 10: 307-315
      PubDate: 2019-05-08T00:00:00+01:00
      DOI: 10.1055/s-0039-1688477
      Issue No: Vol. 10, No. 02 (2019)
       
  • Development and Prospective Validation of a Machine Learning-Based Risk of
           Readmission Model in a Large Military Hospital
    • Authors: Eckert; Carly, Nieves-Robbins, Neris, Spieker, Elena, Louwers, Tom, Hazel, David, Marquardt, James, Solveson, Keith, Zahid, Anam, Ahmad, Muhammad, Barnhill, Richard, McKelvey, T. Greg, Marshall, Robert, Shry, Eric, Teredesai, Ankur
      Pages: 316 - 325
      Abstract: Background Thirty-day hospital readmissions are a quality metric for health care systems. Predictive models aim to identify patients likely to readmit to more effectively target preventive strategies. Many risk of readmission models have been developed on retrospective data, but prospective validation of readmission models is rare. To the best of our knowledge, none of these developed models have been evaluated or prospectively validated in a military hospital. Objectives The objectives of this study are to demonstrate the development and prospective validation of machine learning (ML) risk of readmission models to be utilized by clinical staff at a military medical facility and demonstrate the collaboration between the U.S. Department of Defense's integrated health care system and a private company. Methods We evaluated multiple ML algorithms to develop a predictive model for 30-day readmissions using data from a retrospective cohort of all-cause inpatient readmissions at Madigan Army Medical Center (MAMC). This predictive model was then validated on prospective MAMC patient data. Precision, recall, accuracy, and the area under the receiver operating characteristic curve (AUC) were used to evaluate model performance. The model was revised, retrained, and rescored on additional retrospective MAMC data after the prospective model's initial performance was evaluated. Results Within the initial retrospective cohort, which included 32,659 patient encounters, the model achieved an AUC of 0.68. During prospective scoring, 1,574 patients were scored, of whom 152 were readmitted within 30 days of discharge, with an all-cause readmission rate of 9.7%. The AUC of the prospective predictive model was 0.64. The model achieved an AUC of 0.76 after revision and addition of further retrospective data. Conclusion This work reflects significant collaborative efforts required to operationalize ML models in a complex clinical environment such as that seen in an integrated health care system and the importance of prospective model validation.
      Citation: Appl Clin Inform 2019; 10: 316-325
      PubDate: 2019-05-08T00:00:00+01:00
      DOI: 10.1055/s-0039-1688553
      Issue No: Vol. 10, No. 02 (2019)
       
  • A Bottom-Up Approach to Encouraging Sustained User Adoption of a Secure
           Text Messaging Application
    • Authors: Tsega; Surafel, Kalra, Angeli, Sevilla, Cesar T., Cho, Hyung J.
      Pages: 326 - 330
      Abstract: Background Inpatient providers are increasingly utilizing alternative communication modalities outside what has traditionally been used, including short messaging service text messaging and application-based chat tools. Text messaging that meets the recommendations of the Joint Commission (“secure text messaging”) allows for the communication of sensitive patient information through an encrypted platform. Objective In this quality initiative utilizing the Plan-Do-Study-Act (PDSA) model, we attempted two rollout designs to maximize user adoption of a secure text messaging application. Methods Our institution launched a secure text messaging application (Cureatr) using a top-down approach during the first PDSA cycle, defined as communication and outreach through department chairs and administrative leaders throughout the hospital. After inadequate user adoption, we transitioned to a bottom-up approach in the second PDSA cycle, defined as direct communication and engagement with end users. This campaign targeted the hospital medicine and inpatient social work department, and used discharge planning as a use case to encourage adoption. Results Over a 6-month period, we observed an increase in active users in the hospital medicine department (7.5 unique users per month to 29 users during the first and second PDSA cycles, p 
      Citation: Appl Clin Inform 2019; 10: 326-330
      PubDate: 2019-05-15T00:00:00+01:00
      DOI: 10.1055/s-0039-1688554
      Issue No: Vol. 10, No. 02 (2019)
       
  • Local Investment in Training Drives Electronic Health Record User
           Satisfaction
    • Appl Clin Inform 2019; 10: 331-335
      DOI: 10.1055/s-0039-1688753



      Georg Thieme Verlag KG Stuttgart · New York

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      Inhaltsverzeichnis     open access Volltext

      Appl Clin Inform 2019; 10: 331-3352019-05-15T00:00:00+01:00
      Issue No: Vol. 10, No. 02 (2019)
       
  • CDS in a Learning Health Care System: Identifying Physicians' Reasons for
           Rejection of Best-Practice Recommendations in Pneumonia through
           Computerized Clinical Decision Support
    • Authors: Jones; Barbara E., Collingridge, Dave S., Vines, Caroline G., Post, Herman, Holmen, John, Allen, Todd L., Haug, Peter, Weir, Charlene R., Dean, Nathan C.
      Pages: 001 - 009
      Abstract: Background Local implementation of guidelines for pneumonia care is strongly recommended, but the context of care that affects implementation is poorly understood. In a learning health care system, computerized clinical decision support (CDS) provides an opportunity to both improve and track practice, providing insights into the implementation process. Objectives This article examines physician interactions with a CDS to identify reasons for rejection of guideline recommendations. Methods We implemented a multicenter bedside CDS for the emergency department management of pneumonia that integrated patient data with guideline-based recommendations. We examined the frequency of adoption versus rejection of recommendations for site-of-care and antibiotic selection. We analyzed free-text responses provided by physicians explaining their clinical reasoning for rejection, using concept mapping and thematic analysis. Results Among 1,722 patient episodes, physicians rejected recommendations to send a patient home in 24%, leaving text in 53%; reasons for rejection of the recommendations included additional or alternative diagnoses beyond pneumonia, and comorbidities or signs of physiologic derangement contributing to risk of outpatient failure that were not processed by the CDS. Physicians rejected broad-spectrum antibiotic recommendations in 10%, leaving text in 76%; differences in pathogen risk assessment, additional patient information, concern about antibiotic properties, and admitting physician preferences were given as reasons for rejection. Conclusion While adoption of CDS recommendations for pneumonia was high, physicians rejecting recommendations frequently provided feedback, reporting alternative diagnoses, additional individual patient characteristics, and provider preferences as major reasons for rejection. CDS that collects user feedback is feasible and can contribute to a learning health system.
      Citation: Appl Clin Inform 2019; 10: 001-009
      PubDate: 2019-01-02T00:00:00+0100
      DOI: 10.1055/s-0038-1676587
      Issue No: Vol. 10, No. 01 (2019)
       
  • Qualitative and Quantitative Analysis of Patients' Perceptions of the
           Patient Portal Experience with OpenNotes
    • Authors: Mishra; Vimal K., Hoyt, Robert E., Wolver, Susan E., Yoshihashi, Ann, Banas, Colin
      Pages: 010 - 018
      Abstract: Background Access to medical encounter notes (OpenNotes) is believed to empower patients and improve the quality and safety of care. The impact of such access is not well understood beyond select health care systems and notes from primary care providers. Objectives This article analyzes patients' perceptions about the patient portal experience with access to primary care and specialist's notes and evaluates free-text comments as an improvement opportunity. Materials and Methods Patients at an academic health care system who accessed the patient portal from February 2016 to May 2016 were provided a link to complete a 15-item online survey. Those who had viewed at least one note were asked about patient characteristics, frequency of note access, note usefulness, note understanding, and if any action was taken after accessing the note. Free-text comments were associated with nine questions which were analyzed using qualitative methods. Results A total of 23% (1,487/6,439) of patients who viewed the survey in the portal, participated. Seventy-six percent (1,126/1,487) knew that the notes were available on the portal, and of those, 957 had viewed at least one note to continue the survey. Ninety percent of those were older than 30 years of age, and 90% had some college education. The majority (83%) thought OpenNotes helped them take better care of themselves, without increasing worry (94%) or contacting the physician after reading the note (91%). The qualitative analysis of free-text responses demonstrated multiple positive and negative themes, and they were analyzed for potential improvement opportunities. Conclusion Our survey confirms that patients who choose to access their primary care and specialists' online medical records perceive benefits of OpenNotes. Additionally, the qualitative analysis of comments revealed positive benefits and several potential patient portal improvement opportunities which could inform implementation of OpenNotes at other health systems.
      Citation: Appl Clin Inform 2019; 10: 010-018
      PubDate: 2019-01-02T00:00:00+0100
      DOI: 10.1055/s-0038-1676588
      Issue No: Vol. 10, No. 01 (2019)
       
  • The Reach and Feasibility of an Interactive Lung Cancer Screening Decision
           Aid Delivered by Patient Portal
    • Authors: Dharod; Ajay, Bellinger, Christina, Foley, Kristie, Case, L. Doug, Miller, David
      Pages: 019 - 027
      Abstract: Objective Health systems could adopt population-level approaches to screening by identifying potential screening candidates from the electronic health record and reaching out to them via the patient portal. However, whether patients would read or act on sent information is unknown. We examined the feasibility of this digital health outreach strategy. Methods We conducted a single-arm pragmatic trial in a large academic health system. An electronic health record algorithm identified primary care patients who were potentially eligible for lung cancer screening (LCS). Identified patients were sent a patient portal invitation to visit a LCS interactive Web site which assessed screening eligibility and included a decision aid. The primary outcome was screening completion. Secondary outcomes included the proportion of patients who read the invitation, visited the interactive Web site, and completed the interactive Web site. Results We sent portal invitations to 1,000 patients. Almost all patients (86%, 862/1,000) read the invitation, 404 (40%) patients visited the interactive Web site, and 349 patients (35%) completed it. Of the 99 patients who were confirmed screening eligible by the Web site, 81 made a screening decision (30% wanted screening, 44% unsure, 26% declined screening), and 22 patients had a chest computed tomography completed. Conclusion The digital outreach strategy reached the majority of patient portal users. While the study focused on LCS, this digital outreach approach could be generalized to other health needs. Given the broad reach and potential low cost of this digital strategy, future research should investigate best practices for implementing the system.
      Citation: Appl Clin Inform 2019; 10: 019-027
      PubDate: 2019-01-09T00:00:00+0100
      DOI: 10.1055/s-0038-1676807
      Issue No: Vol. 10, No. 01 (2019)
       
  • Automatic Detection of Front-Line Clinician Hospital Shifts: A Novel Use
           of Electronic Health Record Timestamp Data
    • Authors: Dziorny; Adam C., Orenstein, Evan W., Lindell, Robert B., Hames, Nicole A., Washington, Nicole, Desai, Bimal
      Pages: 028 - 037
      Abstract: Objective Excess physician work hours contribute to burnout and medical errors. Self-report of work hours is burdensome and often inaccurate. We aimed to validate a method that automatically determines provider shift duration based on electronic health record (EHR) timestamps across multiple inpatient settings within a single institution. Methods We developed an algorithm to calculate shift start and end times for inpatient providers based on EHR timestamps. We validated the algorithm based on overlap between calculated shifts and scheduled shifts. We then demonstrated a use case by calculating shifts for pediatric residents on inpatient rotations from July 1, 2015 through June 30, 2016, comparing hours worked and number of shifts by rotation and role. Results We collected 6.3 × 107 EHR timestamps for 144 residents on 771 inpatient rotations, yielding 14,678 EHR-calculated shifts. Validation on a subset of shifts demonstrated 100% shift match and 87.9 ± 0.3% overlap (mean ± standard error [SE]) with scheduled shifts. Senior residents functioning as front-line clinicians worked more hours per 4-week block (mean ± SE: 273.5 ± 1.7) than senior residents in supervisory roles (253 ± 2.3) and junior residents (241 ± 2.5). Junior residents worked more shifts per block (21 ± 0.1) than senior residents (18 ± 0.1). Conclusion Automatic calculation of inpatient provider work hours is feasible using EHR timestamps. An algorithm to assess provider work hours demonstrated criterion validity via comparison with scheduled shifts. Differences between junior and senior residents in calculated mean hours worked and number of shifts per 4-week block were also consistent with differences in scheduled shifts and duty-hour restrictions.
      Citation: Appl Clin Inform 2019; 10: 028-037
      PubDate: 2019-01-09T00:00:00+0100
      DOI: 10.1055/s-0038-1676819
      Issue No: Vol. 10, No. 01 (2019)
       
  • Active Participation and Engagement of Residents in Clinical Informatics
    • Appl Clin Inform 2019; 10: 038-039
      DOI: 10.1055/s-0038-1676970



      Georg Thieme Verlag KG Stuttgart · New York

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      Appl Clin Inform 2019; 10: 038-0392019-01-16T00:00:00+0100
      Issue No: Vol. 10, No. 01 (2019)
       
  • Technology Access, Technical Assistance, and Disparities in Inpatient
           Portal Use
    • Authors: Grossman; Lisa V., Masterson Creber, Ruth M., Ancker, Jessica S., Ryan, Beatriz, Polubriaginof, Fernanda, Qian, Min, Alarcon, Irma, Restaino, Susan, Bakken, Suzanne, Hripcsak, George, Vawdrey, David K.
      Pages: 040 - 050
      Abstract: Background Disadvantaged populations, including minorities and the elderly, use patient portals less often than relatively more advantaged populations. Limited access to and experience with technology contribute to these disparities. Free access to devices, the Internet, and technical assistance may eliminate disparities in portal use. Objective To examine predictors of frequent versus infrequent portal use among hospitalized patients who received free access to an iPad, the Internet, and technical assistance. Materials and Methods This subgroup analysis includes 146 intervention-arm participants from a pragmatic randomized controlled trial of an inpatient portal. The participants received free access to an iPad and inpatient portal while hospitalized on medical and surgical cardiac units, together with hands-on help using them. We used logistic regression to identify characteristics predictive of frequent use. Results More technology experience (adjusted odds ratio [OR] = 5.39, p = 0.049), less severe illness (adjusted OR = 2.07, p = 0.077), and private insurance (adjusted OR = 2.25, p = 0.043) predicted frequent use, with a predictive performance (area under the curve) of 65.6%. No significant differences in age, gender, race, ethnicity, level of education, employment status, or patient activation existed between the frequent and infrequent users in bivariate analyses. Significantly more frequent users noticed medical errors during their hospital stay. Discussion and Conclusion Portal use was not associated with several sociodemographic characteristics previously found to limit use in the inpatient setting. However, limited technology experience and high illness severity were still barriers to frequent use. Future work should explore additional strategies, such as enrolling health care proxies and improving usability, to reduce potential disparities in portal use.
      Citation: Appl Clin Inform 2019; 10: 040-050
      PubDate: 2019-01-16T00:00:00+0100
      DOI: 10.1055/s-0038-1676971
      Issue No: Vol. 10, No. 01 (2019)
       
  • Integration of Postcoordination Content into a Clinical Interface
           Terminology to Support Administrative Coding
    • Authors: Rose; Eric, Rube, Steven, Kanter, Andrew S., Cardwell, Matthew, Naeymi-Rad, Frank
      Pages: 051 - 059
      Abstract: Background Clinical interface terminologies (CITs) consist of terms designed for clinical documentation and, through mappings to standardized vocabularies, to support secondary uses of patient data, including clinical decision support, quality measurement, and billing for health care services. The latter purpose requires maps to administrative coding systems, such as the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), for diagnoses in the United States. Objectives The transition from ICD-9-CM to ICD-10-CM posed a challenge to CIT users due to the substantially increased details in ICD-10-CM. To address this, we developed a content layer within a CIT that provides postcoordination prompts for the details required for accurate ICD-10-CM coding. Methods We developed content to support prompting for and capture of additional information specified by the user in a single, clinically relevant term that is added to the patient's record, and whose mapping to other coding systems (like Systematized Nomenclature of Medicine—Clinical Terms [SNOMED CT]) reflects the details added during postcoordination. We worked with clinical information system developers to incorporate this into user interfaces, and with end-users to refine the design. Results While the prompts were designed around the precoordinated elements implicit in ICD-10-CM, irregularities in ICD-10-CM required some additional design measures, such as providing postcoordination options that interpolate gaps in ICD-10-CM to avoid user confusion. The system we describe has been implemented by ∼30,000 health care provider organizations, with content that covers the vast majority of encounter diagnoses. User feedback has been largely positive, though concerns have been raised about expanding postcoordination content beyond that required for ICD-10-CM coding. Conclusion We have demonstrated the design and development of what, to our knowledge, is the first system that uses postcoordination to capture ICD-10-CM-relevant details in a CIT while also reflecting the details added by the user in maps to other vocabularies.
      Citation: Appl Clin Inform 2019; 10: 051-059
      PubDate: 2019-01-23T00:00:00+0100
      DOI: 10.1055/s-0038-1676972
      Issue No: Vol. 10, No. 01 (2019)
       
  • Automated Generation of CONSORT Diagrams Using Relational Database
           Software
    • Authors: O'Leary; Teresa, Weiss, June, Toll, Benjamin, Brandt, Cynthia, Bernstein, Steven L.
      Pages: 060 - 065
      Abstract: Background Investigators conducting prospective clinical trials must report patient flow using the Consolidated Standards of Reporting Trials (CONSORT) statement. Depending on how data are collected, this can be a laborious, time-intensive process. However, because many trials enter data electronically, CONSORT diagrams may be generated in an automated fashion. Objective Our objective was to use an off-the-shelf software to develop a technique to generate CONSORT diagrams automatically. Methods During a recent trial, data were entered into FileMaker Pro, a commercially available software, at enrollment and three waves of follow-up. Patient-level data were coded to automatically generate CONSORT diagrams for use by the study team. Results From August 2012 to July 2014, 1,044 participants were enrolled. CONSORT diagrams were generated weekly for study team meetings to track follow-ups at 1, 6, and 12 months, for 960 (92%), 921 (90%), and 871 (88%) participants who were contacted or deceased, respectively. Reasons for loss to follow-up were captured at each follow-up. Conclusion CONSORT diagrams can be generated using a standard software for any trial and can facilitate data collection, project management, and reporting.
      Citation: Appl Clin Inform 2019; 10: 060-065
      PubDate: 2019-01-23T00:00:00+0100
      DOI: 10.1055/s-0038-1677043
      Issue No: Vol. 10, No. 01 (2019)
       
  • Reduced Verification of Medication Alerts Increases Prescribing Errors
    • Authors: Lyell; David, Magrabi, Farah, Coiera, Enrico
      Pages: 066 - 076
      Abstract: Objective Clinicians using clinical decision support (CDS) to prescribe medications have an obligation to ensure that prescriptions are safe. One option is to verify the safety of prescriptions if there is uncertainty, for example, by using drug references. Supervisory control experiments in aviation and process control have associated errors, with reduced verification arising from overreliance on decision support. However, it is unknown whether this relationship extends to clinical decision-making. Therefore, we examine whether there is a relationship between verification behaviors and prescribing errors, with and without CDS medication alerts, and whether task complexity mediates this. Methods A total of 120 students in the final 2 years of a medical degree prescribed medicines for patient scenarios using a simulated electronic prescribing system. CDS (correct, incorrect, and no CDS) and task complexity (low and high) were varied. Outcomes were omission (missed prescribing errors) and commission errors (accepted false-positive alerts). Verification measures were access of drug references and view time percentage of task time. Results Failure to access references for medicines with prescribing errors increased omission errors with no CDS (high-complexity: χ 2(1) = 12.716; p 
      Citation: Appl Clin Inform 2019; 10: 066-076
      PubDate: 2019-01-30T00:00:00+0100
      DOI: 10.1055/s-0038-1677009
      Issue No: Vol. 10, No. 01 (2019)
       
  • Rebuilding the Standing Prescription Renewal Orders
    • Authors: Nelson; Scott D., Rector, Hayley H., Brashear, Daniel, Mathe, Janos L., Wen, Haomin, English, Stacey Lynn, Hedges, William, Lehmann, Christoph U., Ozdas-Weitkamp, Asli, Stenner, Shane P.
      Pages: 077 - 086
      Abstract: Background Managing prescription renewal requests is a labor-intensive challenge in ambulatory care. In 2009, Vanderbilt University Medical Center developed clinic-specific standing prescription renewal orders that allowed nurses, under specific conditions, to authorize renewal requests. Formulary and authorization changes made maintaining these documents very challenging. Objective This article aims to review, standardize, and restructure legacy standing prescription renewal orders into a modular, scalable, and easier to manage format for conversion and use in a new electronic health record (EHR). Methods We created an enterprise-wide renewal domain model using modular subgroups within the main institutional standing renewal order policy by extracting metadata, medication group names, medication ingredient names, and renewal criteria from approved legacy standing renewal orders. Instance-based matching compared medication groups in a pairwise manner to calculate a similarity score between medication groups. We grouped and standardized medication groups with high similarity by mapping them to medication classes from a medication terminology vendor and filtering them by intended route (e.g., oral, subcutaneous, inhalation). After standardizing the renewal criteria to a short list of reusable criteria, the Pharmacy and Therapeutics (P&T) committee reviewed and approved candidate medication groups and corresponding renewal criteria. Results Seventy-eight legacy standing prescription renewal orders covered 135 clinics (some applied to multiple clinics). Several standing orders were perfectly congruent, listing identical medications for renewal. We consolidated 870 distinct medication classes to 164 subgroups and assigned renewal criteria. We consolidated 379 distinct legacy renewal criteria to 21 criteria. After approval by the P&T committee, we built subgroups in a structured and consistent format in the new EHR, where they facilitated chart review and standing order adherence by nurses. Additionally, clinicians could search an autogenerated document of the standing order content from the EHR data warehouse. Conclusion We describe a methodology for standardizing and scaling standing prescription renewal orders at an enterprise level while transitioning to a new EHR.
      Citation: Appl Clin Inform 2019; 10: 077-086
      PubDate: 2019-01-30T00:00:00+0100
      DOI: 10.1055/s-0038-1675813
      Issue No: Vol. 10, No. 01 (2019)
       
  • Lessons Learned in Creating Interoperable Fast Healthcare Interoperability
           Resources Profiles for Large-Scale Public Health Programs
    • Authors: Matney; Susan A., Heale, Bret, Hasley, Steve, Decker, Emily, Frederiksen, Brittni, Davis, Nathan, Langford, Patrick, Ramey, Nadia, Huff, Stanley M.
      Pages: 087 - 095
      Abstract: Objective This article describes lessons learned from the collaborative creation of logical models and standard Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR) profiles for family planning and reproductive health. The National Health Service delivery program will use the FHIR profiles to improve federal reporting, program monitoring, and quality improvement efforts. Materials and Methods Organizational frameworks, work processes, and artifact testing to create FHIR profiles are described. Results Logical models and FHIR profiles for the Family Planning Annual Report 2.0 dataset have been created and validated. Discussion Using clinical element models and FHIR to meet the needs of a real-world use case has been accomplished but has also demonstrated the need for additional tooling, terminology services, and application sandbox development. Conclusion FHIR profiles may reduce the administrative burden for the reporting of federally mandated program data.
      Citation: Appl Clin Inform 2019; 10: 087-095
      PubDate: 2019-02-06T00:00:00+0100
      DOI: 10.1055/s-0038-1677527
      Issue No: Vol. 10, No. 01 (2019)
       
  • How Patients Use a Patient Portal: An Institutional Case Study of
           Demographics and Usage Patterns
    • Authors: Tsai; Raymond, Bell, Elijah J., Woo, Hawkin, Baldwin, Kevin, Pfeffer, Michael A.
      Pages: 096 - 102
      Abstract: Background Given the widespread electronic health record adoption, there is increasing interest to leverage patient portals to improve care. Objective To determine characteristics of patient portal users and the activities they accessed in the patient portal. Methods We performed a retrospective analysis of patient portal usage at University of California, Los Angeles, Health from July 2014 to May 2015. A total dataset of 505,503 patients was compiled with 396,303 patients who did not register for the patient portal and 109,200 patients who registered for a patient portal account. We compared patients who did not register for the online portal to the top 75th percentile of users based on number of logins, which was done to exclude those who only logged in to register. Finally, to avoid doing statistical analysis on too large of a sample and overpower the analysis, we performed statistical tests on a random sample of 300 patients in each of the two groups. Results Patient portal users tended to be older (49.45 vs. 46.22 years in the entire sample, p = 0.008 in the random sample) and more likely female (62.59 vs. 54.91% in the entire sample, p = 0.035 in the random sample). Nonusers had more monthly emergency room (ER) visits on average (0.047 vs. 0.014, p 
      Citation: Appl Clin Inform 2019; 10: 096-102
      PubDate: 2019-02-06T00:00:00+0100
      DOI: 10.1055/s-0038-1677528
      Issue No: Vol. 10, No. 01 (2019)
       
  • Empowering Patients during Hospitalization: Perspectives on Inpatient
           Portal Use
    • Authors: McAlearney; Ann Scheck, Fareed, Naleef, Gaughan, Alice, MacEwan, Sarah R., Volney, Jaclyn, Sieck, Cynthia J.
      Pages: 103 - 112
      Abstract: Background Patients have demonstrated an eagerness to use portals to access their health information and connect with care providers. While outpatient portals have been extensively studied, there is a recognized need for research that examines inpatient portals. Objective We conducted this study to improve our understanding about the role of a portal in the context of inpatient care. Our study focused on a large sample of the general adult inpatient population and obtained perspectives from both patients and care team members about inpatient portal use. Methods We interviewed patients (n = 120) who used an inpatient portal during their hospitalization at 15 days or 6 months after discharge to learn about their portal use. We also interviewed care team members (n = 331) 4 weeks, 6 months, and 12 months after inpatient portal implementation to collect information about their ongoing perspectives about patients' use of the portal. Results The perspectives of patients and care team members generally converged on their views of the inpatient portal. Three features—(1) ordering meals, (2) looking up health information, and (3) viewing the care team—were most commonly used; the secure messaging feature was less commonly used and of some concern to care team members. The inpatient portal benefited patients in four main ways: (1) promoted independence, (2) reduced anxiety, (3) informed families, and (4) increased empowerment. Conclusion Inpatient portals are recognized as a tool that can enhance the delivery of patient-centered care. In addition to empowering patients by increasing their sense of control, inpatient portals can support family members and caregivers throughout the hospital stay. Given the consistency of perspectives about portal use across patients and care team members, our findings suggest that inpatient portals may facilitate shifts in organizational culture that increase the patient centeredness of care and improve patient experience in the hospital context.
      Citation: Appl Clin Inform 2019; 10: 103-112
      PubDate: 2019-02-13T00:00:00+0100
      DOI: 10.1055/s-0039-1677722
      Issue No: Vol. 10, No. 01 (2019)
       
  • Physician Perceptions of the Electronic Problem List in Pediatric Trauma
           Care
    • Authors: Hose; Bat-Zion, Hoonakker, Peter L. T., Wooldridge, Abigail R., Brazelton III, Thomas B., Dean, Shannon M., Eithun, Ben, Fackler, James C., Gurses, Ayse P., Kelly, Michelle M., Kohler, Jonathan E., McGeorge, Nicolette M., Ross, Joshua C., Rusy, Deborah A., Carayon, Pascale
      Pages: 113 - 122
      Abstract: Objective To describe physician perceptions of the potential goals, characteristics, and content of the electronic problem list (PL) in pediatric trauma. Methods We conducted 12 semistructured interviews with physicians involved in the pediatric trauma care process, including residents, fellows, and attendings from four services: emergency medicine, surgery, anesthesia, and pediatric critical care. Using qualitative content analysis, we identified PL goals, characteristics, and patient-related information from these interviews and the hospital's PL etiquette document of guideline. Results We identified five goals of the PL (to document the patient's problems, to make sense of the patient's problems, to make decisions about the care plan, to know who is involved in the patient's care, and to communicate with others), seven characteristics of the PL (completeness, efficiency, accessibility, multiple users, organized, created before arrival, and representing uncertainty), and 22 patient-related information elements (e.g., injuries, vitals). Physicians' suggested criteria for a PL varied across services with respect to goals, characteristics, and patient-related information. Conclusion Physicians involved in pediatric trauma care described the electronic PL as ideally more than a list of a patient's medical diagnoses and injuries. The information elements mentioned are typically found in other parts of the patient's electronic record besides the PL, such as past medical history and labs. Future work is needed to evaluate the optimal design of the PL so that users with emergent cases, such as pediatric trauma, have access to key information related to the patient's immediate problems.
      Citation: Appl Clin Inform 2019; 10: 113-122
      PubDate: 2019-02-13T00:00:00+0100
      DOI: 10.1055/s-0039-1677737
      Issue No: Vol. 10, No. 01 (2019)
       
  • Using Electronic Health Records to Identify Adverse Drug Events in
           Ambulatory Care: A Systematic Review
    • Authors: Feng; Chenchen, Le, David, McCoy, Allison B.
      Pages: 123 - 128
      Abstract: Objective We identified the methods used and determined the roles of electronic health records (EHRs) in detecting and assessing adverse drug events (ADEs) in the ambulatory setting. Methods We performed a systematic literature review by searching PubMed and Google Scholar for studies on ADEs detected in the ambulatory setting involving any EHR use published before June 2017. We extracted study characteristics from included studies related to ADE detection methods for analysis. Results We identified 30 studies that evaluated ADEs in an ambulatory setting with an EHR. In 27 studies, EHRs were used only as the data source for ADE identification. In two studies, the EHR was used as both a data source and to deliver decision support to providers during order entry. In one study, the EHR was a source of data and generated patient safety reports that researchers used in the process of identifying ADEs. Methods of identification included manual chart review by trained nurses, pharmacists, and/or physicians; prescription review; computer monitors; electronic triggers; International Classification of Diseases codes; natural language processing of clinical notes; and patient phone calls and surveys. Seven studies provided examples of search phrases, laboratory values, and rules used to identify ADEs. Conclusion The majority of studies examined used EHRs as sources of data for ADE detection. This retrospective approach is appropriate to measure incidence rates of ADEs but not adequate to detect preventable ADEs before patient harm occurs. New methods involving computer monitors and electronic triggers will enable researchers to catch preventable ADEs and take corrective action.
      Citation: Appl Clin Inform 2019; 10: 123-128
      PubDate: 2019-02-20T00:00:00+0100
      DOI: 10.1055/s-0039-1677738
      Issue No: Vol. 10, No. 01 (2019)
       
  • Electronic Health Record Adoption and Nurse Reports of Usability and
           Quality of Care: The Role of Work Environment
    • Authors: Kutney-Lee; Ann, Sloane, Douglas M., Bowles, Kathryn H., Burns, Lawton R., Aiken, Linda H.
      Pages: 129 - 139
      Abstract: Background Despite evidence suggesting higher quality and safer care in hospitals with comprehensive electronic health record (EHR) systems, factors related to advanced system usability remain largely unknown, particularly among nurses. Little empirical research has examined sociotechnical factors, such as the work environment, that may shape the relationship between advanced EHR adoption and quality of care. Objective The objective of this study was to examine the independent and joint effects of comprehensive EHR adoption and the hospital work environment on nurse reports of EHR usability and nurse-reported quality of care and safety. Methods This study was a secondary analysis of nurse and hospital survey data. Unadjusted and adjusted logistic regression models were used to assess the relationship between EHR adoption level, work environment, and a set of EHR usability and quality/safety outcomes. The sample included 12,377 nurses working in 353 hospitals. Results In fully adjusted models, comprehensive EHR adoption was associated with lower odds of nurses reporting poor usability outcomes, such as dissatisfaction with the system (odds ratio [OR]: 0.75; 95% confidence interval [CI]: 0.61–0.92). The work environment was associated with all usability outcomes with nurses in better environments being less likely to report negatively. Comprehensive EHRs (OR: 0.83; 95% CI: 0.71–0.96) and better work environments (OR: 0.47; 95% CI: 0.42–0.52) were associated with lower odds of nurses reporting fair/poor quality of care, while poor patient safety grade was associated with the work environment (OR: 0.50; 95% CI: 0.46–0.54), but not EHR adoption level. Conclusion Our findings suggest that adoption of a comprehensive EHR is associated with more positive usability ratings and higher quality of care. We also found that—independent of EHR adoption level—the hospital work environment plays a significant role in how nurses evaluate EHR usability and whether EHRs have their intended effects on improving quality and safety of care.
      Citation: Appl Clin Inform 2019; 10: 129-139
      PubDate: 2019-02-20T00:00:00+0100
      DOI: 10.1055/s-0039-1678551
      Issue No: Vol. 10, No. 01 (2019)
       
  • Evaluation of Secure Messaging Applications for a Health Care System: A
           Case Study
    • Authors: Liu; Xinran, Sutton, Paul R., McKenna, Rory, Sinanan, Mika N., Fellner, B. Jane, Leu, Michael G., Ewell, Cris
      Pages: 140 - 150
      Abstract: Objective The use of text messaging in clinical care has become ubiquitous. Due to security and privacy concerns, many hospital systems are evaluating secure text messaging applications. This paper highlights our evaluation process, and offers an overview of secure messaging functionalities, as well as a framework for how to evaluate such applications. Methods Application functionalities were gathered through literature review, Web sites, speaking with representatives, demonstrations, and use cases. Based on similar levels of functionalities, vendors were grouped into three tiers. Essential and secondary functionalities for our health system were defined to help narrow our vendor choices. Results We stratified 19 secure messaging vendors into three tiers: basic secure communication, secure communication within an existing clinical application, and dedicated communication and collaboration systems. Our essential requirements revolved around functionalities to enhance security and communication, while advanced functionalities were mostly considered secondary. We then narrowed our list of 19 vendors to four, then created clinical use cases to rank the final vendors. Discussion When evaluating a secure messaging application, numerous factors must be considered in parallel. These include: what clinical processes to improve, archiving text messages, mobile device management, bring your own device policy, and Wi-Fi architecture. Conclusion Secure messaging applications provide a Health Insurance Portability and Accountability Act (HIPAA) compliant communication platform, and also include functionality to improve clinical collaboration and workflow. We hope that our evaluation framework can be used by other health systems to find a secure messaging application that meets their needs.
      Citation: Appl Clin Inform 2019; 10: 140-150
      PubDate: 2019-02-27T00:00:00+0100
      DOI: 10.1055/s-0039-1678607
      Issue No: Vol. 10, No. 01 (2019)
       
  • POLAR Diversion: Using General Practice Data to Calculate Risk of
           Emergency Department Presentation at the Time of Consultation
    • Authors: Pearce; Christopher, McLeod, Adam, Rinehart, Natalie, Patrick, Jon, Fragkoudi, Anna, Ferrigi, Jason, Deveny, Elizabeth, Whyte, Robin, Shearer, Marianne
      Pages: 151 - 157
      Abstract: Objective This project examined and produced a general practice (GP) based decision support tool (DST), namely POLAR Diversion, to predict a patient's risk of emergency department (ED) presentation. The tool was built using both GP/family practice and ED data, but is designed to operate on GP data alone. Methods GP data from 50 practices during a defined time frame were linked with three local EDs. Linked data and data mapping were used to develop a machine learning DST to determine a range of variables that, in combination, led to predictive patient ED presentation risk scores. Thirteen percent of the GP data was kept as a control group and used to validate the tool. Results The algorithm performed best in predicting the risk of attending ED within the 30-day time category, and also in the no ED attendance tests, suggesting few false positives. At 0 to 30 days the positive predictive value (PPV) was 74%, with a sensitivity/recall of 68%. Non-ED attendance had a PPV of 82% and sensitivity/recall of 96%. Conclusion Findings indicate that the POLAR Diversion algorithm performed better than previously developed tools, particularly in the 0 to 30 day time category. Its utility increases because of it being based on the data within the GP system alone, with the ability to create real-time “in consultation” warnings. The tool will be deployed across GPs in Australia, allowing us to assess the clinical utility, and data quality needs in further iterations.
      Citation: Appl Clin Inform 2019; 10: 151-157
      PubDate: 2019-02-27T00:00:00+0100
      DOI: 10.1055/s-0039-1678608
      Issue No: Vol. 10, No. 01 (2019)
       
  • Understanding Health Information Technology Induced Medication Safety
           Events by Two Conceptual Frameworks
    • Authors: Wang; Ju, Liang, Hongyuan, Kang, Hong, Gong, Yang
      Pages: 158 - 167
      Abstract: Background While health information technology (health IT) is able to prevent medication errors in many ways, it may also potentially introduce new paths to errors. To understand the impact of health IT induced medication errors, this study aims to conduct a retrospective analysis of medication safety reports. Methods From the U.S. Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience database, we identified reports in which health IT is a contributing factor to medication errors. We applied two conceptual frameworks, Sittig and Singh's sociotechnical model and Coiera's information value chain, to examine the identified reports. Results We identified 152 unique reports on health IT induced medication errors as the final report set for review. The majority (65.13%) of the reports involved multiple contributing factors according to the sociotechnical model. Three dimensions, that is, clinical content, human–computer interface, and people, were involved in more reports than the others. The transition of the effects of health IT on medication practice was summarized using information value chain. Health IT related contributing factors may lead to receiving wrong information, missing information, receiving partial information and delayed information, and receiving wrong information and missing information tend to cause the commission errors in decision-making. Conclusion The two frameworks provide an opportunity to understand a comprehensive context of safety event and the impact of health IT induced errors on medication safety. The sociotechnical model helps identify the aspects causing medication safety issues. The information value chain helps uncover the effect of the health IT induced medication errors on health care process and patient outcomes.
      Citation: Appl Clin Inform 2019; 10: 158-167
      PubDate: 2019-03-06T00:00:00+0100
      DOI: 10.1055/s-0039-1678693
      Issue No: Vol. 10, No. 01 (2019)
       
  • Timely Data for Targeted Quality Improvement Interventions: Use of a
           Visual Analytics Dashboard for Bronchiolitis
    • Authors: Hester; Gabrielle, Lang, Tom, Madsen, Laura, Tambyraja, Rabindra, Zenker, Paul
      Pages: 168 - 174
      Abstract: Background Standard methods for obtaining data may delay quality improvement (QI) interventions including for bronchiolitis, a common cause of childhood hospitalization. Objective To describe the use of a dashboard in the context of a multifaceted QI intervention aimed at reducing the use of chest radiographs, bronchodilators, antibiotics, steroids, and viral testing in patients with bronchiolitis. Methods This QI initiative took place at Children's Minnesota, a large, not-for-profit children's health care organization. A multidisciplinary bronchiolitis workgroup developed a local clinical guideline and order-set. Delays in obtaining baseline data prompted a pediatric hospitalist and information technology specialist to modify a vendor's dashboard to display data related to bronchiolitis guideline metrics. Patients 2 months to 2 years old with a bronchiolitis emergency department (ED)/inpatient encounter in the period October 1, 2014 to April 30, 2018 were included. The primary outcome was a functioning dashboard; a process measure was the percentage of ED clinician logins. Outcome measures included the percent use of guideline metrics (e.g., bronchodilators) displayed on statistical process control charts (ED vs. inpatient). Balancing measures included length of stay, charge ratios, and hospital revisits. Results A workgroup (formed October 2015) implemented a bronchiolitis order-set and guideline (February 2016) followed by a bronchiolitis dashboard (August 2016) consolidating disparate data sources loaded within 2 to 4 days of discharge. In total, 35% of ED clinicians logged in. Leaders used the dashboard to target and track interventions such as a bronchodilator order alert. There were improvements in most outcome metrics; however, timing did not suggest direct dashboard impact. ED balancing measures were lower after implementation. Conclusion We described use of a dashboard to support a multifaceted QI initiative for bronchiolitis. Leaders used the dashboard for targeted interventions but the dashboard did not directly impact the observed improvements. Future studies should assess reasons for low individual dashboard use.
      Citation: Appl Clin Inform 2019; 10: 168-174
      PubDate: 2019-03-06T00:00:00+0100
      DOI: 10.1055/s-0039-1679868
      Issue No: Vol. 10, No. 01 (2019)
       
 
 
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