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  Subjects -> COMPUTER SCIENCE (Total: 2115 journals)
    - ANIMATION AND SIMULATION (31 journals)
    - ARTIFICIAL INTELLIGENCE (105 journals)
    - AUTOMATION AND ROBOTICS (105 journals)
    - CLOUD COMPUTING AND NETWORKS (66 journals)
    - COMPUTER ARCHITECTURE (10 journals)
    - COMPUTER ENGINEERING (11 journals)
    - COMPUTER GAMES (21 journals)
    - COMPUTER PROGRAMMING (26 journals)
    - COMPUTER SCIENCE (1228 journals)
    - COMPUTER SECURITY (49 journals)
    - DATA BASE MANAGEMENT (14 journals)
    - DATA MINING (37 journals)
    - E-BUSINESS (22 journals)
    - E-LEARNING (30 journals)
    - ELECTRONIC DATA PROCESSING (22 journals)
    - IMAGE AND VIDEO PROCESSING (40 journals)
    - INFORMATION SYSTEMS (107 journals)
    - INTERNET (95 journals)
    - SOCIAL WEB (53 journals)
    - SOFTWARE (34 journals)
    - THEORY OF COMPUTING (9 journals)

COMPUTER SCIENCE (1228 journals)                  1 2 3 4 5 6 7 | Last

Showing 1 - 200 of 872 Journals sorted alphabetically
3D Printing and Additive Manufacturing     Full-text available via subscription   (Followers: 24)
Abakós     Open Access   (Followers: 4)
ACM Computing Surveys     Hybrid Journal   (Followers: 30)
ACM Journal on Computing and Cultural Heritage     Hybrid Journal   (Followers: 8)
ACM Journal on Emerging Technologies in Computing Systems     Hybrid Journal   (Followers: 17)
ACM Transactions on Accessible Computing (TACCESS)     Hybrid Journal   (Followers: 3)
ACM Transactions on Algorithms (TALG)     Hybrid Journal   (Followers: 15)
ACM Transactions on Applied Perception (TAP)     Hybrid Journal   (Followers: 5)
ACM Transactions on Architecture and Code Optimization (TACO)     Hybrid Journal   (Followers: 9)
ACM Transactions on Autonomous and Adaptive Systems (TAAS)     Hybrid Journal   (Followers: 9)
ACM Transactions on Computation Theory (TOCT)     Hybrid Journal   (Followers: 12)
ACM Transactions on Computational Logic (TOCL)     Hybrid Journal   (Followers: 3)
ACM Transactions on Computer Systems (TOCS)     Hybrid Journal   (Followers: 18)
ACM Transactions on Computer-Human Interaction     Hybrid Journal   (Followers: 16)
ACM Transactions on Computing Education (TOCE)     Hybrid Journal   (Followers: 7)
ACM Transactions on Design Automation of Electronic Systems (TODAES)     Hybrid Journal   (Followers: 6)
ACM Transactions on Economics and Computation     Hybrid Journal   (Followers: 1)
ACM Transactions on Embedded Computing Systems (TECS)     Hybrid Journal   (Followers: 3)
ACM Transactions on Information Systems (TOIS)     Hybrid Journal   (Followers: 20)
ACM Transactions on Intelligent Systems and Technology (TIST)     Hybrid Journal   (Followers: 8)
ACM Transactions on Interactive Intelligent Systems (TiiS)     Hybrid Journal   (Followers: 4)
ACM Transactions on Multimedia Computing, Communications, and Applications (TOMCCAP)     Hybrid Journal   (Followers: 9)
ACM Transactions on Reconfigurable Technology and Systems (TRETS)     Hybrid Journal   (Followers: 6)
ACM Transactions on Sensor Networks (TOSN)     Hybrid Journal   (Followers: 8)
ACM Transactions on Speech and Language Processing (TSLP)     Hybrid Journal   (Followers: 9)
ACM Transactions on Storage     Hybrid Journal  
ACS Applied Materials & Interfaces     Hybrid Journal   (Followers: 33)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Informatica Malaysia     Open Access  
Acta Universitatis Cibiniensis. Technical Series     Open Access  
Ad Hoc Networks     Hybrid Journal   (Followers: 11)
Adaptive Behavior     Hybrid Journal   (Followers: 10)
Advanced Engineering Materials     Hybrid Journal   (Followers: 28)
Advanced Science Letters     Full-text available via subscription   (Followers: 11)
Advances in Adaptive Data Analysis     Hybrid Journal   (Followers: 7)
Advances in Artificial Intelligence     Open Access   (Followers: 15)
Advances in Calculus of Variations     Hybrid Journal   (Followers: 5)
Advances in Catalysis     Full-text available via subscription   (Followers: 5)
Advances in Computational Mathematics     Hybrid Journal   (Followers: 19)
Advances in Computer Engineering     Open Access   (Followers: 4)
Advances in Computer Science : an International Journal     Open Access   (Followers: 14)
Advances in Computing     Open Access   (Followers: 2)
Advances in Data Analysis and Classification     Hybrid Journal   (Followers: 58)
Advances in Engineering Software     Hybrid Journal   (Followers: 28)
Advances in Geosciences (ADGEO)     Open Access   (Followers: 14)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 23)
Advances in Human-Computer Interaction     Open Access   (Followers: 21)
Advances in Materials Science     Open Access   (Followers: 14)
Advances in Operations Research     Open Access   (Followers: 12)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Remote Sensing     Open Access   (Followers: 50)
Advances in Science and Research (ASR)     Open Access   (Followers: 6)
Advances in Technology Innovation     Open Access   (Followers: 6)
AEU - International Journal of Electronics and Communications     Hybrid Journal   (Followers: 8)
African Journal of Information and Communication     Open Access   (Followers: 9)
African Journal of Mathematics and Computer Science Research     Open Access   (Followers: 4)
AI EDAM     Hybrid Journal   (Followers: 1)
Air, Soil & Water Research     Open Access   (Followers: 14)
AIS Transactions on Human-Computer Interaction     Open Access   (Followers: 7)
Algebras and Representation Theory     Hybrid Journal   (Followers: 1)
Algorithms     Open Access   (Followers: 11)
American Journal of Computational and Applied Mathematics     Open Access   (Followers: 5)
American Journal of Computational Mathematics     Open Access   (Followers: 4)
American Journal of Information Systems     Open Access   (Followers: 6)
American Journal of Sensor Technology     Open Access   (Followers: 4)
Anais da Academia Brasileira de Ciências     Open Access   (Followers: 2)
Analog Integrated Circuits and Signal Processing     Hybrid Journal   (Followers: 7)
Analysis in Theory and Applications     Hybrid Journal   (Followers: 1)
Animation Practice, Process & Production     Hybrid Journal   (Followers: 5)
Annals of Combinatorics     Hybrid Journal   (Followers: 4)
Annals of Data Science     Hybrid Journal   (Followers: 12)
Annals of Mathematics and Artificial Intelligence     Hybrid Journal   (Followers: 12)
Annals of Pure and Applied Logic     Open Access   (Followers: 3)
Annals of Software Engineering     Hybrid Journal   (Followers: 13)
Annals of West University of Timisoara - Mathematics and Computer Science     Open Access  
Annual Reviews in Control     Hybrid Journal   (Followers: 8)
Anuario Americanista Europeo     Open Access  
Applicable Algebra in Engineering, Communication and Computing     Hybrid Journal   (Followers: 3)
Applied and Computational Harmonic Analysis     Full-text available via subscription   (Followers: 1)
Applied Artificial Intelligence: An International Journal     Hybrid Journal   (Followers: 12)
Applied Categorical Structures     Hybrid Journal   (Followers: 3)
Applied Clinical Informatics     Hybrid Journal   (Followers: 2)
Applied Computational Intelligence and Soft Computing     Open Access   (Followers: 14)
Applied Computer Systems     Open Access   (Followers: 2)
Applied Informatics     Open Access  
Applied Mathematics and Computation     Hybrid Journal   (Followers: 34)
Applied Medical Informatics     Open Access   (Followers: 11)
Applied Numerical Mathematics     Hybrid Journal   (Followers: 5)
Applied Soft Computing     Hybrid Journal   (Followers: 17)
Applied Spatial Analysis and Policy     Hybrid Journal   (Followers: 6)
Applied System Innovation     Open Access  
Architectural Theory Review     Hybrid Journal   (Followers: 3)
Archive of Applied Mechanics     Hybrid Journal   (Followers: 5)
Archive of Numerical Software     Open Access  
Archives and Museum Informatics     Hybrid Journal   (Followers: 151)
Archives of Computational Methods in Engineering     Hybrid Journal   (Followers: 5)
arq: Architectural Research Quarterly     Hybrid Journal   (Followers: 8)
Artifact     Hybrid Journal   (Followers: 2)
Artificial Life     Hybrid Journal   (Followers: 7)
Asia Pacific Journal on Computational Engineering     Open Access  
Asia-Pacific Journal of Information Technology and Multimedia     Open Access   (Followers: 1)
Asian Journal of Control     Hybrid Journal  
Assembly Automation     Hybrid Journal   (Followers: 2)
at - Automatisierungstechnik     Hybrid Journal   (Followers: 1)
Australian Educational Computing     Open Access   (Followers: 1)
Automatic Control and Computer Sciences     Hybrid Journal   (Followers: 6)
Automatic Documentation and Mathematical Linguistics     Hybrid Journal   (Followers: 5)
Automatica     Hybrid Journal   (Followers: 12)
Automation in Construction     Hybrid Journal   (Followers: 7)
Autonomous Mental Development, IEEE Transactions on     Hybrid Journal   (Followers: 8)
Balkan Journal of Electrical and Computer Engineering     Open Access  
Basin Research     Hybrid Journal   (Followers: 5)
Behaviour & Information Technology     Hybrid Journal   (Followers: 51)
Big Data and Cognitive Computing     Open Access   (Followers: 3)
Biodiversity Information Science and Standards     Open Access  
Bioinformatics     Hybrid Journal   (Followers: 318)
Biomedical Engineering     Hybrid Journal   (Followers: 16)
Biomedical Engineering and Computational Biology     Open Access   (Followers: 13)
Biomedical Engineering, IEEE Reviews in     Full-text available via subscription   (Followers: 20)
Biomedical Engineering, IEEE Transactions on     Hybrid Journal   (Followers: 35)
Briefings in Bioinformatics     Hybrid Journal   (Followers: 50)
British Journal of Educational Technology     Hybrid Journal   (Followers: 152)
Broadcasting, IEEE Transactions on     Hybrid Journal   (Followers: 12)
c't Magazin fuer Computertechnik     Full-text available via subscription   (Followers: 1)
CALCOLO     Hybrid Journal  
Calphad     Hybrid Journal   (Followers: 2)
Canadian Journal of Electrical and Computer Engineering     Full-text available via subscription   (Followers: 15)
Capturing Intelligence     Full-text available via subscription  
Catalysis in Industry     Hybrid Journal   (Followers: 1)
CEAS Space Journal     Hybrid Journal   (Followers: 2)
Cell Communication and Signaling     Open Access   (Followers: 2)
Central European Journal of Computer Science     Hybrid Journal   (Followers: 5)
CERN IdeaSquare Journal of Experimental Innovation     Open Access   (Followers: 3)
Chaos, Solitons & Fractals     Hybrid Journal   (Followers: 3)
Chemometrics and Intelligent Laboratory Systems     Hybrid Journal   (Followers: 15)
ChemSusChem     Hybrid Journal   (Followers: 7)
China Communications     Full-text available via subscription   (Followers: 8)
Chinese Journal of Catalysis     Full-text available via subscription   (Followers: 2)
CIN Computers Informatics Nursing     Hybrid Journal   (Followers: 11)
Circuits and Systems     Open Access   (Followers: 15)
Clean Air Journal     Full-text available via subscription   (Followers: 1)
CLEI Electronic Journal     Open Access  
Clin-Alert     Hybrid Journal   (Followers: 1)
Clinical eHealth     Open Access  
Cluster Computing     Hybrid Journal   (Followers: 2)
Cognitive Computation     Hybrid Journal   (Followers: 4)
COMBINATORICA     Hybrid Journal  
Combinatorics, Probability and Computing     Hybrid Journal   (Followers: 4)
Combustion Theory and Modelling     Hybrid Journal   (Followers: 14)
Communication Methods and Measures     Hybrid Journal   (Followers: 13)
Communication Theory     Hybrid Journal   (Followers: 23)
Communications Engineer     Hybrid Journal   (Followers: 1)
Communications in Algebra     Hybrid Journal   (Followers: 3)
Communications in Computational Physics     Full-text available via subscription   (Followers: 2)
Communications in Information Science and Management Engineering     Open Access   (Followers: 4)
Communications in Partial Differential Equations     Hybrid Journal   (Followers: 4)
Communications of the ACM     Full-text available via subscription   (Followers: 51)
Communications of the Association for Information Systems     Open Access   (Followers: 16)
COMPEL: The International Journal for Computation and Mathematics in Electrical and Electronic Engineering     Hybrid Journal   (Followers: 3)
Complex & Intelligent Systems     Open Access   (Followers: 1)
Complex Adaptive Systems Modeling     Open Access  
Complex Analysis and Operator Theory     Hybrid Journal   (Followers: 2)
Complexity     Hybrid Journal   (Followers: 6)
Complexus     Full-text available via subscription  
Composite Materials Series     Full-text available via subscription   (Followers: 8)
Computación y Sistemas     Open Access  
Computation     Open Access   (Followers: 1)
Computational and Applied Mathematics     Hybrid Journal   (Followers: 3)
Computational and Mathematical Biophysics     Open Access   (Followers: 1)
Computational and Mathematical Methods in Medicine     Open Access   (Followers: 2)
Computational and Mathematical Organization Theory     Hybrid Journal   (Followers: 2)
Computational and Structural Biotechnology Journal     Open Access   (Followers: 1)
Computational and Theoretical Chemistry     Hybrid Journal   (Followers: 9)
Computational Astrophysics and Cosmology     Open Access   (Followers: 1)
Computational Biology and Chemistry     Hybrid Journal   (Followers: 12)
Computational Chemistry     Open Access   (Followers: 2)
Computational Cognitive Science     Open Access   (Followers: 2)
Computational Complexity     Hybrid Journal   (Followers: 4)
Computational Condensed Matter     Open Access   (Followers: 1)
Computational Ecology and Software     Open Access   (Followers: 9)
Computational Economics     Hybrid Journal   (Followers: 9)
Computational Geosciences     Hybrid Journal   (Followers: 17)
Computational Linguistics     Open Access   (Followers: 24)
Computational Management Science     Hybrid Journal  
Computational Mathematics and Modeling     Hybrid Journal   (Followers: 8)
Computational Mechanics     Hybrid Journal   (Followers: 5)
Computational Methods and Function Theory     Hybrid Journal  
Computational Molecular Bioscience     Open Access   (Followers: 2)
Computational Optimization and Applications     Hybrid Journal   (Followers: 9)
Computational Particle Mechanics     Hybrid Journal   (Followers: 1)
Computational Research     Open Access   (Followers: 1)
Computational Science and Discovery     Full-text available via subscription   (Followers: 2)
Computational Science and Techniques     Open Access  
Computational Statistics     Hybrid Journal   (Followers: 14)
Computational Statistics & Data Analysis     Hybrid Journal   (Followers: 33)
Computer     Full-text available via subscription   (Followers: 104)
Computer Aided Surgery     Open Access   (Followers: 6)
Computer Applications in Engineering Education     Hybrid Journal   (Followers: 8)
Computer Communications     Hybrid Journal   (Followers: 16)

        1 2 3 4 5 6 7 | Last

Journal Cover
Applied Clinical Informatics
Journal Prestige (SJR): 0.624
Citation Impact (citeScore): 1
Number of Followers: 2  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1869-0327
Published by Thieme Publishing Group Homepage  [216 journals]
  • 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

      Artikel in Thieme eJournals:
      Inhaltsverzeichnis     Volltext

      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)
       
  • The Use of Health Information Exchange to Augment Patient Handoff in
           Long-Term Care: A Systematic Review
    • Authors: Kruse; Clemens Scott, Marquez, Gabriella, Nelson, Daniel, Palomares, Olivia
      Pages: 752 - 771
      Abstract: Background Legislation aimed at increasing the use of a health information exchange (HIE) in healthcare has excluded long-term care facilities, resulting in a vulnerable patient population that can benefit from the improvement of communication and reduction of waste. Objective The purpose of this review is to provide a framework for future research by identifying themes in the long-term care information technology sector that could function to enable the adoption and use of HIE mechanisms for patient handoff between long-term care facilities and other levels of care to increase communication between providers, shorten length of stay, reduce 60-day readmissions, and increase patient safety. Methods The authors conducted a systematic search of literature through CINAHL, PubMed, and Discovery Services for Texas A&M University Libraries. Search terms used were (“health information exchange” OR “healthcare information exchange” OR “HIE”) AND (“long term care” OR “long-term care” OR “nursing home” OR “nursing facility” OR “skilled nursing facility” OR “SNF” OR “residential care” OR “assisted living”). Articles were eligible for selection if they were published between 2010 and 2017, published in English, and published in academic journals. All articles were reviewed by all reviewers and literature not relevant to the research objective was excluded. Results Researchers selected and reviewed 22 articles for common themes. Results concluded that the largest facilitator and barrier to the adoption of HIE mechanisms is workflow integration/augmentation and the organizational structure/culture, respectively. Other identified facilitator themes were enhanced communication, increased effectiveness of care, and patient safety. The additional barriers were missing/incomplete data, inefficiency, and market conditions. Conclusion The long-term care industry has been left out of incentives from which the industry could have benefited tremendously. Organizations that are not utilizing health information technology mechanisms, such as electronic health records and HIEs, are at a disadvantage as insurers switch to capitated forms of payment that rely on reduced waste to generate a profit.
      Citation: Appl Clin Inform 2018; 09: 752-771
      PubDate: 2018-10-03T00:00:00+01:00
      DOI: 10.1055/s-0038-1670651
      Issue No: Vol. 09, No. 04 (2018)
       
  • Factors Influencing Sustained Engagement with ECG Self-Monitoring:
           Perspectives from Patients and Health Care Providers
    • Authors: Reading; Meghan, Baik, Dawon, Beauchemin, Melissa, Hickey, Kathleen T., Merrill, Jacqueline A.
      Pages: 772 - 781
      Abstract: Background Patient-generated health data (PGHD) collected digitally with mobile health (mHealth) technology has garnered recent excitement for its potential to improve precision management of chronic conditions such as atrial fibrillation (AF), a common cardiac arrhythmia. However, sustained engagement is a major barrier to collection of PGHD. Little is known about barriers to sustained engagement or strategies to intervene upon engagement through application design. Objective This article investigates individual patient differences in sustained engagement among individuals with a history of AF who are self-monitoring using mHealth technology. Methods This qualitative study involved patients, health care providers, and research coordinators previously involved in a randomized, controlled trial involving electrocardiogram (ECG) self-monitoring of AF. Patients were adults with a history of AF randomized to the intervention arm of this trial who self-monitored using ECG mHealth technology for 6 months. Semistructured interviews and focus groups were conducted separately with health care providers and research coordinators, engaged patients, and unengaged patients. A validated model of sustained engagement, an adapted unified theory of acceptance and use of technology (UTAUT), guided data collection, and analysis through directed content analysis. Results We interviewed 13 patients (7 engaged, 6 unengaged), 6 providers, and 2 research coordinators. In addition to finding differences between engaged and unengaged patients within each predictor in the adapted UTAUT model (perceived ease of use, perceived usefulness, facilitating conditions), four additional factors were identified as being related to sustained engagement in this population. These are: (1) internal motivation to manage health, (2) relationship with health care provider, (3) supportive environments, and (4) feedback and guidance. Conclusion Although it required some modification, the adapted UTAUT model was useful in understanding of the parameters of sustained engagement. The findings of this study provide initial requirement specifications for the design of applications that engage patients in this unique population of adults with AF.
      Citation: Appl Clin Inform 2018; 09: 772-781
      PubDate: 2018-10-10T00:00:00+01:00
      DOI: 10.1055/s-0038-1672138
      Issue No: Vol. 09, No. 04 (2018)
       
  • Asynchronous Speech Recognition Affects Physician Editing of Notes
    • Authors: Lybarger; Kevin J., Ostendorf, Mari, Riskin, Eve, Payne, Thomas H., White, Andrew A., Yetisgen, Meliha
      Pages: 782 - 790
      Abstract: Objective Clinician progress notes are an important record for care and communication, but there is a perception that electronic notes take too long to write and may not accurately reflect the patient encounter, threatening quality of care. Automatic speech recognition (ASR) has the potential to improve clinical documentation process; however, ASR inaccuracy and editing time are barriers to wider use. We hypothesized that automatic text processing technologies could decrease editing time and improve note quality. To inform the development of these technologies, we studied how physicians create clinical notes using ASR and analyzed note content that is revised or added during asynchronous editing. Materials and Methods We analyzed a corpus of 649 dictated clinical notes from 9 physicians. Notes were dictated during rounds to portable devices, automatically transcribed, and edited later at the physician's convenience. Comparing ASR transcripts and the final edited notes, we identified the word sequences edited by physicians and categorized the edits by length and content. Results We found that 40% of the words in the final notes were added by physicians while editing: 6% corresponded to short edits associated with error correction and format changes, and 34% were associated with longer edits. Short error correction edits that affect note accuracy are estimated to be less than 3% of the words in the dictated notes. Longer edits primarily involved insertion of material associated with clinical data or assessment and plans. The longer edits improve note completeness; some could be handled with verbalized commands in dictation. Conclusion Process interventions to reduce ASR documentation burden, whether related to technology or the dictation/editing workflow, should apply a portfolio of solutions to address all categories of required edits. Improved processes could reduce an important barrier to broader use of ASR by clinicians and improve note quality.
      Citation: Appl Clin Inform 2018; 09: 782-790
      PubDate: 2018-10-17T00:00:00+01:00
      DOI: 10.1055/s-0038-1673417
      Issue No: Vol. 09, No. 04 (2018)
       
  • User Testing an Information Foraging Tool for Ambulatory Surgical Site
           Infection Surveillance
    • Authors: Karavite; Dean J., Miller, Matthew W., Ramos, Mark J., Rettig, Susan L., Ross, Rachael K., Xiao, Rui, Muthu, Naveen, Localio, A. Russell, Gerber, Jeffrey S., Coffin, Susan E., Grundmeier, Robert W.
      Pages: 791 - 802
      Abstract: Background Surveillance for surgical site infections (SSIs) after ambulatory surgery in children requires a detailed manual chart review to assess criteria defined by the National Health and Safety Network (NHSN). Electronic health records (EHRs) impose an inefficient search process where infection preventionists must manually review every postsurgical encounter (< 30 days). Using text mining and business intelligence software, we developed an information foraging application, the SSI Workbench, to visually present which postsurgical encounters included SSI-related terms and synonyms, antibiotic, and culture orders. Objective This article compares the Workbench and EHR on four dimensions: (1) effectiveness, (2) efficiency, (3) workload, and (4) usability. Methods Comparative usability test of Workbench and EHR. Objective test metrics are time per case, encounters reviewed per case, time per encounter, and retrieval of information meeting NHSN definitions. Subjective measures are cognitive load using the National Aeronautics and Space Administration (NASA) Task Load Index (NASA TLX), and a questionnaire on system usability and utility. Results Eight infection preventionists participated in the test. There was no difference in effectiveness as subjects retrieved information from all cases, using both systems, to meet the NHSN criteria. There was no difference in efficiency in time per case between the Workbench and EHR (8.58 vs. 7.39 minutes, p = 0.36). However, with the Workbench subjects opened fewer encounters per case (3.0 vs. 7.5, p = 0.002), spent more time per encounter (2.23 vs. 0.92 minutes, p = 0.002), rated the Workbench lower in cognitive load (NASA TLX, 24 vs. 33, p = 0.02), and significantly higher in measures of usability. Conclusion Compared with the EHR, the Workbench was more usable, short, and reduced cognitive load. In overall efficiency, the Workbench did not save time, but demonstrated a shift from between-encounter foraging to within-encounter foraging and was rated as significantly more efficient. Our results suggest that infection surveillance can be better supported by systems applying information foraging theory.
      Citation: Appl Clin Inform 2018; 09: 791-802
      PubDate: 2018-10-24T00:00:00+01:00
      DOI: 10.1055/s-0038-1675179
      Issue No: Vol. 09, No. 04 (2018)
       
  • Automating a Manual Sepsis Screening Tool in a Pediatric Emergency
           Department
    • Authors: Lloyd; Julia K., Ahrens, Erin A., Clark, Donnie, Dachenhaus, Terri, Nuss, Kathryn E.
      Pages: 803 - 808
      Abstract: Objective This article describes the method of integrating a manual pediatric emergency department sepsis screening process into the electronic health record that leverages existing clinical documentation and keeps providers in their current, routine clinical workflows. Methods Criteria in the manual pediatric emergency department sepsis screening tool were mapped to standard documentation routinely entered in the electronic health record. Data elements were extracted and scored from the medical history, medication record, vital signs, and physical assessments. Scores that met a predefined sepsis risk threshold triggered interruptive system alerts which notified emergency department staff to perform sepsis huddles and consider appropriate interventions. Statistical comparison of the new electronic tool to the manual process was completed by a two-tail paired t-test. Results The performance of the pediatric electronic sepsis screening tool was evaluated by comparing flowsheet row documentation of the manual, sepsis alert process against the interruptive system alert instance of the electronic sepsis screening tool. In an 8-week testing period, the automated pediatric electronic sepsis screening tool identified 100% of patients flagged by the manual process (n = 29), on average, 68 minutes earlier. Conclusion Integrating a manual sepsis screening tool into the electronic health record automated identification of pediatric sepsis screening in a busy emergency department. The electronic sepsis screening tool is as accurate as a manual process and would alert bedside clinicians significantly earlier in the emergency department course. Deployment of this electronic tool has the capability to improve timely sepsis detection and management of patients at risk for sepsis without requiring additional documentation by providers.
      Citation: Appl Clin Inform 2018; 09: 803-808
      PubDate: 2018-10-31T00:00:00+0100
      DOI: 10.1055/s-0038-1675211
      Issue No: Vol. 09, No. 04 (2018)
       
  • An Electronic Medical Record in Pediatric Medical Education: Survey of
           Medical Students' Expectations and Experiences
    • Authors: Cheng; Daryl R., Scodellaro, Thomas, Uahwatanasakul, Wonie, South, Mike
      Pages: 809 - 816
      Abstract: Objective This study sought to quantitatively characterize medical students' expectations and experiences of an electronic health record (EHR) system in a hospital setting, and to examine perceived and actual impacts on learning. Methods Medical students from July to December 2016 at a tertiary pediatric institution completed pre- and postrotation surveys evaluating their expectations and experience of using an EHR during a pediatric medicine rotation. Survey data included past technology experience, EHR accessibility, use of learning resources, and effect on learning outcomes and patient–clinician communication. Results Students generally reported high computer self-efficacy (4.16 ± 0.752, mean ± standard deviation), were comfortable with learning new software (4.08 ± 0.771), and expected the EHR to enhance their overall learning (4.074 ± 0.722). Students anticipated the EHR to be easy to learn, use, and operate, which was consistent with their experience (pre 3.86 vs. post 3.90, p = 0.56). Students did not expect nor experience that the EHR reduced their interaction, visual contact, or ability to build rapport with patients. The EHR did not meet expectations to facilitate learning around medication prescribing, placing orders, and utilizing online resources. Students found that the EHR marginally improved feedback surrounding clinical contributions to patient care from clinicians, although not to the expected levels (pre 3.50 vs. post 3.17, p 
      Citation: Appl Clin Inform 2018; 09: 809-816
      PubDate: 2018-11-07T00:00:00+0100
      DOI: 10.1055/s-0038-1675371
      Issue No: Vol. 09, No. 04 (2018)
       
  • An Evidence-Based Tool for Safe Configuration of Electronic Health
           Records: The eSafety Checklist
    • Authors: Dhillon-Chattha; Pritma, McCorkle, Ruth, Borycki, Elizabeth
      Pages: 817 - 830
      Abstract: Background Electronic health records (EHRs) are transforming the way health care is delivered. They are central to improving the quality of patient care and have been attributed to making health care more accessible, reliable, and safe. However, in recent years, evidence suggests that specific features and functions of EHRs can introduce new, unanticipated patient safety concerns that can be mitigated by safe configuration practices. Objective This article outlines the development of a detailed and comprehensive evidence-based checklist of safe configuration practices for use by clinical informatics professionals when configuring hospital-based EHRs. Methods A literature review was conducted to synthesize evidence on safe configuration practices; data were analyzed to elicit themes of common EHR system capabilities. Two rounds of testing were completed with end users to inform checklist design and usability. This was followed by a four-member expert panel review, where each item was rated for clarity (clear, not clear), and importance (high, medium, low). Results An expert panel consisting of three clinical informatics professionals and one health information technology expert reviewed the checklist for clarity and importance. Medium and high importance ratings were considered affirmative responses. Of the 870 items contained in the original checklist, 535 (61.4%) received 100% affirmative agreement among all four panelists. Clinical panelists had a higher affirmative agreement rate of 75.5% (656 items). Upon detailed analysis, items with 100% clinician agreement were retained in the checklist with the exception of 47 items and the addition of 33 items, resulting in a total of 642 items in the final checklist. Conclusion Safe implementation of EHRs requires consideration of both technical and sociotechnical factors through close collaboration of health information technology and clinical informatics professionals. The recommended practices described in this checklist provide systems implementation guidance that should be considered when EHRs are being configured, implemented, audited, or updated, to improve system safety and usability.
      Citation: Appl Clin Inform 2018; 09: 817-830
      PubDate: 2018-11-14T00:00:00+0100
      DOI: 10.1055/s-0038-1675210
      Issue No: Vol. 09, No. 04 (2018)
       
  • Response to: An Evidence-Based Tool for Safe Configuration of Electronic
           Health Records: The eSafety Checklist
    • Appl Clin Inform 2018; 09: 831-832
      DOI: 10.1055/s-0038-1675811



      Georg Thieme Verlag KG Stuttgart · New York

      Artikel in Thieme eJournals:
      Inhaltsverzeichnis     Volltext

      Appl Clin Inform 2018; 09: 831-8322018-11-14T00:00:00+0100
      Issue No: Vol. 09, No. 04 (2018)
       
  • Self-Care Support for Patients with Gastrointestinal Cancer: iCancerHealth
    • Authors: Berry; Donna L., Blonquist, Traci M., Nayak, Manan M., Grenon, Nina, Momani, Thaer G., McCleary, Nadine J.
      Pages: 833 - 840
      Abstract: Background Patient-centered symptom assessment and management tools allow patients to perform self-assessments and engage in self-symptom management. Efficacious tools exist for reducing symptom distress; however, little is known about feature-specific use. Objectives This article evaluates the feasibility of the iCancerHealth app as an adjunct to usual patient education regarding cancer symptoms and medication management. Methods We conducted a single-arm, pilot study grounded in the health outcomes model. Our evaluation included (1) enrollment rates, (2) 2-month utilization rates, (3) patient acceptability, and (4) clinician satisfaction with the provider-side application. English-speaking, adult patients receiving care in the gastrointestinal oncology service of a comprehensive cancer center were invited to participate. Research coordinators enrolled consenting participants who had a personal, Internet-connected device; participants registered and used the platform to complete the baseline symptom assessment in clinic. Participants were reminded weekly to use the app and to perform a symptom report 4 to 6 weeks later. Results A total of 64 patients were approached, of which 57 (89%; 95% exact confidence interval [CI], 79–96%) enrolled. About half were ≥ 60 years old and 40% were women. Fifty-three patients (93%; 95% exact CI, 85–99%) accessed at least one app feature, at least once, from home. The most frequently used (86%) feature was Health Tracker in which participants monitored and reported symptoms; followed by My Inbox (63%) and My Medications features (60%). The mean acceptability score was 24.8 (standard deviation = 4.2), indicating good acceptability. Clinicians reported that the app was most acceptable with regard to facilitating in-person interactions that occurred after app use. Conclusion In a sample of adults with various stages of gastrointestinal malignancies, the iCancerHealth app was utilized at a high rate. Features that focused on symptoms and medication side effects plus communication with clinicians were used most frequently. This extends our understanding of preferences and specific feature use with patient-centered technologies.
      Citation: Appl Clin Inform 2018; 09: 833-840
      PubDate: 2018-11-21T00:00:00+0100
      DOI: 10.1055/s-0038-1675810
      Issue No: Vol. 09, No. 04 (2018)
       
  • The Impact of a Location-Sensing Electronic Health Record on Clinician
           Efficiency and Accuracy: A Pilot Simulation Study
    • Authors: King; Kevin, Quarles, John, Ravi, Vaishnavi, Chowdhury, Tanvir Irfan, Friday, Donia, Sisson, Craig, Feng, Yusheng
      Pages: 841 - 848
      Abstract: Background Through the Health Information Technology for Economic and Clinical Health Act of 2009, the federal government invested $26 billion in electronic health records (EHRs) to improve physician performance and patient safety; however, these systems have not met expectations. One of the cited issues with EHRs is the human–computer interaction, as exhibited by the excessive number of interactions with the interface, which reduces clinician efficiency. In contrast, real-time location systems (RTLS)—technologies that can track the location of people and objects—have been shown to increase clinician efficiency. RTLS can improve patient flow in part through the optimization of patient verification activities. However, the data collected by RTLS have not been effectively applied to optimize interaction with EHR systems. Objectives We conducted a pilot study with the intention of improving the human–computer interaction of EHR systems by incorporating a RTLS. The aim of this study is to determine the impact of RTLS on process metrics (i.e., provider time, number of rooms searched to find a patient, and the number of interactions with the computer interface), and the outcome metric of patient identification accuracy Methods A pilot study was conducted in a simulated emergency department using a locally developed camera-based RTLS-equipped EHR that detected the proximity of subjects to simulated patients and displayed patient information when subjects entered the exam rooms. Ten volunteers participated in 10 patient encounters with the RTLS activated (RTLS-A) and then deactivated (RTLS-D). Each volunteer was monitored and actions recorded by trained observers. We sought a 50% improvement in time to locate patients, number of rooms searched to locate patients, and the number of mouse clicks necessary to perform those tasks. Results The time required to locate patients (RTLS-A = 11.9 ± 2.0 seconds vs. RTLS-D = 36.0 ± 5.7 seconds, p 
      Citation: Appl Clin Inform 2018; 09: 841-848
      PubDate: 2018-11-21T00:00:00+0100
      DOI: 10.1055/s-0038-1675812
      Issue No: Vol. 09, No. 04 (2018)
       
  • Evaluation of Clinical Relevance of Drug–Drug Interaction Alerts
           Prior to Implementation
    • Authors: Meslin; S. M. M., Zheng, W. Y., Day, R. O., Tay, E. M. Y., Baysari, M. T.
      Pages: 849 - 855
      Abstract: Introduction Drug–drug interaction (DDI) alerts are often implemented in the hospital computerized provider order entry (CPOE) systems with limited evaluation. This increases the risk of prescribers experiencing too many irrelevant alerts, resulting in alert fatigue. In this study, we aimed to evaluate clinical relevance of alerts prior to implementation in CPOE using two common approaches: compendia and expert panel review. Methods After generating a list of hypothetical DDI alerts, that is, alerts that would have been triggered if DDI alerts were operational in the CPOE, we calculated the agreement between multiple drug interaction compendia with regards to the severity of these alerts. A subset of DDI alerts (n = 13), with associated patient information, were presented to an expert panel to reach a consensus on whether each alert should be included in the CPOE. Results There was poor agreement between compendia in their classifications of DDI severity (Krippendorff's α: 0.03; 95% confidence interval: –0.07 to 0.14). Only 10% of DDI alerts were classed as severe by all compendia. On the other hand, the panel reached consensus on 12 of the 13 alerts that were presented to them regarding whether they should be included in the CPOE. Conclusion Using an expert panel and allowing them to discuss their views openly likely resulted in high agreement on what alerts should be included in a CPOE system. Presenting alerts in the context of patient cases allowed panelists to identify the conditions under which alerts were clinically relevant. The poor agreement between compendia suggests that this methodology may not be ideal for the evaluation of DDI alerts. Performing preimplementation review of DDI alerts before they are enabled provides an opportunity to minimize the risk of alert fatigue before prescribers are exposed to false-positive alerts.
      Citation: Appl Clin Inform 2018; 09: 849-855
      PubDate: 2018-11-28T00:00:00+0100
      DOI: 10.1055/s-0038-1676039
      Issue No: Vol. 09, No. 04 (2018)
       
  • Social Media in Health Care: Time for Transparent Privacy Policies and
           Consent for Data Use and Disclosure
    • Appl Clin Inform 2018; 09: 856-859
      DOI: 10.1055/s-0038-1676332



      Georg Thieme Verlag KG Stuttgart · New York

      Artikel in Thieme eJournals:
      Inhaltsverzeichnis     Volltext

      Appl Clin Inform 2018; 09: 856-8592018-11-28T00:00:00+0100
      Issue No: Vol. 09, No. 04 (2018)
       
  • Understanding Secure Messaging in the Inpatient Environment: A New Avenue
           for Communication and Patient Engagement
    • Authors: Sieck; Cynthia J., Walker, Daniel M., Hefner, Jennifer L., Volney, Jaclyn, Huerta, Timothy R., McAlearney, Ann Scheck
      Pages: 860 - 868
      Abstract: Background Patient portals, and the secure messaging feature in particular, have been studied in the outpatient setting, but research in the inpatient setting is relatively less mature. Objective To understand the topics discussed in secure messaging in the inpatient environment, we analyzed and categorized messages sent within an inpatient portal. Materials and Methods This observational study examined the content of all secure messages sent from December 2013 to June 2017 within an inpatient portal at a large Midwestern academic medical center (AMC). We analyzed a total of 2,598 messages, categorizing them by sender (patient, family, or care team member), type, and topic, and conducted a descriptive analysis of categories and an examination of code co-occurrence. Results Patients were the most frequent message senders (63%); family members sent the fewest messages (10%). We identified five types of messages: Alert/Request; Thanks; Response; Question; and Other (typo/test message). Patient messages included Alerts/Requests (38%), Questions (31%), Statements of Thanks (24%), Response (1.2%), and Other (5%). We also identified 14 nonmutually exclusive message topics: Medication; Procedure/Treatment Plan; Schedule; Pain; Results; Diet; Discharge; Non-Medication Questions; Provider Requests; Symptoms; Custodial; Technical Issues; Potential Error; and Contact Information. Patient message topics most commonly discussed Symptoms (18%), Procedure/Treatment Plan (14%), or Pain (12%). Conclusion Our analysis of secure message content suggests certain message types and topics such as Alerts/Requests and Questions about symptoms and treatment plans are particularly important to patients. These findings demonstrate that both patients and family members utilize the secure messaging function to engage in the care process by posing questions, making requests, and alerting staff to problems. As this technology is implemented in additional facilities, future work should examine how use of secure messaging may be influenced by factors including patients' demographics, reasons for hospitalization, and length of stay.
      Citation: Appl Clin Inform 2018; 09: 860-868
      PubDate: 2018-12-05T00:00:00+0100
      DOI: 10.1055/s-0038-1675814
      Issue No: Vol. 09, No. 04 (2018)
       
  • Impact of Electronic Physician Order-Set on Antibiotic Ordering Time in
           Septic Patients in the Emergency Department
    • Authors: Fargo; Emily L., D'Amico, Frank, Pickering, Aaron, Fowler, Kathleen, Campbell, Ronald, Baumgartner, Megan
      Pages: 869 - 874
      Abstract: Background Sepsis is a serious medical condition that can lead to organ dysfunction and death. Research shows that each hour delay in antibiotic administration increases mortality. The Surviving Sepsis Campaign Bundles created standards to assist in the timely treatment of patients with suspected sepsis to improve outcomes and reduce mortality. Objective This article determines if the use of an electronic physician order-set decreases time to antibiotic ordering for patients with sepsis in the emergency department (ED). Methods A retrospective chart review was performed on adult patients who presented to the ED of four community hospitals from May to July 2016. Patients with severe sepsis and/or septic shock were included. Primary outcome was the difference in time to antibiotic ordering in patients whose physicians utilized the order-set versus those whose physicians did not. Secondary outcomes included differences in time to antibiotic administration, time to lactate test, hospital length of stay, and posthospitalization disposition. The institution's Quality Improvement Committee approved the project. Results Forty-five of 123 patients (36.6%) with sepsis had physicians who used the order-set. Order-set utilization reduced the mean time to ordering antibiotics by 20 minutes (99 minutes, 95% confidence interval [CI]: 69–128 vs. 119 minutes, 95% CI: 91–147), but this finding was not statistically significant. Mean time to antibiotic administration (145 minutes, 95% CI: 108–181 vs. 182 minutes, 95% CI: 125–239) and median time to lactate tests (12 minutes, 95% CI: 0–20 vs. 19 minutes, 95% CI: 8–34), although in the direction of the hypotheses, were not significantly different. Conclusion Utilization of the order-set was associated with a potentially clinically significant, but not statistically significant, reduced time to antibiotic ordering in patients with sepsis. Electronic order-sets are a promising tool to assist hospitals with meeting the Centers for Medicare and Medicaid Services core measure.
      Citation: Appl Clin Inform 2018; 09: 869-874
      PubDate: 2018-12-05T00:00:00+0100
      DOI: 10.1055/s-0038-1676040
      Issue No: Vol. 09, No. 04 (2018)
       
  • Communicating with Vulnerable Patient Populations: A Randomized
           Intervention to Teach Inpatients to Use the Electronic Patient Portal
    • Authors: Stein; Jacob N., Klein, Jared W., Payne, Thomas H., Jackson, Sara L., Peacock, Sue, Oster, Natalia V., Carpenter, Trinell P., Elmore, Joann G.
      Pages: 875 - 883
      Abstract: Background Patient portals are expanding as a means to engage patients and have evidence for benefit in the outpatient setting. However, few studies have evaluated their use in the inpatient setting, or with vulnerable patient populations. Objective This article assesses an intervention to teach hospitalized vulnerable patients to access their discharge summaries using electronic patient portals. Methods Patients at a safety net hospital were randomly assigned to portal use education or usual care. Surveys assessed perceptions of discharge paperwork and the electronic portal. Results Of the 202 prescreened eligible patients (e.g., deemed mentally competent, spoke English, and had a telephone), only 43% had working emails. Forty-four percent of participants did not remember receiving or reading discharge paperwork. Patients trained in portal use (n = 47) or receiving usual care (n = 23) preferred hospitals with online record access (85 and 83%, respectively), and felt that online access would increase their trust in doctors (85 and 87%) and satisfaction with care (91% each). Those who received training in portal use were more likely to register for the portal (48% vs. 11%; p 
      Citation: Appl Clin Inform 2018; 09: 875-883
      PubDate: 2018-12-12T00:00:00+0100
      DOI: 10.1055/s-0038-1676333
      Issue No: Vol. 09, No. 04 (2018)
       
  • Health Information Exchange in Emergency Medical Services
    • Authors: Martin; Thomas J., Ranney, Megan L., Dorroh, James, Asselin, Nicholas, Sarkar, Indra Neil
      Pages: 884 - 891
      Abstract: Background The Office of the National Coordinator for Health Information Technology has outlined the benefits of health information exchange in emergency medical services (EMSs) according to the SAFR model—search, alert, file, and reconcile—developed in collaboration with the California Emergency Medical Services Authority. Objective This scoping review aims to identify and characterize progress toward the adoption of prehospital health information exchange, as reported in the peer-reviewed literature. Methods A structured review of literature in MEDLINE-indexed journals was conducted using the “Electronic Health Records” topic-specific query, the “Emergency Medical Services” Medical Subject Headings descriptor, and a prehospital identifier. Results Our initial search yielded 368 nonduplicative, English-language articles; 131 articles underwent full-text review and 11 were selected for analysis according to pre-established inclusion criteria. Original research was thematically grouped according to the SAFR model. Conclusion Within isolated systems, there has been limited progress toward the adoption of prehospital health information exchange. Interoperability, accurate match algorithms, security, and wireless connectivity have been identified as potential barriers to adoption. Additional research is required to evaluate the role of health information exchange within EMSs.
      Citation: Appl Clin Inform 2018; 09: 884-891
      PubDate: 2018-12-12T00:00:00+0100
      DOI: 10.1055/s-0038-1676041
      Issue No: Vol. 09, No. 04 (2018)
       
  • Sharing of ADHD Information between Parents and Teachers Using an
           EHR-Linked Application
    • Authors: Michel; Jeremy J., Mayne, Stephanie, Grundmeier, Robert W., Guevara, James P., Blum, Nathan J., Power, Thomas J., Coffin, Emily, Miller, Jeffrey M., Fiks, Alexander G.
      Pages: 892 - 904
      Abstract: Background Appropriate management of attention-deficit/hyperactivity disorder (ADHD) involves parents, clinicians, and teachers. Fragmentation of interventions between different settings can lead to suboptimal care and outcomes. Electronic systems can bridge gaps across settings. Our institution developed an email-based software to collect ADHD information from parents and teachers, which delivered data directly to the clinician within the electronic health record (EHR). Objective We sought to adapt our institution's existing EHR-linked system for ADHD symptom monitoring to support communication between parents and teachers and then to assess child characteristics associated with sharing of ADHD information. Methods We updated our software to support automated sharing of ADHD information between parents and teachers. Sharing was optional for parents but obligatory for teachers. We conducted a retrospective cohort study involving 590 patients at 31 primary care sites to evaluate a system for sharing of ADHD-specific health information between parents and teachers. We used multivariable logistic regression to estimate associations between child characteristics and parental sharing. We further investigated the association between child characteristics and viewing of survey results delivered through the electronic communication system. Results Most parents (64%) elected to share survey results with teachers at the first opportunity and the vast majority (80%) elected to share all possible information. Parents who elected to share usually continue sharing at subsequent opportunities (89%). Younger child age and performance impairments were associated with increased likelihood of sharing. However, parents viewed only 16% of teacher submitted surveys and teachers only viewed 30% of surveys shared by parents. Conclusion This study demonstrates that electronic systems to capture ADHD information from parents and teachers can be adapted to support communication between them, and that parents are amenable to sharing ADHD information with teachers. However, strategies are needed to encourage viewing of shared information.
      Citation: Appl Clin Inform 2018; 09: 892-904
      PubDate: 2018-12-19T00:00:00+0100
      DOI: 10.1055/s-0038-1676087
      Issue No: Vol. 09, No. 04 (2018)
       
  • Identifying, Analyzing, and Visualizing Diagnostic Paths for Patients with
           Nonspecific Abdominal Pain
    • Authors: Rao; Goutham, Kirley, Katherine, Epner, Paul, Zhang, Yiye, Bauer, Victoria, Padman, Rema, Zhou, Ying, Solomonides, Anthony
      Pages: 905 - 913
      Abstract: Background Diagnosis is complex, uncertain, and error-prone. Symptoms such as nonspecific abdominal pain are especially challenging. A diagnostic path consists of diagnostic steps taken from initial presentation until a diagnosis is obtained or the evaluation ends for other reasons. Analysis of diagnostic paths can reveal patterns associated with more timely and accurate diagnosis. Visual analytics can be used to enhance both analysis and comprehension of diagnostic paths. Objective This article applies process-mining methods to extract and visualize diagnostic paths from electronic health records (EHRs). Methods Patient features, actions taken (i.e., tests, referrals, etc.), and diagnoses obtained for 501 adult patients (half female, half ≥50 years of age) presenting with abdominal pain were extracted from an EHR database to construct diagnostic paths from a hospital system in suburban Chicago, Illinois, United States. A stable diagnosis was defined as the same diagnosis recorded twice in a 12-month period; a working diagnosis was recorded only once. Three different types of path visualizations were obtained. Results A stable diagnosis was obtained in 63 (13%) patients after 12 months. In 271 (54%) patients, a working diagnosis was obtained. Mean path duration was 145.3 days (standard deviation, 195.1 days). These 63 patients received 75 stable diagnoses. Conclusion Structured EHR data can be used to construct diagnostic paths to gain insight into diagnostic practices for complaints such as abdominal pain.
      Citation: Appl Clin Inform 2018; 09: 905-913
      PubDate: 2018-12-19T00:00:00+0100
      DOI: 10.1055/s-0038-1676338
      Issue No: Vol. 09, No. 04 (2018)
       
  • CMS Payment Policy, E&M Guideline Reform, and the Prospect of Electronic
           Health Record Optimization
    • Appl Clin Inform 2018; 09: 914-918
      DOI: 10.1055/s-0038-1676337



      Georg Thieme Verlag KG Stuttgart · New York

      Artikel in Thieme eJournals:
      Inhaltsverzeichnis     Volltext

      Appl Clin Inform 2018; 09: 914-9182018-12-26T00:00:00+0100
      Issue No: Vol. 09, No. 04 (2018)
       
  • Comparing Real-Time Self-Tracking and Device-Recorded Exercise Data in
           Subjects with Type 1 Diabetes
    • Authors: Groat; Danielle, Kwon, Hyo Jung, Grando, Maria Adela, Cook, Curtiss B., Thompson, Bithika
      Pages: 919 - 926
      Abstract: Background Insulin therapy, medical nutrition therapy, and physical activity are required for the treatment of type 1 diabetes (T1D). There is a lack of studies in real-life environments that characterize patient-reported data from logs, activity trackers, and medical devices (e.g., glucose sensors) in the context of exercise. Objective The objective of this study was to compare data from continuous glucose monitor (CGM), wristband heart rate monitor (WHRM), and self-tracking with a smartphone application (app), iDECIDE, with regards to exercise behaviors and rate of change in glucose levels. Methods Participants with T1D on insulin pump therapy tracked exercise for 1 month with the smartphone app while WHRM and CGM recorded data in real time. Exercise behaviors tracked with the app were compared against WHRM. The rate of change in glucose levels, as recorded by CGM, resulting from exercise was compared between exercise events documented with the app and recorded by the WHRM. Results Twelve participants generated 277 exercise events. Tracking with the app aligned well with WHRM with respect to frequency, 3.0 (2.1) and 2.5 (1.8) days per week, respectively (p = 0.60). Duration had very high agreement, the mean duration from the app was 65.6 (55.2) and 64.8 (54.9) minutes from WHRM (p = 0.45). Intensity had a low concordance between the data sources (Cohen's kappa = 0.2). The mean rate of change of glucose during exercise was –0.27 mg/(dL*min) and was not significantly different between data sources or intensity (p = 0.21). Conclusion We collated and analyzed data from three heterogeneous sources from free-living participants. Patients' perceived intensity of exercise can serve as a surrogate for exercise tracked by a WHRM when considering the glycemic impact of exercise on self-care regimens.
      Citation: Appl Clin Inform 2018; 09: 919-926
      PubDate: 2018-12-26T00:00:00+0100
      DOI: 10.1055/s-0038-1676458
      Issue No: Vol. 09, No. 04 (2018)
       
 
 
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