Subjects -> MEDICAL SCIENCES (Total: 8669 journals)
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MEDICAL SCIENCES (2406 journals)                  1 2 3 4 5 6 7 8 | Last

Showing 1 - 200 of 3562 Journals sorted alphabetically
16 de Abril     Open Access   (Followers: 4)
3D Printing in Medicine     Open Access   (Followers: 5)
4 open     Open Access  
AADE in Practice     Hybrid Journal   (Followers: 6)
AAS Open Research     Open Access   (Followers: 2)
ABCS Health Sciences     Open Access   (Followers: 8)
Abia State University Medical Students' Association Journal     Full-text available via subscription   (Followers: 3)
AboutOpen     Open Access  
ACIMED     Open Access   (Followers: 1)
ACS Medicinal Chemistry Letters     Hybrid Journal   (Followers: 48)
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   (Followers: 1)
Acta Herediana     Open Access  
Acta Informatica Medica     Open Access   (Followers: 2)
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   (Followers: 1)
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: 3)
Acupuncture & Electro-Therapeutics Research     Full-text available via subscription   (Followers: 7)
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   (Followers: 1)
Adnan Menderes Üniversitesi Sağlık Bilimleri Fakültesi Dergisi     Open Access   (Followers: 1)
Advanced Biomedical Research     Open Access  
Advanced Health Care Technologies     Open Access   (Followers: 10)
Advanced Science, Engineering and Medicine     Partially Free   (Followers: 9)
Advanced Therapeutics     Hybrid Journal   (Followers: 1)
Advances in Bioscience and Clinical Medicine     Open Access   (Followers: 8)
Advances in Cell and Gene Therapy     Hybrid Journal   (Followers: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 27)
Advances in Clinical Radiology     Full-text available via subscription   (Followers: 2)
Advances in Life Course Research     Hybrid Journal   (Followers: 12)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Medical Education and Practice     Open Access   (Followers: 32)
Advances in Medical Ethics     Open Access   (Followers: 1)
Advances in Medical Research     Open Access   (Followers: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 9)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Medicine     Open Access   (Followers: 3)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5)
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   (Followers: 1)
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: 4)
Advances in Skeletal Muscle Function Assessment     Open Access  
Advances in Therapy     Hybrid Journal   (Followers: 5)
Advances in Traditional Medicine     Hybrid Journal   (Followers: 4)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6)
Advances in Wound Care     Hybrid Journal   (Followers: 14)
Aerospace Medicine and Human Performance     Full-text available via subscription   (Followers: 13)
African Health Sciences     Open Access   (Followers: 5)
African Journal of Biomedical Research     Open Access   (Followers: 1)
African Journal of Clinical and Experimental Microbiology     Open Access   (Followers: 4)
African Journal of Laboratory Medicine     Open Access   (Followers: 2)
African Journal of Medical and Health Sciences     Open Access   (Followers: 3)
African Journal of Thoracic and Critical Care Medicine     Open Access  
African Journal of Trauma     Open Access   (Followers: 1)
Afrimedic Journal     Open Access   (Followers: 3)
Aggiornamenti CIO     Hybrid Journal   (Followers: 1)
AIDS Research and Human Retroviruses     Hybrid Journal   (Followers: 9)
AJOB Empirical Bioethics     Hybrid Journal   (Followers: 3)
AJSP: Reviews & Reports     Hybrid Journal   (Followers: 1)
Aktuelle Ernährungsmedizin     Hybrid Journal   (Followers: 5)
Al-Azhar Assiut Medical Journal     Open Access   (Followers: 2)
Al-Qadisiah Medical Journal     Open Access   (Followers: 1)
Alerta : Revista Científica del Instituto Nacional de Salud     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: 2)
Althea Medical Journal     Open Access   (Followers: 2)
American Journal of Biomedical Engineering     Open Access   (Followers: 15)
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: 8)
American Journal of Family Therapy     Hybrid Journal   (Followers: 11)
American Journal of Law & Medicine     Full-text available via subscription   (Followers: 12)
American Journal of Lifestyle Medicine     Hybrid Journal   (Followers: 6)
American Journal of Managed Care     Full-text available via subscription   (Followers: 13)
American Journal of Medical Case Reports     Open Access   (Followers: 2)
American Journal of Medical Sciences and Medicine     Open Access   (Followers: 5)
American Journal of Medicine     Hybrid Journal   (Followers: 50)
American Journal of Medicine and Medical Sciences     Open Access   (Followers: 1)
American Journal of Medicine Studies     Open Access   (Followers: 3)
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: 11)
American medical news     Free   (Followers: 3)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 6)
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: 2)
Anatomy     Open Access   (Followers: 3)
Anatomy Research International     Open Access   (Followers: 4)
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 des Sciences de la Santé     Open Access  
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: 3)
Annals of Bioanthropology     Open Access   (Followers: 5)
Annals of Biomedical Engineering     Hybrid Journal   (Followers: 19)
Annals of Biomedical Sciences     Full-text available via subscription   (Followers: 4)
Annals of Clinical Hypertension     Open Access  
Annals of Clinical Microbiology and Antimicrobials     Open Access   (Followers: 15)
Annals of Family Medicine     Open Access   (Followers: 17)
Annals of Health Research     Open Access   (Followers: 1)
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 Medicine and Surgery Case Reports     Open Access   (Followers: 1)
Annals of Medicine and Surgery Protocols     Open Access   (Followers: 1)
Annals of Microbiology     Hybrid Journal   (Followers: 13)
Annals of Musculoskeletal Medicine     Open Access   (Followers: 2)
Annals of Nigerian Medicine     Open Access   (Followers: 1)
Annals of Rehabilitation Medicine     Open Access  
Annals of Saudi Medicine     Open Access  
Annals of the College of Medicine, Mosul     Open Access   (Followers: 1)
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)
Annals of the RussianAacademy of Medical Sciences     Open Access   (Followers: 1)
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: 18)
Anthropological Review     Open Access   (Followers: 23)
Anthropologie et santé     Open Access   (Followers: 5)
Antibiotics     Open Access   (Followers: 9)
Antibodies     Open Access   (Followers: 2)
Antibody Reports     Open Access   (Followers: 1)
Antibody Technology Journal     Open Access   (Followers: 1)
Antibody Therapeutics     Open Access   (Followers: 1)
Anuradhapura Medical Journal     Open Access  
Anwer Khan Modern Medical College Journal     Open Access   (Followers: 2)
Apmis     Hybrid Journal   (Followers: 2)
Apparence(s)     Open Access   (Followers: 1)
Applied Clinical Informatics     Hybrid Journal   (Followers: 4)
Applied Clinical Research, Clinical Trials and Regulatory Affairs     Hybrid Journal   (Followers: 2)
Applied Medical Informatics     Open Access   (Followers: 14)
Arab Journal of Nephrology and Transplantation     Open Access   (Followers: 1)
Arabian Journal of Scientific Research / المجلة العربية للبحث العلمي     Open Access   (Followers: 1)
Archive of Biomedical Science and Engineering     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 Clinical Hypertension     Open Access   (Followers: 2)
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: 5)
Archives of Medicine and Surgery     Open Access   (Followers: 1)
Archives of Organ Transplantation     Open Access   (Followers: 2)
Archives of Preventive Medicine     Open Access   (Followers: 3)
Archives of Pulmonology and Respiratory Care     Open Access   (Followers: 2)
Archives of Renal Diseases and Management     Open Access   (Followers: 2)
Archives of Trauma Research     Open Access   (Followers: 4)
Archivos de Medicina (Manizales)     Open Access   (Followers: 1)
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   (Followers: 1)
Ars Medica : Revista de Ciencias Médicas     Open Access  
ARS Medica Tomitana     Open Access   (Followers: 1)
Art Therapy: Journal of the American Art Therapy Association     Hybrid Journal   (Followers: 19)
Arterial Hypertension     Open Access   (Followers: 1)
Artificial Intelligence in Medicine     Hybrid Journal   (Followers: 19)
Artificial Organs     Hybrid Journal   (Followers: 1)
ASHA Leader     Open Access   (Followers: 5)
Asia Pacific Family Medicine Journal     Open Access   (Followers: 4)
Asia Pacific Journal of Clinical Nutrition     Full-text available via subscription   (Followers: 13)
Asia Pacific Journal of Clinical Trials : Nervous System Diseases     Open Access   (Followers: 1)
Asian Bioethics Review     Full-text available via subscription   (Followers: 4)

        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: 4  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1869-0327
Published by Thieme Publishing Group Homepage  [241 journals]
  • Conceptual Design, Implementation, and Evaluation of Generic and
           Standard-Compliant Data Transfer into Electronic Health Records
    • Authors: Blitz; Rogério, Dugas, Martin
      Pages: 374 - 386
      Abstract: Objectives The objective of this study is the conceptual design, implementation and evaluation of a system for generic, standard-compliant data transfer into electronic health records (EHRs). This includes patient data from clinical research and medical care that has been semantically annotated and enhanced with metadata. The implementation is based on the single-source approach. Technical and clinical feasibilities, as well as cost-benefit efficiency, were investigated in everyday clinical practice. Methods Münster University Hospital is a tertiary care hospital with 1,457 beds and 10,823 staff who treated 548,110 patients in 2018. Single-source metadata architecture transformation (SMA:T) was implemented as an extension to the EHR system. This architecture uses Model Driven Software Development (MDSD) to generate documentation forms according to the Clinical Data Interchange Standards Consortium (CDISC) operational data model (ODM). Clinical data are stored in ODM format in the EHR system database. Documentation forms are based on Google's Material Design Standard. SMA:T was used at a total of five clinics and one administrative department in the period from March 1, 2018 until March 31, 2019 in everyday clinical practice. Results The technical and clinical feasibility of SMA:T was demonstrated in the course of the study. Seventeen documentation forms including 373 data items were created with SMA:T. Those were created for 2,484 patients by 283 users in everyday clinical practice. A total of 121 documentation forms were examined retrospectively. The Constructive cost model (COCOMO II) was used to calculate cost and time savings. The form development mean time was reduced by 83.4% from 3,357 to 557 hours. Average costs per form went down from EUR 953 to 158. Conclusion Automated generic transfer of standard-compliant data and metadata into EHRs is technically and clinically feasible, cost efficient, and a useful method to establish comprehensive and semantically annotated clinical documentation. Savings of time and personnel resources are possible.
      Citation: Appl Clin Inform 2020; 11: 374-386
      PubDate: 2020-05-27T00:00:00+01:00
      DOI: 10.1055/s-0040-1710023
      Issue No: Vol. 11, No. 03 (2020)
       
  • A Review of Predictive Analytics Solutions for Sepsis Patients
    • Authors: Teng; Andrew K., Wilcox, Adam B.
      Pages: 387 - 398
      Abstract: Background Early detection and efficient management of sepsis are important for improving health care quality, effectiveness, and costs. Due to its high cost and prevalence, sepsis is a major focus area across institutions and many studies have emerged over the past years with different models or novel machine learning techniques in early detection of sepsis or potential mortality associated with sepsis. Objective To understand predictive analytics solutions for sepsis patients, either in early detection of onset or mortality. Methods and Results We performed a systematized narrative review and identified common and unique characteristics between their approaches and results in studies that used predictive analytics solutions for sepsis patients. After reviewing 148 retrieved papers, a total of 31 qualifying papers were analyzed with variances in model, including linear regression (n = 2), logistic regression (n = 5), support vector machines (n = 4), and Markov models (n = 4), as well as population (range: 24–198,833) and feature size (range: 2–285). Many of the studies used local data sets of varying sizes and locations while others used the publicly available Medical Information Mart for Intensive Care data. Additionally, vital signs or laboratory test results were commonly used as features for training and testing purposes; however, a few used more unique features including gene expression data from blood plasma and unstructured text and data from clinician notes. Conclusion Overall, we found variation in the domain of predictive analytics tools for septic patients, from feature and population size to choice of method or algorithm. There are still limitations in transferability and generalizability of the algorithms or methods used. However, it is evident that implementing predictive analytics tools are beneficial in the early detection of sepsis or death related to sepsis. Since most of these studies were retrospective, the translational value in the real-world setting in different wards should be further investigated.
      Citation: Appl Clin Inform 2020; 11: 387-398
      PubDate: 2020-05-27T00:00:00+01:00
      DOI: 10.1055/s-0040-1710525
      Issue No: Vol. 11, No. 03 (2020)
       
  • EHR-Independent Predictive Decision Support Architecture Based on OMOP
    • Authors: Unberath; Philipp, Prokosch, Hans Ulrich, Gründner, Julian, Erpenbeck, Marcel, Maier, Christian, Christoph, Jan
      Pages: 399 - 404
      Abstract: Background The increasing availability of molecular and clinical data of cancer patients combined with novel machine learning techniques has the potential to enhance clinical decision support, example, for assessing a patient's relapse risk. While these prediction models often produce promising results, a deployment in clinical settings is rarely pursued. Objectives In this study, we demonstrate how prediction tools can be integrated generically into a clinical setting and provide an exemplary use case for predicting relapse risk in melanoma patients. Methods To make the decision support architecture independent of the electronic health record (EHR) and transferable to different hospital environments, it was based on the widely used Observational Medical Outcomes Partnership (OMOP) common data model (CDM) rather than on a proprietary EHR data structure. The usability of our exemplary implementation was evaluated by means of conducting user interviews including the thinking-aloud protocol and the system usability scale (SUS) questionnaire. Results An extract-transform-load process was developed to extract relevant clinical and molecular data from their original sources and map them to OMOP. Further, the OMOP WebAPI was adapted to retrieve all data for a single patient and transfer them into the decision support Web application for enabling physicians to easily consult the prediction service including monitoring of transferred data. The evaluation of the application resulted in a SUS score of 86.7. Conclusion This work proposes an EHR-independent means of integrating prediction models for deployment in clinical settings, utilizing the OMOP CDM. The usability evaluation revealed that the application is generally suitable for routine use while also illustrating small aspects for improvement.
      Citation: Appl Clin Inform 2020; 11: 399-404
      PubDate: 2020-06-03T00:00:00+01:00
      DOI: 10.1055/s-0040-1710393
      Issue No: Vol. 11, No. 03 (2020)
       
  • Clinicians' Values and Preferences for Medication Adherence and Cost
           Clinical Decision Support in Primary Care: A Qualitative Study
    • Authors: Bhat; Shubha, Derington, Catherine Grace, Trinkley, Katy E.
      Pages: 405 - 414
      Abstract: Background Medication nonadherence and unaffordability are prevalent, burdensome issues in primary care. In response, technology companies are capitalizing on clinical decision support (CDS) to deliver patient-specific information regarding medication adherence and costs to clinicians using electronic health records (EHRs). To maximize adoption and usability, these CDS tools should be designed with consideration of end users' values and preferences. Objective This article evaluates primary care clinicians' values and preferences for a medication adherence and cost CDS. Methods We conducted semistructured interviews with primary care clinicians with prescribing privileges and EHR access to identify clinicians' perceptions of and approaches to assessing medication adherence and costs, and to determine perceived values and preferences for medication adherence and cost CDS. Interviews were conducted until saturation of responses was reached. ATLAS.ti was used for thematic analysis. Results Among 26 clinicians interviewed, themes identified included a high value, but moderate need for a medication adherence CDS and high value and need for cost CDS. Clinicians expressed the cost CDS would provide actionable solutions and greatly impact patient care. Another theme identified was a desire for medication adherence and cost CDS to be separate tools yet integrated into workflow. The majority of clinicians preferred a medication adherence CDS that integrated claims data and actively displayed data using color-coded adherence categories within patients' medication lists in the EHR. For the cost CDS, clinicians preferred medication out-of-pocket costs and a list of cheaper or payor-preferred alternatives to display within the order queue of the EHR. Conclusion We identified valuable insights regarding clinician values and preferences for medication adherence and cost CDS. Overall, primary care clinicians feel CDS for medication adherence and cost are valuable and prefer them to be separate. These insights should be used to inform the design, implementation, and EHR integration of future medication and cost CDS tools.
      Citation: Appl Clin Inform 2020; 11: 405-414
      PubDate: 2020-06-03T00:00:00+01:00
      DOI: 10.1055/s-0040-1712467
      Issue No: Vol. 11, No. 03 (2020)
       
  • Factors Influencing Problem List Use in Electronic Health
           Records—Application of the Unified Theory of Acceptance and Use of
           Technology
    • Authors: Klappe; Eva S., de Keizer, Nicolette F., Cornet, Ronald
      Pages: 415 - 426
      Abstract: Background Problem-oriented electronic health record (EHR) systems can help physicians to track a patient's status and progress, and organize clinical documentation, which could help improving quality of clinical data and enable data reuse. The problem list is central in a problem-oriented medical record. However, current problem lists remain incomplete because of the lack of end-user training and inaccurate content of underlying terminologies. This leads to modifications of diagnosis code descriptions and use of free-text notes, limiting reuse of data. Objectives We aimed to investigate factors that influence acceptance and actual use of the problem list, and used these to propose recommendations, to increase the value of problem lists for (re)use. Methods Semistructured interviews were conducted with physicians, heads of medical departments, and data quality experts, who were invited through snowball sampling. The interviews were transcribed and coded. Comments were fitted in constructs of the validated framework unified theory of acceptance user technology (UTAUT), and were discussed in terms of facilitators and barriers. Results In total, 24 interviews were conducted. We found large variability in attitudes toward problem list use. Barriers included uncertainty about the responsibility for maintaining the problem list and little perceived benefits. Facilitators included the (re)design of policies, improved (peer-to-peer) training to increase motivation, and positive peer feedback and monitoring. Motivation is best increased through sharing benefits relevant in the care process, such as providing overview, timely generation of discharge or referral letters, and reuse of data. Furthermore, content of the underlying terminology should be improved and the problem list should be better presented in the EHR system. Conclusion To let physicians accept and use the problem list, policies and guidelines should be redesigned, and prioritized by supervising staff. Additionally, peer-to-peer training on the benefits of using the problem list is needed.
      Citation: Appl Clin Inform 2020; 11: 415-426
      PubDate: 2020-06-10T00:00:00+01:00
      DOI: 10.1055/s-0040-1712466
      Issue No: Vol. 11, No. 03 (2020)
       
  • A Randomized Trial of Voice-Generated Inpatient Progress Notes: Effects on
           Professional Fee Billing
    • Authors: White; Andrew A., Lee, Tyler, Garrison, Michelle M., Payne, Thomas H.
      Pages: 427 - 432
      Abstract: Background Prior evaluations of automated speech recognition (ASR) to create hospital progress notes have not analyzed its effect on professional revenue billing codes. As ASR becomes a more common method of entering clinical notes, clinicians, hospital administrators, and payers should understand whether this technology alters charges associated with inpatient physician services. Objectives This study aimed to measure the difference in professional fee charges between using voice and keyboard to create inpatient progress notes. Methods In a randomized trial of a novel voice with ASR system, called voice-generated enhanced electronic note system (VGEENS), to generate physician notes, we compared 1,613 notes created using intervention (VGEENS) or control (keyboard with template) created by 31 physicians. We measured three outcomes, as follows: (1) professional fee billing levels assigned by blinded coders, (2) number of elements within each note domain, and (3) frequency of organ system evaluations documented in review of systems (ROS) and physical exam. Results Participants using VGEENS generated a greater portion of high-level (99233) notes than control users (31.8 vs. 24.3%, p 
      Citation: Appl Clin Inform 2020; 11: 427-432
      PubDate: 2020-06-10T00:00:00+01:00
      DOI: 10.1055/s-0040-1713134
      Issue No: Vol. 11, No. 03 (2020)
       
  • Analysis of Employee Patient Portal Use and Electronic Health Record
           Access at an Academic Medical Center
    • Authors: Sulieman; Lina, Steitz, Bryan, Rosenbloom, S. Trent
      Pages: 433 - 441
      Abstract: Background Patient portals provide patients and their caregivers online access to limited health results. Health care employees with electronic health record (EHR) access may be able to view their health information not available in the patient portal by looking in the EHR. Objective In this study, we examine how employees use the patient portal when they also have access to the tethered EHR. Methods We obtained patient portal and EHR usage logs corresponding to all employees who viewed their health data at our institution between January 1, 2013 and November 1, 2017. We formed three cohorts based on the systems that employees used to view their health data: employees who used the patient portal only, employees who viewed health data in the EHR only, and employees who used both systems. We compared system accesses and usage patterns for each employee cohort. Results During the study period, 35,172 employees accessed the EHR as part of patients' treatment and 28,631 employees accessed their health data: 25,193 of them used the patient portal and 13,318 accessed their clinical data in EHR. All employees who accessed their records in the EHR viewed their clinical notes at least once. Among EHR accesses, clinical note accesses comprised more than 42% of all EHR accesses. Provider messaging and appointment scheduling were the most commonly used functions in the patient portal. Employees who had access to their health data in both systems were more likely to engage with providers through portal messages. Conclusion Employees at a large medical center accessed clinical notes in the EHR to obtain information about their health. Employees also viewed other health data not readily available in the patient portal.
      Citation: Appl Clin Inform 2020; 11: 433-441
      PubDate: 2020-06-17T00:00:00+01:00
      DOI: 10.1055/s-0040-1713412
      Issue No: Vol. 11, No. 03 (2020)
       
  • Attributing Patients to Pediatric Residents Using Electronic Health Record
           Features Augmented with Audit Logs
    • Authors: Mai; Mark V., Orenstein, Evan W., Manning, John D., Luberti, Anthony A., Dziorny, Adam C.
      Pages: 442 - 451
      Abstract: Objective Patient attribution, or the process of attributing patient-level metrics to specific providers, attempts to capture real-life provider–patient interactions (PPI). Attribution holds wide-ranging importance, particularly for outcomes in graduate medical education, but remains a challenge. We developed and validated an algorithm using EHR data to identify pediatric resident PPIs (rPPIs). Methods We prospectively surveyed residents in three care settings to collect self-reported rPPIs. Participants were surveyed at the end of primary care clinic, emergency department (ED), and inpatient shifts, shown a patient census list, asked to mark the patients with whom they interacted, and encouraged to provide a short rationale behind the marked interaction. We extracted routine EHR data elements, including audit logs, note contribution, order placement, care team assignment, and chart closure, and applied a logistic regression classifier to the data to predict rPPIs in each care setting. We also performed a comment analysis of the resident-reported rationales in the inpatient care setting to explore perceived patient interactions in a complicated workflow. Results We surveyed 81 residents over 111 shifts and identified 579 patient interactions. Among EHR extracted data, time-in-chart was the best predictor in all three care settings (primary care clinic: odds ratio [OR] = 19.36, 95% confidence interval [CI]: 4.19–278.56; ED: OR = 19.06, 95% CI: 9.53–41.65' inpatient: OR = 2.95, 95% CI: 2.23–3.97). Primary care clinic and ED specific models had c-statistic values > 0.98, while the inpatient-specific model had greater variability (c-statistic = 0.89). Of 366 inpatient rPPIs, residents provided rationales for 90.1%, which were focused on direct involvement in a patient's admission or transfer, or care as the front-line ordering clinician (55.6%). Conclusion Classification models based on routinely collected EHR data predict resident-defined rPPIs across care settings. While specific to pediatric residents in this study, the approach may be generalizable to other provider populations and scenarios in which accurate patient attribution is desirable.
      Citation: Appl Clin Inform 2020; 11: 442-451
      PubDate: 2020-06-24T00:00:00+01:00
      DOI: 10.1055/s-0040-1713133
      Issue No: Vol. 11, No. 03 (2020)
       
  • Rapid Implementation of an Inpatient Telehealth Program during the
           COVID-19 Pandemic
    • Authors: Hron; Jonathan D., Parsons, Chase R., Williams, Lee Ann, Harper, Marvin B., Bourgeois, Fabienne C.
      Pages: 452 - 459
      Abstract: Background Relaxation of laws and regulations around privacy and billing during the COVID-19 pandemic provide expanded opportunities to use telehealth to provide patient care at a distance. Many health systems have transitioned to providing outpatient care via telehealth; however, there is an opportunity to utilize telehealth for inpatients to promote physical distancing. Objective This article evaluates the use of a rapidly implemented, secure inpatient telehealth program. Methods We assembled a multidisciplinary team to rapidly design, implement, and iteratively improve an inpatient telehealth quality improvement initiative using an existing videoconferencing system at our academic medical center. We assigned each hospital bed space a unique meeting link and updated the meeting password for each new patient. Patients and families were encouraged to use their own mobile devices to join meetings when possible. Results Within 7 weeks of go-live, we hosted 1,820 inpatient telehealth sessions (13.3 sessions per 100 bedded days). We logged 104,647 minutes of inpatient telehealth time with a median session duration of 22 minutes (range 1–1,961). There were 5,288 participant devices used with a mean of 3 devices per telehealth session (range 2–22). Clinicians found they were able to build rapport and perform a reasonable physical exam. Conclusion We successfully implemented and scaled a secure inpatient telehealth program using an existing videoconferencing system in less than 1 week. Our implementation provided an intuitive naming convention for providers and capitalized on the broad availability of smartphones and tablets. Initial comments from clinicians suggest the system was useful; however, further work is needed to streamline initial setup for patients and families as well as care coordination to support clinician communication and workflows. Numerous use cases identified suggest a role for inpatient telehealth will remain after the COVID-19 crisis underscoring the importance of lasting regulatory reform.
      Citation: Appl Clin Inform 2020; 11: 452-459
      PubDate: 2020-07-01T00:00:00+01:00
      DOI: 10.1055/s-0040-1713635
      Issue No: Vol. 11, No. 03 (2020)
       
  • A Viewpoint on the Information Sharing Paradox
    • Appl Clin Inform 2020; 11: 460-463
      DOI: 10.1055/s-0040-1713413



      Georg Thieme Verlag KG Stuttgart · New York

      Artikel in Thieme eJournals:
      Inhaltsverzeichnis     Volltext

      Appl Clin Inform 2020; 11: 460-4632020-07-08T00:00:00+01:00
      Issue No: Vol. 11, No. 03 (2020)
       
  • Defining an Essential Clinical Dataset for Admission Patient History to
           Reduce Nursing Documentation Burden
    • Authors: Sutton; Darinda E., Fogel, Jennifer R., Giard, April S., Gulker, Lisa A., Ivory, Catherine H., Rosa, Amy M.
      Pages: 464 - 473
      Abstract: Background Documentation burden, defined as the need to complete unnecessary documentation elements in the electronic health record (EHR), is significant for nurses and contributes to decreased time with patients as well as burnout. Burden increases when new documentation elements are added, but unnecessary elements are not systematically identified and removed. Objectives Reducing the burden of nursing documentation during the inpatient admission process was a key objective for a group of nurse experts who collaboratively identified essential clinical data elements to be documented by nurses in the EHR. Methods Twelve health care organizations used a data-driven process to evaluate inpatient admission assessment data elements to identify which elements were consistently deemed essential to patient care. Processes used for the twelve organizations to reach consensus included identifying: (1) data elements that were truly essential, (2) which data elements were explicitly required during the admission process, and (3) data elements that must be documented by a registered nurse (RN). Result The result was an Admission Patient History Essential Clinical Dataset (APH ECD) that reduced the amount of admission documentation content by an average of 48.5%. Early adopters experienced an average reduction of more than two minutes per admission history documentation session and an average reduction in clicks of more than 30%. Conclusion The creation of the essential clinical dataset is an example of combining evidence from nursing practice within the EHR with a set of predefined guiding principles to decrease documentation burden for nurses. Establishing essential documentation components for the adult admission history and intake process ensures the efficient use of bedside nurses' time by collecting the right (necessary) information collected by the right person at the right time during the patient's hospital stay. Determining essential elements also provides a framework for mapping components to national standards to facilitate shareable and comparable nursing data.
      Citation: Appl Clin Inform 2020; 11: 464-473
      PubDate: 2020-07-08T00:00:00+01:00
      DOI: 10.1055/s-0040-1713634
      Issue No: Vol. 11, No. 03 (2020)
       
  • Sync for Genes: Making Clinical Genomics Available for Precision Medicine
           at the Point-of-Care
    • Authors: Garcia; Stephanie J., Zayas-Cabán, Teresa, Freimuth, Robert R.
      Pages: 295 - 302
      Abstract: Background Making genomic data available at the point-of-care and for research is critical for the success of the Precision Medicine Initiative (PMI), a research initiative which seeks to change health care by “tak(ing) into account individual differences in people's genes, environments, and lifestyles.” The Office of the National Coordinator for Health Information Technology (ONC) led Sync for Genes, a program to develop standards that make genomic data available when and where it matters most. This article discusses lessons learned from recent Sync for Genes activities. Objectives The goals of Sync for Genes were to (1) demonstrate exchange of genomic data using health data standards, (2) provide feedback for refinement of health data standards, and (3) synthesize project experiences to support the integration of genomic data at the point-of-care and for research. Methods Four organizations participated in a program to test the Health Level Seven International (HL7®) Fast Healthcare Interoperability Resources (FHIR®) standard, which supports sharing genomic data. ONC provided access to subject matter experts, resources, tools, and technical guidance to support testing activities. Three of the four organizations participated in HL7 FHIR Connectathons to test FHIR's ability to exchange genomic diagnostic reports. Results The organizations successfully demonstrated exchange of genomic diagnostic reports using FHIR. The feedback and artifacts that resulted from these activities were shared with HL7 and made publicly available. Four areas were identified as important considerations for similar projects: (1) FHIR proficiency, (2) developer support, (3) project scope, and (4) bridging health information technology and genomic expertise. Conclusion Precision medicine is a rapidly evolving field, and there is opportunity to continue maturing health data standards for the exchange of necessary genomic data, increasing the likelihood that the standard supports the needs of users.
      Citation: Appl Clin Inform 2020; 11: 295-302
      PubDate: 2020-04-22T00:00:00+01:00
      DOI: 10.1055/s-0040-1708051
      Issue No: Vol. 11, No. 02 (2020)
       
  • Celebrating Clinical Informatics as a Specialty Practice
    • Appl Clin Inform 2020; 11: 303-304
      DOI: 10.1055/s-0039-3401812



      Georg Thieme Verlag KG Stuttgart · New York

      Artikel in Thieme eJournals:
      Inhaltsverzeichnis     Volltext

      Appl Clin Inform 2020; 11: 303-3042020-04-22T00:00:00+01:00
      Issue No: Vol. 11, No. 02 (2020)
       
  • Reducing Alert Burden in Electronic Health Records: State of the Art
           Recommendations from Four Health Systems
    • Authors: McGreevey; John D., Mallozzi, Colleen P., Perkins, Randa M., Shelov, Eric, Schreiber, Richard
      Pages: 001 - 012
      Abstract: Background Electronic health record (EHR) alert fatigue, while widely recognized as a concern nationally, lacks a corresponding comprehensive mitigation plan. Objectives The goal of this manuscript is to provide practical guidance to clinical informaticists and other health care leaders who are considering creating a program to manage EHR alerts. Methods This manuscript synthesizes several approaches and recommendations for better alert management derived from four U.S. health care institutions that presented their experiences and recommendations at the American Medical Informatics Association 2019 Clinical Informatics Conference in Atlanta, Georgia, United States. The assembled health care institution leaders represent academic, pediatric, community, and specialized care domains. We describe governance and management, structural concepts and components, and human–computer interactions with alerts, and make recommendations regarding these domains based on our experience supplemented with literature review. This paper focuses on alerts that impact bedside clinicians. Results The manuscript addresses the range of considerations relevant to alert management including a summary of the background literature about alerts, alert governance, alert metrics, starting an alert management program, approaches to evaluating alerts prior to deployment, and optimization of existing alerts. The manuscript includes examples of alert optimization successes at two of the represented institutions. In addition, we review limitations on the ability to evaluate alerts in the current state and identify opportunities for further scholarship. Conclusion Ultimately, alert management programs must strive to meet common goals of improving patient care, while at the same time decreasing the alert burden on clinicians. In so doing, organizations have an opportunity to promote the wellness of patients, clinicians, and EHRs themselves.
      Citation: Appl Clin Inform 2020; 11: 001-012
      PubDate: 2020-01-01T00:00:00+0100
      DOI: 10.1055/s-0039-3402715
      Issue No: Vol. 11, No. 01 (2020)
       
  • Igniting Harmonized Digital Clinical Quality Measurement through
           Terminology, CQL, and FHIR
    • Authors: McClure; Robert C., Macumber, Caroline L., Skapik, Julia L., Smith, Anne Marie
      Pages: 023 - 033
      Abstract: Background Electronic clinical quality measures (eCQMs) seek to quantify the adherence of health care to evidence-based standards. This requires a high level of consistency to reduce the effort of data collection and ensure comparisons are valid. Yet, there is considerable variability in local data capture, in the use of data standards and in implemented documentation processes, so organizations struggle to implement quality measures and extract data reliably for comparison across patients, providers, and systems. Objective In this paper, we discuss opportunities for harmonization within and across eCQMs; specifically, at the level of the measure concept, the logical clauses or phrases, the data elements, and the codes and value sets. Methods The authors, experts in measure development, quality assurance, standards and implementation, reviewed measure structure and content to describe the state of the art for measure analysis and harmonization. Our review resulted in the identification of four measure component levels for harmonization. We provide examples for harmonization of each of the four measure components based on experience with current quality measurement programs including the Centers for Medicare and Medicaid Services eCQM programs. Results In general, there are significant issues with lack of harmonization across measure concepts, logical phrases, and data elements. This magnifies implementation problems, confuses users, and requires more elaborate data mapping and maintenance. Conclusion Comparisons using semantically equivalent data are needed to accurately measure performance and reduce workflow interruptions with the aim of reducing evidence-based care gaps. It comes as no surprise that electronic health record designed for purposes other than quality improvement and used within a fragmented care delivery system would benefit greatly from common data representation, measure harmony, and consistency. We suggest that by enabling measure authors and implementers to deliver consistent electronic quality measure content in four key areas; the industry can improve quality measurement.
      Citation: Appl Clin Inform 2020; 11: 023-033
      PubDate: 2020-01-08T00:00:00+0100
      DOI: 10.1055/s-0039-3402755
      Issue No: Vol. 11, No. 01 (2020)
       
  • Reducing Interruptive Alert Burden Using Quality Improvement Methodology
    • Authors: Chaparro; Juan D., Hussain, Cory, Lee, Jennifer A., Hehmeyer, Jessica, Nguyen, Manjusri, Hoffman, Jeffrey
      Pages: 046 - 058
      Abstract: Background Increased adoption of electronic health records (EHR) with integrated clinical decision support (CDS) systems has reduced some sources of error but has led to unintended consequences including alert fatigue. The “pop-up” or interruptive alert is often employed as it requires providers to acknowledge receipt of an alert by taking an action despite the potential negative effects of workflow interruption. We noted a persistent upward trend of interruptive alerts at our institution and increasing requests for new interruptive alerts. Objectives Using Institute for Healthcare Improvement (IHI) quality improvement (QI) methodology, the primary objective was to reduce the total volume of interruptive alerts received by providers. Methods We created an interactive dashboard for baseline alert data and to monitor frequency and outcomes of alerts as well as to prioritize interventions. A key driver diagram was developed with a specific aim to decrease the number of interruptive alerts from a baseline of 7,250 to 4,700 per week (35%) over 6 months. Interventions focused on the following key drivers: appropriate alert display within workflow, clear alert content, alert governance and standardization, user feedback regarding overrides, and respect for user knowledge. Results A total of 25 unique alerts accounted for 90% of the total interruptive alert volume. By focusing on these 25 alerts, we reduced interruptive alerts from 7,250 to 4,400 per week. Conclusion Systematic and structured improvements to interruptive alerts can lead to overall reduced interruptive alert burden. Using QI methods to prioritize our interventions allowed us to maximize our impact. Further evaluation should be done on the effects of reduced interruptive alerts on patient care outcomes, usability heuristics on cognitive burden, and direct feedback mechanisms on alert utility.
      Citation: Appl Clin Inform 2020; 11: 046-058
      PubDate: 2020-01-15T00:00:00+0100
      DOI: 10.1055/s-0039-3402757
      Issue No: Vol. 11, No. 01 (2020)
       
  • To Share is Human! Advancing Evidence into Practice through a National
           Repository of Interoperable Clinical Decision Support
    • Authors: Lomotan; Edwin A., Meadows, Ginny, Michaels, Maria, Michel, Jeremy J., Miller, Kristen
      Pages: 112 - 121
      Abstract: Background Healthcare systems devote substantial resources to the development of clinical decision support (CDS) largely independently. The process of translating evidence-based practice into useful and effective CDS may be more efficient and less duplicative if healthcare systems shared knowledge about the translation, including workflow considerations, key assumptions made during the translation process, and technical details. Objective Describe how a national repository of CDS can serve as a public resource for healthcare systems, academic researchers, and informaticists seeking to share and reuse CDS knowledge resources or “artifacts.” Methods In 2016, the Agency for Healthcare Research and Quality (AHRQ) launched CDS Connect as a public, web-based platform for authoring and sharing CDS knowledge artifacts. Researchers evaluated early use and impact of the platform by collecting user experiences of AHRQ-sponsored and community-led dissemination efforts and through quantitative/qualitative analysis of site metrics. Efforts are ongoing to quantify efficiencies gained by healthcare systems that leverage shared, interoperable CDS artifacts rather than developing similar CDS de novo and in isolation. Results Federal agencies, academic institutions, and others have contributed over 50 entries to CDS Connect for sharing and dissemination. Analysis indicates shareable CDS resources reduce team sizes and the number of tasks and time required to design, develop, and deploy CDS. However, the platform needs further optimization to address sociotechnical challenges. Benefits of sharing include inspiring others to undertake similar CDS projects, identifying external collaborators, and improving CDS artifacts as a result of feedback. Organizations are adapting content available through the platform for continued research, innovation, and local implementations. Conclusion CDS Connect has provided a functional platform where CDS developers are actively sharing their work. CDS sharing may lead to improved implementation efficiency through numerous pathways, and further research is ongoing to quantify efficiencies gained.
      Citation: Appl Clin Inform 2020; 11: 112-121
      PubDate: 2020-02-12T00:00:00+0100
      DOI: 10.1055/s-0040-1701253
      Issue No: Vol. 11, No. 01 (2020)
       
  • Unsupervised Machine Learning of Topics Documented by Nurses about
           Hospitalized Patients Prior to a Rapid-Response Event
    • Authors: Korach; Zfania Tom, Cato, Kenrick D., Collins, Sarah A., Kang, Min Jeoung, Knaplund, Christopher, Dykes, Patricia C., Wang, Liqin, Schnock, Kumiko O., Garcia, Jose P., Jia, Haomiao, Chang, Frank, Schwartz, Jessica M., Zhou, Li
      Abstract: Background In the hospital setting, it is crucial to identify patients at risk for deterioration before it fully develops, so providers can respond rapidly to reverse the deterioration. Rapid response (RR) activation criteria include a subjective component (“worried about the patient”) that is often documented in nurses' notes and is hard to capture and quantify, hindering active screening for deteriorating patients. Objectives We used unsupervised machine learning to automatically discover RR event risk/protective factors from unstructured nursing notes. Methods In this retrospective cohort study, we obtained nursing notes of hospitalized, nonintensive care unit patients, documented from 2015 through 2018 from Partners HealthCare databases. We applied topic modeling to those notes to reveal topics (clusters of associated words) documented by nurses. Two nursing experts named each topic with a representative Systematized Nomenclature of Medicine–Clinical Terms (SNOMED CT) concept. We used the concepts along with vital signs and demographics in a time-dependent covariates extended Cox model to identify risk/protective factors for RR event risk. Results From a total of 776,849 notes of 45,299 patients, we generated 95 stable topics, of which 80 were mapped to 72 distinct SNOMED CT concepts. Compared with a model containing only demographics and vital signs, the latent topics improved the model's predictive ability from a concordance index of 0.657 to 0.720. Thirty topics were found significantly associated with RR event risk at a 0.05 level, and 11 remained significant after Bonferroni correction of the significance level to 6.94E-04, including physical examination (hazard ratio [HR] = 1.07, 95% confidence interval [CI], 1.03–1.12), informing doctor (HR = 1.05, 95% CI, 1.03–1.08), and seizure precautions (HR = 1.08, 95% CI, 1.04–1.12). Conclusion Unsupervised machine learning methods can automatically reveal interpretable and informative signals from free-text and may support early identification of patients at risk for RR events.
      Citation: Appl Clin Inform 2020; :
      PubDate: 2019-12-18T00:00:00+0100
      DOI: 10.1055/s-0039-3401814
       
  • Facilitating Organizational Change to Accommodate an Inpatient Portal
    • Authors: Walker; Daniel M., Gaughan, Alice, Fareed, Naleef, Moffatt-Bruce, Susan, McAlearney, Ann Scheck
      Abstract: Background Patient portals are becoming more commonly used in the hospital inpatient setting. While the potential benefits of inpatient portals are acknowledged, there is a need for research that examines the challenges of portal implementation and the development of best practice approaches for successful implementation. Objective We conducted this study to improve our understanding of the impact of the implementation of an inpatient portal on care team members in the context of a large academic medical center. Our study focused on the perspectives of nursing care team members about the inpatient portal. Methods We interviewed care team members (n = 437) in four phases throughout the 2 years following implementation of an inpatient portal to learn about their ongoing perspectives regarding the inpatient portal and its impact on the organization. Results The perspectives of care team members demonstrated a change in acceptance of the inpatient portal over time in terms of buy-in, positive workflow changes, and acknowledged benefits of the portal for both care team members and patients. There were also changes over time in perspectives of the care team in regards to (1) challenges with new technology, (2) impact of the portal on workflow, and (3) buy-in. Six strategies were identified as important for implementation success: (1) convene a stakeholder group, (2) offer continual portal training, (3) encourage shared responsibility, (4) identify champions, (5) provide provisioning feedback, and (6) support patient use. Conclusion Inpatient portals are recognized as an important tool for both patients and care team members, but the implementation of such a technology can create challenges. Given the perspectives care team members had about the impact of the inpatient portal, our findings suggest implementation requires attention to organizational changes that are needed to accommodate the tool and the development of strategies that can address challenges associated with the portal.
      Citation: Appl Clin Inform 2020; :
      PubDate: 2019-11-27T00:00:00+0100
      DOI: 10.1055/s-0039-1700867
       
 
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