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Authors:Dharmenaan Palamuthusingam, Elaine M Pascoe, Carmel M Hawley, David W Johnson, Gishan Ratnayake, Stephen McDonald, Neil Boudville, Matthew Jose, Magid Fahim Abstract: Health Information Management Journal, Ahead of Print. Background: Clinical quality registries provide rich and useful data for clinical quality monitoring and research purposes but are susceptible to data quality issues that can impact their usage. Objective: This study assessed the concordance between comorbidities recorded in the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry and those in state-based hospital admission datasets. Method: All patients in New South Wales, South Australia, Tasmania, Victoria and Western Australia recorded in ANZDATA as requiring chronic kidney replacement therapy (KRT) between 01/07/2000 and 31/12/2015 were linked with state-based hospital admission datasets. Coronary artery disease, diabetes mellitus, cerebrovascular disease, chronic lung disease and peripheral vascular disease recorded in ANZDATA at each annual census date were compared overall, over time and between different KRT modalities to comorbidities recorded in hospital admission datasets, as defined by the International Classification of Diseases (ICD-10-AM), using both the kappa statistic and logistic regression analysis. Results: 29, 334 patients with 207,369 hospital admissions were identified. Comparison was made at census date for every patient comparison. Overall agreement was “very good” for diabetes mellitus (92%, k = 0.84) and “poor” to “fair” (21–61%, k = 0.02–0.22) for others. Diabetes mellitus recording had the highest accuracy (sensitivity 93% (±SE 0.2) and specificity 93% (±SE 0.2)), and cerebrovascular disease had the lowest (sensitivity 54% (±SE 0.2) and specificity 21% (±SE 0.3)). The false positive rates for cerebrovascular disease, peripheral vascular disease and chronic airway disease ranged between 18 and 33%. The probability of a false positive was lowest for kidney transplant patients for all comorbidities and highest for patients on haemodialysis. Conclusions and Implications: Agreement between the clinical quality registry and hospital admission datasets was variable, with the prevalence of comorbidities being higher in ANZDATA. Citation: Health Information Management Journal PubDate: 2022-06-11T09:16:21Z DOI: 10.1177/18333583221097724
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Authors:Mohamed A Seif, Brittany C Kruse, Cameron A Keramati, Thomas A Aloia, Ruth A Amaku, Shreyas Bhavsar, Kenneth R DeCarlo, Rose Joan D Erfe, Jarrod S Eska, Maria D Iniesta, Laura R Prakash, Tao Zhang, Vijaya Gottumukkala Abstract: Health Information Management Journal, Ahead of Print. Background: With increasing implementation of enhanced recovery programs (ERPs) in clinical practice, standardised data collection and reporting have become critical in addressing the heterogeneity of metrics used for reporting outcomes. Opportunities exist to leverage electronic health record (EHR) systems to collect, analyse, and disseminate ERP data. Objectives: (i) To consolidate relevant ERP variables into a singular data universe; (ii) To create an accessible and intuitive query tool for rapid data retrieval. Method: We reviewed nine established individual team databases to identify common variables to create one standard ERP data dictionary. To address data automation, we used a third-party business intelligence tool to map identified variables within the EHR system, consolidating variables into a single ERP universe. To determine efficacy, we compared times for four experienced research coordinators to use manual, five-universe, and ERP Universe processes to retrieve ERP data for 10 randomly selected surgery patients. Results: The total times to process data variables for all 10 patients for the manual, five universe, and ERP Universe processes were 510, 111, and 76 min, respectively. Shifting from the five-universe or manual process to the ERP Universe resulted in decreases in time of 32% and 85%, respectively. Conclusion: The ERP Universe improves time spent collecting, analysing, and reporting ERP elements without increasing operational costs or interrupting workflow. Implications: Manual data abstraction places significant burden on resources. The creation of a singular instrument dedicated to ERP data abstraction greatly increases the efficiency in which clinicians and supporting staff can query adherence to an ERP protocol. Citation: Health Information Management Journal PubDate: 2022-06-11T01:58:53Z DOI: 10.1177/18333583221095139
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Authors:Graeme J Duke, Maria Bishara, Steve Hirth, Lyn-Li Lim, Leon J Worth Abstract: Health Information Management Journal, Ahead of Print. BackgroundSepsis is the world’s leading cause of death and its detection from a range of data and coding sources, consistent with consensus clinical definition, is desirable.ObjectiveTo evaluate the performance of three coding definitions (explicit, implicit, and newly proposed synchronous method) for sepsis derived from administrative data compared to a clinical reference standard.MethodExtraction of administratively coded data from Australian metropolitan teaching hospital with 25,000 annual overnight admissions compared to clinical review of medical records; 313 (27.9%) randomly selected adult multi-day stay hospital separations from 1,123 separations with acute infection during July 2019. Estimated prevalence and performance metrics, including positive (PPV) and negative predictive values (NPV), and area under the receiver operator characteristic curve (ROC).ResultsClinical prevalence of sepsis was estimated at 10.7 (95% CI = 10.3–11.3) per 100 separations, and mortality rate of 11.6 (95% CI = 10.3–13.0) per 100 sepsis separations. Explicit method for case detection had high PPV (93.2%) but low NPV (55.8%) compared to the standard implicit method (74.1 and 66.3%, respectively) and proposed synchronous method (80.4% and 80.0%) compared to a standard clinical case definition. ROC for each method: 0.618 (95% CI = 0.538–0.654), 0.698 (95% CI = 0.648–0.748), and 0.802 (95% CI = 0.757–0.846), respectively.ConclusionIn hospitalised Australian patients with community-onset sepsis, the explicit method for sepsis case detection underestimated prevalence. Implicit methods were consistent with consensus definition for sepsis, and proposed synchronous method had better performance. Citation: Health Information Management Journal PubDate: 2022-06-09T01:43:33Z DOI: 10.1177/18333583221107713
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Authors:Joosup Kim, Rohan Grimley, Monique F Kilkenny, Greg Cadigan, Trisha Johnston, Nadine E Andrew, Amanda G Thrift, Natasha A Lannin, Vijaya Sundararajan, Dominique A Cadilhac Abstract: Health Information Management Journal, Ahead of Print. BackgroundStroke is a high-cost condition. Detailed patient-level assessments of the costs of care received and outcomes achieved provide useful information for organisation and optimisation of the health system.ObjectivesTo describe the costs of hospital care for stroke and transient ischaemic attack (TIA) and investigate factors associated with costs.MethodsRetrospective cohort study using data from the Australian Stroke Clinical Registry (AuSCR) collected between 2009 and 2013 linked to hospital administrative data and clinical costing data in Queensland. Clinical costing data include standardised assignment of costs from hospitals that contribute to the National Hospital Costing programme. Patient-level costs for each hospital admission were described according to the demographic, clinical and treatment characteristics of patients. Multivariable median regression with clustering by hospital was used to determine factors associated with greater costs.ResultsAmong 22 hospitals, clinical costing data were available for 3909 of 5522 patient admissions in the AuSCR (71%). Compared to those without clinical costing data, patients with clinical costing data were more often aged Citation: Health Information Management Journal PubDate: 2022-06-06T09:36:23Z DOI: 10.1177/18333583221090277
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Authors:Megan Prictor, Maria Rychkova Abstract: Health Information Management Journal, Ahead of Print. Background: In Australia, national policy prioritises the integration of clinical genetic data with networked electronic medical records (EMRs) for enhanced coordination of care and clinical decision-making. Objective: To examine the needs, privacy expectations and concerns of patients, family members, patient advocates and clinicians in relation to the use of networked EMRs for clinical genetic information. Method: Purposive sampling was used to recruit 27 participants for a semi-structured qualitative interview, primarily over Zoom. The interviews were audio and video-recorded and externally transcribed. Interview transcripts were then coded and analysed in NVivo, using an inductive thematic approach. Results: Thematic analysis revealed diverse preferences regarding genetic information access and handling across participants, with five core themes being identified: degree of access and control; central role of genetic professionals as information gatekeepers; complexities of familial implications; external risks; and law, governance and policy; all strong themes that emerged across numerous participants. Conclusion: This project yielded unprecedented and significant insights into the views, needs and concerns of key stakeholders in Australia regarding the inclusion of health-related genetic test results in networked EMRs. Implications: These findings provide a critical reference point for much-needed law reform and policy-making around genetic test results in Australia. Citation: Health Information Management Journal PubDate: 2022-05-26T06:46:19Z DOI: 10.1177/18333583221090969
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Authors:Ben J Murch, Sarah E Hollier, Charlie Kenward, Richard M Wood Abstract: Health Information Management Journal, Ahead of Print. Background: Within the relatively early stages of the COVID-19 pandemic, there had been an awareness of the potential longer-term effects of infection (so called Long-COVID) but little was known of the ongoing demands such patients may place on healthcare services. Objective: To investigate whether COVID-19 illness is associated with increased post-acute healthcare utilisation. Method: Using linked data from primary care, secondary care, mental health and community services, activity volumes were compared across the 3 months preceding and proceeding COVID-19 diagnoses for 7,791 individuals, with a distinction made between whether or not patients were hospitalised for treatment. Differences were assessed against those of a control group containing individuals who had not received a COVID-19 diagnosis. All data were sourced from the authors’ healthcare system in South West England. Results: For hospitalised COVID-19 cases, a statistically significant increase in non-elective admissions was identified for males and females Citation: Health Information Management Journal PubDate: 2022-05-26T06:39:52Z DOI: 10.1177/18333583221089915
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Authors:Hyunkyung Lee, Sukil Kim Abstract: Health Information Management Journal, Ahead of Print. Background: ICD-11 was officially released at the World Health Assembly on 25 May 2019. Objective: To find effective ways to increase the accuracy of coding for diagnostic terms in Korea for a stable transition from Korean modification of ICD-10 (7th Revision of Korean Classification of Disease, KCD-7) to ICD-11. Method: A total of 27 skilled Korean health information managers performed KCD-7 and ICD-11 coding simultaneously (line coding [56]; case coding [17]). Accuracy rates and percentage agreements were calculated, and granularity and difficulty of the ICD-11 were rated by participants. Results: The average accuracy rate of line coding was 71.6 % in ICD-11 and 80.2% in KCD-7, which was similar to results in other studies. The mean percentage agreements for ICD-11 and KCD-7 for line coding were 64.2% and 72.1%, respectively; while for case coding it was 15.3% and 26.6%. Selection criteria for the case scenarios may have influenced the low agreements in case coding. Cluster coding, changes of terms in ICD-11 and removal of codes used in ICD-10 contributed to low agreement in ICD-11 (46.6% of participants reported that granularity of ICD-11 was similar to ICD-10, while 36.9% reported that ICD-11 had finer granularity). In terms of difficulty, 15.3% of participants found line coding difficult and 10.9% found case coding difficult. Conclusion: Provision of more detailed reference guidelines and efficient training for coding professionals by the World Health Organization would enable ICD-11 to be an excellent tool for gathering relevant information about diseases in Korea. Citation: Health Information Management Journal PubDate: 2022-05-26T05:48:54Z DOI: 10.1177/18333583221095147
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Authors:Anthony J Goff, Christian J Barton, Mark Merolli, Andre Shi Zhang Quah, Caleb Ki-Cheong Hoe, Danilo De Oliveira Silva Abstract: Health Information Management Journal, Ahead of Print. BackgroundPeople are increasingly using the Internet to retrieve health information about chronic musculoskeletal conditions, yet content can be inaccurate and of variable quality.ObjectiveTo summarise (i) comprehensiveness, (ii) accuracy and clarity, iii) quality of information about treatment choices, (iv) credibility and (v) readability of online information about knee osteoarthritis.MethodSystematic appraisal of website content. Searches for “knee osteoarthritis” and “knee arthritis” were performed using Google and Bing (October 2020). The top 20 URLs of each search were screened for eligibility. Comprehensiveness, accuracy and clarity of content were matched against 14 pre-defined topic descriptors. DISCERN and HONcode were used to measure quality of information about treatment choices and website credibility, respectively. Flesch Reading Ease and Flesch-Kincaid Grade Level tests were used to assess readability.ResultsThirty-five websites were included. Websites were generally comprehensive (median, range = 12, 0–14/14) with descriptors available for 67% (n = 330/490) of topics across all websites, but only 35% (n = 116/330) were accurate and clear. Quality of information about treatment choices was generally low (median DISCERN score, range = 40, 16–56/80). Credibility descriptors were present for 65% (n = 181/280) of items, with 81% (n = 146/181) of descriptors being clear. Median Flesch reading ease was 53 (range = 21–74), and Flesch-Kincaid grade level was 8 (range = 5–11).ConclusionFew websites provide accurate and clear content aligned to key research evidence. Quality of information about treatment choices was poor, with large variation in comprehensiveness, credibility and readability.ImplicationsCareful consideration is required by clinicians to identify what online information people with knee osteoarthritis have accessed and to address misinformed beliefs. Citation: Health Information Management Journal PubDate: 2022-05-25T10:02:39Z DOI: 10.1177/18333583221090579
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Authors:Nathan K Mensah, Richard O Boadu, Godwin Adzakpah, Obed U Lasim, Ruth D Amuakwa, Hannah B Taylor-Abdulai, Samuel T Chatio Abstract: Health Information Management Journal, Ahead of Print. BackgroundElectronic health records (EHRs) are useful tools in healthcare settings but implementation in low and middle-income countries (LMIC) face challenges.ObjectiveTo explore post-implementation challenges affecting the deployment of EHRs and their use in selected health facilities in Ghana.MethodUsing a qualitative research approach, 21 in-depth interviews were conducted with health workers in two hospitals in the study area in Ghana, in February and June 2020. Purposive sampling was used to select participants. All interviews were audio recorded, transcribed, and coded into themes using QSR Nvivo12 software to aid thematic analyses.ResultsPost-implementation challenges were grouped into lack of technological, logistical and managerial support, and inadequate training. Inadequate equipment was the most reported post-implementation challenge that affected EHR use. Unreliable Internet and network connectivity was a source of frustration, which caused staff to develop negative attitudes towards use of the system. Lack of funding stalled implementation of the system and limited its use to critical care units only. It was also the reason replacement of equipment delayed.ConclusionWhile EHR post-implementation challenges facing health facilities are surmountable, managerial support, backed with the requisite logistical and technical support is needed. It is not enough to rely on funding; health institutions should prioritise emerging EHR post-implementation challenges in their operating budgets.ImplicationsA national framework is needed to guide effective and sustainable EHR implementation across the country. Citation: Health Information Management Journal PubDate: 2022-05-15T03:02:35Z DOI: 10.1177/18333583221096899
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Authors:Merilyn Riley, Kerin Robinson, Monique F Kilkenny, Sandra G Leggat Abstract: Health Information Management Journal, Ahead of Print. BackgroundGovernments have responsibility for ensuring the quality and fitness-for-purpose of personal health data provided to them. While these health information assets are used widely for research, this secondary usage has received minimal research attention.ObjectiveThis study aimed to investigate the secondary uses, in research, of population health and administrative datasets (information assets) of the Department of Health (DoH), Victoria, Australia. The objectives were to (i) identify research based on these datasets published between 2008 and 2020; (ii) describe the data quality studies published between 2008 and 2020 for each dataset and (iii) evaluate “fitness-for-purpose” of the published research.MethodUsing a modified scoping review, research publications from 2008 to 2020 based on information assets related to health service provision and containing person-level data were reviewed. Publications were summarised by data quality and purpose-categories based on a taxonomy of data use. Fitness-for-purpose was evaluated by comparing the publicly stated purpose(s) for which each information asset was collected, with the purpose(s) assigned to the published research.ResultsOf the>1000 information assets, 28 were utilised in 756 publications: 54% were utilised for general research purposes, 14% for patient safety, 10% for quality of care and 39% included data quality-related publications. Almost 85% of publications used information assets that were fit-for-purpose.ConclusionThe DoH information assets were used widely for secondary purposes, with the majority identified as fit-for-purpose. We recommend that data custodians, including governments, provide information on data quality and transparency on data use of their health information assets. Citation: Health Information Management Journal PubDate: 2022-04-26T05:44:25Z DOI: 10.1177/18333583221078377
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Authors:Kerin Robinson, Simon Barraclough, Elizabeth Cummings, Rick Iedema Abstract: Health Information Management Journal, Ahead of Print. Health information permeates healthcare delivery from point-of-care, across the continuum of care and throughout the healthcare system’s policy, population health, research, planning and funding arenas. Health information managers (HIMs) expertly manage that information. This commentary theorises the health information management profession for the first time. Its purpose is to identify and contextualise, via a historiographical account, the societal and political drivers that have shaped contemporary Australian health information management and HIMs’ scientific work. It seeks to build our knowledge of the socio-political influences on the profession’s emergence and development, and the projected drivers of its future. Eight critical, socio-political drivers were identified and are addressed in temporaneous order. Scientific medicine has reflected the influences on medicine in the past century and a half of the medical record and other technologies, laboratory-based sciences, evidence-based medicine and evidence-based health. Standardisation has underpinned and guided the profession’s practice. The hegemony of non-medical healthcare managers and resource- and performance-related accountabilities emerged in the 1960s, as did the efficiencies of bureaucratisation in healthcare and post-bureaucratic shifts to textualisation and technogovernance. Technologisation has driven constant change in health information management, as have the forces of the fast-paced risk society. Since the 1980s, the health consumer movement has propelled regulatory mechanisms that accord patients’ access rights to their medical records and mandate information privacy protections. Finally, a nascent commodification of health information has emerged. These forces exert ongoing impacts on the profession. They will, we conclude, singularly and collectively continue to shape its discourses and direction. Citation: Health Information Management Journal PubDate: 2022-03-18T02:00:35Z DOI: 10.1177/18333583211070336
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