Sample records for direct recording electronic

  1. Quantifying the Hawthorne Effect in Hand Hygiene Compliance Through Comparing Direct Observation With Automated Hand Hygiene Monitoring.

    PubMed

    Hagel, Stefan; Reischke, Jana; Kesselmeier, Miriam; Winning, Johannes; Gastmeier, Petra; Brunkhorst, Frank M; Scherag, André; Pletz, Mathias W

    2015-08-01

    To quantify the Hawthorne effect of hand hygiene performance among healthcare workers using direct observation. Prospective observational study. Intensive care unit, university hospital. Direct observation of hand hygiene compliance over 48 audits of 2 hours each. Simultaneously, hand hygiene events (HHEs) were recorded using electronic alcohol-based handrub dispensers. Directly observed and electronically recorded HHEs during the 2 hours of direct observation were compared using Spearman correlations and Bland-Altman plots. To quantify the Hawthorne effect, we compared the number of electronically recorded HHEs during the direct observation periods with the re-scaled electronically recorded HHEs in the 6 remaining hours of the 8-hour working shift. A total of 3,978 opportunities for hand hygiene were observed during the 96 hours of direct observation. Hand hygiene compliance was 51% (95% CI, 49%-53%). There was a strong positive correlation between directly observed compliance and electronically recorded HHEs (ρ=0.68 [95% CI, 0.49-0.81], P<.0001). In the 384 hours under surveillance, 4,180 HHEs were recorded by the electronic dispensers. Of those, 2,029 HHEs were recorded during the 96 hours in which direct observation was also performed, and 2,151 HHEs were performed in the remaining 288 hours of the same working shift that were not under direct observation. Healthcare workers performed 8 HHEs per hour when not under observation compared with 21 HHEs per hour during observation. Directly and electronically observed HHEs were in agreement. We observed a marked influence of the Hawthorne effect on hand hygiene performance.

  2. [Electronic versus paper-based patient records: a cost-benefit analysis].

    PubMed

    Neubauer, A S; Priglinger, S; Ehrt, O

    2001-11-01

    The aim of this study is to compare the costs and benefits of electronic, paperless patient records with the conventional paper-based charts. Costs and benefits of planned electronic patient records are calculated for a University eye hospital with 140 beds. Benefit is determined by direct costs saved by electronic records. In the example shown, the additional benefits of electronic patient records, as far as they can be quantified total 192,000 DM per year. The costs of the necessary investments are 234,000 DM per year when using a linear depreciation over 4 years. In total, there are additional annual costs for electronic patient records of 42,000 DM. Different scenarios were analyzed. By increasing the time of depreciation to 6 years, the cost deficit reduces to only approximately 9,000 DM. Increased wages reduce the deficit further while the deficit increases with a loss of functions of the electronic patient record. However, several benefits of electronic records regarding research, teaching, quality control and better data access cannot be easily quantified and would greatly increase the benefit to cost ratio. Only part of the advantages of electronic patient records can easily be quantified in terms of directly saved costs. The small cost deficit calculated in this example is overcompensated by several benefits, which can only be enumerated qualitatively due to problems in quantification.

  3. Programmable hyperspectral image mapper with on-array processing

    NASA Technical Reports Server (NTRS)

    Cutts, James A. (Inventor)

    1995-01-01

    A hyperspectral imager includes a focal plane having an array of spaced image recording pixels receiving light from a scene moving relative to the focal plane in a longitudinal direction, the recording pixels being transportable at a controllable rate in the focal plane in the longitudinal direction, an electronic shutter for adjusting an exposure time of the focal plane, whereby recording pixels in an active area of the focal plane are removed therefrom and stored upon expiration of the exposure time, an electronic spectral filter for selecting a spectral band of light received by the focal plane from the scene during each exposure time and an electronic controller connected to the focal plane, to the electronic shutter and to the electronic spectral filter for controlling (1) the controllable rate at which the recording is transported in the longitudinal direction, (2) the exposure time, and (3) the spectral band so as to record a selected portion of the scene through M spectral bands with a respective exposure time t(sub q) for each respective spectral band q.

  4. 77 FR 65416 - Advisory Committee on the Electronic Records Archives (ACERA)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-26

    ... Minutes ERA Program Update Business Priorities Presidential Directive on Records Management Online Public Access Discussions: Encouraging development of automated tools for electronic records management, impact of big data, and benchmarking Dated: October 24, 2012. Patrice Little Murray, Acting Committee...

  5. Seeing tobacco mosaic virus through direct electron detectors

    PubMed Central

    Fromm, Simon A.; Bharat, Tanmay A.M.; Jakobi, Arjen J.; Hagen, Wim J.H.; Sachse, Carsten

    2015-01-01

    With the introduction of direct electron detectors (DED) to the field of electron cryo-microscopy, a wave of atomic-resolution structures has become available. As the new detectors still require comparative characterization, we have used tobacco mosaic virus (TMV) as a test specimen to study the quality of 3D image reconstructions from data recorded on the two direct electron detector cameras, K2 Summit and Falcon II. Using DED movie frames, we explored related image-processing aspects and compared the performance of micrograph-based and segment-based motion correction approaches. In addition, we investigated the effect of dose deposition on the atomic-resolution structure of TMV and show that radiation damage affects negative carboxyl chains first in a side-chain specific manner. Finally, using 450,000 asymmetric units and limiting the effects of radiation damage, we determined a high-resolution cryo-EM map at 3.35 Å resolution. Here, we provide a comparative case study of highly ordered TMV recorded on different direct electron detectors to establish recording and processing conditions that enable structure determination up to 3.2 Å in resolution using cryo-EM. PMID:25528571

  6. Harnessing electronic healthcare data for wound care research: Standards for reporting observational registry data obtained directly from electronic health records.

    PubMed

    Fife, Caroline E; Eckert, Kristen A

    2017-04-01

    The United States Food and Drug Administration will consider the expansion of coverage indications for some drugs and devices based on real-world data. Real-world data accrual in patient registries has historically been via manual data entry from the medical chart at a time distant from patient care, which is fraught with systematic error. The efficient automated transmission of data directly from electronic health records is replacing this labor-intensive paradigm. However, real-world data collection is unfamiliar. The potential sources of bias arising from the source of data and data accrual, documentation, and aggregation have not been well defined. Furthermore, the technological aspects of data acquisition and transmission are less transparent. We explore opportunities for harnessing direct-from-electronic health record registry reporting and propose the ABCs of Registries (Analysis of Bias Criteria of Registries), which are an evaluation framework for publications to minimize potential bias of real-world data obtained directly from an electronic health record method. These standards are based on a point-of-care data documentation process using a common definitional framework and data dictionaries. By way of example, we describe a wound registry obtained directly from electronic health records. This qualified clinical data registry minimizes bias by ensuring complete and accurate point-of-care data capture, standardizes usual care linked to quality reporting, and prevents post-hoc vetting of outcomes. The resulting data are of high quality and integrity and can be used for comparative effectiveness research in wound care. In this way, the effort needed to succeed with the Quality Payment Program is leveraged to obtain the real-world data needed for comparative effectiveness research. © 2017 by the Wound Healing Society.

  7. Direct imaging detectors for electron microscopy

    NASA Astrophysics Data System (ADS)

    Faruqi, A. R.; McMullan, G.

    2018-01-01

    Electronic detectors used for imaging in electron microscopy are reviewed in this paper. Much of the detector technology is based on the developments in microelectronics, which have allowed the design of direct detectors with fine pixels, fast readout and which are sufficiently radiation hard for practical use. Detectors included in this review are hybrid pixel detectors, monolithic active pixel sensors based on CMOS technology and pnCCDs, which share one important feature: they are all direct imaging detectors, relying on directly converting energy in a semiconductor. Traditional methods of recording images in the electron microscope such as film and CCDs, are mentioned briefly along with a more detailed description of direct electronic detectors. Many applications benefit from the use of direct electron detectors and a few examples are mentioned in the text. In recent years one of the most dramatic advances in structural biology has been in the deployment of the new backthinned CMOS direct detectors to attain near-atomic resolution molecular structures with electron cryo-microscopy (cryo-EM). The development of direct detectors, along with a number of other parallel advances, has seen a very significant amount of new information being recorded in the images, which was not previously possible-and this forms the main emphasis of the review.

  8. Electronic health record use among cancer patients: Insights from the Health Information National Trends Survey.

    PubMed

    Strekalova, Yulia A

    2017-04-01

    Over 90% of US hospitals provide patients with access to e-copy of their health records, but the utilization of electronic health records by the US consumers remains low. Guided by the comprehensive information-seeking model, this study used data from the National Cancer Institute's Health Information National Trends Survey 4 (Cycle 4) and examined the factors that explain the level of electronic health record use by cancer patients. Consistent with the model, individual information-seeking factors and perceptions of security and utility were associated with the frequency of electronic health record access. Specifically, higher income, prior online information seeking, interest in accessing health information online, and normative beliefs were predictive of electronic health record access. Conversely, poorer general health status and lack of health care provider encouragement to use electronic health records were associated with lower utilization rates. The current findings provide theory-based evidence that contributes to the understanding of the explanatory factors of electronic health record use and suggest future directions for research and practice.

  9. The Use of Electronic Data Interchange under the Family Educational Rights and Privacy Act.

    ERIC Educational Resources Information Center

    Rhinehart, Paul T.

    1996-01-01

    When used in managing college student records, electronic data interchange allows electronic student records to be fed directly into a receiving institution's database instead of being sent by mail. Although the process offers many clear advantages, one important question that must be addressed is how students' privacy will be protected under a…

  10. A direct electron detector for time-resolved MeV electron microscopy

    DOE PAGES

    Vecchione, T.; Denes, P.; Jobe, R. K.; ...

    2017-03-15

    The introduction of direct electron detectors enabled the structural biology revolution of cryogenic electron microscopy. Direct electron detectors are now expected to have a similarly dramatic impact on time-resolved MeV electron microscopy, particularly by enabling both spatial and temporal jitter correction. Here in this paper, we report on the commissioning of a direct electron detector for time-resolved MeV electron microscopy. The direct electron detector demonstrated MeV single electron sensitivity and is capable of recording megapixel images at 180 Hz. The detector has a 15-bit dynamic range, better than 30-μm spatial resolution and less than 20 analogue-to-digital converter count RMS pixelmore » noise. The unique capabilities of the direct electron detector and the data analysis required to take advantage of these capabilities are presented. The technical challenges associated with generating and processing large amounts of data are also discussed.« less

  11. A direct electron detector for time-resolved MeV electron microscopy

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Vecchione, T.; Denes, P.; Jobe, R. K.

    The introduction of direct electron detectors enabled the structural biology revolution of cryogenic electron microscopy. Direct electron detectors are now expected to have a similarly dramatic impact on time-resolved MeV electron microscopy, particularly by enabling both spatial and temporal jitter correction. Here we report on the commissioning of a direct electron detector for time-resolved MeV electron microscopy. The direct electron detector demonstrated MeV single electron sensitivity and is capable of recording megapixel images at 180 Hz. The detector has a 15-bit dynamic range, better than 30-μmμm spatial resolution and less than 20 analogue-to-digital converter count RMS pixel noise. The uniquemore » capabilities of the direct electron detector and the data analysis required to take advantage of these capabilities are presented. The technical challenges associated with generating and processing large amounts of data are also discussed.« less

  12. A direct electron detector for time-resolved MeV electron microscopy

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Vecchione, T.; Denes, P.; Jobe, R. K.

    The introduction of direct electron detectors enabled the structural biology revolution of cryogenic electron microscopy. Direct electron detectors are now expected to have a similarly dramatic impact on time-resolved MeV electron microscopy, particularly by enabling both spatial and temporal jitter correction. Here in this paper, we report on the commissioning of a direct electron detector for time-resolved MeV electron microscopy. The direct electron detector demonstrated MeV single electron sensitivity and is capable of recording megapixel images at 180 Hz. The detector has a 15-bit dynamic range, better than 30-μm spatial resolution and less than 20 analogue-to-digital converter count RMS pixelmore » noise. The unique capabilities of the direct electron detector and the data analysis required to take advantage of these capabilities are presented. The technical challenges associated with generating and processing large amounts of data are also discussed.« less

  13. Electronic Health Records: Applying Diffusion of Innovation Theory to the Relationship between Multifactor Authentication and EHR Adoption

    ERIC Educational Resources Information Center

    Lockett, Daeron C.

    2014-01-01

    Electronic Health Record (EHR) systems are increasingly becoming accepted as future direction of medical record management systems. Programs such as the American Recovery and Reinvestment Act have provided incentives to hospitals that adopt EHR systems. In spite of these incentives, the perception of EHR adoption is that is has not achieved the…

  14. A qualitative study of Canada's experience with the implementation of electronic health information technology.

    PubMed

    Rozenblum, Ronen; Jang, Yeona; Zimlichman, Eyal; Salzberg, Claudia; Tamblyn, Melissa; Buckeridge, David; Forster, Alan; Bates, David W; Tamblyn, Robyn

    2011-03-22

    In 2001, Canada Health Infoway unveiled a plan to implement a national system of interoperable electronic health records. This government-funded corporation introduced a novel model for interprovincial/territorial collaboration to establish core aspects of a national framework. Despite this $1.6 billion initiative, Canada continues to lag behind other Western countries in adopting electronic health records. We conducted a study to identify the success of different aspects of the Canadian plan and ways to improve the adoption of electronic health records. We used a case study approach to assess the 10-year history of Canada's e-health plan. National reports and documents were reviewed, and structured interviews were conducted with 29 key stakeholders representing national and provincial organizations responsible for establishing policy and strategic direction for health information technology. Using grounded theory, we analyzed transcripts of the interviews to identify themes and their relationships. Key stakeholders identified funding, national standards, patient registries and digital imaging as important achievements of the e-health plan. Lack of an e-health policy, inadequate involvement of clinicians, failure to establish a business case for using electronic health records, a focus on national rather than regional interoperability, and inflexibility in approach were seen as barriers to adoption of the plan. To accelerate adoption of electronic health records and timely return on investment, an e-health policy needs to be tightly aligned with the major strategic directions of health care reform. Adoption needs to be actively fostered through a bottom-up, clinical-needs-first approach, a national policy for investment in electronic health records, and financial incentives based on patient outcomes that can be achieved with electronic health records.

  15. A qualitative study of Canada’s experience with the implementation of electronic health information technology

    PubMed Central

    Rozenblum, Ronen; Jang, Yeona; Zimlichman, Eyal; Salzberg, Claudia; Tamblyn, Melissa; Buckeridge, David; Forster, Alan; Bates, David W.; Tamblyn, Robyn

    2011-01-01

    Background In 2001, Canada Health Infoway unveiled a plan to implement a national system of interoperable electronic health records. This government-funded corporation introduced a novel model for interprovincial/territorial collaboration to establish core aspects of a national framework. Despite this $1.6 billion initiative, Canada continues to lag behind other Western countries in adopting electronic health records. We conducted a study to identify the success of different aspects of the Canadian plan and ways to improve the adoption of electronic health records. Methods We used a case study approach to assess the 10-year history of Canada’s e-health plan. National reports and documents were reviewed, and structured interviews were conducted with 29 key stakeholders representing national and provincial organizations responsible for establishing policy and strategic direction for health information technology. Using grounded theory, we analyzed transcripts of the interviews to identify themes and their relationships. Results Key stakeholders identified funding, national standards, patient registries and digital imaging as important achievements of the e-health plan. Lack of an e-health policy, inadequate involvement of clinicians, failure to establish a business case for using electronic health records, a focus on national rather than regional interoperability, and inflexibility in approach were seen as barriers to adoption of the plan. Interpretation To accelerate adoption of electronic health records and timely return on investment, an e-health policy needs to be tightly aligned with the major strategic directions of health care reform. Adoption needs to be actively fostered through a bottom-up, clinical-needs-first approach, a national policy for investment in electronic health records, and financial incentives based on patient outcomes that can be achieved with electronic health records. PMID:21343262

  16. Low-dose electron energy-loss spectroscopy using electron counting direct detectors.

    PubMed

    Maigné, Alan; Wolf, Matthias

    2018-03-01

    Since the development of parallel electron energy loss spectroscopy (EELS), charge-coupled devices (CCDs) have been the default detectors for EELS. With the recent development of electron-counting direct-detection cameras, micrographs can be acquired under very low electron doses at significantly improved signal-to-noise ratio. In spectroscopy, in particular in combination with a monochromator, the signal can be extremely weak and the detection limit is principally defined by noise introduced by the detector. Here we report the use of an electron-counting direct-detection camera for EEL spectroscopy. We studied the oxygen K edge of amorphous ice and obtained a signal noise ratio up to 10 times higher than with a conventional CCD.We report the application of electron counting to record time-resolved EEL spectra of a biological protein embedded in amorphous ice, revealing chemical changes observed in situ while exposed by the electron beam. A change in the fine structure of nitrogen K and the carbon K edges were recorded during irradiation. A concentration of 3 at% nitrogen was detected with a total electron dose of only 1.7 e-/Å2, extending the boundaries of EELS signal detection at low electron doses.

  17. 78 FR 21308 - Medicare Program; Physicians' Referrals to Health Care Entities With Which They Have Financial...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-10

    ... electronic health records software and directly related training services, using our authority at section... electronic health records software or information technology and training services. As set forth at 42 CFR...), we explained that we interpreted ``software, information technology and training services necessary...

  18. DIRECT secure messaging as a common transport layer for reporting structured and unstructured lab results to outpatient providers.

    PubMed

    Sujansky, Walter; Wilson, Tom

    2015-04-01

    This report describes a grant-funded project to explore the use of DIRECT secure messaging for the electronic delivery of laboratory test results to outpatient physicians and electronic health record systems. The project seeks to leverage the inherent attributes of DIRECT secure messaging and electronic provider directories to overcome certain barriers to the delivery of lab test results in the outpatient setting. The described system enables laboratories that generate test results as HL7 messages to deliver these results as structured or unstructured documents attached to DIRECT secure messages. The system automatically analyzes generated HL7 messages and consults an electronic provider directory to determine the appropriate DIRECT address and delivery format for each indicated recipient. The system also enables lab results delivered to providers as structured attachments to be consumed by HL7 interface engines and incorporated into electronic health record systems. Lab results delivered as unstructured attachments may be printed or incorporated into patient records as PDF files. The system receives and logs acknowledgement messages to document the status of each transmitted lab result, and a graphical interface allows searching and review of this logged information. The described system is a fully implemented prototype that has been tested in a laboratory setting. Although this approach is promising, further work is required to pilot test the system in production settings with clinical laboratories and outpatient provider organizations. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Positive beliefs and privacy concerns shape the future for the Personally Controlled Electronic Health Record.

    PubMed

    Lehnbom, E C; Douglas, H E; Makeham, M A B

    2016-01-01

    The uptake of the Personally Controlled Electronic Health Record (PCEHR) has been slowly building momentum in Australia. The purpose of the PCEHR is to collect clinically important information from multiple healthcare providers to provide a secure electronic record to patients and their authorised healthcare providers that will ultimately enhance the efficiency and effectiveness of healthcare delivery. Reasons for the slow uptake of the PCEHR and future directions to improve its usefulness is discussed later. © 2016 Royal Australasian College of Physicians.

  20. Electronic Ambient-Temperature Recorder

    NASA Technical Reports Server (NTRS)

    Russell, Larry; Barrows, William

    1995-01-01

    Electronic temperature-recording unit stores data in internal memory for later readout. Records temperatures from minus 40 degrees to plus 60 degrees C at intervals ranging from 1.875 to 15 minutes. With all four data channels operating at 1.875-minute intervals, recorder stores at least 10 days' data. For only one channel at 15-minute intervals, capacity extends to up to 342 days' data. Developed for recording temperatures of instruments and life-science experiments on satellites, space shuttle, and high-altitude aircraft. Adaptable to such terrestrial uses as recording temperatures of perishable goods during transportation and of other systems or processes over long times. Can be placed directly in environment to monitor.

  1. Requirements for prototyping an educational electronic health record: experiences and future directions.

    PubMed

    Kushniruk, Andre; Borycki, Elizabeth; Kuo, Mu-Hsing; Parapini, Eric; Wang, Shu Lin; Ho, Kendall

    2014-01-01

    Electronic health records and related technologies are being increasingly deployed throughout the world. It is expected that upon graduation health professionals will be able to use these technologies in effective and efficient ways. However, educating health professional students about such technologies has lagged behind. There is a need for software that will allow medical, nursing and health informatics students access to this important software to learn how it works and how to use it effectively. Furthermore, electronic health record educational software that is accessed should provide a range of functions including allowing instructors to build patient cases. Such software should also allow for simulation of a course of a patient's stay and the ability to allow instructors to monitor student use of electronic health records. In this paper we describe our work in developing the requirements for an educational electronic health record to support education about this important technology. We also describe a prototype system being developed based on the requirements gathered.

  2. A web-based rapid prototyping and clinical conversational system that complements electronic patient record system.

    PubMed

    Kim, J H; Ferziger, R; Kawaloff, H B; Sands, D Z; Safran, C; Slack, W V

    2001-01-01

    Even the most extensive hospital information system cannot support all the complex and ever-changing demands associated with a clinical database, such as providing department or personal data forms, and rating scales. Well-designed clinical dialogue programs may facilitate direct interaction of patients with their medical records. Incorporation of extensive and loosely structured clinical data into an existing medical record system is an essential step towards a comprehensive clinical information system, and can best be achieved when the practitioner and the patient directly enter the contents. We have developed a rapid prototyping and clinical conversational system that complements the electronic medical record system, with its generic data structure and standard communication interfaces based on Web technology. We believe our approach can enhance collaboration between consumer-oriented and provider-oriented information systems.

  3. 50 CFR 622.5 - Recordkeeping and reporting.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... such record as specified in paragraph (a)(2) of this section. (B) Electronic logbook/video monitoring... participate in the NMFS-sponsored electronic logbook and/or video monitoring reporting program as directed by...) of this section. (ii) Electronic logbook/video monitoring reporting. The owner or operator of a...

  4. Energetic electrons driven in the polarization direction of an intense laser beam incident normal to a solid target

    DOE PAGES

    Seely, J. F.; Hudson, L. T.; Pereira, N.; ...

    2016-02-24

    Experiments were performed at the LLNL Titan laser to measure the propagation direction of the energetic electrons that were generated during the interaction of the polarized laser beam with solid targets in the case of normal incidence. The energetic electrons propagated through vacuum to spectator metal wires in the polarization direction and in the perpendicular direction, and the K shell spectra from the different wire materials were recorded as functions of the distance from the laser focal spot. It was found that the fluence of the energetic electrons driven into the spectator wires in the polarization direction compared to themore » perpendicular direction was larger and increased with the distance from the focal spot. Finally, this indicates that energetic electrons are preferentially driven in the direction of the intense oscillating electric field of the incident laser beam in agreement with the multiphoton inverse Bremsstrahlung absorption process.« less

  5. 76 FR 77625 - Privacy Act of 1974, as Amended; System of Records

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-13

    ... rapid communication to registered FDIC personnel during and after emergency and security events to....'' This system will contain correspondence and other communications addressed or directed to FDIC OIG and..., RETAINING, AND DISPOSING OF RECORDS IN THE SYSTEM: Storage: Records are stored in electronic media and in...

  6. Overcoming structural constraints to patient utilization of electronic medical records: a critical review and proposal for an evaluation framework.

    PubMed

    Winkelman, Warren J; Leonard, Kevin J

    2004-01-01

    There are constraints embedded in medical record structure that limit use by patients in self-directed disease management. Through systematic review of the literature from a critical perspective, four characteristics that either enhance or mitigate the influence of medical record structure on patient utilization of an electronic patient record (EPR) system have been identified: environmental pressures, physician centeredness, collaborative organizational culture, and patient centeredness. An evaluation framework is proposed for use when considering adaptation of existing EPR systems for online patient access. Exemplars of patient-accessible EPR systems from the literature are evaluated utilizing the framework. From this study, it appears that traditional information system research and development methods may not wholly capture many pertinent social issues that arise when expanding access of EPR systems to patients. Critically rooted methods such as action research can directly inform development strategies so that these systems may positively influence health outcomes.

  7. Ambulatory electronic medical record payback analysis 7 years after implementation in a tertiary care county medical system.

    PubMed

    Kaelber, David C; Miller, Vince; Fisher, Nancy; Schlesinger, Jim; Norris, Greg

    2007-10-11

    Electronic medical records (EMRs) are gaining increasing prominence in healthcare, however still have low market penetration. EMR implementation cost is a primary perceived barrier. Here we present a payback analysis on an outpatient EMR implementation, showing capital expense recovery (net of operating costs) at 6 years and now generating $6 million yearly in direct savings for our healthcare system.

  8. Absolute Scale Quantitative Off-Axis Electron Holography at Atomic Resolution

    NASA Astrophysics Data System (ADS)

    Winkler, Florian; Barthel, Juri; Tavabi, Amir H.; Borghardt, Sven; Kardynal, Beata E.; Dunin-Borkowski, Rafal E.

    2018-04-01

    An absolute scale match between experiment and simulation in atomic-resolution off-axis electron holography is demonstrated, with unknown experimental parameters determined directly from the recorded electron wave function using an automated numerical algorithm. We show that the local thickness and tilt of a pristine thin WSe2 flake can be measured uniquely, whereas some electron optical aberrations cannot be determined unambiguously for a periodic object. The ability to determine local specimen and imaging parameters directly from electron wave functions is of great importance for quantitative studies of electrostatic potentials in nanoscale materials, in particular when performing in situ experiments and considering that aberrations change over time.

  9. Lessons about So-Called "Difficult" Patients from the UK Controversy over Patient Access to Electronic Health Records.

    PubMed

    Lucivero, Federica

    2017-04-01

    Increasing numbers of patients have direct access to their electronic health records (EHRs). Proponents of direct access argue that it empowers patients by making them more informed and offering them more control over their health and care. According to some proponents of patients' access to EHRs, clinicians' concerns about potential negative implications are grounded in a form of paternalism that protects clinicians' authority. This paper draws upon narratives from patients in the United Kingdom (UK) who have access to their EHRs and suggests strategies for moving beyond these controversies between proponents and critics of the system. It additionally shows that the very organizational, procedural, and technological infrastructure that promises patients' increased access to records can also exacerbate some patients' "difficult" behaviors. © 2017 American Medical Association. All Rights Reserved.

  10. Medicare Preventive and Screening Services

    MedlinePlus

    ... gov Medicare forms Advance directives & long-term care Electronic prescribing Electronic Health Records (EHRs) Download claims with Medicare’s Blue ... attr("role", "status").addClass("sr-only HiddenText").appendTo(document.body); } } function notify(strFeedback) { setTimeout(function() { var $channel = $(" "). ...

  11. Overcoming Structural Constraints to Patient Utilization of Electronic Medical Records: A Critical Review and Proposal for an Evaluation Framework

    PubMed Central

    Winkelman, Warren J.; Leonard, Kevin J.

    2004-01-01

    There are constraints embedded in medical record structure that limit use by patients in self-directed disease management. Through systematic review of the literature from a critical perspective, four characteristics that either enhance or mitigate the influence of medical record structure on patient utilization of an electronic patient record (EPR) system have been identified: environmental pressures, physician centeredness, collaborative organizational culture, and patient centeredness. An evaluation framework is proposed for use when considering adaptation of existing EPR systems for online patient access. Exemplars of patient-accessible EPR systems from the literature are evaluated utilizing the framework. From this study, it appears that traditional information system research and development methods may not wholly capture many pertinent social issues that arise when expanding access of EPR systems to patients. Critically rooted methods such as action research can directly inform development strategies so that these systems may positively influence health outcomes. PMID:14633932

  12. The scope and direction of health informatics.

    PubMed

    McGinnis, Patrick J

    2002-05-01

    Health Informatics (HI) is a dynamic discipline based on the medical sciences, information sciences, and cognitive sciences. Its domain can broadly be defined as medical information management. The purpose of this paper is to provide an overview of this domain, discuss the current "state of the art," and indicate the likely growth areas for health informatics. The sources of information used in this paper are selected publications from the literature of Health Informatics, HI 5300: Introduction to Health Informatics, which is a course from the Department of Health Informatics at the University of Texas Houston Health Sciences Center, and the author's personal experience in practicing telemedicine and implementing an electronic medical record at the NASA-Johnson Space Center. The conclusion is that the direction of Health Informatics is in the direction of data management, transfer, and representation via electronic medical records and the Internet.

  13. The scope and direction of health informatics

    NASA Technical Reports Server (NTRS)

    McGinnis, Patrick J.

    2002-01-01

    Health Informatics (HI) is a dynamic discipline based on the medical sciences, information sciences, and cognitive sciences. Its domain can broadly be defined as medical information management. The purpose of this paper is to provide an overview of this domain, discuss the current "state of the art," and indicate the likely growth areas for health informatics. The sources of information used in this paper are selected publications from the literature of Health Informatics, HI 5300: Introduction to Health Informatics, which is a course from the Department of Health Informatics at the University of Texas Houston Health Sciences Center, and the author's personal experience in practicing telemedicine and implementing an electronic medical record at the NASA-Johnson Space Center. The conclusion is that the direction of Health Informatics is in the direction of data management, transfer, and representation via electronic medical records and the Internet.

  14. Case Report Form Reporter: A Key Component for the Integration of Electronic Medical Records and the Electronic Data Capture System.

    PubMed

    Matsumura, Yasushi; Hattori, Atsushi; Manabe, Shiro; Takahashi, Daiyo; Yamamoto, Yuichiro; Murata, Taizo; Nakagawa, Akito; Mihara, Naoki; Takeda, Toshihiro

    2017-01-01

    To improve the efficiency of clinical research, we developed a system to integrate electronic medical records (EMRs) and the electronic data capture system (EDC). EDC is divided into case report form (CRF) reporter and CDMS with CRF receiver with data communication using the operational data model (ODM). The CRF reporter is incorporated into the EMR to share data witth the EMR. In the data transcription type, doctors enter data using a progress note template, which are transmitted to the reporter template. It then generates the ODM. In the direct record type, reporter templates open from the progress note and generate narrative text to make record in the progress note. The configuration files for a study are delivered from the contents server to minimize the setup. This system has been used for 15 clinical studies including 3 clinical trials. This system can save labor and financial costs in clinical research.

  15. From papyrus to the electronic tablet: a brief history of the clinical medical record with lessons for the digital age.

    PubMed

    Gillum, Richard F

    2013-10-01

    A major transition is underway in documentation of patient-related data in clinical settings with rapidly accelerating adoption of the electronic health record and electronic medical record. This article examines the history of the development of medical records in the West in order to suggest lessons applicable to the current transition. The first documented major transition in the evolution of the clinical medical record occurred in antiquity, with the development of written case history reports for didactic purposes. Benefiting from Classical and Hellenistic models earlier than physicians in the West, medieval Islamic physicians continued the development of case histories for didactic use. A forerunner of modern medical records first appeared in Paris and Berlin by the early 19th century. Development of the clinical record in America was pioneered in the 19th century in major teaching hospitals. However, a clinical medical record useful for direct patient care in hospital and ambulatory settings was not developed until the 20th century. Several lessons are drawn from the 4000-year history of the medical record that may help physicians improve patient care in the digital age. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Activation of a medical emergency team using an electronic medical recording-based screening system*.

    PubMed

    Huh, Jin Won; Lim, Chae-Man; Koh, Younsuck; Lee, Jury; Jung, Youn-Kyung; Seo, Hyun-Suk; Hong, Sang-Bum

    2014-04-01

    To evaluate the efficacy of a medical emergency team activated using 24-hour monitoring by electronic medical record-based screening criteria followed by immediate intervention by a skilled team. Retrospective cohort study. Academic tertiary care hospital with approximately 2,700 beds. A total of 3,030 events activated by a medical emergency team from March 1, 2008, to February 28, 2010. None. We collected data for all medical emergency team activations: patient characteristics, trigger type for medical emergency team (electronic medical record-based screening vs calling criteria), interventions during each event, outcomes of the medical emergency team intervention, and 28-day mortality after medical emergency team activation. We analyzed data for 2009, when the medical emergency team functioned 24 hours a day, 7 days a week (period 2), compared with that for 2008, when the medical emergency team functioned 12 hours a day, 7 days a week (period 1). The commonest cause of medical emergency team activation was respiratory distress (43.6%), and the medical emergency team performed early goal-directed therapy (21.3%), respiratory care (19.9%), and difficult airway management (12.3%). For patients on general wards, 51.3% (period 1) and 38.4% (period 2) of medical emergency team activations were triggered by the electronic medical record-based screening system (electronic medical record-triggered group). In 23.4%, activation occurred because of an abnormality in laboratory screening criteria. The commonest activation criterion from electronic medical record-based screening was respiratory rate (39.4%). Over half the patients were treated in the general ward, and one third of the patients were transferred to the ICU. The electronic medical record-triggered group had lower ICU admission with an odds ratio of 0.35 (95% CI, 0.22-0.55). In surgical patients, the electronic medical record-triggered group showed the lower 28-day mortality (10.5%) compared with the call-triggered group (26.7%) or the double-triggered group (33.3%) (odds ratio 0.365 with 95% CI, 0.154-0.867, p = 0.022). We successful managed the medical emergency team with electronic medical record-based screening criteria and a skilled intervention team. The electronic medical record-triggered group had lower ICU admission than the call-triggered group or the double-triggered group. In surgical patients, the electronic medical record-triggered group showed better outcome than other groups.

  17. 45 CFR 2507.4 - How are requests for records made?

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... through the Corporation's “electronic reading room” internet site under “Resource Links”. The following address is the Corporation's Internet Web site: http://www.nationalservice.org. (b) Request must... may have produced or may have custody of the record (e.g., AmeriCorps*State/National Direct, Ameri...

  18. 77 FR 22067 - Proposed Collection of Information: Trace Request for Electronic Funds Transfer (EFT) Payment...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-12

    ... Electronic Funds Transfer (EFT) Payment; and Trace Request Direct Deposit AGENCY: Financial Management... collection. By this notice, the Financial Management Service solicits comments concerning forms FMS-150.1... comments to Financial Management Service, 3700 East West Highway, Records and Information Management Branch...

  19. You can't measure what you can't see - detectors for microscopies

    NASA Astrophysics Data System (ADS)

    Denes, Peter

    For centuries, the human eye has been the imaging detector of choice thanks to its high sensitivity, wide dynamic range, and direct connection to a built-in data recording and analysis system. The eye, however, is limited to visible light, which excludes microscopies with electrons and X-rays, and the built-in recording system stores archival information at very low rates. The former limitation has been overcome by ``indirect'' detectors, which convert probe particles to visible light, and the latter by a variety of recording techniques, from photographic film to semiconductor-based imagers. Semiconductor imagers have been used for decades as ``direct'' detectors in particle physics, and almost as long for hard X-rays. For soft X-ray microscopy, the challenge has been the small signal levels - plus getting the X-rays into the detector itself, given how quickly they are absorbed in inert layers. For electron microscopy, the challenge has been reconciling detector spatial resolution and pixel count with the large multiple scattering of electrons with energies used for microscopy. Further, a high recording rate (``movies'' rather than ``snapshots'') enables time-resolved studies, time-dependent corrections, shot-by-shot experiments and scanning techniques - at the expense of creating large data volumes. This talk will discuss solutions to these challenges, as well as an outlook towards future developments.

  20. The Scope and Direction of Health Informatics

    NASA Technical Reports Server (NTRS)

    McGinnis, Patrick J.

    2001-01-01

    Health Informatics (HI) is a dynamic discipline based upon the medical sciences, information sciences, and cognitive sciences. Its domain is can broadly be defined as medical information management. The purpose of this paper is to provide an overview of this domain, discuss the current "state of the art" , and indicate the likely growth areas for health informatics. The sources of information utilized in this paper are selected publications from the literature of Health Informatics, HI 5300: Introduction to Health Informatics, which is a course from the Department of Health Informatics at the University of Texas Houston Health Sciences Center, and the author's personal experience in practicing telemedicine and implementing an electronic medical record at the NASA Johnson Space Center. The conclusion is that the direction of Health Informatics is in the direction of data management, transfer, and representation via electronic medical records and the Internet.

  1. Defining and incorporating basic nursing care actions into the electronic health record.

    PubMed

    Englebright, Jane; Aldrich, Kelly; Taylor, Cathy R

    2014-01-01

    To develop a definition of basic nursing care for the hospitalized adult patient and drive uptake of that definition through the implementation of an electronic health record. A team of direct care nurses, assisted by subject matter experts, analyzed nursing theory and regulatory requirements related to basic nursing care. The resulting list of activities was coded using the Clinical Care Classification (CCC) system and incorporated into the electronic health record system of a 170-bed community hospital. Nine basic nursing care activities were identified as a result of analyzing nursing theory and regulatory requirements in the framework of a hypothetical "well" patient. One additional basic nursing care activity was identified following the pilot implementation in the electronic health record. The pilot hospital has successfully passed a post-implementation regulatory review with no recommendations related to the documentation of basic patient care. This project demonstrated that it is possible to define the concept of basic nursing care and to distinguish it from the interdisciplinary, problem-focused plan of care. The use of the electronic health record can help clarify, document, and communicate basic care elements and improve uptake among nurses. This project to define basic nursing care activities and incorporate into the electronic health record represents a first step in capturing meaningful data elements. When fully implemented, these data could be translated into knowledge for improving care outcomes and collaborative processes. © 2013 Sigma Theta Tau International.

  2. [Access control management in electronic health records: a systematic literature review].

    PubMed

    Carrión Señor, Inmaculada; Fernández Alemán, José Luis; Toval, Ambrosio

    2012-01-01

    This study presents the results of a systematic literature review of aspects related to access control in electronic health records systems, wireless security and privacy and security training for users. Information sources consisted of original articles found in Medline, ACM Digital Library, Wiley InterScience, IEEE Digital Library, Science@Direct, MetaPress, ERIC, CINAHL and Trip Database, published between January 2006 and January 2011. A total of 1,208 articles were extracted using a predefined search string and were reviewed by the authors. The final selection consisted of 24 articles. Of the selected articles, 21 dealt with access policies in electronic health records systems. Eleven articles discussed whether access to electronic health records should be granted by patients or by health organizations. Wireless environments were only considered in three articles. Finally, only four articles explicitly mentioned that technical training of staff and/or patients is required. Role-based access control is the preferred mechanism to deploy access policy by the designers of electronic health records. In most systems, access control is managed by users and health professionals, which promotes patients' right to control personal information. Finally, the security of wireless environments is not usually considered. However, one line of research is eHealth in mobile environments, called mHealth. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

  3. 31 CFR 363.4 - How is TreasuryDirect® different from the Legacy Treasury Direct® system and the commercial book...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... OF THE TREASURY BUREAU OF THE PUBLIC DEBT REGULATIONS GOVERNING SECURITIES HELD IN TREASURYDIRECT... Treasury for purchasing, holding and conducting permitted transactions in eligible Treasury securities in electronic form as a computer record on the books of Treasury. TreasuryDirect currently provides for the...

  4. 31 CFR 363.4 - How is TreasuryDirect ® different from the Legacy Treasury Direct system and the commercial book...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... OF THE TREASURY BUREAU OF THE PUBLIC DEBT REGULATIONS GOVERNING SECURITIES HELD IN TREASURYDIRECT... Treasury for purchasing, holding and conducting permitted transactions in eligible Treasury securities in electronic form as a computer record on the books of Treasury. TreasuryDirect currently provides for the...

  5. 31 CFR 363.4 - How is TreasuryDirect® different from the Legacy Treasury Direct® system and the commercial book...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... OF THE TREASURY BUREAU OF THE PUBLIC DEBT REGULATIONS GOVERNING SECURITIES HELD IN TREASURYDIRECT... Treasury for purchasing, holding and conducting permitted transactions in eligible Treasury securities in electronic form as a computer record on the books of Treasury. TreasuryDirect currently provides for the...

  6. 31 CFR 363.4 - How is TreasuryDirect® different from the Legacy Treasury Direct® system and the commercial book...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ..., DEPARTMENT OF THE TREASURY BUREAU OF THE FISCAL SERVICE REGULATIONS GOVERNING SECURITIES HELD IN... Treasury for purchasing, holding and conducting permitted transactions in eligible Treasury securities in electronic form as a computer record on the books of Treasury. TreasuryDirect currently provides for the...

  7. 31 CFR 363.4 - How is TreasuryDirect® different from the Legacy Treasury Direct® system and the commercial book...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... OF THE TREASURY BUREAU OF THE PUBLIC DEBT REGULATIONS GOVERNING SECURITIES HELD IN TREASURYDIRECT... Treasury for purchasing, holding and conducting permitted transactions in eligible Treasury securities in electronic form as a computer record on the books of Treasury. TreasuryDirect currently provides for the...

  8. Implications for registry-based vaccine effectiveness studies from an evaluation of an immunization registry: a cross-sectional study.

    PubMed

    Mahon, Barbara E; Shea, Kimberly M; Dougherty, Nancy N; Loughlin, Anita M

    2008-05-14

    Population-based electronic immunization registries create the possibility of using registry data to conduct vaccine effectiveness studies which could have methodological advantages over traditional observational studies. For study validity, the base population would have to be clearly defined and the immunization status of members of the population accurately recorded in the registry. We evaluated a city-wide immunization registry, focusing on its potential as a tool to study pertussis vaccine effectiveness, especially in adolescents. We conducted two evaluations - one in sites that were active registry participants and one in sites that had implemented an electronic medical record with plans for future direct data transfer to the registry - of the ability to match patients' medical records to registry records and the accuracy of immunization records in the registry. For each site, records from current pediatric patients were chosen randomly. Data regarding pertussis-related immunizations, clinic usage, and demographic and identifying information were recorded; for 11-17-year-old subjects, information on MMR, hepatitis B, and varicella immunizations was also collected. Records were then matched, when possible, to registry records. For records with a registry match, immunization data were compared. Among 350 subjects from sites that were current registry users, 307 (87.7%) matched a registry record. Discrepancies in pertussis-related data were common for up-to-date status (22.6%), number of immunizations (34.7%), dates (10.2%), and formulation (34.4%). Among 442 subjects from sites that planned direct electronic transfer of immunization data to the registry, 393 (88.9%) would have matched a registry record; discrepancies occurred frequently in number of immunizations (11.9%), formulation (29.1%), manufacturer (94.4%), and lot number (95.1%.) Inability to match and immunization discrepancies were both more common in subjects who were older at their first visit to the provider site. For 11-17-year-old subjects, discrepancies were also common for MMR, hepatitis B, and varicella vaccination data. Provider records frequently could not be matched to registry records or had discrepancies in key immunization data. These issues were more common for older children and were present even with electronic data transfer. These results highlight general challenges that may face investigators wishing to use registry-based immunization data for vaccine effectiveness studies, especially in adolescents.

  9. Implications for registry-based vaccine effectiveness studies from an evaluation of an immunization registry: A cross-sectional study

    PubMed Central

    Mahon, Barbara E; Shea, Kimberly M; Dougherty, Nancy N; Loughlin, Anita M

    2008-01-01

    Background Population-based electronic immunization registries create the possibility of using registry data to conduct vaccine effectiveness studies which could have methodological advantages over traditional observational studies. For study validity, the base population would have to be clearly defined and the immunization status of members of the population accurately recorded in the registry. We evaluated a city-wide immunization registry, focusing on its potential as a tool to study pertussis vaccine effectiveness, especially in adolescents. Methods We conducted two evaluations – one in sites that were active registry participants and one in sites that had implemented an electronic medical record with plans for future direct data transfer to the registry – of the ability to match patients' medical records to registry records and the accuracy of immunization records in the registry. For each site, records from current pediatric patients were chosen randomly. Data regarding pertussis-related immunizations, clinic usage, and demographic and identifying information were recorded; for 11–17-year-old subjects, information on MMR, hepatitis B, and varicella immunizations was also collected. Records were then matched, when possible, to registry records. For records with a registry match, immunization data were compared. Results Among 350 subjects from sites that were current registry users, 307 (87.7%) matched a registry record. Discrepancies in pertussis-related data were common for up-to-date status (22.6%), number of immunizations (34.7%), dates (10.2%), and formulation (34.4%). Among 442 subjects from sites that planned direct electronic transfer of immunization data to the registry, 393 (88.9%) would have matched a registry record; discrepancies occurred frequently in number of immunizations (11.9%), formulation (29.1%), manufacturer (94.4%), and lot number (95.1%.) Inability to match and immunization discrepancies were both more common in subjects who were older at their first visit to the provider site. For 11–17-year-old subjects, discrepancies were also common for MMR, hepatitis B, and varicella vaccination data. Conclusion Provider records frequently could not be matched to registry records or had discrepancies in key immunization data. These issues were more common for older children and were present even with electronic data transfer. These results highlight general challenges that may face investigators wishing to use registry-based immunization data for vaccine effectiveness studies, especially in adolescents. PMID:18479517

  10. An Electronic Health Record Data-driven Model for Identifying Older Adults at Risk of Unintentional Falls

    PubMed Central

    Baus, Adam; Coben, Jeffrey; Zullig, Keith; Pollard, Cecil; Mullett, Charles; Taylor, Henry; Cochran, Jill; Jarrett, Traci; Long, Dustin

    2017-01-01

    Screening for risk of unintentional falls remains low in the primary care setting because of the time constraints of brief office visits. National studies suggest that physicians caring for older adults provide recommended fall risk screening only 30 to 37 percent of the time. Given prior success in developing methods for repurposing electronic health record data for the identification of fall risk, this study involves building a model in which electronic health record data could be applied for use in clinical decision support to bolster screening by proactively identifying patients for whom screening would be beneficial and targeting efforts specifically to those patients. The final model, consisting of priority and extended measures, demonstrates moderate discriminatory power, indicating that it could prove useful in a clinical setting for identifying patients at risk of falls. Focus group discussions reveal important contextual issues involving the use of fall-related data and provide direction for the development of health systems–level innovations for the use of electronic health record data for fall risk identification. PMID:29118679

  11. Electronic Health Object

    PubMed Central

    Almunawar, Mohammad Nabil; Anshari, Muhammad; Younis, Mustafa Z.; Kisa, Adnan

    2015-01-01

    Electronic health records (EHRs) store health-related patient information in an electronic format, improving the quality of health care management and increasing efficiency of health care processes. However, in existing information systems, health-related records are generated, managed, and controlled by health care organizations. Patients are perceived as recipients of care and normally cannot directly interact with the system that stores their health-related records; their participation in enriching this information is not possible. Many businesses now allow customers to participate in generating information for their systems, strengthening customer relationships. This trend is supported by Web 2.0, which enables interactivity through various means, including social networks. Health care systems should be able to take advantage of this development. This article proposes a novel framework in addressing the emerging need for interactivity while preserving and extending existing electronic medical data. The framework has 3 dimensions of patient health record: personal, social, and medical dimensions. The framework is designed to empower patients, changing their roles from static recipient of health care services to dynamic and active partners in health care processes. PMID:26660486

  12. 17 CFR 145.7 - Requests for Commission records and copies thereof.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... form or format (including electronic formats) of the response. The Commission will accommodate... not specify the form or format of the response, the Commission will respond in the form or format in... response will be given to requests for records that are directed to the Commission other than in the manner...

  13. Strong field acceleration and steering of ultrafast electron pulses from a sharp metallic nanotip.

    PubMed

    Park, Doo Jae; Piglosiewicz, Bjoern; Schmidt, Slawa; Kollmann, Heiko; Mascheck, Manfred; Lienau, Christoph

    2012-12-14

    We report a strong, laser-field induced modification of the propagation direction of ultrashort electron pulses emitted from nanometer-sized gold tapers. Angle-resolved kinetic energy spectra of electrons emitted from such tips are recorded using ultrafast near-infrared light pulses of variable wavelength and intensity for excitation. For sufficiently long wavelengths, we observe a pronounced strong-field acceleration of electrons within the field gradient at the taper apex. We find a distinct narrowing of the emission cone angle of the fastest electrons. We ascribe this to the field-induced steering of subcycle electrons as opposed to the diverging emission of quiver electrons. Our findings are corroborated by simulations based on a modified Simpleman model incorporating the curved, vectorial field gradient in the vicinity of the tip. Our results indicate new pathways for designing highly directional nanometer-sized ultrafast electron sources.

  14. A macro-directive mechanism that facilitates automatic updating and processing of the contents of Electronic Healthcare Records: an extension to the CEN architecture.

    PubMed

    Deftereos, S; Lambrinoudakis, C; Gritzalis, S; Georgonikou, D; Andriopoulos, P; Aessopos, A

    2003-03-01

    Facilitating data entry, eliminating redundant effort and providing decision support are some of the factors upon which the successful uptake of Electronic Healthcare Record (EHCR) technology is dependent. The European Standardization Committee (CEN), on the other hand, has proposed a standard EHCR architecture, which allows patient record contents to be highly diverse, customized to individual user needs; this makes their processing a challenging task and poses a demand for specially designed mechanisms. We describe the requirements for a macro-directive mechanism, pertaining to CEN-compatible EHCR software that can automate updating and processing of patient records, thus enhancing the functionality of the software. We have implemented the above-mentioned mechanism in an EHCR application that has been customized for use in the care process of patients suffering from beta-Thalassemia. The application is being used during the last two years in the Thalassemia units of four Greek hospitals, as part of their every day practice. We report on the experience we have acquired so far.

  15. Direct writing on graphene 'paper' by manipulating electrons as 'invisible ink'.

    PubMed

    Zhang, Wei; Zhang, Qiang; Zhao, Meng-Qiang; Kuhn, Luise Theil

    2013-07-12

    The combination of self-assembly (bottom up) and nano-imprint lithography (top down) is an efficient and effective way to record information at the nanoscale by writing. The use of an electron beam for writing is quite a promising strategy; however, the 'paper' on which to save the information is not yet fully realized. Herein, graphene was selected as the thinnest paper for recording information at the nanoscale. In a transmission electron microscope, in situ high precision writing and drawing were achieved on graphene nanosheets by manipulating electrons with a 1 nm probe (probe current ~2 × 10(-9) A m(-2)) in scanning transmission electron microscopy (STEM) mode. Under electron probe irradiation, the carbon atom tends to displace within a crystalline specimen, and dangling bonds are formed from the original sp(2) bonding after local carbon atoms have been kicked off. The absorbed random foreign amorphous carbon assembles along the line of the scanning direction induced by secondary electrons and is immobilized near the edge. With the ultralow secondary electron yield of the graphene, additional foreign atoms determining the accuracy of the pattern have been greatly reduced near the targeting region. Therefore, the electron probe in STEM mode serves as invisible ink for nanoscale writing and drawing. These results not only shed new light on the application of graphene by the interaction of different forms of carbon, but also illuminate the interaction of different carbon forms through electron beams.

  16. Implementation and adoption of nationwide electronic health records in secondary care in England: qualitative analysis of interim results from a prospective national evaluation

    PubMed Central

    Robertson, Ann; Cresswell, Kathrin; Takian, Amirhossein; Petrakaki, Dimitra; Crowe, Sarah; Cornford, Tony; Barber, Nicholas; Avery, Anthony; Fernando, Bernard; Jacklin, Ann; Prescott, Robin; Klecun, Ela; Paton, James; Lichtner, Valentina; Quinn, Casey; Ali, Maryam; Morrison, Zoe; Jani, Yogini; Waring, Justin; Marsden, Kate

    2010-01-01

    Objectives To describe and evaluate the implementation and adoption of detailed electronic health records in secondary care in England and thereby provide early feedback for the ongoing local and national rollout of the NHS Care Records Service. Design A mixed methods, longitudinal, multisite, socio-technical case study. Setting Five NHS acute hospital and mental health trusts that have been the focus of early implementation efforts and at which interim data collection and analysis are complete. Data sources and analysis Dataset for the evaluation consists of semi-structured interviews, documents and field notes, observations, and quantitative data. Qualitative data were analysed thematically with a socio-technical coding matrix, combined with additional themes that emerged from the data. Main results Hospital electronic health record applications are being developed and implemented far more slowly than was originally envisioned; the top-down, standardised approach has needed to evolve to admit more variation and greater local choice, which hospital trusts want in order to support local activity. Despite considerable delays and frustrations, support for electronic health records remains strong, including from NHS clinicians. Political and financial factors are now perceived to threaten nationwide implementation of electronic health records. Interviewees identified a range of consequences of long term, centrally negotiated contracts to deliver the NHS Care Records Service in secondary care, particularly as NHS trusts themselves are not party to these contracts. These include convoluted communication channels between different stakeholders, unrealistic deployment timelines, delays, and applications that could not quickly respond to changing national and local NHS priorities. Our data suggest support for a “middle-out” approach to implementing hospital electronic health records, combining government direction with increased local autonomy, and for restricting detailed electronic health record sharing to local health communities. Conclusions Experiences from the early implementation sites, which have received considerable attention, financial investment and support, indicate that delivering improved healthcare through nationwide electronic health records will be a long, complex, and iterative process requiring flexibility and local adaptability both with respect to the systems and the implementation strategy. The more tailored, responsive approach that is emerging is becoming better aligned with NHS organisations’ perceived needs and is, if pursued, likely to deliver clinically useful electronic health record systems. PMID:20813822

  17. An in-plane magnetic chiral dichroism approach for measurement of intrinsic magnetic signals using transmitted electrons

    PubMed Central

    Song, Dongsheng; Tavabi, Amir H.; Li, Zi-An; Kovács, András; Rusz, Ján; Huang, Wenting; Richter, Gunther; Dunin-Borkowski, Rafal E.; Zhu, Jing

    2017-01-01

    Electron energy-loss magnetic chiral dichroism is a powerful technique that allows the local magnetic properties of materials to be measured quantitatively with close-to-atomic spatial resolution and element specificity in the transmission electron microscope. Until now, the technique has been restricted to measurements of the magnetic circular dichroism signal in the electron beam direction. However, the intrinsic magnetization directions of thin samples are often oriented in the specimen plane, especially when they are examined in magnetic-field-free conditions in the transmission electron microscope. Here, we introduce an approach that allows in-plane magnetic signals to be measured using electron magnetic chiral dichroism by selecting a specific diffraction geometry. We compare experimental results recorded from a cobalt nanoplate with simulations to demonstrate that an electron magnetic chiral dichroism signal originating from in-plane magnetization can be detected successfully. PMID:28504267

  18. Outpatient blood pressure monitoring using bi-directional text messaging.

    PubMed

    Anthony, Chris A; Polgreen, Linnea A; Chounramany, James; Foster, Eric D; Goerdt, Christopher J; Miller, Michelle L; Suneja, Manish; Segre, Alberto M; Carter, Barry L; Polgreen, Philip M

    2015-05-01

    To diagnose hypertension, multiple blood pressure (BP) measurements are recommended. We randomized patients into three groups: EMR-only (patients recorded BP measurements in an electronic medical record [EMR] web portal), EMR + reminders (patients were sent text message reminders to record their BP measurements in the EMR), and bi-directional text messaging (patients were sent a text message asking them to respond with their current BP). Subjects were asked to complete 14 measurements. Automated messages were sent to each patient in the bi-directional text messaging and EMR + reminder groups twice daily. Among 121 patients, those in the bi-directional text messaging group reported the full 14 measurements more often than both the EMR-only group (P < .001) and the EMR + reminders group (P = .038). Also, the EMR + reminders group outperformed the EMR-only group (P < .001). Bi-directional automated text messaging is an effective way to gather patient BP data. Text-message-based reminders alone are an effective way to encourage patients to record BP measurements. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  19. 32 CFR 701.5 - Policy.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... FOIA Directives 5400.7 and 5400.7-R, and this instruction in this part in both letter and spirit..., when responding to FOIA requests for electronic data where creation of a record, programming, or...

  20. Vital sign documentation in electronic records: The development of workarounds.

    PubMed

    Stevenson, Jean E; Israelsson, Johan; Nilsson, Gunilla; Petersson, Goran; Bath, Peter A

    2018-06-01

    Workarounds are commonplace in healthcare settings. An increase in the use of electronic health records has led to an escalation of workarounds as healthcare professionals cope with systems which are inadequate for their needs. Closely related to this, the documentation of vital signs in electronic health records has been problematic. The accuracy and completeness of vital sign documentation has a direct impact on the recognition of deterioration in a patient's condition. We examined workflow processes to identify workarounds related to vital signs in a 372-bed hospital in Sweden. In three clinical areas, a qualitative study was performed with data collected during observations and interviews and analysed through thematic content analysis. We identified paper workarounds in the form of handwritten notes and a total of eight pre-printed paper observation charts. Our results suggested that nurses created workarounds to allow a smooth workflow and ensure patients safety.

  1. A high-level object-oriented model for representing relationships in an electronic medical record.

    PubMed Central

    Dolin, R. H.

    1994-01-01

    The importance of electronic medical records to improve the quality and cost-effectiveness of medical care continues to be realized. This growing importance has spawned efforts at defining the structure and content of medical data, which is heterogeneous, highly inter-related, and complex. Computer-assisted data modeling tools have greatly facilitated the process of representing medical data, however the complex inter-relationships of medical information can result in data models that are large and cumbersome to manipulate and view. This report presents a high-level object-oriented model for representing the relationships between objects or entities that might exist in an electronic medical record. By defining the relationship between objects at a high level and providing for inheritance, this model enables relating any medical entity to any other medical entity, even though the relationships were not directly specified or known during data model design. PMID:7949981

  2. Hand disinfection in a neonatal intensive care unit: continuous electronic monitoring over a one-year period.

    PubMed

    Helder, Onno K; van Goudoever, Johannes B; Hop, Wim C J; Brug, Johannes; Kornelisse, René F

    2012-10-08

    Good hand hygiene compliance is essential to prevent nosocomial infections in healthcare settings. Direct observation of hand hygiene compliance is the gold standard but is time consuming. An electronic dispenser with built-in wireless recording equipment allows continuous monitoring of its usage. The purpose of this study was to monitor the use of alcohol-based hand rub dispensers with a built-in electronic counter in a neonatal intensive care unit (NICU) setting and to determine compliance with hand hygiene protocols by direct observation. A one-year observational study was conducted at a 27 bed level III NICU at a university hospital. All healthcare workers employed at the NICU participated in the study. The use of bedside dispensers was continuously monitored and compliance with hand hygiene was determined by random direct observations. A total of 258,436 hand disinfection events were recorded; i.e. a median (interquartile range) of 697 (559-840) per day. The median (interquartile range) number of hand disinfection events performed per healthcare worker during the day, evening, and night shifts was 13.5 (10.8 - 16.7), 19.8 (16.3 - 24.1), and 16.6 (14.2 - 19.3), respectively. In 65.8% of the 1,168 observations of patient contacts requiring hand hygiene, healthcare workers fully complied with the protocol. We conclude that the electronic devices provide useful information on frequency, time, and location of its use, and also reveal trends in hand disinfection events over time. Direct observations offer essential data on compliance with the hand hygiene protocol. In future research, data generated by the electronic devices can be supplementary used to evaluate the effectiveness of hand hygiene promotion campaigns.

  3. Electronic medical archives: a different approach to applying re-signing mechanisms to digital signatures.

    PubMed

    Chen, Tzer-Long; Lin, Frank Y S

    2011-08-01

    Electronic medical records can be defined as a digital format of the traditionally paper-based anamneses, which contains the history of a patient such as his somewhat illness, current health problems, and his chronic treatments. An electronic anamnesis is meant to make the patient's health information more conveniently accessible and transferable between different medical institutions and also easier to be kept quite a long time. Because of such transferability and accessibility of electronic anamneses, we can use less resource than before on storing the patients' medical information. This also means that medical care providers could save more funds on record-keeping and access a patient's medical background directly since shown on the computer screen more quickly and easily. Overall, the service quality has seemingly improved greatly. However, the usage of electronic anamneses involves in some concerned issues such as its related law declaration, and the security of the patient's confidential information. Because of these concerns, a secure medical networking scheme is taking into consideration. Nowadays, the administrators at the medical institutions are facing more challenges on monitoring computers and network systems, because of dramatic advances in this field. For instance, a trusted third party is authorized to access some medical records for a certain period of time. In regard to the security purpose, all the electronic medical records are embedded with both of the public-key infrastructure (PKI) cryptography and the digital signature technique so as to ensure the records well-protected. Since the signatures will be invalid due to the revocation or time expiration, the security of records under this premise would turn into vulnerable. Hence, we propose a re-signing scheme, whose purpose is to make a going-expired digital signature been resigned in time, in keeping with the premise of not conflicting with the laws, morals, and privacy while maintaining the security of the electronic medical records.

  4. Learning a Health Knowledge Graph from Electronic Medical Records.

    PubMed

    Rotmensch, Maya; Halpern, Yoni; Tlimat, Abdulhakim; Horng, Steven; Sontag, David

    2017-07-20

    Demand for clinical decision support systems in medicine and self-diagnostic symptom checkers has substantially increased in recent years. Existing platforms rely on knowledge bases manually compiled through a labor-intensive process or automatically derived using simple pairwise statistics. This study explored an automated process to learn high quality knowledge bases linking diseases and symptoms directly from electronic medical records. Medical concepts were extracted from 273,174 de-identified patient records and maximum likelihood estimation of three probabilistic models was used to automatically construct knowledge graphs: logistic regression, naive Bayes classifier and a Bayesian network using noisy OR gates. A graph of disease-symptom relationships was elicited from the learned parameters and the constructed knowledge graphs were evaluated and validated, with permission, against Google's manually-constructed knowledge graph and against expert physician opinions. Our study shows that direct and automated construction of high quality health knowledge graphs from medical records using rudimentary concept extraction is feasible. The noisy OR model produces a high quality knowledge graph reaching precision of 0.85 for a recall of 0.6 in the clinical evaluation. Noisy OR significantly outperforms all tested models across evaluation frameworks (p < 0.01).

  5. Direct measurement of electron transfer distance decay constants of single redox proteins by electrochemical tunneling spectroscopy.

    PubMed

    Artés, Juan M; Díez-Pérez, Ismael; Sanz, Fausto; Gorostiza, Pau

    2011-03-22

    We present a method to measure directly and at the single-molecule level the distance decay constant that characterizes the rate of electron transfer (ET) in redox proteins. Using an electrochemical tunneling microscope under bipotentiostatic control, we obtained current−distance spectroscopic recordings of individual redox proteins confined within a nanometric tunneling gap at a well-defined molecular orientation. The tunneling current decays exponentially, and the corresponding decay constant (β) strongly supports a two-step tunneling ET mechanism. Statistical analysis of decay constant measurements reveals differences between the reduced and oxidized states that may be relevant to the control of ET rates in enzymes and biological electron transport chains.

  6. How complete are immunization registries? The Philadelphia story.

    PubMed

    Kolasa, Maureen S; Chilkatowsky, Andrew P; Clarke, Kevin R; Lutz, James P

    2006-01-01

    To assess accuracy and completeness of Philadelphia, Pa, registry data among children served by providers in areas at risk for underimmunization. Philadelphia's Department of Public Health selected a simple random sample of 45 children age 19-35 months (or all children age 19-35 months if there were <45 children in the practice) from each of 30 private practices receiving government-funded vaccine and located in zip codes where children are at risk for underimmunization. Chart and registry data were compared with determine the proportion of children missing from the registry and assess differences in immunization coverage. Of 620 children reviewed, 567 (92%) were in the registry. Significant differences (P < .05) were observed in immunization coverage for 4 diphtheria-tetanus-acellular pertussis vaccinations, 3 polio vaccinations, 1 measles-mumps-rubella vaccination, and 3 Haemophilus influenzae type b vaccinations between the chart (80% coverage) and registry (62% coverage). Providers submitting electronic medical records or directly transferring electronic data to the registry had significantly more children in the registry and higher registry-reported immunization coverage than those whose data were entered from billing records or log forms. All practice types experienced difficulties in transferring complete data to the registry. Although 92% of study children were in the registry, immunization coverage was significantly lower when registry data were compared with chart data. Because electronic medical records and direct electronic data transfer resulted in more complete registry data, these methods should be encouraged in linking providers with immunization registries.

  7. Time-resolved cathodoluminescence microscopy with sub-nanosecond beam blanking for direct evaluation of the local density of states.

    PubMed

    Moerland, Robert J; Weppelman, I Gerward C; Garming, Mathijs W H; Kruit, Pieter; Hoogenboom, Jacob P

    2016-10-17

    We show cathodoluminescence-based time-resolved electron beam spectroscopy in order to directly probe the spontaneous emission decay rate that is modified by the local density of states in a nanoscale environment. In contrast to dedicated laser-triggered electron-microscopy setups, we use commercial hardware in a standard SEM, which allows us to easily switch from pulsed to continuous operation of the SEM. Electron pulses of 80-90 ps duration are generated by conjugate blanking of a high-brightness electron beam, which allows probing emitters within a large range of decay rates. Moreover, we simultaneously attain a resolution better than λ/10, which ensures details at deep-subwavelength scales can be retrieved. As a proof-of-principle, we employ the pulsed electron beam to spatially measure excited-state lifetime modifications in a phosphor material across the edge of an aluminum half-plane, coated on top of the phosphor. The measured emission dynamics can be directly related to the structure of the sample by recording photon arrival histograms together with the secondary-electron signal. Our results show that time-resolved electron cathodoluminescence spectroscopy is a powerful tool of choice for nanophotonics, within reach of a large audience.

  8. Integration of radiographic images with an electronic medical record.

    PubMed Central

    Overhage, J. M.; Aisen, A.; Barnes, M.; Tucker, M.; McDonald, C. J.

    2001-01-01

    Radiographic images are important and expensive diagnostic tests. However, the provider caring for the patient often does not review the images directly due to time constraints. Institutions can use picture archiving and communications systems to make images more available to the provider, but this may not be the best solution. We integrated radiographic image review into the Regenstrief Medical Record System in order to address this problem. To achieve adequate performance, we store JPEG compressed images directly in the RMRS. Currently, physicians review about 5% of all radiographic studies using the RMRS image review function. PMID:11825241

  9. Health Information Systems.

    PubMed

    Sirintrapun, S Joseph; Artz, David R

    2015-06-01

    This article provides surgical pathologists an overview of health information systems (HISs): what they are, what they do, and how such systems relate to the practice of surgical pathology. Much of this article is dedicated to the electronic medical record. Information, in how it is captured, transmitted, and conveyed, drives the effectiveness of such electronic medical record functionalities. So critical is information from pathology in integrated clinical care that surgical pathologists are becoming gatekeepers of not only tissue but also information. Better understanding of HISs can empower surgical pathologists to become stakeholders who have an impact on the future direction of quality integrated clinical care. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Continuity of care through medical records--an explorative study on GPs' management considerations.

    PubMed

    Schers, Henk; van den Hoogen, Henk; Grol, Richard; van den Bosch, Wil

    2006-06-01

    The growing complexity of care with more professionals involved is a threat to the delivery of coherent and consistent care. Excellent exchange of information between professionals may be a way to maintain continuity of care. Relevant information to be passed over includes thoughts about future management for individual patients. To explore the nature of GPs' thoughts about future management, and to determine the extent to which such thoughts are actually recorded in medical records. Cross-sectional study of 5741 consultations. Thirty GPs from 17 practices in a region in the eastern part of The Netherlands. The GPs responded to an electronic questionnaire, directly after 200 successive consultations. The questionnaire included items on management considerations, consultation characteristics and personal continuity. We compared the data from the questionnaire to the actual recording of management considerations in the patient records. The GPs had management considerations in 66.4% of the consultations, involving mainly considerations about additional testing (15.5%), adjustment of medication (22.5%), alternative treatment plans (18.6%), possible referral (11.8%) and coping behaviour (18.0%). These considerations were seldom recorded in the electronic patient record; additional testing (3.0%) adjustment of medication (2.9%) and alternative treatment plans (4.1%). Surprisingly however, GPs rarely found that management considerations from earlier consultations were lacking in the medical record. GPs often have thoughts on how to deal with this patient, but hardly ever record such considerations. We recommend the development of tools that facilitate the recording of management considerations in electronic patient records.

  11. Computer synthesis of high resolution electron micrographs

    NASA Technical Reports Server (NTRS)

    Nathan, R.

    1976-01-01

    Specimen damage, spherical aberration, low contrast and noisy sensors combine to prevent direct atomic viewing in a conventional electron microscope. The paper describes two methods for obtaining ultra-high resolution in biological specimens under the electron microscope. The first method assumes the physical limits of the electron objective lens and uses a series of dark field images of biological crystals to obtain direct information on the phases of the Fourier diffraction maxima; this information is used in an appropriate computer to synthesize a large aperture lens for a 1-A resolution. The second method assumes there is sufficient amplitude scatter from images recorded in focus which can be utilized with a sensitive densitometer and computer contrast stretching to yield fine structure image details. Cancer virus characterization is discussed as an illustrative example. Numerous photographs supplement the text.

  12. Direct Observation of Spatiotemporal Dynamics of Short Electron Bunches in Storage Rings

    NASA Astrophysics Data System (ADS)

    Evain, C.; Roussel, E.; Le Parquier, M.; Szwaj, C.; Tordeux, M.-A.; Brubach, J.-B.; Manceron, L.; Roy, P.; Bielawski, S.

    2017-02-01

    In recent synchrotron radiation facilities, the use of short (picosecond) electron bunches is a powerful method for producing giant pulses of terahertz coherent synchrotron radiation. Here we report on the first direct observation of these pulse shapes with a few picoseconds resolution, and of their dynamics over a long time. We thus confirm in a very direct way the theories predicting an interplay between two physical processes. Below a critical bunch charge, we observe a train of identical THz pulses (a broadband Terahertz comb) stemming from the shortness of the electron bunches. Above this threshold, a large part of the emission is dominated by drifting structures, which appear through spontaneous self-organization. These challenging single-shot THz recordings are made possible by using a recently developed photonic time stretch detector with a high sensitivity. The experiment has been realized at the SOLEIL storage ring.

  13. Accuracy of Laboratory Data Communication on ICU Daily Rounds Using an Electronic Health Record.

    PubMed

    Artis, Kathryn A; Dyer, Edward; Mohan, Vishnu; Gold, Jeffrey A

    2017-02-01

    Accurately communicating patient data during daily ICU rounds is critically important since data provide the basis for clinical decision making. Despite its importance, high fidelity data communication during interprofessional ICU rounds is assumed, yet unproven. We created a robust but simple methodology to measure the prevalence of inaccurately communicated (misrepresented) data and to characterize data communication failures by type. We also assessed how commonly the rounding team detected data misrepresentation and whether data communication was impacted by environmental, human, and workflow factors. Direct observation of verbalized laboratory data during daily ICU rounds compared with data within the electronic health record and on presenters' paper prerounding notes. Twenty-six-bed academic medical ICU with a well-established electronic health record. ICU rounds presenter (medical student or resident physician), interprofessional rounding team. None. During 301 observed patient presentations including 4,945 audited laboratory results, presenters used a paper prerounding tool for 94.3% of presentations but tools contained only 78% of available electronic health record laboratory data. Ninty-six percent of patient presentations included at least one laboratory misrepresentation (mean, 6.3 per patient) and 38.9% of all audited laboratory data were inaccurately communicated. Most misrepresentation events were omissions. Only 7.8% of all laboratory misrepresentations were detected. Despite a structured interprofessional rounding script and a well-established electronic health record, clinician laboratory data retrieval and communication during ICU rounds at our institution was poor, prone to omissions and inaccuracies, yet largely unrecognized by the rounding team. This highlights an important patient safety issue that is likely widely prevalent, yet underrecognized.

  14. Demonstrating Sound Impulses in Pipes.

    ERIC Educational Resources Information Center

    Raymer, M. G.; Micklavzina, Stan

    1995-01-01

    Describes a simple, direct method to demonstrate the effects of the boundary conditions on sound impulse reflections in pipes. A graphical display of the results can be made using a pipe, cork, small hammer, microphone, and fast recording electronics. Explains the principles involved. (LZ)

  15. 2dx_automator: implementation of a semiautomatic high-throughput high-resolution cryo-electron crystallography pipeline.

    PubMed

    Scherer, Sebastian; Kowal, Julia; Chami, Mohamed; Dandey, Venkata; Arheit, Marcel; Ringler, Philippe; Stahlberg, Henning

    2014-05-01

    The introduction of direct electron detectors (DED) to cryo-electron microscopy has tremendously increased the signal-to-noise ratio (SNR) and quality of the recorded images. We discuss the optimal use of DEDs for cryo-electron crystallography, introduce a new automatic image processing pipeline, and demonstrate the vast improvement in the resolution achieved by the use of both together, especially for highly tilted samples. The new processing pipeline (now included in the software package 2dx) exploits the high SNR and frame readout frequency of DEDs to automatically correct for beam-induced sample movement, and reliably processes individual crystal images without human interaction as data are being acquired. A new graphical user interface (GUI) condenses all information required for quality assessment in one window, allowing the imaging conditions to be verified and adjusted during the data collection session. With this new pipeline an automatically generated unit cell projection map of each recorded 2D crystal is available less than 5 min after the image was recorded. The entire processing procedure yielded a three-dimensional reconstruction of the 2D-crystallized ion-channel membrane protein MloK1 with a much-improved resolution of 5Å in-plane and 7Å in the z-direction, within 2 days of data acquisition and simultaneous processing. The results obtained are superior to those delivered by conventional photographic film-based methodology of the same sample, and demonstrate the importance of drift-correction. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

  16. Television animation store: Recording pictures on a parallel transfer magnetic disc

    NASA Astrophysics Data System (ADS)

    Durey, A. J.

    1984-12-01

    The recording and replaying of digital video signals using a computer-type magnetic disc-drive as part of an electronic rostrum camera animation system is described. The system was developed to enable picture sequences to be generated directly as television signals, instead of using cine film. The characteristics of the disc-drive are described together with data processing, error protection and signal synchronization systems, which enable digital television YUV component signals, sampled at 12 MHz, 4 MHz and 4 MHz respectively, to be recorded and replayed in real time.

  17. 47 CFR 36.121 - General.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...: Central Office Switching Account 2210. Non-digital Switching Account 2211. Digital Electronic Switching... Account 2231. Circuit Equipment Account 2232. (b) Records of the cost of central office equipment are... directly to that category, e.g., 130 volt power supply provided for circuit equipment. The cost of...

  18. 47 CFR 36.121 - General.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...: Central Office Switching Account 2210. Non-digital Switching Account 2211. Digital Electronic Switching... Account 2231. Circuit Equipment Account 2232. (b) Records of the cost of central office equipment are... directly to that category, e.g., 130 volt power supply provided for circuit equipment. The cost of...

  19. 47 CFR 36.121 - General.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...: Central Office Switching Account 2210. Non-digital Switching Account 2211. Digital Electronic Switching... Account 2231. Circuit Equipment Account 2232. (b) Records of the cost of central office equipment are... directly to that category, e.g., 130 volt power supply provided for circuit equipment. The cost of...

  20. 47 CFR 36.121 - General.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...: Central Office Switching Account 2210. Non-digital Switching Account 2211. Digital Electronic Switching... Account 2231. Circuit Equipment Account 2232. (b) Records of the cost of central office equipment are... directly to that category, e.g., 130 volt power supply provided for circuit equipment. The cost of...

  1. 47 CFR 36.121 - General.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...: Central Office Switching Account 2210. Non-digital Switching Account 2211. Digital Electronic Switching... Account 2231. Circuit Equipment Account 2232. (b) Records of the cost of central office equipment are... directly to that category, e.g., 130 volt power supply provided for circuit equipment. The cost of...

  2. Legal aspects of E-HEALTH.

    PubMed

    Callens, Stefaan; Cierkens, Kim

    2008-01-01

    Cross-border activities in health care in the European single market are increasing. Many of these cross-border developments are related to e-Health. E-Health describes the application of information and communication technologies across the whole range of functions that affect the health care sector. E-health attracts a growing interest on the European level that highlights the sharp need of appropriate regulatory framework able to ensure its promotion in the European Union. Some Directives constitute a step in this direction. Both the Data Protection Directive, the E-Commerce Directive, the Medical Device Directive and the Directive on Distance Contracting are some of the most important European legal achievements related to e-Health. Although the directives are not adopted especially for e-health applications, they are indirectly very important for e-Health. Firstly, the Data Protection Directive applies to personal data which form part of a filing system and contains several important principles that have to be complied with by e-Health actors processing personal data concerning health. Secondly, the E-commerce Directive applies to services provided at a distance by electronic means. Many e-Health applications fall within this scope. Thirdly, the Medical Devices Directive is of importance for the e-Health sector, especially with regard to e.g. the medical software that is used in many e-health applications. Finally, the Directive on Distance Contracting applies to contracts for goods or services which make use of one or more means of distance communication; E-Health business may involve the conclusion of contracts. Despite these Directives more developments are needed at the European level in order to make sure that e-Health will play an even more important role in health care systems than is the case today. The new e-Health applications like electronic health records, e-health platforms, health grids and the further use of genetic data and tissue involve new legal challenges. Several member states are introducing electronic health records or e-Health platforms. The use of electronic health records that contain data of several health actors poses new risks with some legal consequences. Recently, grids are being used in some ambitious medical and healthcare applications. In order to be truly effective such grid applications must draw together huge amounts of data from disparately located computers - which implies data sharing across jurisdictions and the sharing of responsibilities by a range of different data controllers. E-Health will also enhance the further use of human tissue and genetic data. More and clear guidelines on the reimbursement criteria for telemedicine and on liability would also be very useful. Guidance at the European level can be given as to the criteria that (tele-) health sessions will have to comply with for reimbursement purposes, since it is still unclear when e-Health sessions will be reimbursed. It is clear that the existing European legal framework is not finished yet and that more specific European rules are needed.

  3. How electronic health records can unmask the hidden value of PAs.

    PubMed

    Ogunfiditimi, Folusho; Sherry, Scott P; Foote, Monica; Christie, Sarah L; Shock, Lisa P; Cawley, James; Browne, Aaron

    2017-06-01

    The Fee for Value (FFV) Task Force, a subgroup of the American Academy of PAs' Research and Strategic Initiatives Commission, has examined tools and mechanisms aimed at better clarifying the volume and value of PA work and how that work contributes to improving access to high-quality care. Establishing the value of PAs has been a challenging task for many healthcare providers. Often, PA value has been defined by their clinical productivity, without any clear direction as to what constitutes value versus productivity. The objective of this article is to unmask the value of PAs through the role of electronic health records and highlight PAs' ability to produce services that are value-oriented and quantifiably productive.

  4. High Dynamic Range Pixel Array Detector for Scanning Transmission Electron Microscopy.

    PubMed

    Tate, Mark W; Purohit, Prafull; Chamberlain, Darol; Nguyen, Kayla X; Hovden, Robert; Chang, Celesta S; Deb, Pratiti; Turgut, Emrah; Heron, John T; Schlom, Darrell G; Ralph, Daniel C; Fuchs, Gregory D; Shanks, Katherine S; Philipp, Hugh T; Muller, David A; Gruner, Sol M

    2016-02-01

    We describe a hybrid pixel array detector (electron microscope pixel array detector, or EMPAD) adapted for use in electron microscope applications, especially as a universal detector for scanning transmission electron microscopy. The 128×128 pixel detector consists of a 500 µm thick silicon diode array bump-bonded pixel-by-pixel to an application-specific integrated circuit. The in-pixel circuitry provides a 1,000,000:1 dynamic range within a single frame, allowing the direct electron beam to be imaged while still maintaining single electron sensitivity. A 1.1 kHz framing rate enables rapid data collection and minimizes sample drift distortions while scanning. By capturing the entire unsaturated diffraction pattern in scanning mode, one can simultaneously capture bright field, dark field, and phase contrast information, as well as being able to analyze the full scattering distribution, allowing true center of mass imaging. The scattering is recorded on an absolute scale, so that information such as local sample thickness can be directly determined. This paper describes the detector architecture, data acquisition system, and preliminary results from experiments with 80-200 keV electron beams.

  5. Case Study: The Transformation of the Health Record; The Impact of Electronic Medical Records in a Military Treatment Facility

    DTIC Science & Technology

    2006-06-01

    technology , communication , and incremental and manageable deployment plans. Hospital Leadership Support is Essential AHLTA is supported by the senior leaders...Information Technology The importance of information technology and the desire to utilize it for improved health care outcomes is part of the NMCSD... technology applications had a direct positive impact on AHLTA’s deployment at NMCSD. Communication As previously discussed in the leadership

  6. Multifunctional epidermal electronics printed directly onto the skin.

    PubMed

    Yeo, Woon-Hong; Kim, Yun-Soung; Lee, Jongwoo; Ameen, Abid; Shi, Luke; Li, Ming; Wang, Shuodao; Ma, Rui; Jin, Sung Hun; Kang, Zhan; Huang, Yonggang; Rogers, John A

    2013-05-28

    Materials and designs are presented for electronics and sensors that can be conformally and robustly integrated onto the surface of the skin. A multifunctional device of this type can record various physiological signals relevant to health and wellness. This class of technology offers capabilities in biocompatible, non-invasive measurement that lie beyond those available with conventional, point-contact electrode interfaces to the skin. Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  7. Inflammation-free, gas-permeable, lightweight, stretchable on-skin electronics with nanomeshes

    NASA Astrophysics Data System (ADS)

    Miyamoto, Akihito; Lee, Sungwon; Cooray, Nawalage Florence; Lee, Sunghoon; Mori, Mami; Matsuhisa, Naoji; Jin, Hanbit; Yoda, Leona; Yokota, Tomoyuki; Itoh, Akira; Sekino, Masaki; Kawasaki, Hiroshi; Ebihara, Tamotsu; Amagai, Masayuki; Someya, Takao

    2017-09-01

    Thin-film electronic devices can be integrated with skin for health monitoring and/or for interfacing with machines. Minimal invasiveness is highly desirable when applying wearable electronics directly onto human skin. However, manufacturing such on-skin electronics on planar substrates results in limited gas permeability. Therefore, it is necessary to systematically investigate their long-term physiological and psychological effects. As a demonstration of substrate-free electronics, here we show the successful fabrication of inflammation-free, highly gas-permeable, ultrathin, lightweight and stretchable sensors that can be directly laminated onto human skin for long periods of time, realized with a conductive nanomesh structure. A one-week skin patch test revealed that the risk of inflammation caused by on-skin sensors can be significantly suppressed by using the nanomesh sensors. Furthermore, a wireless system that can detect touch, temperature and pressure is successfully demonstrated using a nanomesh with excellent mechanical durability. In addition, electromyogram recordings were successfully taken with minimal discomfort to the user.

  8. Direct and Electronic Health Record Access to the Clinical Decision Support for Immunizations in the Minnesota Immunization Information System.

    PubMed

    Rajamani, Sripriya; Bieringer, Aaron; Wallerius, Stephanie; Jensen, Daniel; Winden, Tamara; Muscoplat, Miriam Halstead

    2016-01-01

    Immunization information systems (IIS) are population-based and confidential computerized systems maintained by public health agencies containing individual data on immunizations from participating health care providers. IIS hold comprehensive vaccination histories given across providers and over time. An important aspect to IIS is the clinical decision support for immunizations (CDSi), consisting of vaccine forecasting algorithms to determine needed immunizations. The study objective was to analyze the CDSi presentation by IIS in Minnesota (Minnesota Immunization Information Connection [MIIC]) through direct access by IIS interface and by access through electronic health records (EHRs) to outline similarities and differences. The immunization data presented were similar across the three systems examined, but with varying ability to integrate data across MIIC and EHR, which impacts immunization data reconciliation. Study findings will lead to better understanding of immunization data display, clinical decision support, and user functionalities with the ultimate goal of promoting IIS CDSi to improve vaccination rates.

  9. Access control and privilege management in electronic health record: a systematic literature review.

    PubMed

    Jayabalan, Manoj; O'Daniel, Thomas

    2016-12-01

    This study presents a systematic literature review of access control for electronic health record systems to protect patient's privacy. Articles from 2006 to 2016 were extracted from the ACM Digital Library, IEEE Xplore Digital Library, Science Direct, MEDLINE, and MetaPress using broad eligibility criteria, and chosen for inclusion based on analysis of ISO22600. Cryptographic standards and methods were left outside the scope of this review. Three broad classes of models are being actively investigated and developed: access control for electronic health records, access control for interoperability, and access control for risk analysis. Traditional role-based access control models are extended with spatial, temporal, probabilistic, dynamic, and semantic aspects to capture contextual information and provide granular access control. Maintenance of audit trails and facilities for overriding normal roles to allow full access in emergency cases are common features. Access privilege frameworks utilizing ontology-based knowledge representation for defining the rules have attracted considerable interest, due to the higher level of abstraction that makes it possible to model domain knowledge and validate access requests efficiently.

  10. Electronic medical records in diabetes consultations: participants' gaze as an interactional resource.

    PubMed

    Rhodes, Penny; Small, Neil; Rowley, Emma; Langdon, Mark; Ariss, Steven; Wright, John

    2008-09-01

    Two routine consultations in primary care diabetes clinics are compared using extracts from video recordings of interactions between nurses and patients. The consultations were chosen to present different styles of interaction, in which the nurse's gaze was either primarily toward the computer screen or directed more toward the patient. Using conversation analysis, the ways in which nurses shift both gaze and body orientation between the computer screen and patient to influence the style, pace, content, and structure of the consultation were investigated. By examining the effects of different levels of engagement between the electronic medical record and the embodied patient in the consultation room, we argue for the need to consider the contingent nature of the interface of technology and the person in the consultation. Policy initiatives designed to deliver what is considered best-evidenced practice are modified in the micro context of the interactions of the consultation.

  11. One positive impact of health care reform to physicians: the computer-based patient record.

    PubMed

    England, S P

    1993-11-01

    The health care industry is an information-dependent business that will require a new generation of health information systems if successful health care reform is to occur. We critically need integrated clinical management information systems to support the physician and related clinicians at the direct care level, which in turn will have linkages with secondary users of health information such as health payors, regulators, and researchers. The economic dependence of health care industry on the CPR cannot be underestimated, says Jeffrey Ritter. He sees the U.S. health industry as about to enter a bold new age where our records are electronic, our computers are interconnected, and our money is nothing but pulses running across the telephone lines. Hence the United States is now in an age of electronic commerce. Clinical systems reform must begin with the community-based patient chart, which is located in the physician's office, the hospital, and other related health care provider offices. A community-based CPR and CPR system that integrates all providers within a managed care network is the most logical step since all health information begins with the creation of a patient record. Once a community-based CPR system is in place, the physician and his or her clinical associates will have a common patient record upon which all direct providers have access to input and record patient information. Once a community-level CPR system is in place with a community provider network, each physician will have available health information and data processing capability that will finally provide real savings in professional time and effort. Lost patient charts will no longer be a problem. Data input and storage of health information would occur electronically via transcripted text, voice, and document imaging. All electronic clinical information, voice, and graphics could be recalled at any time and transmitted to any terminal location within the health provider network. Hence, health system re-engineering must begin and be developed where health information is initially created--in the physician's office or clinic.

  12. Combined scanning transmission electron microscopy tilt- and focal series.

    PubMed

    Dahmen, Tim; Baudoin, Jean-Pierre; Lupini, Andrew R; Kübel, Christian; Slusallek, Philipp; de Jonge, Niels

    2014-04-01

    In this study, a combined tilt- and focal series is proposed as a new recording scheme for high-angle annular dark-field scanning transmission electron microscopy (STEM) tomography. Three-dimensional (3D) data were acquired by mechanically tilting the specimen, and recording a through-focal series at each tilt direction. The sample was a whole-mount macrophage cell with embedded gold nanoparticles. The tilt-focal algebraic reconstruction technique (TF-ART) is introduced as a new algorithm to reconstruct tomograms from such combined tilt- and focal series. The feasibility of TF-ART was demonstrated by 3D reconstruction of the experimental 3D data. The results were compared with a conventional STEM tilt series of a similar sample. The combined tilt- and focal series led to smaller "missing wedge" artifacts, and a higher axial resolution than obtained for the STEM tilt series, thus improving on one of the main issues of tilt series-based electron tomography.

  13. Using electronic health record alerts to provide public health situational awareness to clinicians.

    PubMed

    Lurio, Joseph; Morrison, Frances P; Pichardo, Michelle; Berg, Rachel; Buck, Michael D; Wu, Winfred; Kitson, Kwame; Mostashari, Farzad; Calman, Neil

    2010-01-01

    Alerting providers to public health situations requires timeliness and context-relevance, both lacking in current systems. Incorporating decision support tools into electronic health records may provide a way to deploy public health alerts to clinicians at the point of care. A timely process for responding to Health Alert Network messages sent by the New York City Department of Health and Mental Hygiene was developed by a network of community health centers. Alerts with order sets and recommended actions were created to notify primary care providers of local disease outbreaks. The process, effect, and lessons learned from alerts for Legionella, toxogenic E coli, and measles outbreaks are described. Electronic alerts have the potential to improve management of diseases during an outbreak, including appropriate laboratory testing, management guidance, and diagnostic assistance as well as to enhance bi-directional data exchange between clinical and public health organizations.

  14. Using electronic health record alerts to provide public health situational awareness to clinicians

    PubMed Central

    Lurio, Joseph; Pichardo, Michelle; Berg, Rachel; Buck, Michael D; Wu, Winfred; Kitson, Kwame; Mostashari, Farzad; Calman, Neil

    2010-01-01

    Alerting providers to public health situations requires timeliness and context-relevance, both lacking in current systems. Incorporating decision support tools into electronic health records may provide a way to deploy public health alerts to clinicians at the point of care. A timely process for responding to Health Alert Network messages sent by the New York City Department of Health and Mental Hygiene was developed by a network of community health centers. Alerts with order sets and recommended actions were created to notify primary care providers of local disease outbreaks. The process, effect, and lessons learned from alerts for Legionella, toxogenic E coli, and measles outbreaks are described. Electronic alerts have the potential to improve management of diseases during an outbreak, including appropriate laboratory testing, management guidance, and diagnostic assistance as well as to enhance bi-directional data exchange between clinical and public health organizations. PMID:20190067

  15. 5 CFR 1303.30 - Definitions.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... included in direct costs are overhead expenses such as costs of space, and heating or lighting the facility... request. Such copies can take the form of paper, microform, audio-visual materials, or electronic records... institution of vocational education, that operates a program or programs of scholarly research. (i) The term...

  16. 5 CFR 1303.30 - Definitions.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... included in direct costs are overhead expenses such as costs of space, and heating or lighting the facility... request. Such copies can take the form of paper, microform, audio-visual materials, or electronic records... institution of vocational education, that operates a program or programs of scholarly research. (i) The term...

  17. 15 CFR 4.11 - Fees.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... benefits). Not included in direct costs are overhead expenses such as the costs of space, heating, or... the form of paper, microform, audiovisual materials, or electronic records (for example, magnetic tape... scholarly research. To be in this category, a requester must show that the request is authorized by and is...

  18. 15 CFR 4.11 - Fees.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... benefits). Not included in direct costs are overhead expenses such as the costs of space, heating, or... the form of paper, microform, audiovisual materials, or electronic records (for example, magnetic tape... scholarly research. To be in this category, a requester must show that the request is authorized by and is...

  19. 15 CFR 4.11 - Fees.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... benefits). Not included in direct costs are overhead expenses such as the costs of space, heating, or... the form of paper, microform, audiovisual materials, or electronic records (for example, magnetic tape... scholarly research. To be in this category, a requester must show that the request is authorized by and is...

  20. 5 CFR 1303.30 - Definitions.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... included in direct costs are overhead expenses such as costs of space, and heating or lighting the facility... request. Such copies can take the form of paper, microform, audio-visual materials, or electronic records... institution of vocational education, that operates a program or programs of scholarly research. (i) The term...

  1. 15 CFR 4.11 - Fees.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... benefits). Not included in direct costs are overhead expenses such as the costs of space, heating, or... the form of paper, microform, audiovisual materials, or electronic records (for example, magnetic tape... scholarly research. To be in this category, a requester must show that the request is authorized by and is...

  2. Changes to Workflow and Process Measures in the PICU During Transition From Semi to Full Electronic Health Record.

    PubMed

    Salib, Mina; Hoffmann, Raymond G; Dasgupta, Mahua; Zimmerman, Haydee; Hanson, Sheila

    2015-10-01

    Studies showing the changes in workflow during transition from semi to full electronic medical records are lacking. This objective study is to identify the changes in workflow in the PICU during transition from semi to full electronic health record. Prospective observational study. Children's Hospital of Wisconsin Institutional Review Board waived the need for approval so this study was institutional review board exempt. This study measured clinical workflow variables at a 72-bed PICU during different phases of transition to a full electronic health record, which occurred on November 4, 2012. Phases of electronic health record transition were defined as follows: pre-electronic health record (baseline data prior to transition to full electronic health record), transition phase (3 wk after electronic health record), and stabilization (6 mo after electronic health record). Data were analyzed for the three phases using Mann-Whitney U test with a two-sided p value of less than 0.05 considered significant. Seventy-two bed PICU. All patients in the PICU were included during the study periods. Five hundred and sixty-four patients with 2,355 patient days were evaluated in the three phases. Duration of rounds decreased from a median of 9 minutes per patient pre--electronic health record to 7 minutes per patient post electronic health record. Time to final note decreased from 2.06 days pre--electronic health record to 0.5 days post electronic health record. Time to first medication administration after admission also decreased from 33 minutes pre--electronic health record and 7 minutes post electronic health record. Time to Time to medication reconciliation was significantly higher pre-electronic health record than post electronic health record and percent of medication reconciliation completion was significantly lower pre--electronic health record than post electronic health record and percent of medication reconciliation completion was significantly higher pre--electronic health record than. There was no significant change in time between placement of discharge order and physical transfer from the unit [corrected].changes clinical workflow in a PICU with decreased duration of rounds, time to final note, time to medication administration, and time to medication reconciliation completion. There was no change in the duration from medical to physical transfer.

  3. Evaluation of immunization data completeness within a large community health care system exchanging data with a state immunization information system.

    PubMed

    Hendrickson, Bryan K; Panchanathan, Sarada S; Petitti, Diana

    2015-01-01

    Information systems are used by most states to maintain registries of immunization data both for monitoring population-level adherence and for use in clinical practice and research. Direct data exchange between such systems and electronic health record systems presents an opportunity to improve the completeness and quality of information available. Our goals were to describe and compare the completeness of the Arizona State Immunization System, the electronic health record at a large community health provider in Arizona exchanging electronic data with the Arizona system, and personal immunization records in an effort to contribute to the discussion on the completeness of state-run immunization registries and data exchange with these registries. Immunization histories from these sources were collected and reviewed sequentially. Unique dates of vaccination administrations were counted for each patient and tagged on the basis of comparisons across sources. We quantified completeness by combining information from all 3 sources and comparing each source with the complete set. We determined that the state registry was 71.8% complete, the hospital electronic health record was 81.9% complete, and personal records were 87.8% complete. Of the 2017 unique vaccination administrations, 65% were present in all 3 sources, 24.6% in 2 of the 3 sources, and 10.4% in only 1 source. Only 11% of patients had records in complete agreement across the 3 sources. This study highlights issues related to data completeness, exchange, and reporting of immunization information to state registries and suggests that there is some degree of deficiency in completeness of immunization registries and other sources. This study indicates that there is a need to strengthen links between electronic data sources with immunization information and describes potential improvements in completeness that such efforts could provide, enabling providers to better rely on state immunization registries and to improve research utilization of immunization information systems.

  4. 77 FR 12231 - Electronic On-Board Recorders and Hours of Service Supporting Documents

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-29

    ... consider as it addresses the distinction between productivity and harassment: what will prevent harassment... be used to monitor productivity of the operators. The court's expectation about how the Agency should address harassment and productivity under the statutory directive included the following: In addition, an...

  5. Concordance of Advance Care Plans With Inpatient Directives in the Electronic Medical Record for Older Patients Admitted From the Emergency Department.

    PubMed

    Grudzen, Corita R; Buonocore, Philip; Steinberg, Jonathan; Ortiz, Joanna M; Richardson, Lynne D

    2016-04-01

    Measuring What Matters identified quality indicators to examine the percentage of patients with documentation of a surrogate decision maker and preferences for life-sustaining treatments. To determine the rate of advance care planning in older adults presenting to the emergency department (ED) and translation into medical directives in the electronic medical record (EMR). A convenience sample of adults 65 years or older was recruited from a large urban ED beginning in January 2012. We administered a baseline interview and survey in English or Spanish, including questions about whether patients had a documented health care proxy or living will. For patients admitted to the hospital who had a health care proxy or living will, chart abstraction was performed to determine whether their advance care preferences were documented in the EMR. From February 2012 to May 2013, 53.8% (367 of 682) of older adults who completed the survey in the ED reported having a health care proxy, and 40.2% (274 of 682) had a living will. Of those admitted to the hospital, only 4% (4 of 94) of patients who said they had a living will had medical directives documented in the EMR. Similarly, only 4% (5 of 115) of patients who had a health care proxy had the person's name or contact information documented in their medical record. About half of the patients 65 years or older arriving in the ED have done significant advance care planning, but most plans are not recorded in the EMR. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  6. Assessment of data quality of and staff satisfaction with an electronic health record system in a developing country (Uganda): a qualitative and quantitative comparative study.

    PubMed

    Ndira, S P; Rosenberger, K D; Wetter, T

    2008-01-01

    To assess if electronic health record systems in developing countries can improve on timeliness, availability and accuracy of routine health reports and staff satisfaction after introducing the electronic system, compared to the paper-based alternative. The research was conducted with hospital staff of Tororo District Hospital in Uganda. A comparative intervention study with qualitative and quantitative methods was used to compare the paper-based (pre-test) to the electronic system (post-test) focusing on accuracy, availability and timeliness of monthly routine reports about mothers visiting the hospital; and staff satisfaction with the electronic system as outcome measures. Timeliness: pre-test 13 of 19 months delivered to the district timely, delivery dates for six months could not be established; post-test 100%. pre-test 79% of reports were present at the district health office; post-test 100%. Accuracy: pre-test 73.2% of selected reports could be independently confirmed as correct; post-test 71.2%. Difficulties were encountered in finding enough mothers through direct follow up to inquire on accuracy of information recorded about them. Staff interviews showed that the electronic system is appreciated by the majority of the hospital staff. Remaining obstacles include staff workload, power shortages, network breakdowns and parallel data entry (paper-based and electronic). While timeliness and availability improved, improvement of accuracy could not be established. Better approaches to ascertaining accuracy have to be devised, e.g. evaluation of intended use. For success, organizational, managerial and social challenges must be addressed beyond technical aspects.

  7. 76 FR 52991 - Renewal of Advisory Committee on Electronic Records Archives

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-24

    ... NATIONAL ARCHIVES AND RECORDS ADMINISTRATION Renewal of Advisory Committee on Electronic Records... Records Administration's (NARA) Advisory Committee on Electronic Records Archives. In accordance with... Committee on Electronic Records Archives in NARA's ceiling of discretionary advisory committees. FOR FURTHER...

  8. The Relationship Between Magnet Designation, Electronic Health Record Adoption, and Medicare Meaningful Use Payments.

    PubMed

    Lippincott, Christine; Foronda, Cynthia; Zdanowicz, Martin; McCabe, Brian E; Ambrosia, Todd

    2017-08-01

    The objective of this study was to examine the relationship between nursing excellence and electronic health record adoption. Of 6582 US hospitals, 4939 were eligible for the Medicare Electronic Health Record Incentive Program, and 6419 were eligible for evaluation on the HIMSS Analytics Electronic Medical Record Adoption Model. Of 399 Magnet hospitals, 330 were eligible for the Medicare Electronic Health Record Incentive Program, and 393 were eligible for evaluation in the HIMSS Analytics Electronic Medical Record Adoption Model. Meaningful use attestation was defined as receipt of a Medicare Electronic Health Record Incentive Program payment. The adoption electronic health record was defined as Level 6 and/or 7 on the HIMSS Analytics Electronic Medical Record Adoption Model. Logistic regression showed that Magnet-designated hospitals were more likely attest to Meaningful Use than non-Magnet hospitals (odds ratio = 3.58, P < .001) and were more likely to adopt electronic health records than non-Magnet hospitals (Level 6 only: odds ratio = 3.68, P < .001; Level 6 or 7: odds ratio = 4.02, P < .001). This study suggested a positive relationship between Magnet status and electronic health record use, which involves earning financial incentives for successful adoption. Continued investigation is needed to examine the relationships between the quality of nursing care, electronic health record usage, financial implications, and patient outcomes.

  9. Measuring up: Implementing a dental quality measure in the electronic health record context.

    PubMed

    Bhardwaj, Aarti; Ramoni, Rachel; Kalenderian, Elsbeth; Neumann, Ana; Hebballi, Nutan B; White, Joel M; McClellan, Lyle; Walji, Muhammad F

    2016-01-01

    Quality improvement requires using quality measures that can be implemented in a valid manner. Using guidelines set forth by the Meaningful Use portion of the Health Information Technology for Economic and Clinical Health Act, the authors assessed the feasibility and performance of an automated electronic Meaningful Use dental clinical quality measure to determine the percentage of children who received fluoride varnish. The authors defined how to implement the automated measure queries in a dental electronic health record. Within records identified through automated query, the authors manually reviewed a subsample to assess the performance of the query. The automated query results revealed that 71.0% of patients had fluoride varnish compared with the manual chart review results that indicated 77.6% of patients had fluoride varnish. The automated quality measure performance results indicated 90.5% sensitivity, 90.8% specificity, 96.9% positive predictive value, and 75.2% negative predictive value. The authors' findings support the feasibility of using automated dental quality measure queries in the context of sufficient structured data. Information noted only in free text rather than in structured data would require using natural language processing approaches to effectively query electronic health records. To participate in self-directed quality improvement, dental clinicians must embrace the accountability era. Commitment to quality will require enhanced documentation to support near-term automated calculation of quality measures. Copyright © 2016 American Dental Association. Published by Elsevier Inc. All rights reserved.

  10. Spaceborne electronic imaging systems

    NASA Technical Reports Server (NTRS)

    1971-01-01

    Criteria and recommended practices for the design of the spaceborne elements of electronic imaging systems are presented. A spaceborne electronic imaging system is defined as a device that collects energy in some portion of the electromagnetic spectrum with detector(s) whose direct output is an electrical signal that can be processed (using direct transmission or delayed transmission after recording) to form a pictorial image. This definition encompasses both image tube systems and scanning point-detector systems. The intent was to collect the design experience and recommended practice of the several systems possessing the common denominator of acquiring images from space electronically and to maintain the system viewpoint rather than pursuing specialization in devices. The devices may be markedly different physically, but each was designed to provide a particular type of image within particular limitations. Performance parameters which determine the type of system selected for a given mission and which influence the design include: Sensitivity, Resolution, Dynamic range, Spectral response, Frame rate/bandwidth, Optics compatibility, Image motion, Radiation resistance, Size, Weight, Power, and Reliability.

  11. Opportunities and challenges in integrating electronic health records into undergraduate medical education: a national survey of clerkship directors.

    PubMed

    Hammoud, Maya M; Margo, Katherine; Christner, Jennifer G; Fisher, Jonathan; Fischer, Shira H; Pangaro, Louis N

    2012-01-01

    Few studies have reported on the utilization and the effect of electronic health records on the education of medical students. The purpose of this study was to describe the current use of electronic health records by medical students in the United States and explore the opportunities and challenges of integrating electronic health records into daily teaching of medical students. A survey with 24 questions regarding the use of electronic health records by medical students was developed by the Alliance for Clinical Educators and sent to clerkship directors across the United States. Both quantitative and qualitative responses were collected and analyzed to determine current access to and use of electronic health records by medical students. This study found that an estimated 64% of programs currently allow student use of electronic health records, of which only two thirds allowed students to write notes within the electronic record. Overall, clerkship directors' opinions on the effects of electronic health records on medical student education were neutral, and despite acknowledging many advantages to electronic health records, there were many concerns raised regarding their use in education. Medical students are using electronic health records at higher rates than physicians in practice. Although this is overall reassuring, educators have to be cautious about the limitations being placed on student's documentation in electronic health records as this can potentially have consequences on their training, and they need to explore ways to maximize the benefits of electronic health records in medical education.

  12. 5 CFR 850.301 - Electronic records; other acceptable records.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... SERVICE REGULATIONS (CONTINUED) ELECTRONIC RETIREMENT PROCESSING Records § 850.301 Electronic records; other acceptable records. (a) Acceptable electronic records for retirement and insurance processing by... (SF 2806 or SF 3100), or data or images obtained from such documents, including images stored in EDMS...

  13. 36 CFR § 1235.44 - What general transfer requirements apply to electronic records?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... requirements apply to electronic records? § 1235.44 Section § 1235.44 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT TRANSFER OF RECORDS TO THE NATIONAL... requirements apply to electronic records? (a) Each agency must retain a copy of permanent electronic records...

  14. 21 CFR 11.70 - Signature/record linking.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Signature/record linking. 11.70 Section 11.70 Food... RECORDS; ELECTRONIC SIGNATURES Electronic Records § 11.70 Signature/record linking. Electronic signatures and handwritten signatures executed to electronic records shall be linked to their respective...

  15. 36 CFR 1236.24 - What are the additional requirements for managing unstructured electronic records?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... requirements for managing unstructured electronic records? 1236.24 Section 1236.24 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional Requirements for Electronic Records § 1236.24 What are the additional requirements for managing...

  16. 36 CFR 1236.24 - What are the additional requirements for managing unstructured electronic records?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... requirements for managing unstructured electronic records? 1236.24 Section 1236.24 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional Requirements for Electronic Records § 1236.24 What are the additional requirements for managing...

  17. 36 CFR 1236.24 - What are the additional requirements for managing unstructured electronic records?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... requirements for managing unstructured electronic records? 1236.24 Section 1236.24 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional Requirements for Electronic Records § 1236.24 What are the additional requirements for managing...

  18. 36 CFR 1236.24 - What are the additional requirements for managing unstructured electronic records?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... requirements for managing unstructured electronic records? 1236.24 Section 1236.24 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional Requirements for Electronic Records § 1236.24 What are the additional requirements for managing...

  19. Classification of cryo electron microscopy images, noisy tomographic images recorded with unknown projection directions, by simultaneously estimating reconstructions and application to an assembly mutant of Cowpea Chlorotic Mottle Virus and portals of the bacteriophage P22

    NASA Astrophysics Data System (ADS)

    Lee, Junghoon; Zheng, Yili; Yin, Zhye; Doerschuk, Peter C.; Johnson, John E.

    2010-08-01

    Cryo electron microscopy is frequently used on biological specimens that show a mixture of different types of object. Because the electron beam rapidly destroys the specimen, the beam current is minimized which leads to noisy images (SNR substantially less than 1) and only one projection image per object (with an unknown projection direction) is collected. For situations where the objects can reasonably be described as coming from a finite set of classes, an approach based on joint maximum likelihood estimation of the reconstruction of each class and then use of the reconstructions to label the class of each image is described and demonstrated on two challenging problems: an assembly mutant of Cowpea Chlorotic Mottle Virus and portals of the bacteriophage P22.

  20. Do surveys with paper and electronic devices differ in quality and cost? Experience from the Rufiji Health and demographic surveillance system in Tanzania.

    PubMed

    Mukasa, Oscar; Mushi, Hildegalda P; Maire, Nicolas; Ross, Amanda; de Savigny, Don

    2017-01-01

    Data entry at the point of collection using mobile electronic devices may make data-handling processes more efficient and cost-effective, but there is little literature to document and quantify gains, especially for longitudinal surveillance systems. To examine the potential of mobile electronic devices compared with paper-based tools in health data collection. Using data from 961 households from the Rufiji Household and Demographic Survey in Tanzania, the quality and costs of data collected on paper forms and electronic devices were compared. We also documented, using qualitative approaches, field workers, whom we called 'enumerators', and households' members on the use of both methods. Existing administrative records were combined with logistics expenditure measured directly from comparison households to approximate annual costs per 1,000 households surveyed. Errors were detected in 17% (166) of households for the paper records and 2% (15) for the electronic records (p < 0.001). There were differences in the types of errors (p = 0.03). Of the errors occurring, a higher proportion were due to accuracy in paper surveys (79%, 95% CI: 72%, 86%) compared with electronic surveys (58%, 95% CI: 29%, 87%). Errors in electronic surveys were more likely to be related to completeness (32%, 95% CI 12%, 56%) than in paper surveys (11%, 95% CI: 7%, 17%).The median duration of the interviews ('enumeration'), per household was 9.4 minutes (90% central range 6.4, 12.2) for paper and 8.3 (6.1, 12.0) for electronic surveys (p = 0.001). Surveys using electronic tools, compared with paper-based tools, were less costly by 28% for recurrent and 19% for total costs. Although there were technical problems with electronic devices, there was good acceptance of both methods by enumerators and members of the community. Our findings support the use of mobile electronic devices for large-scale longitudinal surveys in resource-limited settings.

  1. Technological trends in health care: electronic health record.

    PubMed

    Abraham, Sam

    2010-01-01

    The most relevant technological trend affecting health care organizations and physician services is the electronic health record (EHR). Billions of dollars from the federal government stimulus bill are available for investment toward EHR. Based on the government directives, it is evident EHR has to be a high-priority technological intervention in health care organizations. Addressed in the following pages are the effects of the EHR trend on financial and human resources; analysis of advantages and disadvantages of EHR; action steps involved in implementing EHR, and a timeline for implementation. Medical facilities that do not meet the timetable for using EHR will likely experience reduction of Medicare payments. This article also identifies the strengths, weaknesses, opportunities, and threats of the EHR and steps to be taken by hospitals and physician medical groups to receive stimulus payment.

  2. Publishing data from electronic health records while preserving privacy: a survey of algorithms.

    PubMed

    Gkoulalas-Divanis, Aris; Loukides, Grigorios; Sun, Jimeng

    2014-08-01

    The dissemination of Electronic Health Records (EHRs) can be highly beneficial for a range of medical studies, spanning from clinical trials to epidemic control studies, but it must be performed in a way that preserves patients' privacy. This is not straightforward, because the disseminated data need to be protected against several privacy threats, while remaining useful for subsequent analysis tasks. In this work, we present a survey of algorithms that have been proposed for publishing structured patient data, in a privacy-preserving way. We review more than 45 algorithms, derive insights on their operation, and highlight their advantages and disadvantages. We also provide a discussion of some promising directions for future research in this area. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. 34 CFR 685.309 - Administrative and fiscal control and fund accounting requirements for schools participating in...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 Education 3 2010-07-01 2010-07-01 false Administrative and fiscal control and fund accounting... Direct Loan Program Schools § 685.309 Administrative and fiscal control and fund accounting requirements... may provide the student status confirmation report in either paper or electronic format. (c) Record...

  4. Archiving strategy for USGS EROS center and our future direction

    USGS Publications Warehouse

    Faundeen, John L.

    2010-01-01

    The U. S. Geological Survey's Earth Resources Observation and Science Center has the responsibility to acquire, manage, and preserve our Nation's land observations. These records are obtained primarily from airplanes and satellites dating back to the 1930s. The ability to compare landscapes from the past with current information enables change analysis at local and global scales. With new observations added daily, the records management challenges are daunting, involving petabytes of electronic data and tens of thousands of rolls of analog film. This paper focuses upon the appraisal and preservation functions employed to ensure that these records are available for current and future generations.

  5. Connecting Professional Practice and Technology at the Bedside

    PubMed Central

    Gomes, Melissa; Hash, Pamela; Orsolini, Liana; Watkins, Aimee; Mazzoccoli, Andrea

    2016-01-01

    The purpose of this research is to determine the effects of implementing an electronic health record on medical-surgical registered nurses' time spent in direct professional patient-centered nursing activities, attitudes and beliefs related to implementation, and changes in level of nursing engagement after deployment of the electronic health record. Patient-centered activities were categorized using Watson's Caritas Processes and the Relationship-Based Care Delivery System. Methods included use of an Attitudes and Beliefs Assessment Questionnaire, Nursing Engagement Questionnaire, and Rapid Modeling Corporation's personal digital assistants for time and motion data collection. There was a significant difference in normative belief between nurses with less than 15 years' experience and nurses with more than 15 years' experience (t21 = 2.7, P = .01). While nurses spent less time at the nurses' station, less time charting, significantly more time in patients' rooms and in purposeful interactions, time spent in relationship-based caring behavior categories actually decreased in most categories. Nurses' engagement scores did not significantly increase. These results serve to inform healthcare organizations about potential factors related to electronic health record deployment which create shifts in nursing time spent across care categories and can be used to explore further patient centered care practices. PMID:27496045

  6. Measuring Up: Implementing a Dental Quality Measure in the Electronic Health Record Context

    PubMed Central

    Bhardwaj, Aarti; Ramoni, Rachel; Kalenderian, Elsbeth; Neumann, Ana; Hebballi, Nutan B; White, Joel M; McClellan, Lyle; Walji, Muhammad F

    2015-01-01

    Background Quality improvement requires quality measures that are validly implementable. In this work, we assessed the feasibility and performance of an automated electronic Meaningful Use dental clinical quality measure (percentage of children who received fluoride varnish). Methods We defined how to implement the automated measure queries in a dental electronic health record (EHR). Within records identified through automated query, we manually reviewed a subsample to assess the performance of the query. Results The automated query found 71.0% of patients to have had fluoride varnish compared to 77.6% found using the manual chart review. The automated quality measure performance was 90.5% sensitivity, 90.8% specificity, 96.9% positive predictive value, and 75.2% negative predictive value. Conclusions Our findings support the feasibility of automated dental quality measure queries in the context of sufficient structured data. Information noted only in the free text rather than in structured data would require natural language processing approaches to effectively query. Practical Implications To participate in self-directed quality improvement, dental clinicians must embrace the accountability era. Commitment to quality will require enhanced documentation in order to support near-term automated calculation of quality measures. PMID:26562736

  7. 29 CFR 4000.53 - May I use electronic media to satisfy PBGC's record retention requirements?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 9 2011-07-01 2011-07-01 false May I use electronic media to satisfy PBGC's record... Electronic Means of Record Retention § 4000.53 May I use electronic media to satisfy PBGC's record retention requirements? General requirements. You may use electronic media to satisfy the record maintenance and...

  8. 29 CFR 4000.53 - May I use electronic media to satisfy PBGC's record retention requirements?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 9 2014-07-01 2014-07-01 false May I use electronic media to satisfy PBGC's record... Electronic Means of Record Retention § 4000.53 May I use electronic media to satisfy PBGC's record retention requirements? General requirements. You may use electronic media to satisfy the record maintenance and...

  9. 29 CFR 4000.53 - May I use electronic media to satisfy PBGC's record retention requirements?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 9 2010-07-01 2010-07-01 false May I use electronic media to satisfy PBGC's record... Electronic Means of Record Retention § 4000.53 May I use electronic media to satisfy PBGC's record retention requirements? General requirements. You may use electronic media to satisfy the record maintenance and...

  10. 29 CFR 4000.53 - May I use electronic media to satisfy PBGC's record retention requirements?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 9 2013-07-01 2013-07-01 false May I use electronic media to satisfy PBGC's record... Electronic Means of Record Retention § 4000.53 May I use electronic media to satisfy PBGC's record retention requirements? General requirements. You may use electronic media to satisfy the record maintenance and...

  11. 29 CFR 4000.53 - May I use electronic media to satisfy PBGC's record retention requirements?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 9 2012-07-01 2012-07-01 false May I use electronic media to satisfy PBGC's record... Electronic Means of Record Retention § 4000.53 May I use electronic media to satisfy PBGC's record retention requirements? General requirements. You may use electronic media to satisfy the record maintenance and...

  12. Rotational spectroscopy with an optical centrifuge.

    PubMed

    Korobenko, Aleksey; Milner, Alexander A; Hepburn, John W; Milner, Valery

    2014-03-07

    We demonstrate a new spectroscopic method for studying electronic transitions in molecules with extremely broad range of angular momentum. We employ an optical centrifuge to create narrow rotational wave packets in the ground electronic state of (16)O2. Using the technique of resonance-enhanced multi-photon ionization, we record the spectrum of multiple ro-vibrational transitions between X(3)Σg(-) and C(3)Πg electronic manifolds of oxygen. Direct control of rotational excitation, extending to rotational quantum numbers as high as N ≳ 120, enables us to interpret the complex structure of rotational spectra of C(3)Πg beyond thermally accessible levels.

  13. Dissociative excitation of the manganese atom quartet levels by collisions e-MnBr2

    NASA Astrophysics Data System (ADS)

    Smirnov, Yu M.

    2017-04-01

    Dissociative excitation of quartet levels of the manganese atom was studied in collisions of electrons with manganese dibromide molecules. Eighty-two cross-sections for transitions originating at odd levels and eleven cross-sections for transitions originating at even levels have been measured at an incident electron energy of 100 eV. An optical excitation function has been recorded in the electron energy range of 0-100 eV for transitions originating from 3d 64p z 4 F° levels. For the majority of transitions, a comparison of the resulting cross-section values to cross-sections produced by direct excitation is provided.

  14. Single-Molecule Bioelectronics

    PubMed Central

    Rosenstein, Jacob K.; Lemay, Serge G.; Shepard, Kenneth L.

    2014-01-01

    Experimental techniques which interface single biomolecules directly with microelectronic systems are increasingly being used in a wide range of powerful applications, from fundamental studies of biomolecules to ultra-sensitive assays. Here we review several technologies which can perform electronic measurements of single molecules in solution: ion channels, nanopore sensors, carbon nanotube field-effect transistors, electron tunneling gaps, and redox cycling. We discuss the shared features among these techniques that enable them to resolve individual molecules, and discuss their limitations. Recordings from each of these methods all rely on similar electronic instrumentation, and we discuss the relevant circuit implementations and potential for scaling these single-molecule bioelectronic interfaces to high-throughput arrayed sensing platforms. PMID:25529538

  15. Calibration of a time-resolved hard-x-ray detector using radioactive sources

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Stoeckl, C., E-mail: csto@lle.rochester.edu; Theobald, W.; Regan, S. P.

    A four-channel, time-resolved, hard x-ray detector (HXRD) has been operating at the Laboratory for Laser Energetics for more than a decade. The slope temperature of the hot-electron population in direct-drive inertial confinement fusion experiments is inferred by recording the hard x-ray radiation generated in the interaction of the electrons with the target. Measuring the energy deposited by hot electrons requires an absolute calibration of the hard x-ray detector. A novel method to obtain an absolute calibration of the HXRD using single photons from radioactive sources was developed, which uses a thermoelectrically cooled, low-noise, charge-sensitive amplifier.

  16. 36 CFR § 1236.22 - What are the additional requirements for managing electronic mail records?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... requirements for managing electronic mail records? § 1236.22 Section § 1236.22 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT... management requirements for electronic mail records: (1) The names of sender and all addressee(s) and date...

  17. 36 CFR § 1236.24 - What are the additional requirements for managing unstructured electronic records?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... requirements for managing unstructured electronic records? § 1236.24 Section § 1236.24 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional Requirements for Electronic Records § 1236.24 What are the additional requirements for...

  18. 36 CFR 1236.28 - What additional requirements apply to the selection and maintenance of electronic records storage...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... apply to the selection and maintenance of electronic records storage media for permanent records? 1236... What additional requirements apply to the selection and maintenance of electronic records storage media for permanent records? (a) Agencies must maintain the storage and test areas for electronic records...

  19. 36 CFR 1236.28 - What additional requirements apply to the selection and maintenance of electronic records storage...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... apply to the selection and maintenance of electronic records storage media for permanent records? 1236... What additional requirements apply to the selection and maintenance of electronic records storage media for permanent records? (a) Agencies must maintain the storage and test areas for electronic records...

  20. Consumer Mobile Health Apps: Current State, Barriers, and Future Directions.

    PubMed

    Kao, Cheng-Kai; Liebovitz, David M

    2017-05-01

    This paper discusses the current state, barriers, and future directions of consumer-facing applications (apps). There are currently more than 165,000 mobile health apps publicly available in major app stores, the vast majority of which are designed for patients. The top 2 categories are wellness management and disease management apps, whereas other categories include self-diagnosis, medication reminder, and electronic patient portal apps. Apps specific to physical medicine and rehabilitation also are reviewed. These apps have the potential to provide low-cost, around-the-clock access to high-quality, evidence-based health information to end users on a global scale. However, they have not yet lived up to their potential due to multiple barriers, including lack of regulatory oversight, limited evidence-based literature, and concerns of privacy and security. The future directions may consist of improving data integration into the health care system, an interoperable app platform allowing access to electronic health record data, cloud-based personal health record across health care networks, and increasing app prescription by health care providers. For consumer mobile health apps to fully contribute value to health care delivery and chronic disease management, all stakeholders within the ecosystem must collaborate to overcome the significant barriers. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  1. 36 CFR § 1235.50 - What specifications and standards for transfer apply to electronic records?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT TRANSFER OF RECORDS TO THE... Records Administration, Electronic/Special Media Records Services Division (NWME), 8601 Adelphi Road... and Records Administration, Electronic/Special Media Records Services Division (NWME), 8601 Adelphi...

  2. 78 FR 22345 - Advisory Committee on the Electronic Records Archives (ACERA)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-15

    ... NATIONAL ARCHIVES AND RECORDS ADMINISTRATION Advisory Committee on the Electronic Records Archives... and Records Administration (NARA) announces a meeting of the Advisory Committee on the Electronic... United States, on technical, mission, and service issues related to the Electronic Records Archives (ERA...

  3. 77 FR 21812 - Advisory Committee on the Electronic Records Archives (ACERA).

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-11

    ... NATIONAL ARCHIVES AND RECORDS ADMINISTRATION Advisory Committee on the Electronic Records Archives... and Records Administration (NARA) announces a meeting of the Advisory Committee on the Electronic... United States, on technical, mission, and service issues related to the Electronic Records Archives (ERA...

  4. 5 CFR 850.301 - Electronic records; other acceptable records.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ...; other acceptable records. (a) Acceptable electronic records for processing by the electronic retirement and insurance processing system include— (1) Electronic employee data submitted by an agency or other entity through EHRI and stored within the new retirement and insurance processing system; (2) Electronic...

  5. 5 CFR 850.301 - Electronic records; other acceptable records.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ...; other acceptable records. (a) Acceptable electronic records for processing by the electronic retirement and insurance processing system include— (1) Electronic employee data submitted by an agency or other entity through EHRI and stored within the new retirement and insurance processing system; (2) Electronic...

  6. 5 CFR 850.301 - Electronic records; other acceptable records.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ...; other acceptable records. (a) Acceptable electronic records for processing by the electronic retirement and insurance processing system include— (1) Electronic employee data submitted by an agency or other entity through EHRI and stored within the new retirement and insurance processing system; (2) Electronic...

  7. 5 CFR 850.301 - Electronic records; other acceptable records.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ...; other acceptable records. (a) Acceptable electronic records for processing by the electronic retirement and insurance processing system include— (1) Electronic employee data submitted by an agency or other entity through EHRI and stored within the new retirement and insurance processing system; (2) Electronic...

  8. Simultaneous observations of subauroral electron temperature enhancements and electromagnetic ion cyclotron waves

    NASA Technical Reports Server (NTRS)

    Erlandson, R. E.; Aggson, T. L.; Hogey, W. R.; Slavin, J. A.

    1993-01-01

    Observational results from an investigation of LF (0.5-4.0 Hz) electromagnetic ion cyclotron waves and subauroral electron temperature enhancements recorded from the DE-2 satellite are presented. Four different wave events were analyzed, all recorded at magnetic latitudes from 57-60 deg, magnetic local times from 8-14 hr, and altitudes from 600-900 km. The peak wave amplitudes during the events ranged from 8-70 nT and 5-30 mV/m in the magnetic and electric field, respectively. Te enhancements at the time of the waves were observed in three of four events. A linear relationship between the wave magnetic field spectral density and Te enhancements was found for these events. The Te enhancements were also correlated with an enhanced flux of low energy electrons. During one event (82104) an enhanced flux of electrons were observed at energies up to 50 eV and at nearly all pitch angles, although the flux was largest in the precipitating and upflowing directions. It is suggested that the waves are responsible for heating the low energy electrons which precipitate to the ionosphere and produce the observed Te enhancements. The upflowing electron population appears to be heated at ionospheric altitudes, below the DE-2 satellite.

  9. Direction sensitive neutron detector

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Ahlen, Steven; Fisher, Peter; Dujmic, Denis

    2017-01-31

    A neutron detector includes a pressure vessel, an electrically conductive field cage assembly within the pressure vessel and an imaging subsystem. A pressurized gas mixture of CF.sub.4, .sup.3He and .sup.4He at respective partial pressures is used. The field cage establishes a relatively large drift region of low field strength, in which ionization electrons generated by neutron-He interactions are directed toward a substantially smaller amplification region of substantially higher field strength in which the ionization electrons undergo avalanche multiplication resulting in scintillation of the CF.sub.4 along scintillation tracks. The imaging system generates two-dimensional images of the scintillation patterns and employs track-findingmore » to identify tracks and deduce the rate and direction of incident neutrons. One or more photo-multiplier tubes record the time-profile of the scintillation tracks permitting the determination of the third coordinate.« less

  10. Visualized effect of oxidation on magnetic recording fidelity in pseudo-single-domain magnetite particles

    PubMed Central

    Almeida, Trevor P.; Kasama, Takeshi; Muxworthy, Adrian R.; Williams, Wyn; Nagy, Lesleis; Hansen, Thomas W.; Brown, Paul D.; Dunin-Borkowski, Rafal E.

    2014-01-01

    Magnetite (Fe3O4) is an important magnetic mineral to Earth scientists, as it carries the dominant magnetic signature in rocks, and the understanding of its magnetic recording fidelity provides a critical tool in the field of palaeomagnetism. However, reliable interpretation of the recording fidelity of Fe3O4 particles is greatly diminished over time by progressive oxidation to less magnetic iron oxides, such as maghemite (γ-Fe2O3), with consequent alteration of remanent magnetization potentially having important geological significance. Here we use the complementary techniques of environmental transmission electron microscopy and off-axis electron holography to induce and visualize the effects of oxidation on the magnetization of individual nanoscale Fe3O4 particles as they transform towards γ-Fe2O3. Magnetic induction maps demonstrate a change in both strength and direction of remanent magnetization within Fe3O4 particles in the size range dominant in rocks, confirming that oxidation can modify the original stored magnetic information. PMID:25300366

  11. Visualized effect of oxidation on magnetic recording fidelity in pseudo-single-domain magnetite particles.

    PubMed

    Almeida, Trevor P; Kasama, Takeshi; Muxworthy, Adrian R; Williams, Wyn; Nagy, Lesleis; Hansen, Thomas W; Brown, Paul D; Dunin-Borkowski, Rafal E

    2014-10-10

    Magnetite (Fe3O4) is an important magnetic mineral to Earth scientists, as it carries the dominant magnetic signature in rocks, and the understanding of its magnetic recording fidelity provides a critical tool in the field of palaeomagnetism. However, reliable interpretation of the recording fidelity of Fe3O4 particles is greatly diminished over time by progressive oxidation to less magnetic iron oxides, such as maghemite (γ-Fe2O3), with consequent alteration of remanent magnetization potentially having important geological significance. Here we use the complementary techniques of environmental transmission electron microscopy and off-axis electron holography to induce and visualize the effects of oxidation on the magnetization of individual nanoscale Fe3O4 particles as they transform towards γ-Fe2O3. Magnetic induction maps demonstrate a change in both strength and direction of remanent magnetization within Fe3O4 particles in the size range dominant in rocks, confirming that oxidation can modify the original stored magnetic information.

  12. Integration of clinical research documentation in electronic health records.

    PubMed

    Broach, Debra

    2015-04-01

    Clinical trials of investigational drugs and devices are often conducted within healthcare facilities concurrently with clinical care. With implementation of electronic health records, new communication methods are required to notify nonresearch clinicians of research participation. This article reviews clinical research source documentation, the electronic health record and the medical record, areas in which the research record and electronic health record overlap, and implications for the research nurse coordinator in documentation of the care of the patient/subject. Incorporation of clinical research documentation in the electronic health record will lead to a more complete patient/subject medical record in compliance with both research and medical records regulations. A literature search provided little information about the inclusion of clinical research documentation within the electronic health record. Although regulations and guidelines define both source documentation and the medical record, integration of research documentation in the electronic health record is not clearly defined. At minimum, the signed informed consent(s), investigational drug or device usage, and research team contact information should be documented within the electronic health record. Institutional policies should define a standardized process for this integration in the absence federal guidance. Nurses coordinating clinical trials are in an ideal position to define this integration.

  13. Development of electronic medical record charting for hospital-based transfusion and apheresis medicine services: Early adoption perspectives

    PubMed Central

    Levy, Rebecca; Pantanowitz, Liron; Cloutier, Darlene; Provencher, Jean; McGirr, Joan; Stebbins, Jennifer; Cronin, Suzanne; Wherry, Josh; Fenton, Joseph; Donelan, Eileen; Johari, Vandita; Andrzejewski, Chester

    2010-01-01

    Background: Electronic medical records (EMRs) provide universal access to health care information across multidisciplinary lines. In pathology departments, transfusion and apheresis medicine services (TAMS) involved in direct patient care activities produce data and documentation that typically do not enter the EMR. Taking advantage of our institution's initiative for implementation of a paperless medical record, our TAMS division set out to develop an electronic charting (e-charting) strategy within the EMR. Methods: A focus group of our hospital's transfusion committee consisting of transfusion medicine specialists, pathologists, residents, nurses, hemapheresis specialists, and information technologists was constituted and charged with the project. The group met periodically to implement e-charting TAMS workflow and produced electronic documents within the EMR (Cerner Millenium) for various service line functions. Results: The interdisciplinary working group developed and implemented electronic versions of various paper-based clinical documentation used by these services. All electronic notes collectively gather and reside within a unique Transfusion Medicine Folder tab in the EMR, available to staff with access to patient charts. E-charting eliminated illegible handwritten notes, resulted in more consistent clinical documentation among staff, and provided greater realered. However, minor updates and corrections to documents as well as select work re-designs were required for optimal use of e-charting-time review/access of hemotherapy practices. No major impediments to workflow or inefficiencies have been encount by these services. Conclusion: Documentation of pathology subspecialty activities such as TAMS can be successfully incorporated into the EMR. E-charting by staff enhances communication and helps promote standardized documentation of patient care within and across service lines. Well-constructed electronic documents in the EMR may also enhance data mining, quality improvement, and biovigilance monitoring activities. PMID:20805955

  14. Electronic Personal Health Record Use Among Nurses in the Nursing Informatics Community.

    PubMed

    Gartrell, Kyungsook; Trinkoff, Alison M; Storr, Carla L; Wilson, Marisa L

    2015-07-01

    An electronic personal health record is a patient-centric tool that enables patients to securely access, manage, and share their health information with healthcare providers. It is presumed the nursing informatics community would be early adopters of electronic personal health record, yet no studies have been identified that examine the personal adoption of electronic personal health record's for their own healthcare. For this study, we sampled nurse members of the American Medical Informatics Association and the Healthcare Information and Management Systems Society with 183 responding. Multiple logistic regression analysis was used to identify those factors associated with electronic personal health record use. Overall, 72% were electronic personal health record users. Users tended to be older (aged >50 years), be more highly educated (72% master's or doctoral degrees), and hold positions as clinical informatics specialists or chief nursing informatics officers. Those whose healthcare providers used electronic health records were significantly more likely to use electronic personal health records (odds ratio, 5.99; 95% confidence interval, 1.40-25.61). Electronic personal health record users were significantly less concerned about privacy of health information online than nonusers (odds ratio, 0.32; 95% confidence interval, 0.14-0.70) adjusted for ethnicity, race, and practice region. Informatics nurses, with their patient-centered view of technology, are in prime position to influence development of electronic personal health records. Our findings can inform policy efforts to encourage informatics and other professional nursing groups to become leaders and users of electronic personal health record; such use could help them endorse and engage patients to use electronic personal health records. Having champions with expertise in and enthusiasm for the new technology can promote the adoptionof electronic personal health records among healthcare providers as well as their patients.

  15. 76 FR 19147 - Advisory Committee on the Electronic Records Archives (ACERA)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-06

    ... NATIONAL ARCHIVES AND RECORDS ADMINISTRATION Advisory Committee on the Electronic Records Archives... Electronic Records Archives (ACERA). The meeting has been consolidated into one day. This meeting will be... number of individuals planning to attend must be submitted to the Electronic Records Archives Program at...

  16. Photoelectron imaging using an ellipsoidal display analyzer

    NASA Astrophysics Data System (ADS)

    Dütemeyer, T.; Quitmann, C.; Kitz, M.; Dörnemann, K.; Johansson, L. S. O.; Reihl, B.

    2001-06-01

    We have built an ellipsoidal display analyzer (EDA) for angle-resolved photoelectron spectroscopy and related techniques. The instrument is an improved version of a design by Eastman et al. [Nucl. Instrum. Methods 172, 327 (1980)] and measures the angle-resolved intensity distribution of photoelectrons at fixed energy I(θ,φ)|E=const.. Such two-dimensional cuts through the Brillouin zone are recorded using a position-sensitive detector. The large acceptance angle (Δθ=43° in the polar direction and Δφ=360° in the azimuthal direction) leads to a collection efficiency which exceeds that of conventional hemispherical analyzers by a factor of about 3000. Using ray-tracing calculations we analyze the electron optical properties of the various analyzer components and optimize their arrangement. This minimizes distortions and aberrations in the recorded images and greatly improves the performance compared to previous realizations of this analyzer. We present examples demonstrating the performance of the analyzer and its versatility. Using a commercial He-discharge lamp we are able to measure complete angular distribution patterns in less than 5 s. The energy and angular resolution are ΔEEDA=85 meV and Δθ=1.2°, respectively. Complete stacks of such cuts through the Brillouin zone at different kinetic energies E can be acquired automatically using custom software. The raw data are processed leading to a three-dimensional set (I(EB,k∥) of photoelectron intensity versus binding energy E and wave vector k∥. From this all relevant information, like the dispersion relations EB(k∥) along arbitrary directions of the Brillouin zone or Fermi-surface maps, can then be computed. An additional electron gun enables low-energy electron diffraction, Auger electron spectroscopy, and electron energy-loss spectroscopy. Switching between electrons and photons as the excitation source is possible without any movement of the sample or analyzer. Because of the high acquisition speed it is possible to study the electronic structure of solids as a function of an external parameter (i.e., temperature) or to make animated movies showing, for example, the evolution of electronic states in reciprocal space. After installation of this EDA at a synchrotron providing tunable photon energy, the full power of the instrument will come into play by adding techniques like constant final state or constant initial state spectroscopy, and x-ray photoelectron diffraction.

  17. 36 CFR 1236.22 - What are the additional requirements for managing electronic mail records?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... requirements for managing electronic mail records? 1236.22 Section 1236.22 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional... accordance with the provisions of GRS 23, Item 5. (5) Draft documents that are circulated on electronic mail...

  18. 36 CFR 1236.22 - What are the additional requirements for managing electronic mail records?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... requirements for managing electronic mail records? 1236.22 Section 1236.22 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional... accordance with the provisions of GRS 23, Item 5. (5) Draft documents that are circulated on electronic mail...

  19. 36 CFR 1236.22 - What are the additional requirements for managing electronic mail records?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... requirements for managing electronic mail records? 1236.22 Section 1236.22 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional... accordance with the provisions of GRS 23, Item 5. (5) Draft documents that are circulated on electronic mail...

  20. 36 CFR 1236.22 - What are the additional requirements for managing electronic mail records?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... requirements for managing electronic mail records? 1236.22 Section 1236.22 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT Additional... accordance with the provisions of GRS 23, Item 5. (5) Draft documents that are circulated on electronic mail...

  1. Technology as friend or foe? Do electronic health records increase burnout?

    PubMed

    Ehrenfeld, Jesse M; Wanderer, Jonathan P

    2018-06-01

    To summarize recent relevant studies regarding the use of electronic health records and physician burnout. Recently acquired knowledge regarding the relationship between electronic health record use, professional satisfaction, burnout, and desire to leave clinical practice are discussed. Adoption of electronic health records has increased across the United States and worldwide. Although electronic health records have many benefits, there is growing concern about the adverse consequences of their use on physician satisfaction and burnout. Poor usability, incongruent workflows, and the addition of clerical tasks to physician documentation requirements have been previously highlighted as ongoing concerns with electronic health record adoption. In multiple recent studies, electronic health records have been shown to decrease professional satisfaction, increase burnout, and the likelihood that a physician will reduce or leave clinical practice. One interventional study demonstrated a positive effect of a dedicated electronic health record entry clerk on physicians working in an outpatient practice.

  2. 36 CFR 1235.50 - What specifications and standards for transfer apply to electronic records?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT TRANSFER OF REC- ORDS TO THE... Records Administration, Electronic/Special Media Records Services Division (NWME), 8601 Adelphi Road... and Records Administration, Electronic/Special Media Records Services Division (NWME), 8601 Adelphi...

  3. Use of electronic microprocessor-based instrumentation by the U.S. geological survey for hydrologic data collection

    USGS Publications Warehouse

    Shope, William G.; ,

    1991-01-01

    The U.S. Geological Survey is acquiring a new generation of field computers and communications software to support hydrologic data-collection at field locations. The new computer hardware and software mark the beginning of the Survey's transition from the use of electromechanical devices and paper tapes to electronic microprocessor-based instrumentation. Software is being developed for these microprocessors to facilitate the collection, conversion, and entry of data into the Survey's National Water Information System. The new automated data-collection process features several microprocessor-controlled sensors connected to a serial digital multidrop line operated by an electronic data recorder. Data are acquired from the sensors in response to instructions programmed into the data recorder by the user through small portable lap-top or hand-held computers. The portable computers, called personal field computers, also are used to extract data from the electronic recorders for transport by courier to the office computers. The Survey's alternative to manual or courier retrieval is the use of microprocessor-based remote telemetry stations. Plans have been developed to enhance the Survey's use of the Geostationary Operational Environmental Satellite telemetry by replacing the present network of direct-readout ground stations with less expensive units. Plans also provide for computer software that will support other forms of telemetry such as telephone or land-based radio.

  4. Electronic health records to support obesity-related patient care: Results from a survey of United States physicians.

    PubMed

    Bronder, Kayla L; Dooyema, Carrie A; Onufrak, Stephen J; Foltz, Jennifer L

    2015-08-01

    Obesity-related electronic health record functions increase the rates of measuring Body Mass Index, diagnosing obesity, and providing obesity services. This study describes the prevalence of obesity-related electronic health record functions in clinical practice and analyzes characteristics associated with increased obesity-related electronic health record sophistication. Data were analyzed from DocStyles, a web-based panel survey administered to 1507 primary care providers practicing in the United States in June, 2013. Physicians were asked if their electronic health record has specific obesity-related functions. Logistical regression analyses identified characteristics associated with improved obesity-related electronic health record sophistication. Of the 88% of providers with an electronic health record, 83% of electronic health records calculate Body Mass Index, 52% calculate pediatric Body Mass Index percentile, and 32% flag patients with abnormal Body Mass Index values. Only 36% provide obesity-related decision support and 17% suggest additional resources for obesity-related care. Characteristics associated with having a more sophisticated electronic health record include age ≤45years old, being a pediatrician or family practitioner, and practicing in a larger, outpatient practice. Few electronic health records optimally supported physician's obesity-related clinical care. The low rates of obesity-related electronic health record functions currently in practice highlight areas to improve the clinical health information technology in primary care practice. More work can be done to develop, implement, and promote the effective utilization of obesity-related electronic health record functions to improve obesity treatment and prevention efforts. Published by Elsevier Inc.

  5. Physician capability to electronically exchange clinical information, 2011.

    PubMed

    Patel, Vaishali; Swain, Matthew J; King, Jennifer; Furukawa, Michael F

    2013-10-01

    To provide national estimates of physician capability to electronically share clinical information with other providers and to describe variation in exchange capability across states and electronic health record (EHR) vendors using the 2011 National Ambulatory Medical Care Survey Electronic Medical Record Supplement. Survey of a nationally representative sample of nonfederal office-based physicians who provide direct patient care. The survey was administered by mail with telephone follow-up and had a 61% weighted response rate. The overall sample consisted of 4326 respondents. We calculated estimates of electronic exchange capability at the national and state levels, and applied multivariate analyses to examine the association between the capability to exchange different types of clinical information and physician and practice characteristics. In 2011, 55% of physicians had computerized capability to send prescriptions electronically; 67% had the capability to view lab results electronically; 42% were able to incorporate lab results into their EHR; 35% were able to send lab orders electronically; and, 31% exchanged patient clinical summaries with other providers. The strongest predictor of exchange capability is adoption of an EHR. However, substantial variation exists across geography and EHR vendors in exchange capability, especially electronic exchange of clinical summaries. In 2011, a majority of office-based physicians could exchange lab and medication data, and approximately one-third could exchange clinical summaries with patients or other providers. EHRs serve as a key mechanism by which physicians can exchange clinical data, though physicians' capability to exchange varies by vendor and by state.

  6. Archetype-based electronic health records: a literature review and evaluation of their applicability to health data interoperability and access.

    PubMed

    Wollersheim, Dennis; Sari, Anny; Rahayu, Wenny

    Health Information Managers (HIMs) are responsible for overseeing health information. The change management necessary during the transition to electronic health records (EHR) is substantial, and ongoing. Archetype-based EHRs are a core health information system component which solve many of the problems that arise during this period of change. Archetypes are models of clinical content, and they have many beneficial properties. They are interoperable, both between settings and through time. They are more amenable to change than conventional paradigms, and their design is congruent with clinical practice. This paper is an overview of the current archetype literature relevant to Health Information Managers. The literature was sourced in the English language sections of ScienceDirect, IEEE Explore, Pubmed, Google Scholar, ACM Digital library and other databases on the usage of archetypes for electronic health record storage, looking at the current areas of archetype research, appropriate usage, and future research. We also used reference lists from the cited papers, papers referenced by the openEHR website, and the recommendations from experts in the area. Criteria for inclusion were (a) if studies covered archetype research and (b) were either studies of archetype use, archetype system design, or archetype effectiveness. The 47 papers included show a wide and increasing worldwide archetype usage, in a variety of medical domains. Most of the papers noted that archetypes are an appropriate solution for future-proof and interoperable medical data storage. We conclude that archetypes are a suitable solution for the complex problem of electronic health record storage and interoperability.

  7. 36 CFR § 1236.28 - What additional requirements apply to the selection and maintenance of electronic records storage...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... unscheduled data on magnetic records storage media onto tested and verified new electronic media. ... apply to the selection and maintenance of electronic records storage media for permanent records? Â... storage media for permanent records? (a) Agencies must maintain the storage and test areas for electronic...

  8. Breaches of health information: are electronic records different from paper records?

    PubMed

    Sade, Robert M

    2010-01-01

    Breaches of electronic medical records constitute a type of healthcare error, but should be considered separately from other types of errors because the national focus on the security of electronic data justifies special treatment of medical information breaches. Guidelines for protecting electronic medical records should be applied equally to paper medical records.

  9. Integrating knowledge based functionality in commercial hospital information systems.

    PubMed

    Müller, M L; Ganslandt, T; Eich, H P; Lang, K; Ohmann, C; Prokosch, H U

    2000-01-01

    Successful integration of knowledge-based functions in the electronic patient record depends on direct and context-sensitive accessibility and availability to clinicians and must suit their workflow. In this paper we describe an exemplary integration of an existing standalone scoring system for acute abdominal pain into two different commercial hospital information systems using Java/Corba technolgy.

  10. Ontology-Based Data Integration of Open Source Electronic Medical Record and Data Capture Systems

    ERIC Educational Resources Information Center

    Guidry, Alicia F.

    2013-01-01

    In low-resource settings, the prioritization of clinical care funding is often determined by immediate health priorities. As a result, investment directed towards the development of standards for clinical data representation and exchange are rare and accordingly, data management systems are often redundant. Open-source systems such as OpenMRS and…

  11. Principal Challenges Facing Electronic Records Management in Federal Agencies Today.

    ERIC Educational Resources Information Center

    Patterson, Giovanna; Sprehe, J. Timothy

    2002-01-01

    Discusses electronic records management in the federal government. Highlights include managing electronic mail; information technology planning, systems design, and architecture; updating conventional records management; integrating electronic records management with other information technology systems; challenges of end-user training; business…

  12. Clinical genomics in the world of the electronic health record.

    PubMed

    Marsolo, Keith; Spooner, S Andrew

    2013-10-01

    The widespread adoption of electronic health records presents a number of benefits to the field of clinical genomics. They include the ability to return results to the practitioner, to use genetic findings in clinical decision support, and to have data collected in the electronic health record that serve as a source of phenotypic information for analysis purposes. Not all electronic health records are created equal, however. They differ in their features, capabilities, and ease of use. Therefore, to understand the potential of the electronic health record, it is first necessary to understand its capabilities and the impact that implementation strategy has on usability. Specifically, we focus on the following areas: (i) how the electronic health record is used to capture data in clinical practice settings; (ii) how the implementation and configuration of the electronic health record affect the quality and availability of data; (iii) the management of clinical genetic test results and the feasibility of electronic health record integration; and (iv) the challenges of implementing an electronic health record in a research-intensive environment. This is followed by a discussion of the minimum functional requirements that an electronic health record must meet to enable the satisfactory integration of genomic results as well as the open issues that remain.

  13. Exploring practical approaches to maximising data quality in electronic healthcare records in the primary care setting and associated benefits. Report of panel-led discussion held at SAPC in July 2014.

    PubMed

    Dungey, Sheena; Glew, Simon; Heyes, Barbara; Macleod, John; Tate, A Rosemary

    2016-09-01

    Electronic healthcare records provide information about patient care over time which not only affords the opportunity to improve patient care directly through effective monitoring and identification of care requirements but also offers a unique platform for both clinical and service-model research essential to the longer-term development of the health service. The quality of the recorded data can, however, be variable and can compromise the validity of data use both for primary and secondary purposes. In order to explore the challenges and benefits of and approaches to recording high quality primary care electronic records, a Clinical Practice Research Datalink (CPRD) sponsored workshop was held at the Society of Academic Primary Care (SAPC) conference in 2014 with the aim of engaging GPs and other data users. The workshop was held as a structured discussion, led by an expert panel and focused around three questions: (1) What are the data quality priorities for clinicians and researchers? How do these priorities differ or overlap? (2) What challenges might GPs face in provision of good data quality both for treating their patients and for research? Do these aims conflict? (3) What tools (such as data metrics and visualisations or software components) could assist the GP in improving data quality and patient management and could this tie in with analytical processes occurring at the research stage? The discussion highlighted both overlap and differences in the perceived data quality priorities and challenges for different user groups. Five key areas of focus were agreed upon and recommendations determined for moving forward in improving quality. The importance of good high quality electronic healthcare records has been set forth along with the need for a practical user-considered and collaborative approach to its improvement.

  14. 36 CFR 1236.6 - What are agency responsibilities for electronic records management?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...-1235 of this subchapter; (b) Integrate records management and preservation considerations into the... responsibilities for electronic records management? 1236.6 Section 1236.6 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT General...

  15. 36 CFR 1236.6 - What are agency responsibilities for electronic records management?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...-1235 of this subchapter; (b) Integrate records management and preservation considerations into the... responsibilities for electronic records management? 1236.6 Section 1236.6 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT General...

  16. 36 CFR 1236.6 - What are agency responsibilities for electronic records management?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...-1235 of this subchapter; (b) Integrate records management and preservation considerations into the... responsibilities for electronic records management? 1236.6 Section 1236.6 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT General...

  17. 36 CFR 1236.6 - What are agency responsibilities for electronic records management?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...-1235 of this subchapter; (b) Integrate records management and preservation considerations into the... responsibilities for electronic records management? 1236.6 Section 1236.6 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT General...

  18. Ethics of medical records and professional communications.

    PubMed

    Recupero, Patricia R

    2008-01-01

    In child and adolescent psychiatry, medical records and professional communications raise important ethical concerns for the treating or consulting clinician. Although a distinction may be drawn between internal records (eg, medical records and psychotherapy notes) and external communications (eg, consultation reports and correspondence with pediatricians), several ethical principles apply to both types of documentation; however, specific considerations may vary, depending upon the context in which the records or communications were produced. Special care is due with regard to thoroughness and honesty, collaboration and cooperation, autonomy and dignity of the patient, confidentiality of the patient and family members, maintaining objectivity and neutrality, electronic communications media, and professional activities (eg, political advocacy). This article reviews relevant ethical concerns for child and adolescent psychiatrists with respect to medical records and professional communications, drawing heavily from forensic and legal sources, and offers additional recommendations for further reading for clarification and direction on ethical dilemmas.

  19. The implementation of a mobile problem-specific electronic CEX for assessing directly observed student-patient encounters.

    PubMed

    Ferenchick, Gary S; Foreback, Jami; Towfiq, Basim; Kavanaugh, Kevin; Solomon, David; Mohmand, Asad

    2010-01-29

    Facilitating direct observation of medical students' clinical competencies is a pressing need. We developed an electronic problem-specific Clinical Evaluation Exercise (eCEX) based on a national curriculum. We assessed its feasibility in monitoring and recording students' competencies and the impact of a grading incentive on the frequency of direct observations in an internal medicine clerkship. Students (n = 56) at three clinical sites used the eCEX and comparison students (n = 56) at three other clinical sites did not. Students in the eCEX group were required to arrange 10 evaluations with faculty preceptors. Students in the second group were required to document a single, faculty observed 'Full History and Physical' encounter with a patient. Students and preceptors were surveyed at the end of each rotation. eCEX increased students' and evaluators' understanding of direct-observation objectives and had a positive impact on the evaluators' ability to provide feedback and assessments. The grading incentive increased the number of times a student reported direct observation by a resident preceptor. eCEX appears to be an effective means of enhancing student evaluation.

  20. Your Medical Records

    MedlinePlus

    ... sometimes, but many health care providers now keep electronic records. You might hear medical people call these EHRs — short for electronic health records . Electronic records make it easier for ...

  1. Determinants of primary care nurses' intention to adopt an electronic health record in their clinical practice.

    PubMed

    Leblanc, Genevieve; Gagnon, Marie-Pierre; Sanderson, Duncan

    2012-09-01

    A provincial electronic health record is being developed in the Province of Quebec (and in all other provinces in Canada), and authorities hope that it will enable a safer and more efficient healthcare system for citizens. However, the expected benefits can occur only if healthcare professionals, including nurses, adopt this technology. Although attention to the use of the electronic health record by nurses is growing, better understanding of nurses' intention to use an electronic health record is needed and could help managers to better plan its implementation. This study examined the factors that influence primary care nurses' intention to adopt the provincial electronic health record, since intention influences electronic health record use and implementation success. Using a modified version of Ajzen's Theory of Planned Theory of Planned Behavior, a questionnaire was developed and pretested. Questionnaires were distributed to 199 primary care nurses. Multiple hierarchical regression indicated that the Theory of Planned Behavior variables explained 58% of the variance in nurses' intention to adopt an electronic health record. The strong intention to adopt the electronic health record is mainly determined by perceived behavioral control, normative beliefs, and attitudes. The implications of the study are that healthcare managers could facilitate adoption of an electronic health record by strengthening nurses' intention to adopt the electronic health record, which in turn can be influenced through interventions oriented toward the belief that using an electronic health record will improve the quality of patient care.

  2. 3 CFR - Managing Government Records

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... opportunities for agency records management. Greater reliance on electronic communication and systems has... improving or maintaining its records management program, particularly with respect to managing electronic... litigation; and (vi) transitioning from paper-based records management to electronic records management where...

  3. Are low income patients receiving the benefits of electronic health records? A statewide survey.

    PubMed

    Butler, Matthew J; Harootunian, Gevork; Johnson, William G

    2013-06-01

    There are concerns that physicians serving low-income, Medicaid patients, in the United States are less likely to adopt electronic health records and, if so, that Medicaid patients will be denied the benefits from electronic health record use. This study seeks to determine whether physicians treating Medicaid patients were less likely to have adopted electronic health records. Physician surveys completed during physicians' license renewal process in Arizona were merged with the physician licensing data and Medicaid administrative claims data. Survey responses were received from 50.7 percent (6,780 out of 13,380) of all physicians practicing in Arizona. Physician survey responses were used to identify whether the physician used electronic health records and the degree to which the physician exchanged electronic health records with other health-care providers. Medicaid claims data were used to identify which physicians provided health care to Medicaid beneficiaries. The primary outcome of interest was whether Medicaid providers were more or less likely to have adopted electronic health records. Logistic regression analysis was used to estimate average marginal effects. In multivariate analysis, physicians with 20 or more Medicaid patients during the survey cycle were 4.1 percent more likely to use an electronic health record and 5.2 percent more likely to be able to transmit electronic health records to at least one health-care provider outside of their practice. These effects increase in magnitude when the analysis is restricted to solo practice physicians This is the first study to find a pro-Medicaid gap in electronic health record adoption suggesting that the low income patients served by Arizona's Health Care Cost Containment System are not at a disadvantage with regard to electronic health record access and that Arizona's model of promoting electronic health record adoption merits further study.

  4. Capacitively Coupled Arrays of Multiplexed Flexible Silicon Transistors for Long-Term Cardiac Electrophysiology

    PubMed Central

    Fang, Hui; Yu, Ki Jun; Gloschat, Christopher; Yang, Zijian; Chiang, Chia-Han; Zhao, Jianing; Won, Sang Min; Xu, Siyi; Trumpis, Michael; Zhong, Yiding; Song, Enming; Han, Seung Won; Xue, Yeguang; Xu, Dong; Cauwenberghs, Gert; Kay, Matthew; Huang, Yonggang; Viventi, Jonathan; Efimov, Igor R.; Rogers, John A.

    2017-01-01

    Advanced capabilities in electrical recording are essential for the treatment of heart-rhythm diseases. The most advanced technologies use flexible integrated electronics; however, the penetration of biological fluids into the underlying electronics and any ensuing electrochemical reactions pose significant safety risks. Here, we show that an ultrathin, leakage-free, biocompatible dielectric layer can completely seal an underlying layer of flexible electronics while allowing for electrophysiological measurements through capacitive coupling between tissue and the electronics, and thus without the need for direct metal contact. The resulting current-leakage levels and operational lifetimes are, respectively, four orders of magnitude smaller and between two and three orders of magnitude longer than those of any other flexible-electronics technology. Systematic electrophysiological studies with normal, paced and arrhythmic conditions in Langendorff hearts highlight the capabilities of the capacitive-coupling approach. Our technology provides a realistic pathway towards the broad applicability of biocompatible, flexible electronic implants. PMID:28804678

  5. Electronic plants

    PubMed Central

    Stavrinidou, Eleni; Gabrielsson, Roger; Gomez, Eliot; Crispin, Xavier; Nilsson, Ove; Simon, Daniel T.; Berggren, Magnus

    2015-01-01

    The roots, stems, leaves, and vascular circuitry of higher plants are responsible for conveying the chemical signals that regulate growth and functions. From a certain perspective, these features are analogous to the contacts, interconnections, devices, and wires of discrete and integrated electronic circuits. Although many attempts have been made to augment plant function with electroactive materials, plants’ “circuitry” has never been directly merged with electronics. We report analog and digital organic electronic circuits and devices manufactured in living plants. The four key components of a circuit have been achieved using the xylem, leaves, veins, and signals of the plant as the template and integral part of the circuit elements and functions. With integrated and distributed electronics in plants, one can envisage a range of applications including precision recording and regulation of physiology, energy harvesting from photosynthesis, and alternatives to genetic modification for plant optimization. PMID:26702448

  6. 32 CFR 701.21 - Electronic record.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 5 2013-07-01 2013-07-01 false Electronic record. 701.21 Section 701.21... THE NAVY DOCUMENTS AFFECTING THE PUBLIC FOIA Definitions and Terms § 701.21 Electronic record. Records (including e-mail) which are created, stored, and retrieved by electronic means. ...

  7. 32 CFR 701.21 - Electronic record.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 5 2012-07-01 2012-07-01 false Electronic record. 701.21 Section 701.21... THE NAVY DOCUMENTS AFFECTING THE PUBLIC FOIA Definitions and Terms § 701.21 Electronic record. Records (including e-mail) which are created, stored, and retrieved by electronic means. ...

  8. 32 CFR 701.21 - Electronic record.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 5 2010-07-01 2010-07-01 false Electronic record. 701.21 Section 701.21... THE NAVY DOCUMENTS AFFECTING THE PUBLIC FOIA Definitions and Terms § 701.21 Electronic record. Records (including e-mail) which are created, stored, and retrieved by electronic means. ...

  9. 32 CFR 701.21 - Electronic record.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 5 2011-07-01 2011-07-01 false Electronic record. 701.21 Section 701.21... THE NAVY DOCUMENTS AFFECTING THE PUBLIC FOIA Definitions and Terms § 701.21 Electronic record. Records (including e-mail) which are created, stored, and retrieved by electronic means. ...

  10. 32 CFR 701.21 - Electronic record.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 5 2014-07-01 2014-07-01 false Electronic record. 701.21 Section 701.21... THE NAVY DOCUMENTS AFFECTING THE PUBLIC FOIA Definitions and Terms § 701.21 Electronic record. Records (including e-mail) which are created, stored, and retrieved by electronic means. ...

  11. Interfacial scanning tunneling spectroscopy (STS) of chalcogenide/metal hybrid nanostructure

    NASA Astrophysics Data System (ADS)

    Saad, Mahmoud M.; Abdallah, Tamer; Easawi, Khalid; Negm, Sohair; Talaat, Hassan

    2015-05-01

    The electronic structure at the interface of chalcogenide/metal hybrid nanostructure (CdSe-Au tipped) had been studied by UHV scanning tunneling spectroscopy (STS) technique at room temperature. This nanostructure was synthesized by a phase transfer chemical method. The optical absorption of this hybrid nanostructure was recorded, and the application of the effective mass approximation (EMA) model gave dimensions that were confirmed by the direct measurements using the scanning tunneling microscopy (STM) as well as the high-resolution transmission electron microscope (HRTEM). The energy band gap obtained by STS agrees with the values obtained from the optical absorption. Moreover, the STS at the interface of CdSe-Au tipped hybrid nanostructure between CdSe of size about 4.1 ± 0.19 nm and Au tip of size about 3.5 ± 0.29 nm shows a band bending about 0.18 ± 0.03 eV in CdSe down in the direction of the interface. Such a result gives a direct observation of the electron accumulation at the interface of CdSe-Au tipped hybrid nanostructure, consistent with its energy band diagram. The presence of the electron accumulation at the interface of chalcogenides with metals has an important implication for hybrid nanoelectronic devices and the newly developed plasmon/chalcogenide photovoltaic solar energy conversion.

  12. Influence of pay-for-performance programs on information technology use among child health providers: the devil is in the details.

    PubMed

    Menachemi, Nir; Struchen-Shellhorn, Wendy; Brooks, Robert G; Simpson, Lisa

    2009-01-01

    Pay-for-performance programs are used to promote improved health care quality, often through increased use of health information technology. However, little is known about whether pay-for-performance programs influence the adoption of health information technology, especially among child health providers. This study explored how various pay-for-performance compensation methods are related to health information technology use. Survey data from 1014 child health providers practicing in Florida were analyzed by using univariate and multivariate techniques. Questions asked about the adoption of electronic health records and personal digital assistants, as well as types of activities that affected child health provider compensation or income. The most common reported method to affect respondents' compensation was traditional productivity or billing (78%). Of the pay-for-performance-related methods of compensation, child health providers indicated that measures of clinical care (41%), patient surveys and experience (34%), the use of health information technology (29%), and quality bonuses or incentives (27%) were a major or minor factor in their compensation. In multivariate logistic regression analyses, only pay-for-performance programs that compensated directly for health information technology use were associated with an increased likelihood of electronic health record system adoption. Pay-for-performance programs linking measures of clinical quality to compensation were positively associated with personal digital assistant use among child health providers. Pay-for-performance programs that do not directly emphasize health information technology use do not influence the adoption of electronic health records among Florida physicians treating children. Understanding how different pay-for-performance compensation methods incentivize health information technology adoption is important for improving quality.

  13. Implementing and Improving Automated Electronic Tumor Molecular Profiling

    PubMed Central

    Staggs, David B.; Hackett, Lauren; Haberman, Erich; Tod, Mike; Levy, Mia; Warner, Jeremy

    2016-01-01

    Oncology practice increasingly requires the use of molecular profiling of tumors to inform the use of targeted therapeutics. However, many oncologists use third-party laboratories to perform tumor genomic testing, and these laboratories may not have electronic interfaces with the provider’s electronic medical record (EMR) system. The resultant reporting mechanisms, such as plain-paper faxing, can reduce report fidelity, slow down reporting procedures for a physician’s practice, and make reports less accessible. Vanderbilt University Medical Center and its genomic laboratory testing partner have collaborated to create an automated electronic reporting system that incorporates genetic testing results directly into the clinical EMR. This system was iteratively tested, and causes of failure were discovered and addressed. Most errors were attributable to data entry or typographical errors that made reports unable to be linked to the correct patient in the EMR. By providing direct feedback to providers, we were able to significantly decrease the rate of transmission errors (from 6.29% to 3.84%; P < .001). The results and lessons of 1 year of using the system and transmitting 832 tumor genomic testing reports are reported. PMID:26813927

  14. Electronic health records to facilitate clinical research.

    PubMed

    Cowie, Martin R; Blomster, Juuso I; Curtis, Lesley H; Duclaux, Sylvie; Ford, Ian; Fritz, Fleur; Goldman, Samantha; Janmohamed, Salim; Kreuzer, Jörg; Leenay, Mark; Michel, Alexander; Ong, Seleen; Pell, Jill P; Southworth, Mary Ross; Stough, Wendy Gattis; Thoenes, Martin; Zannad, Faiez; Zalewski, Andrew

    2017-01-01

    Electronic health records (EHRs) provide opportunities to enhance patient care, embed performance measures in clinical practice, and facilitate clinical research. Concerns have been raised about the increasing recruitment challenges in trials, burdensome and obtrusive data collection, and uncertain generalizability of the results. Leveraging electronic health records to counterbalance these trends is an area of intense interest. The initial applications of electronic health records, as the primary data source is envisioned for observational studies, embedded pragmatic or post-marketing registry-based randomized studies, or comparative effectiveness studies. Advancing this approach to randomized clinical trials, electronic health records may potentially be used to assess study feasibility, to facilitate patient recruitment, and streamline data collection at baseline and follow-up. Ensuring data security and privacy, overcoming the challenges associated with linking diverse systems and maintaining infrastructure for repeat use of high quality data, are some of the challenges associated with using electronic health records in clinical research. Collaboration between academia, industry, regulatory bodies, policy makers, patients, and electronic health record vendors is critical for the greater use of electronic health records in clinical research. This manuscript identifies the key steps required to advance the role of electronic health records in cardiovascular clinical research.

  15. Graphene-Based Three-Dimensional Capacitive Touch Sensor for Wearable Electronics.

    PubMed

    Kang, Minpyo; Kim, Jejung; Jang, Bongkyun; Chae, Youngcheol; Kim, Jae-Hyun; Ahn, Jong-Hyun

    2017-08-22

    The development of input device technology in a conformal and stretchable format is important for the advancement of various wearable electronics. Herein, we report a capacitive touch sensor with good sensing capabilities in both contact and noncontact modes, enabled by the use of graphene and a thin device geometry. This device can be integrated with highly deformable areas of the human body, such as the forearms and palms. This touch sensor detects multiple touch signals in acute recordings and recognizes the distance and shape of the approaching objects before direct contact is made. This technology offers a convenient and immersive human-machine interface and additional potential utility as a multifunctional sensor for emerging wearable electronics and robotics.

  16. 36 CFR 1236.20 - What are appropriate recordkeeping systems for electronic records?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... into the electronic information system or records can be transferred to an electronic recordkeeping... and retrieval. Establish the appropriate rights for users to access the records and facilitate the search and retrieval of records. (6) Preserve records. Ensure that all records in the system are...

  17. 36 CFR § 1236.20 - What are appropriate recordkeeping systems for electronic records?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... into the electronic information system or records can be transferred to an electronic recordkeeping... and retrieval. Establish the appropriate rights for users to access the records and facilitate the search and retrieval of records. (6) Preserve records. Ensure that all records in the system are...

  18. 36 CFR 1236.20 - What are appropriate recordkeeping systems for electronic records?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... into the electronic information system or records can be transferred to an electronic recordkeeping... and retrieval. Establish the appropriate rights for users to access the records and facilitate the search and retrieval of records. (6) Preserve records. Ensure that all records in the system are...

  19. 36 CFR 1236.20 - What are appropriate recordkeeping systems for electronic records?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... into the electronic information system or records can be transferred to an electronic recordkeeping... and retrieval. Establish the appropriate rights for users to access the records and facilitate the search and retrieval of records. (6) Preserve records. Ensure that all records in the system are...

  20. 36 CFR 1236.20 - What are appropriate recordkeeping systems for electronic records?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... into the electronic information system or records can be transferred to an electronic recordkeeping... and retrieval. Establish the appropriate rights for users to access the records and facilitate the search and retrieval of records. (6) Preserve records. Ensure that all records in the system are...

  1. 77 FR 27859 - Privacy Act of 1974; System of Records

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-11

    ... Veterans Affairs. ACTION: Notice of New System of Records ``Virtual Lifetime Electronic Record (VLER)-VA... ``Virtual Lifetime Electronic Record (VLER)-VA'' (168VA10P2). DATES: Comments on this new system of records... Virtual Lifetime Electronic Record (VLER) is an overarching program being developed by the Department of...

  2. 36 CFR § 1236.6 - What are agency responsibilities for electronic records management?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...-1235 of this subchapter; (b) Integrate records management and preservation considerations into the... responsibilities for electronic records management? § 1236.6 Section § 1236.6 Parks, Forests, and Public Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT ELECTRONIC RECORDS MANAGEMENT General...

  3. MedlinePlus Connect: Linking Patient Portals and Electronic Health Records to Health Information

    MedlinePlus

    ... Patient portals, patient health record (PHR) systems, and electronic health record (EHR) systems can use MedlinePlus Connect ... patient portal, patient health record (PHR) system, or electronic health record (EHR) system sends a problem, medication, ...

  4. Nursing Student Experiences Regarding Safe Use of Electronic Health Records: A Pilot Study of the Safety and Assurance Factors for EHR Resilience Guides.

    PubMed

    Whitt, Karen J; Eden, Lacey; Merrill, Katreena Collette; Hughes, Mckenna

    2017-01-01

    Previous research has linked improper electronic health record configuration and use with adverse patient events. In response to this problem, the US Office of the National Coordinator for Health Information Technology developed the Safety and Assurance Factors for EHR Resilience guides to evaluate electronic health records for optimal use and safety features. During the course of their education, nursing students are exposed to a variety of clinical practice settings and electronic health records. This descriptive study evaluated 108 undergraduate and 51 graduate nursing students' ratings of electronic health record features and safe practices, as well as what they learned from utilizing the computerized provider order entry and clinician communication Safety and Assurance Factors for EHR Resilience guide checklists. More than 80% of the undergraduate and 70% of the graduate students reported that they experienced user problems with electronic health records in the past. More than 50% of the students felt that electronic health records contribute to adverse patient outcomes. Students reported that many of the features assessed were not fully implemented in their electronic health record. These findings highlight areas where electronic health records can be improved to optimize patient safety. The majority of students reported that utilizing the Safety and Assurance Factors for EHR Resilience guides increased their understanding of electronic health record features.

  5. To act or not to act: responses to electronic health record prompts by family medicine clinicians.

    PubMed

    Zazove, Philip; McKee, Michael; Schleicher, Lauren; Green, Lee; Kileny, Paul; Rapai, Mary; Mulhem, Elie

    2017-03-01

    A major focus of health care today is a strong emphasis on improving the health and quality of care for entire patient populations. One common approach utilizes electronic clinical alerts to prompt clinicians when certain interventions are due for individual patients being seen. However, these alerts have not been consistently effective, particularly for less visible (though important) conditions such as hearing loss (HL) screening. We conducted hour-long cognitive task analysis interviews to explore how family medicine clinicians view, perceive, and use electronic clinical alerts, and to utilize this information to design a more effective alert using HL identification and referral as a model diagnosis. Four key direct barriers were identified that impeded alert use: poor standardization and formatting, time pressures in primary care, clinic workflow variations, and mental models of the condition being prompted (in this case, HL). One indirect barrier was identified: electronic health record and institution/government regulations. We identified that clinicians' mental model of the condition being prompted was probably the major barrier, though this was often expressed as time pressure. We discuss solutions to each of the 5 identified barriers, such as addressing physicians' mental models, by focusing on physicians' expertise rather than knowledge to improve their comfort when caring for patients with the conditions being prompted. To unleash the potential of electronic clinical alerts, electronic health record and health care institutions need to address some key barriers. We outline these barriers and propose solutions. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  6. Perceptions of electronic health record implementation: a statewide survey of physicians in Rhode Island.

    PubMed

    Wylie, Matthew C; Baier, Rosa R; Gardner, Rebekah L

    2014-10-01

    Although electronic health record use improves healthcare delivery, adoption into clinical practice is incomplete. We sought to identify the extent of adoption in Rhode Island and the characteristics of physicians and electronic health records associated with positive experience. We performed a cross-sectional study of data collected by the Rhode Island Department of Health for the Health Information Technology Survey 2009 to 2013. Survey questions included provider and practice demographics, health record information, and Likert-type scaled questions regarding how electronic health record use affected clinical practice. The survey response rate ranged from 50% to 65%, with 62% in 2013. Increasing numbers of physicians in Rhode Island use an electronic health record. In 2013, 81% of physicians used one, and adoption varied by clinical subspecialty. Most providers think that electronic health record use improves billing and quality improvement but has not improved job satisfaction. Physicians with longer and more sophisticated electronic health record use report positive effects of introduction on all aspects of practice examined (P < .001). Older physician age is associated with worse opinion of electronic health record introduction (P < .001). Of the 18 electronic health record vendors most frequently used in Rhode Island, 5 were associated with improved job satisfaction. We report the largest statewide study of electronic health record adoption to date. We found increasing physician use in Rhode Island, and the extent of adoption varies by subspecialty. Although older physicians are less likely to be positive about electronic health record adoption, longer and more sophisticated use are associated with more positive opinions, suggesting acceptance will grow over time. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Automatic address validation and health record review to identify homeless Social Security disability applicants.

    PubMed

    Erickson, Jennifer; Abbott, Kenneth; Susienka, Lucinda

    2018-06-01

    Homeless patients face a variety of obstacles in pursuit of basic social services. Acknowledging this, the Social Security Administration directs employees to prioritize homeless patients and handle their disability claims with special care. However, under existing manual processes for identification of homelessness, many homeless patients never receive the special service to which they are entitled. In this paper, we explore address validation and automatic annotation of electronic health records to improve identification of homeless patients. We developed a sample of claims containing medical records at the moment of arrival in a single office. Using address validation software, we reconciled patient addresses with public directories of homeless shelters, veterans' hospitals and clinics, and correctional facilities. Other tools annotated electronic health records. We trained random forests to identify homeless patients and validated each model with 10-fold cross validation. For our finished model, the area under the receiver operating characteristic curve was 0.942. The random forest improved sensitivity from 0.067 to 0.879 but decreased positive predictive value to 0.382. Presumed false positive classifications bore many characteristics of homelessness. Organizations could use these methods to prompt early collection of information necessary to avoid labor-intensive attempts to reestablish contact with homeless individuals. Annually, such methods could benefit tens of thousands of patients who are homeless, destitute, and in urgent need of assistance. We were able to identify many more homeless patients through a combination of automatic address validation and natural language processing of unstructured electronic health records. Copyright © 2018. Published by Elsevier Inc.

  8. Health-oriented electronic oral health record: development and evaluation.

    PubMed

    Wongsapai, Mansuang; Suebnukarn, Siriwan; Rajchagool, Sunsanee; Beach, Daryl; Kawaguchi, Sachiko

    2014-06-01

    This study aims to develop and evaluate a new Health-oriented Electronic Oral Health Record that implements the health-oriented status and intervention index. The index takes the principles of holistic oral healthcare and applies them to the design and implementation of the Health-oriented Electronic Oral Health Record. We designed an experiment using focus groups and a consensus (Delphi process) method to develop a new health-oriented status and intervention index and graphical user interface. A comparative intervention study with qualitative and quantitative methods was used to compare an existing Electronic Oral Health Record to the Health-oriented Electronic Oral Health Record, focusing on dentist satisfaction, accuracy, and completeness of oral health status recording. The study was conducted by the dental staff of the Inter-country Center for Oral Health collaborative hospitals in Thailand. Overall, the user satisfaction questionnaire had a positive response to the Health-oriented Electronic Oral Health Record. The dentists found it easy to use and were generally satisfied with the impact on their work, oral health services, and surveillance. The dentists were significantly satisfied with the Health-oriented Electronic Oral Health Record compared to the existing Electronic Oral Health Record (p < 0.001). The accuracy and completeness values of the oral health information recorded using the Health-oriented Electronic Oral Health Record were 97.15 and 93.74 percent, respectively. This research concludes that the Health-oriented Electronic Oral Health Record satisfied many dentists, provided benefits to holistic oral healthcare, and facilitated the planning, managing, and evaluation of the healthcare delivery system.

  9. Fragmentation mechanism of UV-excited peptides in the gas phase

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Zabuga, Aleksandra V., E-mail: aleksandra.zabuga@epfl.ch; Kamrath, Michael Z.; Boyarkin, Oleg V.

    We present evidence that following near-UV excitation, protonated tyrosine- or phenylalanine–containing peptides undergo intersystem crossing to produce a triplet species. This pathway competes with direct dissociation from the excited electronic state and with dissociation from the electronic ground state subsequent to internal conversion. We employ UV-IR double-resonance photofragment spectroscopy to record conformer-specific vibrational spectra of cold peptides pre-excited to their S{sub 1} electronic state. The absorption of tunable IR light by these electronically excited peptides leads to a drastic increase in fragmentation, selectively enhancing the loss of neutral phenylalanine or tyrosine side-chain, which are not the lowest dissociation channels inmore » the ground electronic state. The recorded IR spectra evolve upon increasing the time delay between the UV and IR pulses, reflecting the dynamics of the intersystem crossing on a timescale of ∼80 ns and <10 ns for phenylalanine- and tyrosine-containing peptides, respectively. Once in the triplet state, phenylalanine-containing peptides may live for more than 100 ms, unless they absorb IR photons and undergo dissociation by the loss of an aromatic side-chain. We discuss the mechanism of this fragmentation channel and its possible implications for photofragment spectroscopy and peptide photostability.« less

  10. [Support of the nursing process through electronic nursing documentation systems (UEPD) – Initial validation of an instrument].

    PubMed

    Hediger, Hannele; Müller-Staub, Maria; Petry, Heidi

    2016-01-01

    Electronic nursing documentation systems, with standardized nursing terminology, are IT-based systems for recording the nursing processes. These systems have the potential to improve the documentation of the nursing process and to support nurses in care delivery. This article describes the development and initial validation of an instrument (known by its German acronym UEPD) to measure the subjectively-perceived benefits of an electronic nursing documentation system in care delivery. The validity of the UEPD was examined by means of an evaluation study carried out in an acute care hospital (n = 94 nurses) in German-speaking Switzerland. Construct validity was analyzed by principal components analysis. Initial references of validity of the UEPD could be verified. The analysis showed a stable four factor model (FS = 0.89) scoring in 25 items. All factors loaded ≥ 0.50 and the scales demonstrated high internal consistency (Cronbach's α = 0.73 – 0.90). Principal component analysis revealed four dimensions of support: establishing nursing diagnosis and goals; recording a case history/an assessment and documenting the nursing process; implementation and evaluation as well as information exchange. Further testing with larger control samples and with different electronic documentation systems are needed. Another potential direction would be to employ the UEPD in a comparison of various electronic documentation systems.

  11. 75 FR 63208 - Advisory Committee on the Electronic Records Archives (ACERA)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-14

    ... NATIONAL ARCHIVES AND RECORDS ADMINISTRATION Advisory Committee on the Electronic Records Archives (ACERA) AGENCY: National Archives and Records Administration. ACTION: Notice of meeting. SUMMARY: In... and Records Administration (NARA) announces a meeting of the Advisory Committee on the Electronic...

  12. 76 FR 65218 - Advisory Committee on the Electronic Records Archives (ACERA)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-20

    ... NATIONAL ARCHIVES AND RECORDS ADMINISTRATION Advisory Committee on the Electronic Records Archives (ACERA) AGENCY: National Archives and Records Administration. ACTION: Notice of meeting. SUMMARY: In... and Records Administration (NARA) announces a meeting of the Advisory Committee on the Electronic...

  13. Structured electronic physiotherapy records.

    PubMed

    Buyl, Ronald; Nyssen, Marc

    2009-07-01

    With the introduction of the electronic health record, physiotherapists too are encouraged to store their patient records in a structured digital format. The typical nature of a physiotherapy treatment requires a specific record structure to be implemented, with special attention to user-friendliness and communication with other healthcare providers. The objective of this study was to establish a framework for the electronic physiotherapy record and to define a model for the interoperability with the other healthcare providers involved in the patients' care. Although we started from the Belgian context, we used a generic approach so that the results can easily be extrapolated to other countries. The framework we establish here defines not only the different building blocks of the electronic physiotherapy record, but also describes the structure and the content of the exchanged data elements. Through a combined effort by all involved parties, we elaborated an eight-level structure for the electronic physiotherapy record. Furthermore we designed a server-based model for the exchange of data between electronic record systems held by physicians and those held by physiotherapists. Two newly defined XML messages enable data interchange: the physiotherapy prescription and the physiotherapy report. We succeeded in defining a solid, structural model for electronic physiotherapist record systems. Recent wide scale implementation of operational elements such as the electronic registry has proven to make the administrative work easier for the physiotherapist. Moreover, within the proposed framework all the necessary building blocks are present for further data exchange and communication with other healthcare parties in the future. Although we completed the design of the structure and already implemented some new aspects of the electronic physiotherapy record, the real challenge lies in persuading the end-users to start using these electronic record systems. Via a quality label certification procedure, based on adequate criteria, the Ministry of Health tries to promote the use of electronic physiotherapy records. We must keep in mind that physiotherapists will show an interest in electronic record keeping, only if this will lead to a positive return for them.

  14. 36 CFR 1225.24 - When can an agency apply previously approved schedules to electronic records?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... may apply a previously approved schedule for hard copy records to electronic versions of the permanent records when the electronic records system replaces a single series of hard copy permanent records or the... have been previously scheduled as permanent in hard copy form, including special media records as...

  15. 36 CFR 1236.10 - What records management controls must agencies establish for records in electronic information...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Implementing Electronic Information Systems § 1236.10 What records management controls must agencies establish for records in electronic information systems? The following types of records management controls are... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false What records management...

  16. 36 CFR 1236.10 - What records management controls must agencies establish for records in electronic information...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Implementing Electronic Information Systems § 1236.10 What records management controls must agencies establish for records in electronic information systems? The following types of records management controls are... 36 Parks, Forests, and Public Property 3 2011-07-01 2011-07-01 false What records management...

  17. 36 CFR 1236.10 - What records management controls must agencies establish for records in electronic information...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Implementing Electronic Information Systems § 1236.10 What records management controls must agencies establish for records in electronic information systems? The following types of records management controls are... 36 Parks, Forests, and Public Property 3 2012-07-01 2012-07-01 false What records management...

  18. 36 CFR § 1236.10 - What records management controls must agencies establish for records in electronic information...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Implementing Electronic Information Systems § 1236.10 What records management controls must agencies establish for records in electronic information systems? The following types of records management controls are... 36 Parks, Forests, and Public Property 3 2013-07-01 2012-07-01 true What records management...

  19. 36 CFR 1236.10 - What records management controls must agencies establish for records in electronic information...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Implementing Electronic Information Systems § 1236.10 What records management controls must agencies establish for records in electronic information systems? The following types of records management controls are... 36 Parks, Forests, and Public Property 3 2014-07-01 2014-07-01 false What records management...

  20. 76 FR 15349 - Advisory Committee on the Electronic Records Archives (ACERA); Meeting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-21

    ... NATIONAL ARCHIVES AND RECORDS ADMINISTRATION Advisory Committee on the Electronic Records Archives (ACERA); Meeting AGENCY: National Archives and Records Administration. ACTION: Notice of Meeting. SUMMARY... Archives and Records Administration (NARA) announces a meeting of the Advisory Committee on the Electronic...

  1. Holographic Reconstruction of Photoelectron Diffraction and Its Circular Dichroism for Local Structure Probing

    NASA Astrophysics Data System (ADS)

    Matsui, Fumihiko; Matsushita, Tomohiro; Daimon, Hiroshi

    2018-06-01

    The local atomic structure around a specific element atom can be recorded as a photoelectron diffraction pattern. Forward focusing peaks and diffraction rings around them indicate the directions and distances from the photoelectron emitting atom to the surrounding atoms. The state-of-the-art holography reconstruction algorithm enables us to image the local atomic arrangement around the excited atom in a real space. By using circularly polarized light as an excitation source, the angular momentum transfer from the light to the photoelectron induces parallax shifts in these diffraction patterns. As a result, stereographic images of atomic arrangements are obtained. These diffraction patterns can be used as atomic-site-resolved probes for local electronic structure investigation in combination with spectroscopy techniques. Direct three-dimensional atomic structure visualization and site-specific electronic property analysis methods are reviewed. Furthermore, circular dichroism was also found in valence photoelectron and Auger electron diffraction patterns. The investigation of these new phenomena provides hints for the development of new techniques for local structure probing.

  2. 31 CFR 370.1 - What special terms do I need to know to understand this part?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    .... 3101). Investor account is our record of your TreasuryDirect holdings, including a list of your total... ELECTRONIC TRANSACTIONS AND FUNDS TRANSFERS RELATING TO UNITED STATES SECURITIES General Information § 370.1... payment of money to a deposit account. Debit entry means an ACH entry for the collection of money from a...

  3. 77 FR 28447 - Electronic On-Board Recorders for Hours-of-Service Compliance; Removal of Final Rule Vacated by...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-14

    ... reviews, requiring such carriers to use EOBRs for a 2-year period; (3) altered the Agency's safety fitness standard to take into account issuance of a remedial directive when determining a carrier's fitness; and (4... conditions: * * * * * PART 385--SAFETY FITNESS PROCEDURES 0 3. The authority citation for part 385 continues...

  4. EVALUATING RISK-PREDICTION MODELS USING DATA FROM ELECTRONIC HEALTH RECORDS.

    PubMed

    Wang, L E; Shaw, Pamela A; Mathelier, Hansie M; Kimmel, Stephen E; French, Benjamin

    2016-03-01

    The availability of data from electronic health records facilitates the development and evaluation of risk-prediction models, but estimation of prediction accuracy could be limited by outcome misclassification, which can arise if events are not captured. We evaluate the robustness of prediction accuracy summaries, obtained from receiver operating characteristic curves and risk-reclassification methods, if events are not captured (i.e., "false negatives"). We derive estimators for sensitivity and specificity if misclassification is independent of marker values. In simulation studies, we quantify the potential for bias in prediction accuracy summaries if misclassification depends on marker values. We compare the accuracy of alternative prognostic models for 30-day all-cause hospital readmission among 4548 patients discharged from the University of Pennsylvania Health System with a primary diagnosis of heart failure. Simulation studies indicate that if misclassification depends on marker values, then the estimated accuracy improvement is also biased, but the direction of the bias depends on the direction of the association between markers and the probability of misclassification. In our application, 29% of the 1143 readmitted patients were readmitted to a hospital elsewhere in Pennsylvania, which reduced prediction accuracy. Outcome misclassification can result in erroneous conclusions regarding the accuracy of risk-prediction models.

  5. 76 FR 40454 - Proposed Information Collection (VSO Access to VHA Electronic Health Records) Activity; Comment...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-08

    ... Access to VHA Electronic Health Records) Activity; Comment Request AGENCY: Veterans Health Administration... Access to VHA Electronic Health Records, VA Form 10- 0400. OMB Control Number: 2900-0710. Type of Review... were granted power of attorney by veterans who have medical information recorded in VHA electronic...

  6. Recording signs of deterioration in acute patients: The documentation of vital signs within electronic health records in patients who suffered in-hospital cardiac arrest.

    PubMed

    Stevenson, Jean E; Israelsson, Johan; Nilsson, Gunilla C; Petersson, Göran I; Bath, Peter A

    2016-03-01

    Vital sign documentation is crucial to detecting patient deterioration. Little is known about the documentation of vital signs in electronic health records. This study aimed to examine documentation of vital signs in electronic health records. We examined the vital signs documented in the electronic health records of patients who had suffered an in-hospital cardiac arrest and on whom cardiopulmonary resuscitation was attempted between 2007 and 2011 (n = 228), in a 372-bed district general hospital. We assessed the completeness of vital sign data compared to VitalPAC™ Early Warning Score and the location of vital signs within the electronic health records. There was a noticeable lack of completeness of vital signs. Vital signs were fragmented through various sections of the electronic health records. The study identified serious shortfalls in the representation of vital signs in the electronic health records, with consequential threats to patient safety. © The Author(s) 2014.

  7. Management of laboratory data and information exchange in the electronic health record.

    PubMed

    Wilkerson, Myra L; Henricks, Walter H; Castellani, William J; Whitsitt, Mark S; Sinard, John H

    2015-03-01

    In the era of the electronic health record, the success of laboratories and pathologists will depend on effective presentation and management of laboratory information, including test orders and results, and effective exchange of data between the laboratory information system and the electronic health record. In this third paper of a series that explores empowerment of pathology in the era of the electronic health record, we review key elements of managing laboratory information within the electronic health record and examine functional issues pertinent to pathologists and laboratories in the exchange of laboratory information between electronic health records and both anatomic and clinical pathology laboratory information systems. Issues with electronic order-entry and results-reporting interfaces are described, and considerations for setting up these interfaces are detailed in tables. The role of the laboratory medical director as mandated by the Clinical Laboratory Improvement Amendments of 1988 and the impacts of discordance between laboratory results and their display in the electronic health record are also discussed.

  8. A compensation scheme for tape-speed variation in cassette recorders.

    PubMed

    Wodicka, G R; Aguirre, A; Burns, S K; Shannon, D C

    1988-06-01

    A scheme to reduce the data corruption caused by tape-speed variation in cassette recorders used for monitoring infant apnea was developed. Low-frequency timing information is recorded on the tape, under the constraints of the frequency response of the recorder, simultaneously with the other signals. This information is extracted during playback and multiplied to a frequency suitable for data sampling, using an electronic, phase-locked loop. Analog-to-digital conversion of the data is performed at a rate proportional to the tape speed, resulting in compensation for speed variation. No direct modification of the speed-control mechanism of the recorder is required. The scheme was evaluated by comparing interval measurements of recorded timing information with and without compensation. Compensation reduced the error of the measurement by nearly an order of magnitude, which was consistent with theoretical predictions. This allows analysis of clinical value to be performed on signals recorded by systems that lack sophisticated speed-control mechanisms.

  9. Neonatal Nurses Experience Unintended Consequences and Risks to Patient Safety With Electronic Health Records.

    PubMed

    Dudding, Katherine M; Gephart, Sheila M; Carrington, Jane M

    2018-04-01

    In this article, we examine the unintended consequences of nurses' use of electronic health records. We define these as unforeseen events, change in workflow, or an unanticipated result of implementation and use of electronic health records. Unintended consequences experienced by nurses while using electronic health records have been well researched. However, few studies have focused on neonatal nurses, and it is unclear to what extent unintended consequences threaten patient safety. A new instrument called the Carrington-Gephart Unintended Consequences of Electronic Health Record Questionnaire has been validated, and secondary analysis using the tool explored the phenomena among neonatal nurses (N = 40). The purposes of this study were to describe unintended consequences of use of electronic health records for neonatal nurses and to explore relationships between the phenomena and characteristics of the nurse and the electronic health record. The most frequent unintended consequences of electronic health record use were due to interruptions, followed by a heavier workload due to the electronic health record, changes to the workflow, and altered communication patterns. Neonatal nurses used workarounds most often with motivation to better assist patients. Teamwork was moderately related to higher unintended consequences including patient safety risks (r = 0.427, P = .007), system design (r = 0.419, P = .009), and technology barriers (r = 0.431, P = .007). Communication about patients was reduced when patient safety risks were high (r = -0.437, P = .003). By determining the frequency with which neonatal nurses experience unintended consequences of electronic health record use, future research can be targeted to improve electronic health record design through customization, integration, and refinement to support patient safety and better outcomes.

  10. Honoring Choices Minnesota: Preliminary Data from a Community-Wide Advance Care Planning Model

    PubMed Central

    Wilson, Kent S; Kottke, Thomas E; Schettle, Sue

    2014-01-01

    Advance care planning (ACP) increases the likelihood that individuals who are dying receive the care that they prefer. It also reduces depression and anxiety in family members and increases family satisfaction with the process of care. Honoring Choices Minnesota is an ACP program based on the Respecting Choices model of La Crosse, Wisconsin. The objective of this report is to describe the process, which began in 2008, of implementing Honoring Choices Minnesota in a large, diverse metropolitan area. All eight large healthcare systems in the metropolitan area agreed to participate in the project, and as of April 30, 2013, the proportion of hospitalized individuals 65 and older with advance care directives in the electronic medical record was 12.1% to 65.6%. The proportion of outpatients aged 65 and older was 11.6% to 31.7%. Organizations that had sponsored recruitment initiatives had the highest proportions of records containing healthcare directives. It was concluded that it is possible to reduce redundancy by recruiting all healthcare systems in a metropolitan area to endorse the same ACP model, although significantly increasing the proportion of individuals with a healthcare directive in their medical record requires a campaign with recruitment of organizations and individuals. PMID:25516036

  11. The strategic use of lecture recordings to facilitate an active and self-directed learning approach.

    PubMed

    Topale, Luminica

    2016-08-12

    New learning technologies have the capacity to dramatically impact how students go about learning and to facilitate an active, self-directed learning approach. In U. S. medical education, students encounter a large volume of content, which must be mastered at an accelerated pace. The added pressure to excel on the USMLE Step 1 licensing exam and competition for residency placements, require that students adopt an informed approach to the use of learning technologies so as to enhance rather than to detract from the learning process. The primary aim of this study was to gain a better understanding of how students were using recorded lectures in their learning and how their study habits have been influenced by the technology. Survey research was undertaken using a convenience sample. Students were asked to voluntarily participate in an electronic survey comprised of 27 closed ended, multiple choice questions, and one open ended item. The survey was designed to explore students' perceptions of how recorded lectures affected their choices regarding class participation and impacted their learning and to gain an understanding of how recorded lectures facilitated a strategic, active learning process. Findings revealed that recorded lectures had little influence on students' choices to participate, and that the perceived benefits of integrating recorded lectures into study practices were related to their facilitation of and impact on efficient, active, and self-directed learning. This study was a useful investigation into how the availability of lecture capture technology influenced medical students' study behaviors and how students were making valuable use of the technology as an active learning tool.

  12. Data from clinical notes: a perspective on the tension between structure and flexible documentation

    PubMed Central

    Denny, Joshua C; Xu, Hua; Lorenzi, Nancy; Stead, William W; Johnson, Kevin B

    2011-01-01

    Clinical documentation is central to patient care. The success of electronic health record system adoption may depend on how well such systems support clinical documentation. A major goal of integrating clinical documentation into electronic heath record systems is to generate reusable data. As a result, there has been an emphasis on deploying computer-based documentation systems that prioritize direct structured documentation. Research has demonstrated that healthcare providers value different factors when writing clinical notes, such as narrative expressivity, amenability to the existing workflow, and usability. The authors explore the tension between expressivity and structured clinical documentation, review methods for obtaining reusable data from clinical notes, and recommend that healthcare providers be able to choose how to document patient care based on workflow and note content needs. When reusable data are needed from notes, providers can use structured documentation or rely on post-hoc text processing to produce structured data, as appropriate. PMID:21233086

  13. Electronic Records, Registries, and the Development of "Big Data": Crowd-Sourcing Quality toward Knowledge.

    PubMed

    Dewdney, Summer B; Lachance, Jason

    2016-01-01

    Despite many perceived advances in treatment over the past few decades, cancer continues to present a significant health burden, particularly to the aging US population. Forces including shrinking funding mechanisms, cost and quality concerns, as well as disappointing clinical outcomes have driven a surge of recent efforts into utilizing the technological innovation that has permeated other industries by leveraging large and complex data sets, so called "big data." In this review, we will review some of the history of oncology data collection, including the earliest data registries, as well as explore the future directions of this new brand of research while highlighting some of the more recent and promising efforts to harness the power of the electronic health record and the multitude of data co-located there, in an effort to improve individualized cancer-related outcomes in rapid real time.

  14. Patients' experiences when accessing their on-line electronic patient records in primary care.

    PubMed Central

    Pyper, Cecilia; Amery, Justin; Watson, Marion; Crook, Claire

    2004-01-01

    BACKGROUND: Patient access to on-line primary care electronic patient records is being developed nationally. Knowledge of what happens when patients access their electronic records is poor. AIM: To enable 100 patients to access their electronic records for the first time to elicit patients' views and to understand their requirements. DESIGN OF STUDY: In-depth interviews using semi-structured questionnaires as patients accessed their electronic records, plus a series of focus groups. SETTING: Secure facilities for patients to view their primary care records privately. METHOD: One hundred patients from a randomised group viewed their on-line electronic records for the first time. The questionnaire and focus groups addressed patients' views on the following topics: ease of use; confidentiality and security; consent to access; accuracy; printing records; expectations regarding content; exploitation of electronic records; receiving new information and bad news. RESULTS: Most patients found the computer technology used acceptable. The majority found viewing their record useful and understood most of the content, although medical terms and abbreviations required explanation. Patients were concerned about security and confidentiality, including potential exploitation of records. They wanted the facility to give informed consent regarding access and use of data. Many found errors, although most were not medically significant. Many expected more detail and more information. Patients wanted to add personal information. CONCLUSION: Patients have strong views on what they find acceptable regarding access to electronic records. Working in partnership with patients to develop systems is essential to their success. Further work is required to address legal and ethical issues of electronic records and to evaluate their impact on patients, health professionals and service provision. PMID:14965405

  15. Volatility of aerosols in the western European environment. Interim report No. 1 thru 3

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Jennings, S.G.

    1987-10-01

    The volatility apparatus to be used in the proposed work is being currently assembled at the Atmospheric Sciences Laboratory, White Sands Missile Range, New Mexico. When the volatility apparatus is constructed and tested it will be shipped to University College Galway. It is then planned to carry out field-volatility measurements of the ambient aerosol, primarily for the unmodified maritime air mass and secondly for the partially modified European continental air mass. Continuous measurements for periods up to some weeks spanning all four seasons are planned. In preparation for these measurements, a digital readout facility was acquired for the IM 146more » velocity and direction transmitter to be used for recording wind speed and direction. The measurement system was electronically processed to facilitate continuous recording on a microcomputer.« less

  16. A large area high resolution imaging detector for fast atom diffraction

    NASA Astrophysics Data System (ADS)

    Lupone, Sylvain; Soulisse, Pierre; Roncin, Philippe

    2018-07-01

    We describe a high resolution imaging detector based on a single 80 mm micro-channel-plate (MCP) and a phosphor screen mounted on a UHV flange of only 100 mm inner diameter. It relies on standard components and we describe its performance with one or two MCPs. A resolution of 80 μm rms is observed on the beam profile. At low count rate, individual impact can be pinpointed with few μm accuracy but the resolution is probably limited by the MCP channel diameter. The detector has been used to record the diffraction of fast atoms at grazing incidence on crystal surfaces (GIFAD), a technique probing the electronic density of the topmost layer only. The detector was also used to record the scattering profile during azimuthal scan of the crystal to produce triangulation curves revealing the surface crystallographic directions of molecular layers. It should also be compatible with reflection high energy electron (RHEED) experiment when fragile surfaces require a low exposure to the electron beam. The discussions on the mode of operation specific to diffraction experiments apply also to commercial detectors.

  17. Utilization of the Tablet Application Proband in Pedigree Construction and Assessment.

    PubMed

    McCarty, Andrew Joseph; Miller, Jeffrey M; Fecteau, Heather; Pennington, Jeffrey W; Kessler, Lisa

    2018-04-01

    Many medical institutions have converted to a digital model for record keeping due to the Health Information Technology for Economic and Clinical Health Act. This Act provides incentives to health care systems to accelerate and encourage the adoption of electronic health record (EHR) systems. The pedigree as a tool in medicine provides an efficient method to assess and represent an individual's health and family health risks that may otherwise not be apparent in the medical record in a clearly identifiable way (Schuette, J. L., & Bennett 2009). Many clinicians continue to construct pedigrees using pen and paper method despite findings of improved identification of at risk patients with similar electronic intake tools (Arar et al. in Personalized Medicine 2011 8:523-32). The goal of this study was to explore the patient and practitioner experience with electronic pedigree programs using Proband, an application developed at The Children's Hospital of Philadelphia for genetic counselors to construct pedigrees during genetic counseling sessions directly on iPads. The first part of this study looked at the patient experience and assessed time to take the pedigree and the impact of using an electronic pedigree tool on the relationship between participant and genetic counselor. This involved 50 participants and was compared with the traditional paper method of taking a pedigree. There was no statistical significance found between the two different mediums in accuracy, speed, and rapport with provider. The second part of the study assessed the usability of Proband by ten genetic counselors. Overall, the application received a system usability score of 90/100 with a majority (7/10) of counselors agreeing that they would use this application in their clinic. The positive outcome of this study encourages future work to assess the impact and usability of programs on a larger scale as they continue to integrate into current electronic health records.

  18. Impact of an electronic medication administration record on medication administration efficiency and errors.

    PubMed

    McComas, Jeffery; Riingen, Michelle; Chae Kim, Son

    2014-12-01

    The study aims were to evaluate the impact of electronic medication administration record implementation on medication administration efficiency and occurrence of medication errors as well as to identify the predictors of medication administration efficiency in an acute care setting. A prospective, observational study utilizing time-and-motion technique was conducted before and after electronic medication administration record implementation in November 2011. A total of 156 cases of medication administration activities (78 pre- and 78 post-electronic medication administration record) involving 38 nurses were observed at the point of care. A separate retrospective review of the hospital Midas+ medication error database was also performed to collect the rates and origin of medication errors for 6 months before and after electronic medication administration record implementation. The mean medication administration time actually increased from 11.3 to 14.4 minutes post-electronic medication administration record (P = .039). In a multivariate analysis, electronic medication administration record was not a predictor of medication administration time, but the distractions/interruptions during medication administration process were significant predictors. The mean hospital-wide medication errors significantly decreased from 11.0 to 5.3 events per month post-electronic medication administration record (P = .034). Although no improvement in medication administration efficiency was observed, electronic medication administration record improved the quality of care with a significant decrease in medication errors.

  19. Video requirements for remote medical diagnosis

    NASA Technical Reports Server (NTRS)

    Davis, J. G.

    1974-01-01

    Minimal television system requirements for medical telediagnosis were studied. The experiment was conducted with the aid of a simulated telemedicine system. The first step involved making high quality videotape recordings of actual medical examinations conducted by a skilled nurse under the direction of a physician watching on closed circuit television. These recordings formed the baseline for the study. Next, these videotape recordings were electronically degraded to simulate television systems of less than broadcast quality. Finally, the baseline and degraded video recordings were shown (via a statistically randomized procedure) to a large number of physicians who attempted to reach a correct medical diagnosis and to visually recognize key physical signs for each patient. By careful scoring and analysis of the results of these viewings, the pictorial and diagnostic limitations as a function of technical video characteristics were to be defined.

  20. Nurses' Experiences of an Initial and Reimplemented Electronic Health Record Use.

    PubMed

    Chang, Chi-Ping; Lee, Ting-Ting; Liu, Chia-Hui; Mills, Mary Etta

    2016-04-01

    The electronic health record is a key component of healthcare information systems. Currently, numerous hospitals have adopted electronic health records to replace paper-based records to document care processes and improve care quality. Integrating healthcare information system into traditional nursing daily operations requires time and effort for nurses to become familiarized with this new technology. In the stages of electronic health record implementation, smooth adoption can streamline clinical nursing activities. In order to explore the adoption process, a descriptive qualitative study design and focus group interviews were conducted 3 months after and 2 years after electronic health record system implementation (system aborted 1 year in between) in one hospital located in southern Taiwan. Content analysis was performed to analyze the interview data, and six main themes were derived, in the first stage: (1) liability, work stress, and anticipation for electronic health record; (2) slow network speed, user-unfriendly design for learning process; (3) insufficient information technology/organization support; on the second stage: (4) getting used to electronic health record and further system requirements, (5) benefits of electronic health record in time saving and documentation, (6) unrealistic information technology competence expectation and future use. It concluded that user-friendly design and support by informatics technology and manpower backup would facilitate this adoption process as well.

  1. Extended use of electronic health records by primary care physicians: Does the electronic health record artefact matter?

    PubMed

    Raymond, Louis; Paré, Guy; Marchand, Marie

    2017-04-01

    The deployment of electronic health record systems is deemed to play a decisive role in the transformations currently being implemented in primary care medical practices. This study aims to characterize electronic health record systems from the perspective of family physicians. To achieve this goal, we conducted a survey of physicians practising in private clinics located in Quebec, Canada. We used valid responses from 331 respondents who were found to be representative of the larger population. Data provided by the physicians using the top three electronic health record software products were analysed in order to obtain statistically adequate sub-sample sizes. Significant differences were observed among the three products with regard to their functional capability. The extent to which each of the electronic health record functionalities are used by physicians also varied significantly. Our results confirm that the electronic health record artefact 'does matter', its clinical functionalities explaining why certain physicians make more extended use of their system than others.

  2. 49 CFR 228.205 - Access to electronic records.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 4 2013-10-01 2013-10-01 false Access to electronic records. 228.205 Section 228.205 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD...; SLEEPING QUARTERS Electronic Recordkeeping § 228.205 Access to electronic records. (a) FRA inspectors and...

  3. 49 CFR 228.205 - Access to electronic records.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 4 2012-10-01 2012-10-01 false Access to electronic records. 228.205 Section 228.205 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD...; SLEEPING QUARTERS Electronic Recordkeeping § 228.205 Access to electronic records. (a) FRA inspectors and...

  4. 49 CFR 228.205 - Access to electronic records.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 4 2014-10-01 2014-10-01 false Access to electronic records. 228.205 Section 228.205 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL RAILROAD...; SLEEPING QUARTERS Electronic Recordkeeping § 228.205 Access to electronic records. (a) FRA inspectors and...

  5. Merging Electronic Health Record Data and Genomics for Cardiovascular Research

    PubMed Central

    Hall, Jennifer L.; Ryan, John J.; Bray, Bruce E.; Brown, Candice; Lanfear, David; Newby, L. Kristin; Relling, Mary V.; Risch, Neil J.; Roden, Dan M.; Shaw, Stanley Y.; Tcheng, James E.; Tenenbaum, Jessica; Wang, Thomas N.; Weintraub, William S.

    2017-01-01

    The process of scientific discovery is rapidly evolving. The funding climate has influenced a favorable shift in scientific discovery toward the use of existing resources such as the electronic health record. The electronic health record enables long-term outlooks on human health and disease, in conjunction with multidimensional phenotypes that include laboratory data, images, vital signs, and other clinical information. Initial work has confirmed the utility of the electronic health record for understanding mechanisms and patterns of variability in disease susceptibility, disease evolution, and drug responses. The addition of biobanks and genomic data to the information contained in the electronic health record has been demonstrated. The purpose of this statement is to discuss the current challenges in and the potential for merging electronic health record data and genomics for cardiovascular research. PMID:26976545

  6. Ethical, legal, and social implications of incorporating genomic information into electronic health records.

    PubMed

    Hazin, Ribhi; Brothers, Kyle B; Malin, Bradley A; Koenig, Barbara A; Sanderson, Saskia C; Rothstein, Mark A; Williams, Marc S; Clayton, Ellen W; Kullo, Iftikhar J

    2013-10-01

    The inclusion of genomic data in the electronic health record raises important ethical, legal, and social issues. In this article, we highlight these challenges and discuss potential solutions. We provide a brief background on the current state of electronic health records in the context of genomic medicine, discuss the importance of equitable access to genome-enabled electronic health records, and consider the potential use of electronic health records for improving genomic literacy in patients and providers. We highlight the importance of privacy, access, and security, and of determining which genomic information is included in the electronic health record. Finally, we discuss the challenges of reporting incidental findings, storing and reinterpreting genomic data, and nondocumentation and duty to warn family members at potential genetic risk.

  7. Measurements of the energy spectrum of electrons emanating from solid materials irradiated by a picosecond laser

    DOE PAGES

    Di Stefano, C. A.; Kuranz, C. C.; Seely, J. F.; ...

    2015-04-01

    Here, we present the results of experiments observing the properties of the electron stream generated laterally when a laser irradiates a metal. We also found that the directionality of the electrons is dependent upon their energies, with the higher-energy tail of the spectrum ( 1MeV and higher) being more narrowly focused. This behavior is likely due to the coupling of the electrons to the electric field of the laser. We performed these experiments by using the Titan laser to irradiate a metal wire, creating the electron stream of interest. These electrons propagate to nearby spectator wires of differing metals, causingmore » them to fluoresce at their characteristic K-shell energies. This fluorescence is recorded by a crystal spectrometer. By varying the distances between the wires, we are able to probe the divergence of the electron stream, while by varying the medium through which the electrons propagate (and hence the energy-dependence of electron attenuation), we are able to probe the energy spectrum of the stream.« less

  8. Tracking the ultrafast motion of a single molecule by femtosecond orbital imaging

    NASA Astrophysics Data System (ADS)

    Cocker, Tyler L.; Peller, Dominik; Yu, Ping; Repp, Jascha; Huber, Rupert

    2016-11-01

    Watching a single molecule move on its intrinsic timescale has been one of the central goals of modern nanoscience, and calls for measurements that combine ultrafast temporal resolution with atomic spatial resolution. Steady-state experiments access the requisite spatial scales, as illustrated by direct imaging of individual molecular orbitals using scanning tunnelling microscopy or the acquisition of tip-enhanced Raman and luminescence spectra with sub-molecular resolution. But tracking the intrinsic dynamics of a single molecule directly in the time domain faces the challenge that interactions with the molecule must be confined to a femtosecond time window. For individual nanoparticles, such ultrafast temporal confinement has been demonstrated by combining scanning tunnelling microscopy with so-called lightwave electronics, which uses the oscillating carrier wave of tailored light pulses to directly manipulate electronic motion on timescales faster even than a single cycle of light. Here we build on ultrafast terahertz scanning tunnelling microscopy to access a state-selective tunnelling regime, where the peak of a terahertz electric-field waveform transiently opens an otherwise forbidden tunnelling channel through a single molecular state. It thereby removes a single electron from an individual pentacene molecule’s highest occupied molecular orbital within a time window shorter than one oscillation cycle of the terahertz wave. We exploit this effect to record approximately 100-femtosecond snapshot images of the orbital structure with sub-ångström spatial resolution, and to reveal, through pump/probe measurements, coherent molecular vibrations at terahertz frequencies directly in the time domain. We anticipate that the combination of lightwave electronics and the atomic resolution of our approach will open the door to visualizing ultrafast photochemistry and the operation of molecular electronics on the single-orbital scale.

  9. 49 CFR 213.369 - Inspection records.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... transfer records through electronic transmission, storage, and retrieval provided that— (1) The electronic... security such as recognition of an electronic signature, or other means, which uniquely identify the initiating person as the author of that record. No two persons shall have the same electronic identity; (2...

  10. Key Decision Record Creation and Approval Module

    NASA Technical Reports Server (NTRS)

    Hebert, Barrt; Messer, Elizabeth A.; Albasini, Colby; Le, Thang; ORourke, William, Sr.; Stiglets, Tim; Strain, Ted

    2012-01-01

    Retaining good key decision records is critical to ensuring the success of a project or operation. Having adequately documented decisions with supporting documents and rationale can greatly reduce the amount of rework or reinvention over a project's, vehicle's, or facility's lifecycle. Stennis Space Center developed and uses a software tool that automates the Key Decision Record (KDR) process for its engineering and test projects. It provides the ability for a user to log key decisions that are made during the course of a project. By customizing Parametric Technology Corporation's (PTC) Windchill product, the team was able to log all information about a decision, and electronically route that information for approval. Customizing the Windchill product allowed the team to directly connect these decisions to the engineering data that it might affect and notify data owners of the decision. The user interface was created in JSP and Javascript, within the OOTB (Out of the Box) Windchill product, allowing users to create KDRs. Not only does this interface allow users to create and track KDRs, but it also plugs directly into the OOTB ability to associate these decision records with other relevant engineering data such as drawings, designs, models, requirements, or specifications

  11. Geographic Information Systems to Assess External Validity in Randomized Trials.

    PubMed

    Savoca, Margaret R; Ludwig, David A; Jones, Stedman T; Jason Clodfelter, K; Sloop, Joseph B; Bollhalter, Linda Y; Bertoni, Alain G

    2017-08-01

    To support claims that RCTs can reduce health disparities (i.e., are translational), it is imperative that methodologies exist to evaluate the tenability of external validity in RCTs when probabilistic sampling of participants is not employed. Typically, attempts at establishing post hoc external validity are limited to a few comparisons across convenience variables, which must be available in both sample and population. A Type 2 diabetes RCT was used as an example of a method that uses a geographic information system to assess external validity in the absence of a priori probabilistic community-wide diabetes risk sampling strategy. A geographic information system, 2009-2013 county death certificate records, and 2013-2014 electronic medical records were used to identify community-wide diabetes prevalence. Color-coded diabetes density maps provided visual representation of these densities. Chi-square goodness of fit statistic/analysis tested the degree to which distribution of RCT participants varied across density classes compared to what would be expected, given simple random sampling of the county population. Analyses were conducted in 2016. Diabetes prevalence areas as represented by death certificate and electronic medical records were distributed similarly. The simple random sample model was not a good fit for death certificate record (chi-square, 17.63; p=0.0001) and electronic medical record data (chi-square, 28.92; p<0.0001). Generally, RCT participants were oversampled in high-diabetes density areas. Location is a highly reliable "principal variable" associated with health disparities. It serves as a directly measurable proxy for high-risk underserved communities, thus offering an effective and practical approach for examining external validity of RCTs. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  12. Health Care Personnel Perception of the Privacy of Electronic Health Records.

    PubMed

    Saito, Kenji; Shofer, Frances S; Saberi, Poune; Green-McKenzie, Judith

    2017-06-01

    : Health care facilities are increasingly converting paper medical records to electronic health records. This study investigates the perception of privacy health care personnel have of electronic health records. A pilot tested, anonymous survey was administered to a convenience sample of health care personnel. Standard summary statistics and Chi-square analysis were used to assess differences in perception. Of the 93% (96/103) who responded, 65% were female and 43% white. The mean age was 44.3 years. Most (94%) felt that Medical Record privacy was important and one-third reported they would not seek care at their workplace if Electronic Health Records were used. Efforts to assure and communicate the integrity of electronic health records are essential toward reducing deterrents for health care personnel to access geographically convenient and timely health care.

  13. 32 CFR 518.7 - FOIA terms defined.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... books, papers, maps, photographs, and machine readable materials, inclusive of those in electronic form... create or compile a record to satisfy a FOIA request. (3) Hard copy or electronic records that are... conduct. (h) Electronic record. Records (including e-mail) that are created, stored, and retrievable by...

  14. 49 CFR 228.205 - Access to electronic records.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 4 2011-10-01 2011-10-01 false Access to electronic records. 228.205 Section 228... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION HOURS OF SERVICE OF RAILROAD EMPLOYEES Electronic Recordkeeping § 228.205 Access to electronic records. (a) FRA inspectors and State inspectors participating under 49...

  15. 49 CFR 228.205 - Access to electronic records.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Access to electronic records. 228.205 Section 228... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION HOURS OF SERVICE OF RAILROAD EMPLOYEES Electronic Recordkeeping § 228.205 Access to electronic records. (a) FRA inspectors and State inspectors participating under 49...

  16. Electronic health record use, intensity of hospital care, and patient outcomes.

    PubMed

    Blecker, Saul; Goldfeld, Keith; Park, Naeun; Shine, Daniel; Austrian, Jonathan S; Braithwaite, R Scott; Radford, Martha J; Gourevitch, Marc N

    2014-03-01

    Previous studies have suggested that weekend hospital care is inferior to weekday care and that this difference may be related to diminished care intensity. The purpose of this study was to determine whether a metric for measuring intensity of hospital care based on use of the electronic health record was associated with patient-level outcomes. We performed a cohort study of hospitalizations at an academic medical center. Intensity of care was defined as the hourly number of provider accessions of the electronic health record, termed "electronic health record interactions." Hospitalizations were categorized on the basis of the mean difference in electronic health record interactions between the first Friday and the first Saturday of hospitalization. We used regression models to determine the association of these categories with patient outcomes after adjusting for covariates. Electronic health record interactions decreased from Friday to Saturday in 77% of the 9051 hospitalizations included in the study. Compared with hospitalizations with no change in Friday to Saturday electronic health record interactions, the relative lengths of stay for hospitalizations with a small, moderate, and large decrease in electronic health record interactions were 1.05 (95% confidence interval [CI], 1.00-1.10), 1.11 (95% CI, 1.05-1.17), and 1.25 (95% CI, 1.15-1.35), respectively. Although a large decrease in electronic health record interactions was associated with in-hospital mortality, these findings were not significant after risk adjustment (odds ratio 1.74, 95% CI, 0.93-3.25). Intensity of inpatient care, measured by electronic health record interactions, significantly diminished from Friday to Saturday, and this decrease was associated with length of stay. Hospitals should consider monitoring and correcting temporal fluctuations in care intensity. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. The Future Is Coming: Electronic Health Records

    MedlinePlus

    ... Current Issue Past Issues The Future Is Coming: Electronic Health Records Past Issues / Spring 2009 Table of ... special conference on the cutting-edge topic of electronic health records (EHR) on May 20-21, 2009, ...

  18. Electronic recorder study

    DOT National Transportation Integrated Search

    1998-06-01

    Information on the current use of electronic recorders and opinions on mandatory electronic recorder use was obtained from truck and bus fleets and owner operators through the cooperation of several trucking industry associations. Due to the low resp...

  19. Separate may not be equal: A preliminary investigation of clinical correlates of electronic psychiatric record accessibility in academic medical centers

    PubMed Central

    Kozubal, Dana E.; Samus, Quincy M.; Bakare, Aishat A.; Trecker, Carrilin C.; Wong, Hei-Wah; Guo, Huiying; Cheng, Jeffrey; Allen, Paul X.; Mayer, Lawrence S.; Jamison, Kay R.; Kaplin, Adam I.

    2014-01-01

    Objectives Electronic Medical Records (EMR) have the potential to improve the coordination of healthcare in this country, yet the field of psychiatry has lagged behind other medical disciplines in its adoption of EMR. Methods Psychiatrists at 18 of the top US hospitals completed an electronic survey detailing whether their psychiatric records were stored electronically and accessible to non-psychiatric physicians. Electronic hospital records and accessibility statuses were correlated with patient care outcomes obtained from the University Health System Consortium Clinical Database available for 13 of the 18 top US hospitals. Results 44% of hospitals surveyed maintained most or all of their psychiatric records electronically and 28% made psychiatric records accessible to non-psychiatric physicians; only 22% did both. Compared with hospitals where psychiatric records were not stored electronically, the average 7-day readmission rate of psychiatric patients was significantly lower at hospitals with psychiatric EMR (5.1% vs. 7.0%, p = .040). Similarly, the 14 and 30-day readmission rates at hospitals where psychiatric records were accessible to non-psychiatric physicians were lower than those of their counterparts with non-accessible records (5.8% vs. 9.5%, p = .019, 8.6% vs. 13.6%, p = .013, respectively). The 7, 14, and 30-day readmission rates were significantly lower in hospitals where psychiatric records were both stored electronically and made accessible than at hospitals where records were either not electronic or not accessible (4% vs 6.6%, 5.8% vs 9.1%, 8.9 vs 13%, respectively, all with p = 0.045). Conclusions Having psychiatric EMR that were accessible to non-psychiatric physicians correlated with improved clinical care as measured by lower readmission rates specific for psychiatric patients. PMID:23266060

  20. 77 FR 67203 - Privacy Act of 1974; Republication of Systems of Records Notices

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-08

    ... file folders and on electronic media. RETRIEVABILITY: Accessed by name, tag number, and/or permit... DISPOSING OF RECORDS IN THE SYSTEM: STORAGE: Records are maintained on electronic media. RETRIEVABILITY... electronic media. RETRIEVABILITY: Records are accessed by individual action file number or by the name of the...

  1. 76 FR 56503 - Agency Information Collection Activity (VSO Access to VHA Electronic Health Records) Under OMB...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-13

    ... power of attorney by veterans who have medical information recorded in VHA electronic health records... DEPARTMENT OF VETERANS AFFAIRS [OMB Control No. 2900-0710] Agency Information Collection Activity (VSO Access to VHA Electronic Health Records) Under OMB Review AGENCY: Veterans Health Administration...

  2. Diffraction and microscopy with attosecond electron pulse trains

    NASA Astrophysics Data System (ADS)

    Morimoto, Yuya; Baum, Peter

    2018-03-01

    Attosecond spectroscopy1-7 can resolve electronic processes directly in time, but a movie-like space-time recording is impeded by the too long wavelength ( 100 times larger than atomic distances) or the source-sample entanglement in re-collision techniques8-11. Here we advance attosecond metrology to picometre wavelength and sub-atomic resolution by using free-space electrons instead of higher-harmonic photons1-7 or re-colliding wavepackets8-11. A beam of 70-keV electrons at 4.5-pm de Broglie wavelength is modulated by the electric field of laser cycles into a sequence of electron pulses with sub-optical-cycle duration. Time-resolved diffraction from crystalline silicon reveals a < 10-as delay of Bragg emission and demonstrates the possibility of analytic attosecond-ångström diffraction. Real-space electron microscopy visualizes with sub-light-cycle resolution how an optical wave propagates in space and time. This unification of attosecond science with electron microscopy and diffraction enables space-time imaging of light-driven processes in the entire range of sample morphologies that electron microscopy can access.

  3. 36 CFR § 1226.24 - How must agencies destroy temporary records?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... records or documents. (2) Records on electronic and other media. Records other than paper records (audio, visual, and electronic records on physical media data tapes, disks, and diskettes) may be salvaged and... RECORDS ADMINISTRATION RECORDS MANAGEMENT IMPLEMENTING DISPOSITION § 1226.24 How must agencies destroy...

  4. Dual function seal: visualized digital signature for electronic medical record systems.

    PubMed

    Yu, Yao-Chang; Hou, Ting-Wei; Chiang, Tzu-Chiang

    2012-10-01

    Digital signature is an important cryptography technology to be used to provide integrity and non-repudiation in electronic medical record systems (EMRS) and it is required by law. However, digital signatures normally appear in forms unrecognizable to medical staff, this may reduce the trust from medical staff that is used to the handwritten signatures or seals. Therefore, in this paper we propose a dual function seal to extend user trust from a traditional seal to a digital signature. The proposed dual function seal is a prototype that combines the traditional seal and digital seal. With this prototype, medical personnel are not just can put a seal on paper but also generate a visualized digital signature for electronic medical records. Medical Personnel can then look at the visualized digital signature and directly know which medical personnel generated it, just like with a traditional seal. Discrete wavelet transform (DWT) is used as an image processing method to generate a visualized digital signature, and the peak signal to noise ratio (PSNR) is calculated to verify that distortions of all converted images are beyond human recognition, and the results of our converted images are from 70 dB to 80 dB. The signature recoverability is also tested in this proposed paper to ensure that the visualized digital signature is verifiable. A simulated EMRS is implemented to show how the visualized digital signature can be integrity into EMRS.

  5. Doctors' use of electronic medical records systems in hospitals: cross sectional survey

    PubMed Central

    Lærum, Hallvard; Ellingsen, Gunnar; Faxvaag, Arild

    2001-01-01

    Objectives To compare the use of three electronic medical records systems by doctors in Norwegian hospitals for general clinical tasks. Design Cross sectional questionnaire survey. Semistructured telephone interviews with key staff in information technology in each hospital for details of local implementation of the systems. Setting 32 hospital units in 19 Norwegian hospitals with electronic medical records systems. Participants 227 (72%) of 314 hospital doctors responded, equally distributed between the three electronic medical records systems. Main outcome measures Proportion of respondents who used the electronic system, calculated for each of 23 tasks; difference in proportions of users of different systems when functionality of systems was similar. Results Most tasks listed in the questionnaire (15/23) were generally covered with implemented functions in the electronic medical records systems. However, the systems were used for only 2-7 of the tasks, mainly associated with reading patient data. Respondents showed significant differences in frequency of use of the different systems for four tasks for which the systems offered equivalent functionality. The respondents scored highly in computer literacy (72.2/100), and computer use showed no correlation with respondents' age, sex, or work position. User satisfaction scores were generally positive (67.2/100), with some difference between the systems. Conclusions Doctors used electronic medical records systems for far fewer tasks than the systems supported. What is already known on this topicElectronic information systems in health care have not undergone systematic evaluation, and few comparisons between electronic medical records systems have been madeGiven the information intensive nature of clinical work, electronic medical records systems should be of help to doctors for most clinical tasksWhat this study addsDoctors in Norwegian hospitals reported a low level of use of all electronic medical records systemsThe systems were mainly used for reading patient data, and doctors used the systems for less than half of the tasks for which the systems were functionalAnalyses of actual use of electronic medical records provide more information than user satisfaction or functionality of such records systems PMID:11739222

  6. 'The right direction'. Primary-care docs see promise in CMS' proposed pay for non face-to-face work.

    PubMed

    Robeznieks, Andis

    2013-07-15

    The CMS has proposed paying physicians for managing patients apart from face-to-face office visits. Among the details under consideration are requiring practices to use an electronic health-record system that supports access to care, care coordination, care management and communications. "It's a step in the right direction. The devil will be in the details and, if the burden of documentation is so high, people may choose not to spend their time doing it," says Dr. Matt Handley, physician and medical director for quality at the Group Health Cooperative.

  7. Very low frequency waves stimulated by an electron accelerator in the auroral ionosphere

    NASA Technical Reports Server (NTRS)

    Holtet, J. A.; Pran, B. K.; Egeland, A.; Grandal, B.; Jacobsen, T. A.; Maehlum, B. N.; Troim, J.

    1981-01-01

    The sounding rocket, Polar 5, carrying a 10 keV electron accelerator in a mother-daughter configuration and other diagnostic instruments, was launched into a slightly disturbed ionosphere with weak auroral activity on February 1, 1976 from Northern Norway to study VLF wave phenomena. The rocket trajectory crossed two auroral regions: one, between 86 and 111 s flight time, and a secondary region between 230 and 330 s. The daughter, carrying the accelerator, was separated axially from the mother in a forward direction at an altitude of 90 km. The VLF experiment, carried by the mother payload, recorded both electromagnetic and electrostatic waves. The receiving antenna was an electric dipole, 0.3 m tip-to-tip, oriented 90 degrees to the rocket spin axis. The onboard particle detector recorded increased electron fluxes in the two auroral regions. A double peaked structure was observed in the fluxes of 4-5 and 12-27 keV electrons within the northern auroral form. The number density of thermal plasma varied during the flight, with maximum density within the main auroral region. To the north of this aurora a slow, steady decrease in the density was observed, with no enhancement in the region of the second aurora.

  8. Clinical height measurements are unreliable: a call for improvement.

    PubMed

    Mikula, A L; Hetzel, S J; Binkley, N; Anderson, P A

    2016-10-01

    Height measurements are currently used to guide imaging decisions that assist in osteoporosis care, but their clinical reliability is largely unknown. We found both clinical height measurements and electronic health record height data to be unreliable. Improvement in height measurement is needed to improve osteoporosis care. The aim of this study is to assess the accuracy and reliability of clinical height measurement in a university healthcare clinical setting. Electronic health record (EHR) review, direct measurement of clinical stadiometer accuracy, and observation of staff height measurement technique at outpatient facilities of the University of Wisconsin Hospital and Clinics. We examined 32 clinical stadiometers for reliability and observed 34 clinic staff perform height measurements at 12 outpatient primary care and specialty clinics. An EHR search identified 4711 men and women age 43 to 89 with no known metabolic bone disease who had more than one height measurement over 3 months. The short study period and exclusion were selected to evaluate change in recorded height not due to pathologic processes. Mean EHR recorded height change (first to last measurement) was -0.02 cm (SD 1.88 cm). Eighteen percent of patients had height measurement differences noted in the EHR of ≥2 cm over 3 months. The technical error of measurement (TEM) was 1.77 cm with a relative TEM of 1.04 %. None of the staff observed performing height measurements followed all recommended height measurement guidelines. Fifty percent of clinic staff reported they on occasion enter patient reported height into the EHR rather than performing a measurement. When performing direct measurements on stadiometers, the mean difference from a gold standard length was 0.24 cm (SD 0.80). Nine percent of stadiometers examined had an error of >1.5 cm. Clinical height measurements and EHR recorded height results are unreliable. Improvement in this measure is needed as an adjunct to improve osteoporosis care.

  9. Thinking About Taking The Leap? Hear From Those Who Did So...and Survived A Case Study: NASA Stennis Space Center Electronic Records Management

    NASA Technical Reports Server (NTRS)

    Albasini, Colby V.

    2008-01-01

    Increased visibility into records management: a) Partnered with NARA to provide electronic records management and Emergency Response training; b) Mandate all civil servants and records personnel attend training.Improve Disaster Recovery: a) TechDoc considered a vital system; b) All electronic documentation and records managed by our system available offsite.

  10. Personal, Electronic, Secure National Library of Medicine Hosts Health Records Conference

    MedlinePlus

    ... Bar Home Current Issue Past Issues EHR Personal, Electronic, Secure: National Library of Medicine Hosts Health Records ... One suggestion for saving money is to implement electronic personal health records. With this in mind, the ...

  11. Electronic Health Records Place 1st at Indy 500

    MedlinePlus

    ... Navigation Bar Home Current Issue Past Issues EHR Electronic Health Records Place 1st at Indy 500 Past ... last May's Indy 500 had thousands of personal Electronic Health Records on hand for those attending—and ...

  12. Electronic Health Records: VAs Efforts Raise Concerns about Interoperability Goals and Measures, Duplication with DOD, and Future Plans

    DTIC Science & Technology

    2016-07-13

    ELECTRONIC HEALTH RECORDS VA’s Efforts Raise Concerns about Interoperability Goals and Measures, Duplication with DOD...Agencies, Committee on Appropriations, U.S. Senate July 13, 2016 ELECTRONIC HEALTH RECORDS VA’s Efforts Raise Concerns about Interoperability Goals...initiatives with the Department of Defense (DOD) that were intended to advance the ability of the two departments to share electronic health records , the

  13. Merging Electronic Health Record Data and Genomics for Cardiovascular Research: A Science Advisory From the American Heart Association.

    PubMed

    Hall, Jennifer L; Ryan, John J; Bray, Bruce E; Brown, Candice; Lanfear, David; Newby, L Kristin; Relling, Mary V; Risch, Neil J; Roden, Dan M; Shaw, Stanley Y; Tcheng, James E; Tenenbaum, Jessica; Wang, Thomas N; Weintraub, William S

    2016-04-01

    The process of scientific discovery is rapidly evolving. The funding climate has influenced a favorable shift in scientific discovery toward the use of existing resources such as the electronic health record. The electronic health record enables long-term outlooks on human health and disease, in conjunction with multidimensional phenotypes that include laboratory data, images, vital signs, and other clinical information. Initial work has confirmed the utility of the electronic health record for understanding mechanisms and patterns of variability in disease susceptibility, disease evolution, and drug responses. The addition of biobanks and genomic data to the information contained in the electronic health record has been demonstrated. The purpose of this statement is to discuss the current challenges in and the potential for merging electronic health record data and genomics for cardiovascular research. © 2016 American Heart Association, Inc.

  14. CTEPP STANDARD OPERATING PROCEDURE FOR MAINTAINING AND RECORDING ELECTRONIC CHAIN-OF-CUSTODY (SOP-4.11)

    EPA Science Inventory

    The method for maintaining and recording electronic Chain-of-Custody (CoC) Records for CTEPP samples is summarized in this SOP. The CoC Records that will be logged electronically include the creation of a sample's identification code, bar code labels, and hard-copy CoC document...

  15. When holography meets coherent diffraction imaging.

    PubMed

    Latychevskaia, Tatiana; Longchamp, Jean-Nicolas; Fink, Hans-Werner

    2012-12-17

    The phase problem is inherent to crystallographic, astronomical and optical imaging where only the intensity of the scattered signal is detected and the phase information is lost and must somehow be recovered to reconstruct the object's structure. Modern imaging techniques at the molecular scale rely on utilizing novel coherent light sources like X-ray free electron lasers for the ultimate goal of visualizing such objects as individual biomolecules rather than crystals. Here, unlike in the case of crystals where structures can be solved by model building and phase refinement, the phase distribution of the wave scattered by an individual molecule must directly be recovered. There are two well-known solutions to the phase problem: holography and coherent diffraction imaging (CDI). Both techniques have their pros and cons. In holography, the reconstruction of the scattered complex-valued object wave is directly provided by a well-defined reference wave that must cover the entire detector area which often is an experimental challenge. CDI provides the highest possible, only wavelength limited, resolution, but the phase recovery is an iterative process which requires some pre-defined information about the object and whose outcome is not always uniquely-defined. Moreover, the diffraction patterns must be recorded under oversampling conditions, a pre-requisite to be able to solve the phase problem. Here, we report how holography and CDI can be merged into one superior technique: holographic coherent diffraction imaging (HCDI). An inline hologram can be recorded by employing a modified CDI experimental scheme. We demonstrate that the amplitude of the Fourier transform of an inline hologram is related to the complex-valued visibility, thus providing information on both, the amplitude and the phase of the scattered wave in the plane of the diffraction pattern. With the phase information available, the condition of oversampling the diffraction patterns can be relaxed, and the phase problem can be solved in a fast and unambiguous manner. We demonstrate the reconstruction of various diffraction patterns of objects recorded with visible light as well as with low-energy electrons. Although we have demonstrated our HCDI method using laser light and low-energy electrons, it can also be applied to any other coherent radiation such as X-rays or high-energy electrons.

  16. A knowledge-based taxonomy of critical factors for adopting electronic health record systems by physicians: a systematic literature review

    PubMed Central

    2010-01-01

    Background The health care sector is an area of social and economic interest in several countries; therefore, there have been lots of efforts in the use of electronic health records. Nevertheless, there is evidence suggesting that these systems have not been adopted as it was expected, and although there are some proposals to support their adoption, the proposed support is not by means of information and communication technology which can provide automatic tools of support. The aim of this study is to identify the critical adoption factors for electronic health records by physicians and to use them as a guide to support their adoption process automatically. Methods This paper presents, based on the PRISMA statement, a systematic literature review in electronic databases with adoption studies of electronic health records published in English. Software applications that manage and process the data in the electronic health record have been considered, i.e.: computerized physician prescription, electronic medical records, and electronic capture of clinical data. Our review was conducted with the purpose of obtaining a taxonomy of the physicians main barriers for adopting electronic health records, that can be addressed by means of information and communication technology; in particular with the information technology roles of the knowledge management processes. Which take us to the question that we want to address in this work: "What are the critical adoption factors of electronic health records that can be supported by information and communication technology?". Reports from eight databases covering electronic health records adoption studies in the medical domain, in particular those focused on physicians, were analyzed. Results The review identifies two main issues: 1) a knowledge-based classification of critical factors for adopting electronic health records by physicians; and 2) the definition of a base for the design of a conceptual framework for supporting the design of knowledge-based systems, to assist the adoption process of electronic health records in an automatic fashion. From our review, six critical adoption factors have been identified: user attitude towards information systems, workflow impact, interoperability, technical support, communication among users, and expert support. The main limitation of the taxonomy is the different impact of the adoption factors of electronic health records reported by some studies depending on the type of practice, setting, or attention level; however, these features are a determinant aspect with regard to the adoption rate for the latter rather than the presence of a specific critical adoption factor. Conclusions The critical adoption factors established here provide a sound theoretical basis for research to understand, support, and facilitate the adoption of electronic health records to physicians in benefit of patients. PMID:20950458

  17. Implementation of a Novel Electronic Health Record-Embedded Physician Orders for Life-Sustaining Treatment System.

    PubMed

    Zive, Dana M; Cook, Jennifer; Yang, Charissa; Sibell, David; Tolle, Susan W; Lieberman, Michael

    2016-11-01

    In April 2015, Oregon Health & Science University (OHSU) deployed a web-based, electronic medical record-embedded application created by third party vendor Vynca Inc. to allow real-time education, and completion of Physician Orders for Life Sustaining Treatment (POLST). Forms are automatically linked to the Epic Systems™ electronic health record (EHR) patient header and submitted to a state Registry, improving efficiency, accuracy, and rapid access to and retrieval of these important medical orders. POLST Forms, implemented in Oregon in 1992, are standardized portable medical orders used to document patient treatment goals for end-of-life care. In 2009, Oregon developed the first POLST-only statewide registry with a legislative mandate requiring POLST form signers to register the form unless the patient opts out. The Registry offers 24/7 emergency access to POLST Forms for Emergency Medical Services, Emergency Departments, and Acute Care Units. Because POLST is intended for those nearing end of life, immediate access to these forms at the time of an emergency is critical. Delays in registering a POLST Form may result in unwanted treatment if the paper form is not immediately available. An electronic POLST Form completion system (ePOLST) was implemented to support direct Registry submission. Other benefits of the system include single-sign-on, transmission of HL7 data for patient demographics and other relevant information, elimination of potential errors in form completion using internalized logic, built-in real-time video and text-based education materials for both patients and health care professionals, and mobile linkage for signature capture.

  18. Simultaneous transcranial magnetic stimulation and single neuron recording in alert non-human primates

    PubMed Central

    Mueller, Jerel K.; Grigsby, Erinn M.; Prevosto, Vincent; Petraglia, Frank W.; Rao, Hrishikesh; Deng, Zhi-De; Peterchev, Angel V.; Sommer, Marc A.; Egner, Tobias; Platt, Michael L.; Grill, Warren M.

    2014-01-01

    Transcranial magnetic stimulation (TMS) is a widely used, noninvasive method for stimulating nervous tissue, yet its mechanisms of effect are poorly understood. Here we report novel methods for studying the influence of TMS on single neurons in the brain of alert non-human primates. We designed a TMS coil that focuses its effect near the tip of a recording electrode and recording electronics that enable direct acquisition of neuronal signals at the site of peak stimulus strength minimally perturbed by stimulation artifact in intact, awake monkeys (Macaca mulatta). We recorded action potentials within ~1 ms after 0.4 ms TMS pulses and observed changes in activity that differed significantly for active stimulation as compared to sham stimulation. The methodology is compatible with standard equipment in primate laboratories, allowing for easy implementation. Application of these new tools will facilitate the refinement of next generation TMS devices, experiments, and treatment protocols. PMID:24974797

  19. [Qualitative evaluation of blood products records in a hospital].

    PubMed

    Lartigue, B; Catillon, E

    2012-02-01

    This study aimed at evaluating the qualitative performance of blood products traceability from paper and electronic medical records in a hospital. Quality of date/time documentation was assessed by detection, for 20minutes or more, of chronological errors and inter-source inconsistencies, in a random sample of 168 blood products transfused during 2009. A receipt date/time was confirmed in 52% of paper records; a data entry error was attested in 25% of paper records, and 21% of electronic records. A transfusion date/time was notified in 93% of paper records, with a data entry error in 26% of paper records and 25% of electronic records. The patient medical record held at least one date/time error in 18% and 17%, for receipt and transfusion respectively. Environmental factors (clinical setting, urgency, blood product category) did not contributed to data error rates. Although blood products traceability has good quantitative results, the recorded documentation is not qualitative. In our study, data entry errors are similar in electronic or paper records, but the global failure rate is lesser in electronic records because omissions are controlled. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  20. Use of electronic health record structured text and its payoffs. The approach and barriers to using structured text in EHR to document care encounters.

    PubMed

    Benge, James; Beach, Thomas; Gladding, Connie; Maestas, Gail

    2008-01-01

    The Military Health System (MHS) deployed its electronic health record (EHR), AHLTA to Military Treatment Facilities (MTFs) around the world. This paper focuses on the approach and barriers to using structured text in AHLTA to document care encounters and illustrates the direct correlation between the use of structured text and achievement of expected benefits. AHLTA uses commercially available products, a health data dictionary and standardized medical terminology, enabling the capture of structured computable data. With structured text stored in the AHLTA Clinical Data Repository (CDR), the MHS has seen a return on its EHR investment with improvements in the accuracy and completeness of coding and the documentation of care provided. Determining the aspects of documentation where structured text is most beneficial, as well as the degree of structured text needed has been a significant challenge. This paper describes how the economic value framework aligns the enterprise strategic objectives with the EHR investment features, performance metrics and expected benefits. The framework analyses focus on return on investment calculations, baseline assessment and post-implementation benefits validation. Cost avoidance, revenue enhancements and operational improvements, such as evidence-based medicine and medical surveillance can be directly attributed to use structured text.

  1. The effect of electronic health record software design on resident documentation and compliance with evidence-based medicine.

    PubMed

    Rodriguez Torres, Yasaira; Huang, Jordan; Mihlstin, Melanie; Juzych, Mark S; Kromrei, Heidi; Hwang, Frank S

    2017-01-01

    This study aimed to determine the role of electronic health record software in resident education by evaluating documentation of 30 elements extracted from the American Academy of Ophthalmology Dry Eye Syndrome Preferred Practice Pattern. The Kresge Eye Institute transitioned to using electronic health record software in June 2013. We evaluated the charts of 331 patients examined in the resident ophthalmology clinic between September 1, 2011, and March 31, 2014, for an initial evaluation for dry eye syndrome. We compared documentation rates for the 30 evidence-based elements between electronic health record chart note templates among the ophthalmology residents. Overall, significant changes in documentation occurred when transitioning to a new version of the electronic health record software with average compliance ranging from 67.4% to 73.6% (p < 0.0005). Electronic Health Record A had high compliance (>90%) in 13 elements while Electronic Health Record B had high compliance (>90%) in 11 elements. The presence of dialog boxes was responsible for significant changes in documentation of adnexa, puncta, proptosis, skin examination, contact lens wear, and smoking exposure. Significant differences in documentation were correlated with electronic health record template design rather than individual resident or residents' year in training. Our results show that electronic health record template design influences documentation across all resident years. Decreased documentation likely results from "mouse click fatigue" as residents had to access multiple dialog boxes to complete documentation. These findings highlight the importance of EHR template design to improve resident documentation and integration of evidence-based medicine into their clinical notes.

  2. 36 CFR 1226.24 - How must agencies destroy temporary records?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... documents. (2) Records on electronic and other media. Records other than paper records (audio, visual, and electronic records on physical media data tapes, disks, and diskettes) may be salvaged and sold in the same... ADMINISTRATION RECORDS MANAGEMENT IMPLEMENTING DISPOSITION § 1226.24 How must agencies destroy temporary records...

  3. 36 CFR 1226.24 - How must agencies destroy temporary records?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... documents. (2) Records on electronic and other media. Records other than paper records (audio, visual, and electronic records on physical media data tapes, disks, and diskettes) may be salvaged and sold in the same... ADMINISTRATION RECORDS MANAGEMENT IMPLEMENTING DISPOSITION § 1226.24 How must agencies destroy temporary records...

  4. 36 CFR 1226.24 - How must agencies destroy temporary records?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... documents. (2) Records on electronic and other media. Records other than paper records (audio, visual, and electronic records on physical media data tapes, disks, and diskettes) may be salvaged and sold in the same... ADMINISTRATION RECORDS MANAGEMENT IMPLEMENTING DISPOSITION § 1226.24 How must agencies destroy temporary records...

  5. 36 CFR 1226.24 - How must agencies destroy temporary records?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... documents. (2) Records on electronic and other media. Records other than paper records (audio, visual, and electronic records on physical media data tapes, disks, and diskettes) may be salvaged and sold in the same... ADMINISTRATION RECORDS MANAGEMENT IMPLEMENTING DISPOSITION § 1226.24 How must agencies destroy temporary records...

  6. 75 FR 12573 - Advisory Committee on the Electronic Records Archives (ACERA)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-16

    ... NATIONAL ARCHIVES AND RECORDS ADMINISTRATION Advisory Committee on the Electronic Records Archives (ACERA) AGENCY: National Archives and Records Administration. ACTION: Notice of meeting. SUMMARY: In... and Records Administration (NARA) announces a [[Page 12574

  7. Non-spectroscopic composition measurements of SrTiO 3-La 0.7Sr 0.3MnO 3 multilayers using scanning convergent beam electron diffraction

    DOE PAGES

    Ophus, Colin; Ercius, Peter; Huijben, Mark; ...

    2017-02-08

    The local atomic structure of a crystalline sample aligned along a zone axis can be probed with a focused electron probe, which produces a convergent beam electron diffraction pattern. The introduction of high speed direct electron detectors has allowed for experiments that can record a full diffraction pattern image at thousands of probe positions on a sample. By incoherently summing these patterns over crystalline unit cells, we demonstrate in this paper that in addition to crystal structure and thickness, we can also estimate the local composition of a perovskite superlattice sample. This is achieved by matching the summed patterns tomore » a library of simulated diffraction patterns. Finally, this technique allows for atomic-scale chemical measurements without requiring a spectrometer or hardware aberration correction.« less

  8. GOSSIP: A vertex detector combining a thin gas layer as signal generator with a CMOS readout pixel array

    NASA Astrophysics Data System (ADS)

    Campbell, M.; Heijne, E. H. M.; Llopart, X.; Colas, P.; Giganon, A.; Giomataris, Y.; Chefdeville, M.; Colijn, A. P.; Fornaini, A.; van der Graaf, H.; Kluit, P.; Timmermans, J.; Visschers, J. L.; Schmitz, J.

    2006-05-01

    A small TPC has been read out by means of a Medipix2 chip as direct anode. A Micromegas foil was placed 50 μm above the chip, and electron multiplication occurred in the gap. With a He/isobutane 80/20 mixture, gas multiplication factors up to tens of thousands were achieved, resulting in an efficiency for detecting single electrons of better than 90%. With this new readout technology for gas-filled detectors we recorded many image frames containing 2D images with tracks from cosmic muons. Along these tracks, electron clusters were observed, as well as δ-rays. With a gas layer thickness of only 1 mm, the device could be applied as vertex detector, outperforming all Si-based detectors.

  9. Coupled particle-in-cell and Monte Carlo transport modeling of intense radiographic sources

    NASA Astrophysics Data System (ADS)

    Rose, D. V.; Welch, D. R.; Oliver, B. V.; Clark, R. E.; Johnson, D. L.; Maenchen, J. E.; Menge, P. R.; Olson, C. L.; Rovang, D. C.

    2002-03-01

    Dose-rate calculations for intense electron-beam diodes using particle-in-cell (PIC) simulations along with Monte Carlo electron/photon transport calculations are presented. The electromagnetic PIC simulations are used to model the dynamic operation of the rod-pinch and immersed-B diodes. These simulations include algorithms for tracking electron scattering and energy loss in dense materials. The positions and momenta of photons created in these materials are recorded and separate Monte Carlo calculations are used to transport the photons to determine the dose in far-field detectors. These combined calculations are used to determine radiographer equations (dose scaling as a function of diode current and voltage) that are compared directly with measured dose rates obtained on the SABRE generator at Sandia National Laboratories.

  10. [Views of health system administrators, professionals, and users concerning the electronic health record and facilitators and obstacles to its implementation].

    PubMed

    Costa, Jose Felipe Riani; Portela, Margareth Crisóstomo

    2018-02-05

    The design and deployment of complex technologies like the electronic health record (EHR) involve technical, personal, social, and organizational issues. The Brazilian public and private scenario includes different local and regional initiatives for implementation of the electronic health record. The Brazilian Ministry of Health also has a proposal to develop a national EHR. The current study aimed to provide a comprehensive view of perceptions by health system administrators, professionals, and users concerning their experiences with the electronic health record and their opinions of the possibility of developing a national EHR. This qualitative study involved 28 semi-structured interviews. The results revealed both the diversity of factors that can influence the implementation of an electronic health record and the existence of convergences and aspects that tend to be valued differently according to the different points of view. Key aspects include discussions on the electronic health record's attributes and it impact on healthcare, especially in the case of local electronic health records, concerns over costs and confidentiality and privacy pertaining to electronic health records in general, and the possible implications of centralized versus decentralized data storage in the case of a national EHR. The interviews clearly showed the need to establish more effective communication among the various stakeholders, and that the different perspectives should be considered when drafting and deploying an EHR at the local, regional, and national levels.

  11. Operating Room Delays: Meaningful Use in Electronic Health Record.

    PubMed

    Van Winkle, Rachelle A; Champagne, Mary T; Gilman-Mays, Meri; Aucoin, Julia

    2016-06-01

    Perioperative areas are the most costly to operate and account for more than 40% of expenses. The high costs prompted one organization to analyze surgical delays through a retrospective review of their new electronic health record. Electronic health records have made it easier to access and aggregate clinical data; 2123 operating room cases were analyzed. Implementing a new electronic health record system is complex; inaccurate data and poor implementation can introduce new problems. Validating the electronic health record development processes determines the ease of use and the user interface, specifically related to user compliance with the intent of the electronic health record development. The revalidation process after implementation determines if the intent of the design was fulfilled and data can be meaningfully used. In this organization, the data fields completed through automation provided quantifiable, meaningful data. However, data fields completed by staff that required subjective decision making resulted in incomplete data nearly 24% of the time. The ease of use was further complicated by 490 permutations (combinations of delay types and reasons) that were built into the electronic health record. Operating room delay themes emerged notwithstanding the significant complexity of the electronic health record build; however, improved accuracy could improve meaningful data collection and a more accurate root cause analysis of operating room delays. Accurate and meaningful use of data affords a more reliable approach in quality, safety, and cost-effective initiatives.

  12. The need for academic electronic health record systems in nurse education.

    PubMed

    Chung, Joohyun; Cho, Insook

    2017-07-01

    The nursing profession has been slow to incorporate information technology into formal nurse education and practice. The aim of this study was to identify the use of academic electronic health record systems in nurse education and to determine student and faculty perceptions of academic electronic health record systems in nurse education. A quantitative research design with supportive qualitative research was used to gather information on nursing students' perceptions and nursing faculty's perceptions of academic electronic health record systems in nurse education. Eighty-three participants (21 nursing faculty and 62 students), from 5 nursing schools, participated in the study. A purposive sample of 9 nursing faculty was recruited from one university in the Midwestern United States to provide qualitative data for the study. The researcher-designed surveys (completed by faculty and students) were used for quantitative data collection. Qualitative data was taken from interviews, which were transcribed verbatim for analysis. Students and faculty agreed that academic electronic health record systems could be useful for teaching students to think critically about nursing documentation. Quantitative and qualitative findings revealed that academic electronic health record systems regarding nursing documentation could help prepare students for the future of health information technology. Meaningful adoption of academic electronic health record systems will help in building the undergraduate nursing students' competence in nursing documentation with electronic health record systems. Copyright © 2017. Published by Elsevier Ltd.

  13. 75 FR 63434 - Availability of Compliance Guide for the Use of Video or Other Electronic Monitoring or Recording...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-15

    ...] Availability of Compliance Guide for the Use of Video or Other Electronic Monitoring or Recording Equipment in... the availability of a compliance guide on the use of video or other electronic monitoring or recording... Procedures video records. FSIS is soliciting comments on this compliance guide. Once FSIS receives OMB...

  14. Nurses' perceptions of the impact of electronic health records on work and patient outcomes.

    PubMed

    Kossman, Susan P; Scheidenhelm, Sandra L

    2008-01-01

    This study addresses community hospital nurses' use of electronic health records and views of the impact of such records on job performance and patient outcomes. Questionnaire, interview, and observation data from 46 nurses in medical-surgical and intensive care units at two community hospitals were analyzed. Nurses preferred electronic health records to paper charts and were comfortable with technology. They reported use of electronic health records enhanced nursing work through increased information access, improved organization and efficiency, and helpful alert screens. They thought use of the records hindered nursing work through impaired critical thinking, decreased interdisciplinary communication, and a high demand on work time (73% reported spending at least half their shift using the records). They thought use of electronic health records enabled them to provide safer care but decreased the quality of care. Administrative implications include involving bedside nurses in system choice, streamlining processes, developing guidelines for consistent documentation quality and location, increasing system speed, choosing hardware that encourages bedside use, and improving system information technology support.

  15. Development of an electronic claim system based on an integrated electronic health record platform to guarantee interoperability.

    PubMed

    Kim, Hwa Sun; Cho, Hune; Lee, In Keun

    2011-06-01

    We design and develop an electronic claim system based on an integrated electronic health record (EHR) platform. This system is designed to be used for ambulatory care by office-based physicians in the United States. This is achieved by integrating various medical standard technologies for interoperability between heterogeneous information systems. The developed system serves as a simple clinical data repository, it automatically fills out the Centers for Medicare and Medicaid Services (CMS)-1500 form based on information regarding the patients and physicians' clinical activities. It supports electronic insurance claims by creating reimbursement charges. It also contains an HL7 interface engine to exchange clinical messages between heterogeneous devices. The system partially prevents physician malpractice by suggesting proper treatments according to patient diagnoses and supports physicians by easily preparing documents for reimbursement and submitting claim documents to insurance organizations electronically, without additional effort by the user. To show the usability of the developed system, we performed an experiment that compares the time spent filling out the CMS-1500 form directly and time required create electronic claim data using the developed system. From the experimental results, we conclude that the system could save considerable time for physicians in making claim documents. The developed system might be particularly useful for those who need a reimbursement-specialized EHR system, even though the proposed system does not completely satisfy all criteria requested by the CMS and Office of the National Coordinator for Health Information Technology (ONC). This is because the criteria are not sufficient but necessary condition for the implementation of EHR systems. The system will be upgraded continuously to implement the criteria and to offer more stable and transparent transmission of electronic claim data.

  16. Probing electronic binding potentials with attosecond photoelectron wavepackets

    NASA Astrophysics Data System (ADS)

    Kiesewetter, D.; Jones, R. R.; Camper, A.; Schoun, S. B.; Agostini, P.; Dimauro, L. F.

    2018-01-01

    The central goal of attosecond science is to visualize, understand and ultimately control electron dynamics in matter over the fastest relevant timescales. To date, numerous schemes have demonstrated exquisite temporal resolution, on the order of ten attoseconds, in measurements of the response of photo-excited electrons to time-delayed probes. However, attributing this response to specific dynamical mechanisms is difficult, requiring guidance from advanced calculations. Here we show that energy transfer between an oscillating field and low-energy attosecond photoelectron wavepackets directly provides coarse-grained information on the effective binding potential from which the electrons are liberated. We employ a dense extreme ultraviolet (XUV) harmonic comb to photoionize He, Ne and Ar atoms and record the electron spectra as a function of the phase of a mid-infrared dressing field. The amplitude and phase of the resulting interference modulations in the electron spectra reveal the average momentum and change in momentum of the electron wavepackets during the first quarter-period of the dressing field after their creation, reflecting the corresponding coarse characteristics of the binding potential.

  17. Measure once, cut twice--adding patient-reported outcome measures to the electronic health record for comparative effectiveness research.

    PubMed

    Wu, Albert W; Kharrazi, Hadi; Boulware, L Ebony; Snyder, Claire F

    2013-08-01

    This article presents the current state of patient-reported outcome measures and explains new opportunities for leveraging the recent adoption of electronic health records to expand the application of patient-reported outcomes in both clinical care and comparative effectiveness research. Historic developments of patient-reported outcome, electronic health record, and comparative effectiveness research are analyzed in two dimensions: patient centeredness and digitization. We pose the question, "What needs to be standardized around the collection of patient-reported outcomes in electronic health records for comparative effectiveness research?" We identified three converging trends: the progression of patient-reported outcomes toward greater patient centeredness and electronic adaptation; the evolution of electronic health records into personalized and fully digitized solutions; and the shift toward patient-oriented comparative effectiveness research. Related to this convergence, we propose an architecture for patient-reported outcome standardization that could serve as a first step toward a more comprehensive integration of patient-reported outcomes with electronic health record for both practice and research. The science of patient-reported outcome measurement has matured sufficiently to be integrated routinely into electronic health records and other electronic health solutions to collect data on an ongoing basis for clinical care and comparative effectiveness research. Further efforts and ideally coordinated efforts from various stakeholders are needed to refine the details of the proposed framework for standardization. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. Quality of nursing documentation: Paper-based health records versus electronic-based health records.

    PubMed

    Akhu-Zaheya, Laila; Al-Maaitah, Rowaida; Bany Hani, Salam

    2018-02-01

    To assess and compare the quality of paper-based and electronic-based health records. The comparison examined three criteria: content, documentation process and structure. Nursing documentation is a significant indicator of the quality of patient care delivery. It can be either paper-based or organised within the system known as the electronic health records. Nursing documentation must be completed at the highest standards, to ensure the safety and quality of healthcare services. However, the evidence is not clear on which one of the two forms of documentation (paper-based versus electronic health records is more qualified. A retrospective, descriptive, comparative design was used to address the study's purposes. A convenient number of patients' records, from two public hospitals, were audited using the Cat-ch-Ing audit instrument. The sample size consisted of 434 records for both paper-based health records and electronic health records from medical and surgical wards. Electronic health records were better than paper-based health records in terms of process and structure. In terms of quantity and quality content, paper-based records were better than electronic health records. The study affirmed the poor quality of nursing documentation and lack of nurses' knowledge and skills in the nursing process and its application in both paper-based and electronic-based systems. Both forms of documentation revealed drawbacks in terms of content, process and structure. This study provided important information, which can guide policymakers and administrators in identifying effective strategies aimed at enhancing the quality of nursing documentation. Policies and actions to ensure quality nursing documentation at the national level should focus on improving nursing knowledge, competencies, practice in nursing process, enhancing the work environment and nursing workload, as well as strengthening the capacity building of nursing practice to improve the quality of nursing care and patients' outcomes. © 2017 John Wiley & Sons Ltd.

  19. 21 CFR 1002.30 - Records to be maintained by manufacturers.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... (CONTINUED) RADIOLOGICAL HEALTH RECORDS AND REPORTS Manufacturers' Records § 1002.30 Records to be maintained... procedures with respect to electronic product radiation safety. (2) Records of the results of tests for... increase electronic product radiation emission, records of the results of tests for durability and...

  20. Measurement of neutron and charged particle fluxes toward earthquake prediction

    NASA Astrophysics Data System (ADS)

    Maksudov, Asatulla U.; Zufarov, Mars A.

    2017-12-01

    In this paper, we describe a possible method for predicting the earthquakes, which is based on simultaneous recording of the intensity of fluxes of neutrons and charged particles by detectors, commonly used in nuclear physics. These low-energy particles originate from radioactive nuclear processes in the Earth's crust. The variations in the particle flux intensity can be the precursor of the earthquake. A description is given of an electronic installation that records the fluxes of charged particles in the radial direction, which are a possible response to the accumulated tectonic stresses in the Earth's crust. The obtained results showed an increase in the intensity of the fluxes for 10 or more hours before the occurrence of the earthquake. The previous version of the installation was able to indicate for the possibility of an earthquake (Maksudov et al. in Instrum Exp Tech 58:130-131, 2015), but did not give information about the direction of the epicenter location. In this regard, the installation was modified by adding eight directional detectors. With the upgraded setup, we have received both the predictive signals, and signals determining the directions of the location of the forthcoming earthquake, starting 2-3 days before its origin.

  1. Quality of routine health data collected by health workers using smartphone at primary health care in Ethiopia.

    PubMed

    Medhanyie, Araya Abrha; Spigt, Mark; Yebyo, Henock; Little, Alex; Tadesse, Kidane; Dinant, Geert-Jan; Blanco, Roman

    2017-05-01

    Mobile phone based applications are considered by many as potentially useful for addressing challenges and improving the quality of data collection in developing countries. Yet very little evidence is available supporting or refuting the potential and widely perceived benefits on the use of electronic forms on smartphones for routine patient data collection by health workers at primary health care facilities. A facility based cross sectional study using a structured paper checklist was prepared to assess the completeness and accuracy of 408 electronic records completed and submitted to a central database server using electronic forms on smartphones by 25 health workers. The 408 electronic records were selected randomly out of a total of 1772 maternal health records submitted by the health workers to the central database over a period of six months. Descriptive frequencies and percentages of data completeness and error rates were calculated. When compared to paper records, the use of electronic forms significantly improved data completeness by 209 (8%) entries. Of a total 2622 entries checked for completeness, 2602 (99.2%) electronic record entries were complete, while 2393 (91.3%) paper record entries were complete. A very small percentage of error rates, which was easily identifiable, occurred in both electronic and paper forms although the error rate in the electronic records was more than double that of paper records (2.8% vs. 1.1%). More than half of entry errors in the electronic records related to entering a text value. With minimal training, supervision, and no incentives, health care workers were able to use electronic forms for patient assessment and routine data collection appropriately and accurately with a very small error rate. Minimising the number of questions requiring text responses in electronic forms would be helpful in minimizing data errors. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Using social knowledge networking technology to enable meaningful use of electronic health record technology in hospitals and health systems.

    PubMed

    Rangachari, Pavani

    2014-12-01

    Despite the federal policy momentum towards "meaningful use" of Electronic Health Records, the healthcare organizational literature remains replete with reports of unintended adverse consequences of implementing Electronic Health Records, including: increased work for clinicians, unfavorable workflow changes, and unexpected changes in communication patterns & practices. In addition to being costly and unsafe, these unintended adverse consequences may pose a formidable barrier to "meaningful use" of Electronic Health Records. Correspondingly, it is essential for hospital administrators to understand and detect the causes of unintended adverse consequences, to ensure successful implementation of Electronic Health Records. The longstanding Technology-in-Practice framework emphasizes the role of human agency in enacting structures of technology use or "technologies-in-practice." Given a set of unintended adverse consequences from health information technology implementation, this framework could help trace them back to specific actions (types of technology-in-practice) and institutional conditions (social structures). On the other hand, the more recent Knowledge-in-Practice framework helps understand how information and communication technologies ( e.g. , social knowledge networking systems) could be implemented alongside existing technology systems, to create new social structures, generate new knowledge-in-practice, and transform technology-in-practice. Therefore, integrating the two literature streams could serve the dual purpose of understanding and overcoming unintended adverse consequences of Electronic Health Record implementation. This paper seeks to: (1) review the theoretical literatures on technology use & implementation, and identify a framework for understanding & overcoming unintended adverse consequences of implementing Electronic Health Records; (2) outline a broad project proposal to test the applicability of the framework in enabling "meaningful use" of Electronic Health Records in a healthcare context; and (3) identify strategies for successful implementation of Electronic Health Records in hospitals & health systems, based on the literature review and application.

  3. [Shared electronic health record in Catalonia, Spain].

    PubMed

    Marimon-Suñol, Santiago; Rovira-Barberà, María; Acedo-Anta, Mateo; Nozal-Baldajos, Montserrat A; Guanyabens-Calvet, Joan

    2010-02-01

    Under the law adopted by its Parliament, the Government of Catalonia has developed an electronic medical record system for its National Health System (NHS). The model is governed by the following principles: 1) The citizen as owner of the data: direct access to his data and right to exercise his opposition's privileges; 2) Generate confidence in the system: security and confidentiality strength; 3) Shared model of information management: publishing system and access to organized and structured information, keeping in mind that the NHS of Catalonia is formally an "Integrated system of healthcare public use" (catalan acronym: SISCAT) with a wide variety of legal structures within its healthcare institutions; 4) Use of communication standards and catalogs as a need for technological and functional integration. In summary: single system of medical records shared between different actors, using interoperability tools and whose development is according to the legislation applicable in Catalonia and within its healthcare system. The result has been the establishment of a set of components and relation rules among which we highlight the following: 1) Display of information that collects sociodemographic data of the citizen, documents or reports (radiology, laboratory, therapeutic procedures, hospital release, emergency room), diagnostic health, prescription and immunization plus a summary screen with the most recent and relevant references; 2) Set of tools helping the user and direct messaging between professionals to facilitate their cooperation; 3) Model designed for supranational connections which will allow adding later, with ad hoc rules, clinical data provided by the private health sector or the proper citizen. 2010 Elsevier España S.L. All rights reserved.

  4. Cadmium sulphide (CdS) thin films deposited by chemical bath deposition (CBD) and dip coating techniques—a comparative study

    NASA Astrophysics Data System (ADS)

    Khimani, Ankurkumar J.; Chaki, Sunil H.; Malek, Tasmira J.; Tailor, Jiten P.; Chauhan, Sanjaysinh M.; Deshpande, M. P.

    2018-03-01

    The CdS thin films were deposited on glass slide substrates by Chemical Bath Deposition and dip coating techniques. The films thickness variation with deposition time showed maximum films deposition at 35 min for both the films. The energy dispersive analysis of x-ray showed both the films to be stoichiometric. The x-ray diffraction analysis confirmed the films possess hexagonal crystal structure. The transmission electron, scanning electron and optical microscopy study showed the films deposition to be uniform. The selected area electron diffraction exhibited ring patterns stating the films to be polycrystalline in nature. The atomic force microscopy images showed surface formed of spherical grains, hills and valleys. The recorded optical absorbance spectra analysis revealed the films possess direct optical bandgap having values of 2.25 eV for CBD and 2.40 eV for dip coating. The refractive index (η), extinction coefficient (k), complex dielectric constant (ε) and optical conductivity (σ 0) variation with wavelength showed maximum photon absorption till the respective wavelengths corresponding to the optical bandgap energy values. The recorded photoluminescence spectra showed two emission peaks. All the obtained results have been discussed in details.

  5. The diagnosis related groups enhanced electronic medical record.

    PubMed

    Müller, Marcel Lucas; Bürkle, Thomas; Irps, Sebastian; Roeder, Norbert; Prokosch, Hans-Ulrich

    2003-07-01

    The introduction of Diagnosis Related Groups as a basis for hospital payment in Germany announced essential changes in the hospital reimbursement practice. A hospital's economical survival will depend vitally on the accuracy and completeness of the documentation of DRG relevant data like diagnosis and procedure codes. In order to enhance physicians' coding compliance, an easy-to-use interface integrating coding tasks seamlessly into clinical routine had to be developed. A generic approach should access coding and clinical guidelines from different information sources. Within the Electronic Medical Record (EMR) a user interface ('DRG Control Center') for all DRG relevant clinical and administrative data has been built. A comprehensive DRG-related web site gives online access to DRG grouping software and an electronic coding expert. Both components are linked together using an application supporting bi-directional communication. Other web based services like a guideline search engine can be integrated as well. With the proposed method, the clinician gains quick access to context sensitive clinical guidelines for appropriate treatment of his/her patient and administrative guidelines for the adequate coding of the diagnoses and procedures. This paper describes the design and current implementation and discusses our experiences.

  6. Observing microscopic structures of a relativistic object using a time-stretch strategy.

    PubMed

    Roussel, E; Evain, C; Le Parquier, M; Szwaj, C; Bielawski, S; Manceron, L; Brubach, J-B; Tordeux, M-A; Ricaud, J-P; Cassinari, L; Labat, M; Couprie, M-E; Roy, P

    2015-05-28

    Emission of light by a single electron moving on a curved trajectory (synchrotron radiation) is one of the most well-known fundamental radiation phenomena. However experimental situations are more complex as they involve many electrons, each being exposed to the radiation of its neighbors. This interaction has dramatic consequences, one of the most spectacular being the spontaneous formation of spatial structures inside electrons bunches. This fundamental effect is actively studied as it represents one of the most fundamental limitations in electron accelerators, and at the same time a source of intense terahertz radiation (Coherent Synchrotron Radiation, or CSR). Here we demonstrate the possibility to directly observe the electron bunch microstructures with subpicosecond resolution, in a storage ring accelerator. The principle is to monitor the terahertz pulses emitted by the structures, using a strategy from photonics, time-stretch, consisting in slowing-down the phenomena before recording. This opens the way to unpreceeded possibilities for analyzing and mastering new generation high power coherent synchrotron sources.

  7. Observing microscopic structures of a relativistic object using a time-stretch strategy

    NASA Astrophysics Data System (ADS)

    Roussel, E.; Evain, C.; Le Parquier, M.; Szwaj, C.; Bielawski, S.; Manceron, L.; Brubach, J.-B.; Tordeux, M.-A.; Ricaud, J.-P.; Cassinari, L.; Labat, M.; Couprie, M.-E.; Roy, P.

    2015-05-01

    Emission of light by a single electron moving on a curved trajectory (synchrotron radiation) is one of the most well-known fundamental radiation phenomena. However experimental situations are more complex as they involve many electrons, each being exposed to the radiation of its neighbors. This interaction has dramatic consequences, one of the most spectacular being the spontaneous formation of spatial structures inside electrons bunches. This fundamental effect is actively studied as it represents one of the most fundamental limitations in electron accelerators, and at the same time a source of intense terahertz radiation (Coherent Synchrotron Radiation, or CSR). Here we demonstrate the possibility to directly observe the electron bunch microstructures with subpicosecond resolution, in a storage ring accelerator. The principle is to monitor the terahertz pulses emitted by the structures, using a strategy from photonics, time-stretch, consisting in slowing-down the phenomena before recording. This opens the way to unpreceeded possibilities for analyzing and mastering new generation high power coherent synchrotron sources.

  8. Implementation of an Electronic Medical Records System

    DTIC Science & Technology

    2008-05-07

    Hartman, MAJ Roddex Barlow , CPT Christopher Besser and Capt Michael Emerson...thank you I am truly honored to call each of you my friends. Electronic... abnormal findings are addressed. 18 Electronic Medical Record Implementation Barriers of the Electronic Medical Records System There are several...examination findings • Psychological and social assessment findings N. The system provides a flexible mechanism for retrieval of encounter

  9. 76 FR 1440 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-10

    ... grantees: Health Information Technology Planning Grants, Electronic Health Record Implementation (including High Impact Electronic Health Records Implementation) for Health Center Controlled Networks, and Health... Application respondents respondent responses response hours Planning 1 2 2 10 20 Electronic Health Records 56...

  10. Exploring patients' perceptions of accessing electronic health records: Innovation in healthcare.

    PubMed

    Wass, Sofie; Vimarlund, Vivian; Ros, Axel

    2017-04-01

    The more widespread implementation of electronic health records has led to new ways of providing access to healthcare information, allowing patients to view their medical notes, test results, medicines and so on. In this article, we explore how patients perceive the possibility to access their electronic health record online and whether this influences patient involvement. The study includes interviews with nine patients and a survey answered by 56 patients. Our results show that patients perceive healthcare information to be more accessible and that electronic health record accessibility improves recall, understanding and patient involvement. However, to achieve the goal of involving patients as active decision-makers in their own treatment, electronic health records need to be fully available and test results, referrals and information on drug interactions need to be offered. As patient access to electronic health records spreads, it is important to gain a deeper understanding of how documentation practices can be changed to serve healthcare professionals and patients.

  11. Acoustic signature of thunder from seismic records

    NASA Astrophysics Data System (ADS)

    Kappus, Mary E.; Vernon, Frank L.

    1991-06-01

    Thunder, the sound wave through the air associated with lightning, transfers sufficient energy to the ground to trigger seismometers set to record regional earthquakes. The acoustic signature recorded on seismometers, in the form of ground velocity as a function of time, contains the same type features as pressure variations recorded with microphones in air. At a seismic station in Kislovodsk, USSR, a nearly direct lightning strike caused electronic failure of borehole instruments while leaving a brief impulsive acoustic signature on the surface instruments. The peak frequency of 25-55 Hz is consistent with previously published values for cloud-to-ground lightning strikes, but spectra from this station are contaminated by very strong wind noise in this band. A thunderstorm near a similar station in Karasu triggered more than a dozen records of individual lightning strikes during a 2-hour period. The spectra for these events are fairly broadband, with peaks at low frequencies, varying from 6 to 13 Hz. The spectra were all computed by multitaper analysis, which deals appropriately with the nonstationary thunder signal. These independent measurements of low-frequency peaks corroborate the occasional occurrences in traditional microphone records, but a theory concerning the physical mechanism to account for them is still in question. Examined separately, the individual claps in each record have similar frequency distributions, discounting a need for multiple mechanisms to explain different phases of the thunder sequence. Particle motion, determined from polarization analysis of the three-component records, is predominantly vertical downward, with smaller horizontal components indicative of the direction to the lightning bolt. In three of the records the azimuth to the lightning bolt changes with time, confirming a significant horizontal component to the lightning channel itself.

  12. Evaluating a scalable model for implementing electronic health records in resource-limited settings.

    PubMed

    Were, Martin C; Emenyonu, Nneka; Achieng, Marion; Shen, Changyu; Ssali, John; Masaba, John P M; Tierney, William M

    2010-01-01

    Current models for implementing electronic health records (EHRs) in resource-limited settings may not be scalable because they fail to address human-resource and cost constraints. This paper describes an implementation model which relies on shared responsibility between local sites and an external three-pronged support infrastructure consisting of: (1) a national technical expertise center, (2) an implementer's community, and (3) a developer's community. This model was used to implement an open-source EHR in three Ugandan HIV-clinics. Pre-post time-motion study at one site revealed that Primary Care Providers spent a third less time in direct and indirect care of patients (p<0.001) and 40% more time on personal activities (p=0.09) after EHRs implementation. Time spent by previously enrolled patients with non-clinician staff fell by half (p=0.004) and with pharmacy by 63% (p<0.001). Surveyed providers were highly satisfied with the EHRs and its support infrastructure. This model offers a viable approach for broadly implementing EHRs in resource-limited settings.

  13. [Challenges of Digital Medicine].

    PubMed

    Blaser, Jürg

    2018-06-01

    Challenges of Digital Medicine Abstract. Digitization is increasingly covering more and more sectors, including medicine. To ensure medical operation 365 × 24 hours, progressively more human and financial resources are necessary. The transformation of patient histories from paper into electronic patient records focused initially on documentation. Today, hospital information systems are increasingly used as a platform for the communication of all professionals involved in the patient process - in Switzerland, however, so far without providing patients direct access to their data. Digititizing processes intend to increase efficiency, but also to enhance clinical and administrative decision support and quality assurance. The introduction of the electronic patient record in Switzerland in 2020 is expected to provide cross-company, more complete documentation of patient care. Multimorbid patients, often treated in different institutions and by different specialists, should benefit from this in particular. Advances in artificial intelligence offer new opportunities in medicine. Challenges include ensuring reliable data protection, and better interoperability of the systems involved. Semantically structured, machine-readable data exchange is a necessity for both networked services and internationally competitive research.

  14. Upgrades to improve the usability, reliability, and spectral range of the MST Thomson scattering diagnostic

    NASA Astrophysics Data System (ADS)

    Kubala, S. Z.; Borchardt, M. T.; Den Hartog, D. J.; Holly, D. J.; Jacobson, C. M.; Morton, L. A.; Young, W. C.

    2016-11-01

    The Thomson scattering diagnostic on MST records both equilibrium and fluctuating electron temperature with a range capability of 10 eV-5 keV. Standard operation with two modified commercial Nd:YAG lasers allows measurements at rates of 1 kHz-25 kHz. Several subsystems of the diagnostic are being improved. The power supplies for the avalanche photodiode detectors (APDs) that record the scattered light are being replaced to improve usability, reliability, and maintainability. Each of the 144 APDs will have an individual rack mounted switching supply, with bias voltage adjustable to match the APD. Long-wavelength filters (1140 nm center, 80 nm bandwidth) have been added to the polychromators to improve capability to resolve non-Maxwellian distributions and to enable directed electron flow measurements. A supercontinuum (SC) pulsed white light source has replaced the tungsten halogen lamp previously used for spectral calibration of the polychromators. The SC source combines substantial brightness produced in nanosecond pulses with a spectrum that covers the entire range of the polychromators.

  15. Upgrades to improve the usability, reliability, and spectral range of the MST Thomson scattering diagnostic.

    PubMed

    Kubala, S Z; Borchardt, M T; Den Hartog, D J; Holly, D J; Jacobson, C M; Morton, L A; Young, W C

    2016-11-01

    The Thomson scattering diagnostic on MST records both equilibrium and fluctuating electron temperature with a range capability of 10 eV-5 keV. Standard operation with two modified commercial Nd:YAG lasers allows measurements at rates of 1 kHz-25 kHz. Several subsystems of the diagnostic are being improved. The power supplies for the avalanche photodiode detectors (APDs) that record the scattered light are being replaced to improve usability, reliability, and maintainability. Each of the 144 APDs will have an individual rack mounted switching supply, with bias voltage adjustable to match the APD. Long-wavelength filters (1140 nm center, 80 nm bandwidth) have been added to the polychromators to improve capability to resolve non-Maxwellian distributions and to enable directed electron flow measurements. A supercontinuum (SC) pulsed white light source has replaced the tungsten halogen lamp previously used for spectral calibration of the polychromators. The SC source combines substantial brightness produced in nanosecond pulses with a spectrum that covers the entire range of the polychromators.

  16. Physician Activities During Time Out of the Examination Room

    PubMed Central

    Gilchrist, Valerie; McCord, Gary; Schrop, Susan Labuda; King, Bridget D.; McCormick, Kenelm F.; Oprandi, Allison M.; Selius, Brian A.; Cowher, Michael; Maheshwary, Rishi; Patel, Falguni; Shah, Ami; Tsai, Bonny; Zaharna, Mia

    2005-01-01

    PURPOSE Comprehensive medical care requires direct physician-patient contact, other office-based medical activities, and medical care outside of the office. This study was a systematic investigation of family physician office-based activities outside of the examination room. METHODS In the summer of 2000, 6 medical students directly observed and recorded the office-based activities of 27 northeastern Ohio community-based family physicians during 1 practice day. A checklist was used to record physician activity every 20 seconds outside of the examination room. Observation excluded medical care provided at other sites. Physicians were also asked to estimate how they spent their time on average and on the observed day. RESULTS The average office day was 8 hours 8 minutes. On average, 20.1 patients were seen and physicians spent 17.5 minutes per patient in direct contact time. Office-based time outside of the examination room averaged 3 hours 8 minutes or 39% of the office practice day; 61% of that time was spent in activities related to medical care. Charting (32.9 minutes per day) and dictating (23.4 minutes per day) were the most common medical activities. Physicians overestimated the time they spent in direct patient care and medical activities. None of the participating practices had electronic medical records. CONCLUSIONS If office-based, medically related activities were averaged over the number of patients seen in the office that day, the average office visit time per patient would increase by 7 minutes (40%). Care delivery extends beyond direct patient contact. Models of health care delivery need to recognize this component of care. PMID:16338912

  17. PAVE PAWS Early Warning Radar Operation Cape Cod Air Force Station, MA. Record of Decision

    DTIC Science & Technology

    2009-06-01

    Electrical and Electronics Engineers (IEEE) C95.1-1999. Accordingly, the highest measurement was obtained directly in front of the feedhorn (i.e...waveform characterization of the Cape Cod AFS Pave PAWS radar. The data acquired during the Phase IV survey indicated that the electric fields produced...level observed among the ambient sites. During this survey, peak/average power density measurements and peak/average electric field measurements

  18. Using a logical information model-driven design process in healthcare.

    PubMed

    Cheong, Yu Chye; Bird, Linda; Tun, Nwe Ni; Brooks, Colleen

    2011-01-01

    A hybrid standards-based approach has been adopted in Singapore to develop a Logical Information Model (LIM) for healthcare information exchange. The Singapore LIM uses a combination of international standards, including ISO13606-1 (a reference model for electronic health record communication), ISO21090 (healthcare datatypes), SNOMED CT (healthcare terminology) and HL7 v2 (healthcare messaging). This logic-based design approach also incorporates mechanisms for achieving bi-directional semantic interoperability.

  19. Shallow Water UXO Technology Demonstration Site, Scoring Record Number 2

    DTIC Science & Technology

    2006-09-01

    The Sound Metrics Corporation High frequency Imaging Sonar ( HFIS ) (fig. 4) dual frequency imaging sonar operates at 1.1 and 1.8 MHz. For this...the HFIS unit was determined using a National Marine Electronics Association (NMEA) GPRMC string from a Leica GPS system antenna mounted directly...above the HFIS instrument. This permits the image data to be integrated with the Multiple Frequency Sub-Bottom Profiler (MFSBP) and MGS data during

  20. Three-axis electron-beam test facility

    NASA Technical Reports Server (NTRS)

    Dayton, J. A., Jr.; Ebihara, B. T.

    1981-01-01

    An electron beam test facility, which consists of a precision multidimensional manipulator built into an ultra-high-vacuum bell jar, was designed, fabricated, and operated at Lewis Research Center. The position within the bell jar of a Faraday cup which samples current in the electron beam under test, is controlled by the manipulator. Three orthogonal axes of motion are controlled by stepping motors driven by digital indexers, and the positions are displayed on electronic totalizers. In the transverse directions, the limits of travel are approximately + or - 2.5 cm from the center with a precision of 2.54 micron (0.0001 in.); in the axial direction, approximately 15.0 cm of travel are permitted with an accuracy of 12.7 micron (0.0005 in.). In addition, two manually operated motions are provided, the pitch and yaw of the Faraday cup with respect to the electron beam can be adjusted to within a few degrees. The current is sensed by pulse transformers and the data are processed by a dual channel box car averager with a digital output. The beam tester can be operated manually or it can be programmed for automated operation. In the automated mode, the beam tester is controlled by a microcomputer (installed at the test site) which communicates with a minicomputer at the central computing facility. The data are recorded and later processed by computer to obtain the desired graphical presentations.

  1. Electronic health record use in an affluent region in India: Findings from a survey of Chandigarh hospitals.

    PubMed

    Powell, Adam C; Ludhar, Jasmine K; Ostrovsky, Yuri

    2017-07-01

    To characterize the electronic health record (EHR) systems in use in an affluent region of India in order to understand the state-of-the-art within the Indian market. A survey on EHR features was created by combining an instrument developed by the Organisation for International Cooperation and Development and an instrument developed by an American team of researchers. An interviewer directly administered the survey to leaders from hospitals in greater Chandigarh which possessed electronic health information systems. Summary statistics from the survey are reported. 24 hospitals offering multi-specialty inpatient care were identified in greater Chandigarh. 18 of these hospitals had electronic health information systems, 17 of which were interviewed. Of the hospitals with systems, 17 (100%) could access patient demographic information internally, but 12 (71%) could not access vital sign, allergy, or immunization data internally. 11 (65%) of the systems were capable of sharing patient summaries internally, but 13 (76%) could not send electronic referrals internally. Among organizations which have adopted systems, major barriers tend to have been around financial and staff matters. Concerns over interoperability, privacy, and security were infrequently cited as barriers to adoption. EHRs are ubiquitous in at least one region of India. Systems are more likely to have capabilities for intra-organizational information sharing than for inter-organizational information sharing. The availability of EHR data may foster clinical research. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Dutch virtual integration of healthcare information.

    PubMed

    de Graaf, J C; Vlug, A E; van Boven, G J

    2007-01-01

    As information technology creates opportunities for cooperation which crosses the boundaries between healthcare institutions, it will become an integral part of the Dutch healthcare system. Along with many involved organizations in healthcare the National IT Institute for Healthcare in the Netherlands (NICTIZ) is working on the realization of a national IT infrastructure for healthcare and a national electronic patient record (EPR). An underlying national architecture is designed to enable the Dutch EPR virtually, not in a national database, nor on a patient's smartcard. The required secure infrastructure provides generic functions for healthcare applications: patient identification, authentication and authorization of healthcare professionals. The first national applications in the EPR program using a national index of where patient data is stored, are the electronic medication record and the electronic record for after hours GP services. The rollout of the electronic medication record and electronic record for after hours GP services has been started in 2007. To guarantee progress of electronic data exchange in healthcare in the Netherlands we have primarily opted for two healthcare applications: the electronic medication record and the electronic record for after hours GP services. The use of a national switch-point containing the registry of where to find what information, guarantees that the professional receives the most recent information and omits large databases to contain downloaded data. Proper authorization, authentication as well as tracing by the national switchpoint also ensures a secure environment for the communication of delicate information.

  3. Use of the QR Reader to Provide Real-Time Evaluation of Residents' Skills Following Surgical Procedures.

    PubMed

    Reynolds, Kellin; Barnhill, Danny; Sias, Jamie; Young, Amy; Polite, Florencia Greer

    2014-12-01

    A portable electronic method of providing instructional feedback and recording an evaluation of resident competency immediately following surgical procedures has not previously been documented in obstetrics and gynecology. This report presents a unique electronic format that documents resident competency and encourages verbal communication between faculty and residents immediately following operative procedures. The Microsoft Tag system and SurveyMonkey platform were linked by a 2-D QR code using Microsoft QR code generator. Each resident was given a unique code (TAG) embedded onto an ID card. An evaluation form was attached to each resident's file in SurveyMonkey. Postoperatively, supervising faculty scanned the resident's TAG with a smartphone and completed the brief evaluation using the phone's screen. The evaluation was reviewed with the resident and automatically submitted to the resident's educational file. The evaluation system was quickly accepted by residents and faculty. Of 43 residents and faculty in the study, 38 (88%) responded to a survey 8 weeks after institution of the electronic evaluation system. Thirty (79%) of the 38 indicated it was superior to the previously used handwritten format. The electronic system demonstrated improved utilization compared with paper evaluations, with a mean of 23 electronic evaluations submitted per resident during a 6-month period versus 14 paper assessments per resident during an earlier period of 6 months. This streamlined portable electronic evaluation is an effective tool for direct, formative feedback for residents, and it creates a longitudinal record of resident progress. Satisfaction with, and use of, this evaluation system was high.

  4. Use of the QR Reader to Provide Real-Time Evaluation of Residents' Skills Following Surgical Procedures

    PubMed Central

    Reynolds, Kellin; Barnhill, Danny; Sias, Jamie; Young, Amy; Polite, Florencia Greer

    2014-01-01

    Background A portable electronic method of providing instructional feedback and recording an evaluation of resident competency immediately following surgical procedures has not previously been documented in obstetrics and gynecology. Objective This report presents a unique electronic format that documents resident competency and encourages verbal communication between faculty and residents immediately following operative procedures. Methods The Microsoft Tag system and SurveyMonkey platform were linked by a 2-D QR code using Microsoft QR code generator. Each resident was given a unique code (TAG) embedded onto an ID card. An evaluation form was attached to each resident's file in SurveyMonkey. Postoperatively, supervising faculty scanned the resident's TAG with a smartphone and completed the brief evaluation using the phone's screen. The evaluation was reviewed with the resident and automatically submitted to the resident's educational file. Results The evaluation system was quickly accepted by residents and faculty. Of 43 residents and faculty in the study, 38 (88%) responded to a survey 8 weeks after institution of the electronic evaluation system. Thirty (79%) of the 38 indicated it was superior to the previously used handwritten format. The electronic system demonstrated improved utilization compared with paper evaluations, with a mean of 23 electronic evaluations submitted per resident during a 6-month period versus 14 paper assessments per resident during an earlier period of 6 months. Conclusions This streamlined portable electronic evaluation is an effective tool for direct, formative feedback for residents, and it creates a longitudinal record of resident progress. Satisfaction with, and use of, this evaluation system was high. PMID:26140128

  5. Implementation of the Agitated Behavior Scale in the Electronic Health Record.

    PubMed

    Wilson, Helen John; Dasgupta, Kritis; Michael, Kathleen

    The purpose of the study was to implement an Agitated Behavior Scale through an electronic health record and to evaluate the usability of the scale in a brain injury unit at a rehabilitation hospital. A quality improvement project was conducted in the brain injury unit at a large rehabilitation hospital with registered nurses as participants using convenience sampling. The project consisted of three phases and included education, implementation of the scale in the electronic health record, and administration of the survey questionnaire, which utilized the system usability scale. The Agitated Behavior Scale was found to be usable, and there was 92.2% compliance with the use of the electronic Electronic Agitated Behavior Scale. The Agitated Behavior Scale was effectively implemented in the electronic health record and was found to be usable in the assessment of agitation. Utilization of the scale through the electronic health record on a daily basis will allow for an early identification of agitation in patients with traumatic brain injury and enable prompt interventions to manage agitation.

  6. Permanent record. Electronic records aid in the aftermath of Joplin tornado.

    PubMed

    Russell, Matthew

    2011-09-01

    When a tornado struck St. John's Regional Medical Center in May 2011, its patient records were stored in a newly launched electronic health record system, helping prevent a bad situation from being worse.

  7. Digital methods of recording color television images on film tape

    NASA Astrophysics Data System (ADS)

    Krivitskaya, R. Y.; Semenov, V. M.

    1985-04-01

    Three methods are now available for recording color television images on film tape, directly or after appropriate finish of signal processing. Conventional recording of images from the screens of three kinescopes with synthetic crystal face plates is still most effective for high fidelity. This method was improved by digital preprocessing of brightness color-difference signal. Frame-by-frame storage of these signals in the memory in digital form is followed by gamma and aperture correction and electronic correction of crossover distortions in the color layers of the film with fixing in accordance with specific emulsion procedures. The newer method of recording color television images with line arrays of light-emitting diodes involves dichromic superposing mirrors and a movable scanning mirror. This method allows the use of standard movie cameras, simplifies interlacing-to-linewise conversion and the mechanical equipment, and lengthens exposure time while it shortens recording time. The latest image transform method requires an audio-video recorder, a memory disk, a digital computer, and a decoder. The 9-step procedure includes preprocessing the total color television signal with reduction of noise level and time errors, followed by frame frequency conversion and setting the number of lines. The total signal is then resolved into its brightness and color-difference components and phase errors and image blurring are also reduced. After extraction of R,G,B signals and colorimetric matching of TV camera and film tape, the simultaneous R,B, B signals are converted from interlacing to sequential triades of color-quotient frames with linewise scanning at triple frequency. Color-quotient signals are recorded with an electron beam on a smoothly moving black-and-white film tape under vacuum. While digital techniques improve the signal quality and simplify the control of processes, not requiring stabilization of circuits, image processing is still analog.

  8. USE OF ELECTRONIC HEALTH RECORDS TO CHARACTERIZE A RARE DISEASE IN THE U.S.: TREATMENT, COMORBIDITIES, AND FOLLOW-UP TRENDS AMONG PATIENTS WITH A CONFIRMED DIAGNOSIS OF ACROMEGALY.

    PubMed

    Silverstein, Julie M; Roe, Erin D; Munir, Kashif M; Fox, Janet L; Emir, Birol; Kouznetsova, Maria; Lamerato, Lois E; King, Donna

    2018-06-01

    Understanding of acromegaly disease management is hampered in the U.S. by the lack of a national registry. We describe medical management in a population with confirmed acromegaly. Inpatient and outpatient electronic health records (EHRs) were used to create a database of de-identified patients assigned the Acromegaly and Gigantism International Classification of Diseases, 9 th revision (ICD-9) code and/or an appropriate pituitary procedure code at 1 of 4 regional hospital systems over a 6- to 11-year period. Information regarding demographics, medical history, labs, procedures, and medications was collected and supplemented with a chart review to validate the diagnosis of acromegaly. Of 367 patients with validated acromegaly, available records showed that during the years studied, pituitary surgery was performed on 31%, 4% received radiosurgery, and 22% were prescribed a drug indicated for acromegaly. Insulin-like growth factor-1 (IGF-1) levels were measured in 62% of patients, 83% of whom had at least 1 normal value. Coded comorbidities reflect those reported previously in patients with acromegaly, with the exception of esophageal reflux in 20% of patient records. Fewer data regarding acromegaly-specific medications and testing were available for patients aged 65 and older. AcroMEDIC is a U.S. multisite retrospective study of acromegaly that captured medical management in the majority of patients included in the cohort. Chart review highlighted the importance of verification of coded diagnoses. Most of the acromegaly-related comorbidities identified here are known to increase with age and obesity. Patients ≥65 appeared to have less active management/monitoring of their disease. Medical attention should be directed to this population to address evolving needs over time. AcroMEDIC = Acromegaly Multisite Electronic Data Innovative Consortium; BMI = body mass index; CCI = Charlson Comorbidity Index; EHR = electronic health record; GH = growth hormone; GHRA = growth hormone receptor antagonist; ICD-9 = International Classification of Diseases, 9 th revision; IGF-1 = insulin-like growth factor-1; SSA = somatostatin analogue.

  9. Tracking the ultrafast motion of a single molecule by femtosecond orbital imaging

    PubMed Central

    Yu, Ping; Repp, Jascha; Huber, Rupert

    2017-01-01

    Watching a single molecule move on its intrinsic time scale—one of the central goals of modern nanoscience—calls for measurements that combine ultrafast temporal resolution1–8 with atomic spatial resolution9–30. Steady-state experiments achieve the requisite spatial resolution, as illustrated by direct imaging of individual molecular orbitals using scanning tunnelling microscopy9–11 or the acquisition of tip-enhanced Raman and luminescence spectra with sub-molecular resolution27–29. But tracking the dynamics of a single molecule directly in the time domain faces the challenge that single-molecule excitations need to be confined to an ultrashort time window. A first step towards overcoming this challenge has combined scanning tunnelling microscopy with so-called ‘lightwave electronics”1–8, which uses the oscillating carrier wave of tailored light pulses to directly manipulate electronic motion on time scales faster even than that of a single cycle of light. Here we use such ultrafast terahertz scanning tunnelling microscopy to access a state-selective tunnelling regime, where the peak of a terahertz electric-field waveform transiently opens an otherwise forbidden tunnelling channel through a single molecular state and thereby removes a single electron from an individual pentacene molecule’s highest occupied molecular orbital within a time window shorter than one oscillation cycle of the terahertz wave. We exploit this effect to record ~100 fs snapshot images of the structure of the orbital involved, and to reveal through pump-probe measurements coherent molecular vibrations at terahertz frequencies directly in the time domain and with sub-angstrom spatial resolution. We anticipate that the combination of lightwave electronics1–8 and atomic resolution of our approach will open the door to controlling electronic motion inside individual molecules at optical clock rates. PMID:27830788

  10. Choices in Cataloging Electronic Journals

    ERIC Educational Resources Information Center

    Leathem, Cecilia A.

    2005-01-01

    Libraries and catalogers face choices in the treatment of the growing collections of electronic journals. Policies issued by CONSER and the Library of Congress allow libraries to edit existing print records to accommodate information pertaining to the electronic versions (single record option) or to create new records for them. The discussion…

  11. 42 CFR 425.506 - Electronic health records technology.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Electronic health records technology. 425.506 Section 425.506 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Standards and Reporting § 425.506 Electronic health records technology. (a) ACOs, ACO participants, and ACO...

  12. 42 CFR 425.506 - Electronic health records technology.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Electronic health records technology. 425.506 Section 425.506 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Standards and Reporting § 425.506 Electronic health records technology. (a) ACOs, ACO participants, and ACO...

  13. 42 CFR 425.506 - Electronic health records technology.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Electronic health records technology. 425.506 Section 425.506 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Standards and Reporting § 425.506 Electronic health records technology. (a) ACOs, ACO participants, and ACO...

  14. 21 CFR 11.30 - Controls for open systems.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 1 2011-04-01 2011-04-01 false Controls for open systems. 11.30 Section 11.30... RECORDS; ELECTRONIC SIGNATURES Electronic Records § 11.30 Controls for open systems. Persons who use open systems to create, modify, maintain, or transmit electronic records shall employ procedures and controls...

  15. 21 CFR 11.30 - Controls for open systems.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Controls for open systems. 11.30 Section 11.30... RECORDS; ELECTRONIC SIGNATURES Electronic Records § 11.30 Controls for open systems. Persons who use open systems to create, modify, maintain, or transmit electronic records shall employ procedures and controls...

  16. 21 CFR 11.30 - Controls for open systems.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 1 2013-04-01 2013-04-01 false Controls for open systems. 11.30 Section 11.30... RECORDS; ELECTRONIC SIGNATURES Electronic Records § 11.30 Controls for open systems. Persons who use open systems to create, modify, maintain, or transmit electronic records shall employ procedures and controls...

  17. 21 CFR 11.30 - Controls for open systems.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 1 2012-04-01 2012-04-01 false Controls for open systems. 11.30 Section 11.30... RECORDS; ELECTRONIC SIGNATURES Electronic Records § 11.30 Controls for open systems. Persons who use open systems to create, modify, maintain, or transmit electronic records shall employ procedures and controls...

  18. 21 CFR 11.30 - Controls for open systems.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 1 2014-04-01 2014-04-01 false Controls for open systems. 11.30 Section 11.30... RECORDS; ELECTRONIC SIGNATURES Electronic Records § 11.30 Controls for open systems. Persons who use open systems to create, modify, maintain, or transmit electronic records shall employ procedures and controls...

  19. Teaching Electronic Records Management in the Archival Curriculum

    ERIC Educational Resources Information Center

    Zhang, Jane

    2016-01-01

    Electronic records management has been incorporated into the archival curriculum in North America since the 1990s. This study reported in this paper provides a systematic analysis of the content of electronic records management (ERM) courses currently taught in archival education programs. Through the analysis of course combinations and their…

  20. Privacy, confidentiality, and electronic medical records.

    PubMed Central

    Barrows, R C; Clayton, P D

    1996-01-01

    The enhanced availability of health information in an electronic format is strategic for industry-wide efforts to improve the quality and reduce the cost of health care, yet it brings a concomitant concern of greater risk for loss of privacy among health care participants. The authors review the conflicting goals of accessibility and security for electronic medical records and discuss nontechnical and technical aspects that constitute a reasonable security solution. It is argued that with guiding policy and current technology, an electronic medical record may offer better security than a traditional paper record. PMID:8653450

  1. Are electronic health records ready for genomic medicine?

    PubMed

    Scheuner, Maren T; de Vries, Han; Kim, Benjamin; Meili, Robin C; Olmstead, Sarah H; Teleki, Stephanie

    2009-07-01

    The goal of this project was to assess genetic/genomic content in electronic health records. Semistructured interviews were conducted with key informants. Questions addressed documentation, organization, display, decision support and security of family history and genetic test information, and challenges and opportunities relating to integrating genetic/genomics content in electronic health records. There were 56 participants: 10 electronic health record specialists, 18 primary care clinicians, 16 medical geneticists, and 12 genetic counselors. Few clinicians felt their electronic record met their current genetic/genomic medicine needs. Barriers to integration were mostly related to problems with family history data collection, documentation, and organization. Lack of demand for genetics content and privacy concerns were also mentioned as challenges. Data elements and functionality requirements that clinicians see include: pedigree drawing; clinical decision support for familial risk assessment and genetic testing indications; a patient portal for patient-entered data; and standards for data elements, terminology, structure, interoperability, and clinical decision support rules. Although most said that there is little impact of genetics/genomics on electronic records today, many stated genetics/genomics would be a driver of content in the next 5-10 years. Electronic health records have the potential to enable clinical integration of genetic/genomic medicine and improve delivery of personalized health care; however, structured and standardized data elements and functionality requirements are needed.

  2. Guide to the NITRD Program FY 2004-FY 2005. Supplement to the President’s Budget for FY 2005

    DTIC Science & Technology

    2004-12-01

    electronic medical records systems . At the core of such systems is the concept of a secure, patient-centered electronic health record ( EHR ) that: 1...support the development of an NHII that includes an Electronic Health Record System ( EHRS ). The EHRS will be a longitudinal collection of electronic... health information for and about persons. It will allow electronic access to person- and population-level information by authorized users. The system

  3. Use of the pH sensitive fluorescence probe pyranine to monitor internal pH changes in Escherichia coli membrane vesicles.

    PubMed

    Damiano, E; Bassilana, M; Rigaud, J L; Leblanc, G

    1984-01-23

    Measurements of the fluorescent properties of 8-hydroxy-1,3,6-pyrenetrisulfonate (pyranine) enclosed within the internal space of Escherichia coli membrane vesicles enable recordings and quantitative analysis of: (i) changes in intravesicular pH taking place during oxidation of electron donors by the membrane respiratory chain; (ii) transient alkalization of the internal aqueous space resulting from the creation of outwardly directed acetate diffusion gradients across the vesicular membrane. Quantitation of the fluorescence variations recorded during the creation of transmembrane acetate gradients shows a close correspondence between the measured shifts in internal pH value and those expected from the amplitude of the imposed acetate gradients.

  4. Virtual mask digital electron beam lithography

    DOEpatents

    Baylor, L.R.; Thomas, C.E.; Voelkl, E.; Moore, J.A.; Simpson, M.L.; Paulus, M.J.

    1999-04-06

    Systems and methods for direct-to-digital holography are described. An apparatus includes a laser; a beamsplitter optically coupled to the laser; a reference beam mirror optically coupled to the beamsplitter; an object optically coupled to the beamsplitter, a focusing lens optically coupled to both the reference beam mirror and the object; and a digital recorder optically coupled to the focusing lens. A reference beam is incident upon the reference beam mirror at a non-normal angle, and the reference beam and an object beam are focused by the focusing lens at a focal plane of the digital recorder to form an image. The systems and methods provide advantages in that computer assisted holographic measurements can be made. 5 figs.

  5. Virtual mask digital electron beam lithography

    DOEpatents

    Baylor, Larry R.; Thomas, Clarence E.; Voelkl, Edgar; Moore, James A.; Simpson, Michael L.; Paulus, Michael J.

    1999-01-01

    Systems and methods for direct-to-digital holography are described. An apparatus includes a laser; a beamsplitter optically coupled to the laser; a reference beam mirror optically coupled to the beamsplitter; an object optically coupled to the beamsplitter, a focusing lens optically coupled to both the reference beam mirror and the object; and a digital recorder optically coupled to the focusing lens. A reference beam is incident upon the reference beam mirror at a non-normal angle, and the reference beam and an object beam are focused by the focusing lens at a focal plane of the digital recorder to form an image. The systems and methods provide advantages in that computer assisted holographic measurements can be made.

  6. Femtosecond dynamics of energetic electrons in high intensity laser-matter interactions

    NASA Astrophysics Data System (ADS)

    Pompili, R.; Anania, M. P.; Bisesto, F.; Botton, M.; Castellano, M.; Chiadroni, E.; Cianchi, A.; Curcio, A.; Ferrario, M.; Galletti, M.; Henis, Z.; Petrarca, M.; Schleifer, E.; Zigler, A.

    2016-10-01

    Highly energetic electrons are generated at the early phases of the interaction of short-pulse high-intensity lasers with solid targets. These escaping particles are identified as the essential core of picosecond-scale phenomena such as laser-based acceleration, surface manipulation, generation of intense magnetic fields and electromagnetic pulses. Increasing the number of the escaping electrons facilitate the late time processes in all cases. Up to now only indirect evidences of these important forerunners have been recorded, thus no detailed study of the governing mechanisms was possible. Here we report, for the first time, direct time-dependent measurements of energetic electrons ejected from solid targets by the interaction with a short-pulse high-intensity laser. We measured electron bunches up to 7 nanocoulombs charge, picosecond duration and 12 megaelectronvolts energy. Our ’snapshots’ capture their evolution with an unprecedented temporal resolution, demonstrat- ing a significant boost in charge and energy of escaping electrons when increasing the geometrical target curvature. These results pave the way toward significant improvement in laser acceleration of ions using shaped targets allowing the future development of small scale laser-ion accelerators.

  7. Clinical and Para Clinical Information Needs of Infertility Electronic Health Records in Iran: A Delphi Study.

    PubMed

    Farzandipour, Mehrdad; Jeddi, Fateme Rangraz; Gilasi, Hamid Reza; Shirzadi, Diana

    2017-09-01

    infertility is referred to the person's inability to conceive pregnancy after one year of intercourse without using protection. This study paves the ground for creating a complete, united, and coherent source of patients' medical information. this is an applied research of descriptive-cross sectional type which has been carried out through qualitative - quantitative methods. The sample of the present study was 50 specialists in the field of infertility which has been chosen based on purposive sampling method. Designing the questionnaire was done based on library studies and Gathering experts' views was done based on Delphi technique. 261 items from clinical and Para clinical information of infertile patients' electronic health records were subjected to an opinion poll by experts. During this process 223 items were accepted and 38 items have been rejected after two sessions of surveys by infertility experts. Para clinical information section consisted of 57 items that all of them have been accepted by the experts. Also, clinical information section consisted of 242 items from which 204 items were accepted and 38 items were rejected by the experts. existence of a structured electronic record system of infertile patients' information leads to the integration of patients' information, improvement of health care services and a decrease in treatment costs: all working to increase information safety. Furthermore, only essential and relevant information would be provided for the specialists and it will facilitate and direct the future infertility related studies due to the coherence, unity and relevance of the information.

  8. EMR management system for patient pulse data.

    PubMed

    Lee, Junyoung

    2012-10-01

    The purpose of this study is to build an integrated medical information system for effective database management of clinical information and to improve the existing Electronic Medical Record (EMR)-based system that is currently being used in hospitals. The integrated medical information system of hospitals consists of an Order Communication System (OCS), Picture Archiving Communication System (PACS), and Laboratory Information System (LIS), as well as Electronic Medical Record (EMR). It is designed so that remote health screening and patient data search can be accessed through a high speed network-even in remote areas-in order to effectively manage data on medical treatment that patients received at their respective hospitals. The existing oriental treatment system is one in which the doctor requires the patient to visit the hospital in person, so as to be able to check the patient's pulse and measure it with his hand for proper diagnosis and treatment. However, due to the recent development of digitalized medical measurement equipment, not only can doctors now check a patient's pulse without touching it directly, but the measured data are computerized and stored into the database as the electronic obligation record. Thus, even if a patient cannot visit the hospital, proper medical treatment is available by analyzing the patient's medical history and diagnosis process in the remote area. Furthermore, when a comprehensive medical testing center system including the people medical examination and diverse physical examination is established, the quality of medical service is expected to be improved than now.

  9. Factors influencing the adoption of health information technologies: a systematic review

    PubMed Central

    Garavand, Ali; Mohseni, Mohammah; Asadi, Heshmatollah; Etemadi, Manal; Moradi-Joo, Mohammad; Moosavi, Ahmad

    2016-01-01

    Introduction The successful implementation of health information technologies requires investigating the factors affecting the acceptance and use of them. The aim of this study was to determine the most important factors affecting the adoption of health information technologies by doing a systematic review on the factors affecting the acceptance of health information technology. Methods This systematic review was conducted by searching the major databases, such as Google Scholar, Emerald, Science Direct, Web of Science, Pubmed, and Scopus. We used various keywords, such as adoption, use, acceptance of IT in medicine, hospitals, and IT theories in health services, and we also searched on the basis of several important technologies, such as Electronic Health Records (HER), Electronic Patient Records (EPR), Electronic Medical Records (EMR), Computerized Physician Order Entry (CPOE), Hospital Information System (HIS), Picture Archiving and Communication System (PACS), and others in the 2004–2014 period. Results The technology acceptance model (TAM) is the most important model used to identify the factors influencing the adoption of information technologies in the health system; also, the unified theory of acceptance and use of technology (UTAUT) model has had a lot of applications in recent years in the health system. Ease of use, usefulness, social impact, facilitating conditions, attitudes and behavior of users are effective in the adoption of health information technologies. Conclusion By considering various factors, including ease of use, usefulness, and social impact, the rate of the adoption of health information technology can be increased. PMID:27757179

  10. Factors influencing the adoption of health information technologies: a systematic review.

    PubMed

    Garavand, Ali; Mohseni, Mohammah; Asadi, Heshmatollah; Etemadi, Manal; Moradi-Joo, Mohammad; Moosavi, Ahmad

    2016-08-01

    The successful implementation of health information technologies requires investigating the factors affecting the acceptance and use of them. The aim of this study was to determine the most important factors affecting the adoption of health information technologies by doing a systematic review on the factors affecting the acceptance of health information technology. This systematic review was conducted by searching the major databases, such as Google Scholar, Emerald, Science Direct, Web of Science, Pubmed, and Scopus. We used various keywords, such as adoption, use, acceptance of IT in medicine, hospitals, and IT theories in health services, and we also searched on the basis of several important technologies, such as Electronic Health Records (HER), Electronic Patient Records (EPR), Electronic Medical Records (EMR), Computerized Physician Order Entry (CPOE), Hospital Information System (HIS), Picture Archiving and Communication System (PACS), and others in the 2004-2014 period. The technology acceptance model (TAM) is the most important model used to identify the factors influencing the adoption of information technologies in the health system; also, the unified theory of acceptance and use of technology (UTAUT) model has had a lot of applications in recent years in the health system. Ease of use, usefulness, social impact, facilitating conditions, attitudes and behavior of users are effective in the adoption of health information technologies. By considering various factors, including ease of use, usefulness, and social impact, the rate of the adoption of health information technology can be increased.

  11. Research data collection methods: from paper to tablet computers.

    PubMed

    Wilcox, Adam B; Gallagher, Kathleen D; Boden-Albala, Bernadette; Bakken, Suzanne R

    2012-07-01

    Primary data collection is a critical activity in clinical research. Even with significant advances in technical capabilities, clear benefits of use, and even user preferences for using electronic systems for collecting primary data, paper-based data collection is still common in clinical research settings. However, with recent developments in both clinical research and tablet computer technology, the comparative advantages and disadvantages of data collection methods should be determined. To describe case studies using multiple methods of data collection, including next-generation tablets, and consider their various advantages and disadvantages. We reviewed 5 modern case studies using primary data collection, using methods ranging from paper to next-generation tablet computers. We performed semistructured telephone interviews with each project, which considered factors relevant to data collection. We address specific issues with workflow, implementation and security for these different methods, and identify differences in implementation that led to different technology considerations for each case study. There remain multiple methods for primary data collection, each with its own strengths and weaknesses. Two recent methods are electronic health record templates and next-generation tablet computers. Electronic health record templates can link data directly to medical records, but are notably difficult to use. Current tablet computers are substantially different from previous technologies with regard to user familiarity and software cost. The use of cloud-based storage for tablet computers, however, creates a specific challenge for clinical research that must be considered but can be overcome.

  12. Diurnal patterns of salivary cortisol and DHEA using a novel collection device: electronic monitoring confirms accurate recording of collection time using this device.

    PubMed

    Laudenslager, Mark L; Calderone, Jacqueline; Philips, Sam; Natvig, Crystal; Carlson, Nichole E

    2013-09-01

    The accurate indication of saliva collection time is important for defining the diurnal decline in salivary cortisol as well as characterizing the cortisol awakening response. We tested a convenient and novel collection device for collecting saliva on strips of filter paper in a specially constructed booklet for determination of both cortisol and DHEA. In the present study, 31 healthy adults (mean age 43.5 years) collected saliva samples four times a day on three consecutive days using filter paper collection devices (Saliva Procurement and Integrated Testing (SPIT) booklet) which were maintained during the collection period in a large plastic bottle with an electronic monitoring cap. Subjects were asked to collect saliva samples at awakening, 30 min after awakening, before lunch and 600 min after awakening. The time of awakening and the time of collection before lunch were allowed to vary by each subjects' schedule. A reliable relationship was observed between the time recorded by the subject directly on the booklet and the time recorded by electronic collection device (n=286 observations; r(2)=0.98). However, subjects did not consistently collect the saliva samples at the two specific times requested, 30 and 600 min after awakening. Both cortisol and DHEA revealed diurnal declines. In spite of variance in collection times at 30 min and 600 min after awakening, the slope of the diurnal decline in both salivary cortisol and DHEA was similar when we compared collection tolerances of ±7.5 and ±15 min for each steroid. These unique collection booklets proved to be a reliable method for recording collection times by subjects as well as for estimating diurnal salivary cortisol and DHEA patterns. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Diurnal patterns of salivary cortisol and DHEA using a novel collection device: Electronic monitoring confirms accurate recording of collection time using this device

    PubMed Central

    Laudenslager, Mark L.; Calderone, Jacqueline; Philips, Sam; Natvig, Crystal; Carlson, Nichole E.

    2013-01-01

    The accurate indication of saliva collection time is important for defining the diurnal decline in salivary cortisol as well as characterizing the cortisol awakening response.. We tested a convenient and novel collection device for collecting saliva on strips of filter paper in a specially constructed booklet for determination of both cortisol and DHEA. In the present study, 31 healthy adults (mean age 43.5 yrs.) collected saliva samples four times a day on three consecutive days using filter paper collection devices (Saliva Procurement and Integrated Testing (SPIT) booklet) which were maintained during the collection period in a large plastic bottle with an electronic monitoring cap. Subjects were asked to collect saliva samples at awakening, 30 min. after awakening, before lunch and 600 min. after awakening. The time of awakening and the time of collection before lunch were allowed to vary by each subjects’ schedule. A reliable relationship was observed between the time recorded by the subject directly on the booklet and the time recorded by electronic collection device (n = 286 observations; r2 = 0.98). However, subjects did not consistently collect the saliva samples at the two specific times requested, 30 and 600 min. after awakening. Both cortisol and DHEA revealed diurnal declines.. In spite of variance in collection times at 30 min. and 600 min. after awakening, the slope of the diurnal decline in both salivary cortisol and DHEA were similar when we compared collection tolerances of ± 7.5 and ± 15 min. for each steroid.. These unique collection booklets proved to be a reliable method for recording collection times by subjects as well as for estimating diurnal salivary cortisol and DHEA patterns. PMID:23490073

  14. [Electronic indicators for determining the optimum moment for inseminating cows and sheep].

    PubMed

    Kostov, I; Bodurov, N; Todorova, I

    1984-01-01

    Three types of electron indicators to measure the electric resistance of the vagina with cows and ewes are described. The first type of such indicators gives a direct scale record of resistance as measured in ohm units. The remaining two types present a simpler construction, and are intended for practical purposes, pointing to the threshold value of resistance. It has been found by means of these indicators that the optimal time for insemination in the case of cows is when the electric resistance is lower than 250 omega; for ewes--when the resistance is lower than 550 omega. The indicators rate totally designed with Bulgarian transistors and integral schemes.

  15. Electronic data generation and display system

    NASA Technical Reports Server (NTRS)

    Wetekamm, Jules

    1988-01-01

    The Electronic Data Generation and Display System (EDGADS) is a field tested paperless technical manual system. The authoring provides subject matter experts the option of developing procedureware from digital or hardcopy inputs of technical information from text, graphics, pictures, and recorded media (video, audio, etc.). The display system provides multi-window presentations of graphics, pictures, animations, and action sequences with text and audio overlays on high resolution color CRT and monochrome portable displays. The database management system allows direct access via hierarchical menus, keyword name, ID number, voice command or touch of a screen pictoral of the item (ICON). It contains operations and maintenance technical information at three levels of intelligence for a total system.

  16. System for tomographic determination of the power distribution in electron beams

    DOEpatents

    Elmer, John W.; Teruya, Alan T.; O'Brien, Dennis W.

    1995-01-01

    A tomographic technique for measuring the current density distribution in electron beams using electron beam profile data acquired from a modified Faraday cup to create an image of the current density in high and low power beams. The modified Faraday cup includes a narrow slit and is rotated by a stepper motor and can be moved in the x, y and z directions. The beam is swept across the slit perpendicular thereto and controlled by deflection coils, and the slit rotated such that waveforms are taken every few degrees form 0.degree. to 360.degree. and the waveforms are recorded by a digitizing storage oscilloscope. Two-dimensional and three-dimensional images of the current density distribution in the beam can be reconstructed by computer tomography from this information, providing quantitative information about the beam focus and alignment.

  17. System for tomographic determination of the power distribution in electron beams

    DOEpatents

    Elmer, J.W.; Teruya, A.T.; O`Brien, D.W.

    1995-11-21

    A tomographic technique for measuring the current density distribution in electron beams using electron beam profile data acquired from a modified Faraday cup to create an image of the current density in high and low power beams. The modified Faraday cup includes a narrow slit and is rotated by a stepper motor and can be moved in the x, y and z directions. The beam is swept across the slit perpendicular thereto and controlled by deflection coils, and the slit rotated such that waveforms are taken every few degrees form 0{degree} to 360{degree} and the waveforms are recorded by a digitizing storage oscilloscope. Two-dimensional and three-dimensional images of the current density distribution in the beam can be reconstructed by computer tomography from this information, providing quantitative information about the beam focus and alignment. 12 figs.

  18. Design and implementation of a web-based patient portal linked to an ambulatory care electronic health record: patient gateway for diabetes collaborative care.

    PubMed

    Grant, Richard W; Wald, Jonathan S; Poon, Eric G; Schnipper, Jeffrey L; Gandhi, Tejal K; Volk, Lynn A; Middleton, Blackford

    2006-10-01

    Despite the availability of expert guidelines and widespread diabetes quality improvement efforts, care of patients with diabetes remains suboptimal. Two key barriers to care that may be amenable to informatics-based interventions include (1) lack of patient engagement with therapeutic care plans and (2) lack of medication adjustment by physicians ("clinical inertia") during clinical encounters. The authors describe the conceptual framework, design, implementation, and analysis plan for a diabetes patient web-portal linked directly to the electronic health record (EHR) of a large academic medical center via secure Internet access designed to overcome barriers to effective diabetes care. Partners HealthCare System (Boston, MA), a multi-hospital health care network comprising several thousand physicians caring for over 1 million individual patients, has developed a comprehensive patient web-portal called Patient Gateway that allows patients to interact directly with their EHR via secure Internet access. Using this portal, a specific diabetes interface was designed to maximize patient engagement by importing the patient's current clinical data in an educational format, providing patient-tailored decision support, and enabling the patient to author a "Diabetes Care Plan." The physician view of the patient's Diabetes Care Plan was designed to be concise and to fit into typical EHR clinical workflow. We successfully designed and implemented a Diabetes Patient portal that allows direct interaction with our system's EHR. We are assessing the impact of this advanced informatics tool for collaborative diabetes care in a clinic-randomized controlled trial among 14 primary care practices within our integrated health care system.

  19. Impact of Adoption of a Comprehensive Electronic Health Record on Nursing Work and Caring Efficacy.

    PubMed

    Schenk, Elizabeth; Schleyer, Ruth; Jones, Cami R; Fincham, Sarah; Daratha, Kenn B; Monsen, Karen A

    2018-04-23

    Nurses in acute care settings are affected by the technologies they use, including electronic health records. This study investigated the impacts of adoption of a comprehensive electronic health record by measuring nursing locations and interventions in three units before and 12 months after adoption. Time-motion methodology with a handheld recording platform based on Omaha System standardized terminology was used to collect location and intervention data. In addition, investigators administered the Caring Efficacy Scale to better understand the effects of the electronic health record on nursing care efficacy. Several differences were noted after the electronic health record was adopted. Nurses spent significantly more time in patient rooms and less in other measured locations. They spent more time overall performing nursing interventions, with increased time in documentation and medication administration, but less time reporting and providing patient-family teaching. Both before and after electronic health record adoption, nurses spent most of their time in case management interventions (coordinating, planning, and communicating). Nurses showed a slight decrease in perceived caring efficacy after adoption. While initial findings demonstrated a trend toward increased time efficiency, questions remain regarding nurse satisfaction, patient satisfaction, quality and safety outcomes, and cost.

  20. 21 CFR 1305.27 - Preservation of electronic orders.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 9 2013-04-01 2013-04-01 false Preservation of electronic orders. 1305.27 Section... II CONTROLLED SUBSTANCES Electronic Orders § 1305.27 Preservation of electronic orders. (a) A... two years. (c) If electronic order records are maintained on a central server, the records must be...

  1. 21 CFR 1305.27 - Preservation of electronic orders.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 9 2012-04-01 2012-04-01 false Preservation of electronic orders. 1305.27 Section... II CONTROLLED SUBSTANCES Electronic Orders § 1305.27 Preservation of electronic orders. (a) A... two years. (c) If electronic order records are maintained on a central server, the records must be...

  2. 21 CFR 1305.27 - Preservation of electronic orders.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 9 2011-04-01 2011-04-01 false Preservation of electronic orders. 1305.27 Section... II CONTROLLED SUBSTANCES Electronic Orders § 1305.27 Preservation of electronic orders. (a) A... two years. (c) If electronic order records are maintained on a central server, the records must be...

  3. 21 CFR 1305.27 - Preservation of electronic orders.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 9 2014-04-01 2014-04-01 false Preservation of electronic orders. 1305.27 Section... II CONTROLLED SUBSTANCES Electronic Orders § 1305.27 Preservation of electronic orders. (a) A... two years. (c) If electronic order records are maintained on a central server, the records must be...

  4. 21 CFR 1305.27 - Preservation of electronic orders.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Preservation of electronic orders. 1305.27 Section... II CONTROLLED SUBSTANCES Electronic Orders § 1305.27 Preservation of electronic orders. (a) A... two years. (c) If electronic order records are maintained on a central server, the records must be...

  5. 7 CFR 1409.8 - Public inspection and copying of records; applicable fees.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ..., electronic recording, transcription of the recording, or minutes of the discussion of any item on the agenda...., Washington, DC 20250. (c) The transcripts, minutes, or transcriptions of electronic recordings of a Board... of transcription or duplication. ...

  6. 7 CFR 1409.8 - Public inspection and copying of records; applicable fees.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ..., electronic recording, transcription of the recording, or minutes of the discussion of any item on the agenda...., Washington, DC 20250. (c) The transcripts, minutes, or transcriptions of electronic recordings of a Board... of transcription or duplication. ...

  7. 22 CFR 503.9 - Electronic records.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... electronically by accessing the BBG's Home Page via the Internet at http://www.ibb.gov. To set up an appointment to view such records in hard copy or to access the Internet via the BBG's computer, please contact... copying, both electronically via the Internet and in hard copy, those records that have been previously...

  8. 22 CFR 503.9 - Electronic records.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... electronically by accessing the BBG's Home Page via the Internet at http://www.ibb.gov. To set up an appointment to view such records in hard copy or to access the Internet via the BBG's computer, please contact... copying, both electronically via the Internet and in hard copy, those records that have been previously...

  9. 22 CFR 503.9 - Electronic records.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... electronically by accessing the BBG's Home Page via the Internet at http://www.ibb.gov. To set up an appointment to view such records in hard copy or to access the Internet via the BBG's computer, please contact... copying, both electronically via the Internet and in hard copy, those records that have been previously...

  10. 76 FR 13121 - Electronic On-Board Recorders and Hours of Service Supporting Documents

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-10

    ... DEPARTMENT OF TRANSPORTATION Federal Motor Carrier Safety Administration 49 CFR Parts 385, 390, and 395 [Docket No. FMCSA-2010-0167] RIN 2126-AB20 Electronic On-Board Recorders and Hours of Service... comment period for the Electronic On-Board Recorder and Hours of Service Supporting Documents Notice of...

  11. Mandatory Use of Electronic Health Records: Overcoming Physician Resistance

    ERIC Educational Resources Information Center

    Brown, Viseeta K.

    2012-01-01

    Literature supports the idea that electronic health records hold tremendous value for the healthcare system in that it increases patient safety, improves the quality of care and provides greater efficiency. The move toward mandatory implementation of electronic health records is a growing concern in the United States health care industry. The…

  12. Electronic Imaging in Admissions, Records & Financial Aid Offices.

    ERIC Educational Resources Information Center

    Perkins, Helen L.

    Over the years, efforts have been made to work more efficiently with the ever increasing number of records and paper documents that cross workers' desks. Filing records on optical disk through electronic imaging is an alternative that many feel is the answer to successful document management. The pioneering efforts in electronic imaging in…

  13. Technology Acceptance of Electronic Medical Records by Nurses

    ERIC Educational Resources Information Center

    Stocker, Gary

    2010-01-01

    The purpose of this study was to evaluate the Technology Acceptance Model's (TAM) relevance of the intention of nurses to use electronic medical records in acute health care settings. The basic technology acceptance research of Davis (1989) was applied to the specific technology tool of electronic medical records (EMR) in a specific setting…

  14. Can an alert in primary care electronic medical records increase participation in a population-based screening programme for colorectal cancer? COLO-ALERT, a randomised clinical trial

    PubMed Central

    2014-01-01

    Background Colorectal cancer is an important public health problem in Spain. Over the last decade, several regions have carried out screening programmes, but population participation rates remain below recommended European goals. Reminders on electronic medical records have been identified as a low-cost and high-reach strategy to increase participation. Further knowledge is needed about their effect in a population-based screening programme. The main aim of this study is to evaluate the effectiveness of an electronic reminder to promote the participation in a population-based colorectal cancer screening programme. Secondary aims are to learn population’s reasons for refusing to take part in the screening programme and to find out the health professionals’ opinion about the official programme implementation and on the new computerised tool. Methods/Design This is a parallel randomised trial with a cross-sectional second stage. Participants: all the invited subjects to participate in the public colorectal cancer screening programme that includes men and women aged between 50–69, allocated to the eleven primary care centres of the study and all their health professionals. The randomisation unit will be the primary care physician. The intervention will consist of activating an electronic reminder, in the patient’s electronic medical record, in order to promote colorectal cancer screening, during a synchronous medical appointment, throughout the year that the intervention takes place. A comparison of the screening rates will then take place, using the faecal occult blood test of the patients from the control and the intervention groups. We will also take a questionnaire to know the opinions of the health professionals. The main outcome is the screening status at the end of the study. Data will be analysed with an intention-to-treat approach. Discussion We expect that the introduction of specific reminders in electronic medical records, as a tool to facilitate and encourage direct referral by physicians and nurse practitioners to perform colorectal cancer screening will mean an increase in participation of the target population. The introduction of this new software tool will have good acceptance and increase compliance with recommendations from health professionals. Trial registration Clinical Trials.gov identifier NCT01877018 PMID:24685117

  15. Cumulative effective radiation dose received by blunt trauma patients arriving to a military level I trauma center from point of injury and interhospital transfers.

    PubMed

    Van Arnem, Kerri A; Supinski, David P; Tucker, Jonathan E; Varney, Shawn

    2016-12-01

    Trauma patients sustaining blunt injuries are exposed to multiple radiologic studies. Evidence indicates that the risk of cancer from exposure to ionizing radiation rises in direct proportion to the cumulative effective dose (CED) received. The purpose of this study is to quantify the amount of ionizing radiation accumulated when arriving directly from point of injury to San Antonio Military Medical Center (SAMMC), a level I trauma center, compared with those transferred from other facilities. A retrospective record review was conducted from 1st January 2010 through 31st December 2012. The SAMMC trauma registry, electronic medical records, and the digital radiology imaging system were searched for possible candidates. The medical records were then analyzed for sex, age, mechanism of injury, received directly from point of injury (direct group), transfer from another medical facility (transfer group), computed tomographic scans received, dose-length product, CED of radiation, and injury severity score. A diagnostic imaging physicist then calculated the estimated CED each subject received based on the dose-length product of each computed tomographic scan. A total of 300 patients were analyzed, with 150 patients in the direct group and 150 patients in the transfer group. Both groups were similar in age and sex. Patients in the transfer group received a significantly greater CED of radiation compared with the direct group (mean, 37.6 mSv vs 28 mSv; P=.001). The radiation received in the direct group correlates with a lifetime attributable risk (LAR) of 1 in 357 compared with the transfer group with an increase in LAR to 1 in 266. Patients transferred to our facility received a 34% increase in ionizing radiation compared with patients brought directly from the injury scene. This increased dose of ionizing radiation contributes to the LAR of cancer and needs to be considered before repeating imaging studies. III. Published by Elsevier Inc.

  16. Measure Once, Cut Twice – Adding Patient-Reported Outcome Measures to the Electronic Health Record for Comparative Effectiveness Research

    PubMed Central

    Wu, Albert W.; Kharrazi, Hadi; Boulware, L. Ebony; Snyder, Claire F.

    2013-01-01

    Objective This paper presents the current state of patient-reported outcome measures, and explains new opportunities for leveraging the recent adoption of electronic health records to expand the application of patient-reported outcomes in both clinical care and comparative effectiveness research. Study Design and Setting Historic developments of patient-reported outcome, electronic health record, and comparative effectiveness research are analyzed in two dimensions: patient-centeredness and digitization. We pose the question: “What needs to be standardized around the collection of patient-reported outcomes in electronic health records for comparative effectiveness research?” Results We identified three converging trends: the progression of patient-reported outcomes toward greater patient centeredness and electronic adaptation; the evolution of electronic health records into personalized and fully digitized solutions; the shift toward patient-oriented comparative effectiveness research. Related to this convergence, we propose an architecture for patient-reported outcome standardization that could serve as a first step toward a more comprehensive integration of patient-reported outcomes with electronic health record for both practice and research. Conclusion The science of patient-reported outcome measurement has matured sufficiently to be integrated routinely into electronic health records and other e-health solutions to collect data on an ongoing basis for clinical care and comparative effectiveness research. Further efforts and ideally coordinated efforts from various stakeholders are needed to refine the details of the proposed framework for standardization. PMID:23849145

  17. Organizational learning in the implementation and adoption of national electronic health records: case studies of two hospitals participating in the National Programme for Information Technology in England.

    PubMed

    Takian, Amirhossein; Sheikh, Aziz; Barber, Nicholas

    2014-09-01

    To explore the role of organizational learning in enabling implementation and supporting adoption of electronic health record systems into two English hospitals. In the course of conducting our prospective and sociotechnical evaluation of the implementation and adoption of electronic health record into 12 "early adopter" hospitals across England, we identified two hospitals implementing virtually identical versions of the same "off-the-shelf" software (Millennium) within a comparable timeframe. We undertook a longitudinal qualitative case study-based analysis of these two hospitals (referred to hereafter as Alpha and Omega) and their implementation experiences. Data included the following: 63 in-depth interviews with various groups of internal and external stakeholders; 41-h on-site observation; and content analysis of 218 documents of various types. Analysis was both inductive and deductive, the latter being informed by the "sociotechnical changing" theoretical perspective. Although Alpha and Omega shared a number of contextual similarities, our evaluation revealed fundamental differences in visions of electronic health record and the implementation strategy between the hospitals, which resulted in distinct local consequences of electronic health record implementation and impacted adoption. Both hospitals did not, during our evaluation, see the hoped-for benefits to the organization as a result of the introduction of electronic health record, such as speeding-up tasks. Nonetheless, the Millennium software worked out to be easier to use at Omega. Interorganizational learning was at the heart of this difference. Despite the turbulent overall national "roll out" of electronic health record systems into the English hospitals, considerable opportunities for organizational learning were offered by sequential delivery of the electronic health record software into "early adopter" hospitals. We argue that understanding the process of organizational learning and its enabling factors has the potential to support efforts at implementing national electronic health record implementation endeavors. © The Author(s) 2013.

  18. EHR/PHR Basics

    MedlinePlus

    ... a hospital, an insurance company, or an employer. Electronic Health Records—Are They Secure? Many people wonder ... information is kept private and secure in an electronic health record system. In an electronic health record, ...

  19. 21 CFR 111.605 - What requirements apply to the records that you make and keep?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ..., microfiche, or other accurate reproductions of the original records), or as electronic records. (c) All electronic records must comply with part 11 of this chapter. ... 21 Food and Drugs 2 2010-04-01 2010-04-01 false What requirements apply to the records that you...

  20. Applicability of different types of Patient Records for Patient Recruitment Systems.

    PubMed

    Schreiweis, Björn; Bergh, Björn

    2015-01-01

    Patient records--types of Electronic Medical Records--are implemented to support patient recruitment. Different types of patient records have not yet been analyzed as to the number of Patient Recruitment System requirements can be found in each type of patient record. According to our analysis, personal electronic health records (PEHRs) tend to allow for most requirements to be found.

  1. Cancer Deep Phenotyping Extraction from Electronic Medical Records | Informatics Technology for Cancer Research (ITCR)

    Cancer.gov

    As sequencing costs continue to decline, a torrent of cancer genomic data is looming. Very soon, our ability to deeply investigate the cancer genome will outpace our ability to correlate these changes with the phenotypes that they produce. We propose the advanced development and extension of a software platform for performing deep phenotype extraction directly from clinical text of cancer patients, with the goal of enabling translational cancer research and precision medicine.

  2. Ophthalmology and information technology in tuzla canton health care system.

    PubMed

    Zvornicanin, Jasmin; Zvornicanin, Edita; Sabanovic, Zekerijah

    2012-06-01

    To analyze organization of ophthalmology health care in Tuzla canton and use of information technologies(IT). IT in ophthalmology is the technology required for the data processing and other information important for patient and essential for building an electronic health record(EHR). IT in ophthalmology should include the study, science, and solution sets for all aspects of data, information and knowledge management in health information processing. We have analyzed organization of ophthalmology health care in Tuzla canton. Data relevant for this research were acquired from annual reports of Tuzla Canton health ministry. All institutions and ambulances were visited and all health care professionals interviewed. A questionnaire was made which included questions for health care professionals about knowledge and use of computers, internet and information technology. Ophthalmology health care in Tuzla canton has paper based medical record. There is no information system with any possibility to exchange data electronically. None of the medical devices is directly connected to the Internet and all data are typed, printed and delivered directly to the patient. All interviewed health care professionals agree that implementation of IT and EHR would contribute and improve work quality. Computer use and easy information access will make a qualitative difference in eye-care delivery in Tuzla canton. Implementation phase will be difficult because it will likely impact present style of practice. Strategy for implementation of IT in medicine in general must be made at the country level.

  3. Stakeholder engagement: a key component of integrating genomic information into electronic health records

    PubMed Central

    Hartzler, Andrea; McCarty, Catherine A.; Rasmussen, Luke V.; Williams, Marc S.; Brilliant, Murray; Bowton, Erica A.; Clayton, Ellen Wright; Faucett, William A.; Ferryman, Kadija; Field, Julie R.; Fullerton, Stephanie M.; Horowitz, Carol R.; Koenig, Barbara A.; McCormick, Jennifer B.; Ralston, James D.; Sanderson, Saskia C.; Smith, Maureen E.; Trinidad, Susan Brown

    2014-01-01

    Integrating genomic information into clinical care and the electronic health record can facilitate personalized medicine through genetically guided clinical decision support. Stakeholder involvement is critical to the success of these implementation efforts. Prior work on implementation of clinical information systems provides broad guidance to inform effective engagement strategies. We add to this evidence-based recommendations that are specific to issues at the intersection of genomics and the electronic health record. We describe stakeholder engagement strategies employed by the Electronic Medical Records and Genomics Network, a national consortium of US research institutions funded by the National Human Genome Research Institute to develop, disseminate, and apply approaches that combine genomic and electronic health record data. Through select examples drawn from sites of the Electronic Medical Records and Genomics Network, we illustrate a continuum of engagement strategies to inform genomic integration into commercial and homegrown electronic health records across a range of health-care settings. We frame engagement as activities to consult, involve, and partner with key stakeholder groups throughout specific phases of health information technology implementation. Our aim is to provide insights into engagement strategies to guide genomic integration based on our unique network experiences and lessons learned within the broader context of implementation research in biomedical informatics. On the basis of our collective experience, we describe key stakeholder practices, challenges, and considerations for successful genomic integration to support personalized medicine. PMID:24030437

  4. Nurse's use of power to standardise nursing terminology in electronic health records.

    PubMed

    Ali, Samira; Sieloff, Christina L

    2017-07-01

    To describe nurses' use of power to influence the incorporation of standardised nursing terminology within electronic health records. Little is known about nurses' potential use of power to influence the incorporation of standardised nursing terminology within electronic health records. The theory of group power within organisations informed the design of the descriptive, cross-sectional study used a survey method to assess nurses' use of power to influence the incorporation of standardised nursing terminology within electronic health records. The Sieloff-King Assessment of Group Power within Organizations © and Nursing Power Scale was used. A total of 232 nurses responded to the survey. The mean power capability score was moderately high at 134.22 (SD 18.49), suggesting that nurses could use power to achieve the incorporation of standardised nursing terminology within electronic health records. The nurses' power capacity was significantly correlated with their power capability (r = 0.96, P < 0.001). Nurses may use power to achieve their goals, such as the incorporation of standardised nursing terminology within electronic health records. Nurse administrators may use their power to influence the incorporation of standardised nursing terminology within electronic health records. If nurses lack power, this could decrease nurses' ability to achieve their goals and contribute to the achievement of effective patient outcomes. © 2017 John Wiley & Sons Ltd.

  5. Effectiveness of Using Mobile Phone Image Capture for Collecting Secondary Data: A Case Study on Immunization History Data Among Children in Remote Areas of Thailand.

    PubMed

    Jandee, Kasemsak; Kaewkungwal, Jaranit; Khamsiriwatchara, Amnat; Lawpoolsri, Saranath; Wongwit, Waranya; Wansatid, Peerawat

    2015-07-20

    Entering data onto paper-based forms, then digitizing them, is a traditional data-management method that might result in poor data quality, especially when the secondary data are incomplete, illegible, or missing. Transcription errors from source documents to case report forms (CRFs) are common, and subsequently the errors pass from the CRFs to the electronic database. This study aimed to demonstrate the usefulness and to evaluate the effectiveness of mobile phone camera applications in capturing health-related data, aiming for data quality and completeness as compared to current routine practices exercised by government officials. In this study, the concept of "data entry via phone image capture" (DEPIC) was introduced and developed to capture data directly from source documents. This case study was based on immunization history data recorded in a mother and child health (MCH) logbook. The MCH logbooks (kept by parents) were updated whenever parents brought their children to health care facilities for immunization. Traditionally, health providers are supposed to key in duplicate information of the immunization history of each child; both on the MCH logbook, which is returned to the parents, and on the individual immunization history card, which is kept at the health care unit to be subsequently entered into the electronic health care information system (HCIS). In this study, DEPIC utilized the photographic functionality of mobile phones to capture images of all immunization-history records on logbook pages and to transcribe these records directly into the database using a data-entry screen corresponding to logbook data records. DEPIC data were then compared with HCIS data-points for quality, completeness, and consistency. As a proof-of-concept, DEPIC captured immunization history records of 363 ethnic children living in remote areas from their MCH logbooks. Comparison of the 2 databases, DEPIC versus HCIS, revealed differences in the percentage of completeness and consistency of immunization history records. Comparing the records of each logbook in the DEPIC and HCIS databases, 17.3% (63/363) of children had complete immunization history records in the DEPIC database, but no complete records were reported in the HCIS database. Regarding the individual's actual vaccination dates, comparison of records taken from MCH logbook and those in the HCIS found that 24.2% (88/363) of the children's records were absolutely inconsistent. In addition, statistics derived from the DEPIC records showed a higher immunization coverage and much more compliance to immunization schedule by age group when compared to records derived from the HCIS database. DEPIC, or the concept of collecting data via image capture directly from their primary sources, has proven to be a useful data collection method in terms of completeness and consistency. In this study, DEPIC was implemented in data collection of a single survey. The DEPIC concept, however, can be easily applied in other types of survey research, for example, collecting data on changes or trends based on image evidence over time. With its image evidence and audit trail features, DEPIC has the potential for being used even in clinical studies since it could generate improved data integrity and more reliable statistics for use in both health care and research settings.

  6. Implementation of a next-generation electronic nursing records system based on detailed clinical models and integration of clinical practice guidelines.

    PubMed

    Min, Yul Ha; Park, Hyeoun-Ae; Chung, Eunja; Lee, Hyunsook

    2013-12-01

    The purpose of this paper is to describe the components of a next-generation electronic nursing records system ensuring full semantic interoperability and integrating evidence into the nursing records system. A next-generation electronic nursing records system based on detailed clinical models and clinical practice guidelines was developed at Seoul National University Bundang Hospital in 2013. This system has two components, a terminology server and a nursing documentation system. The terminology server manages nursing narratives generated from entity-attribute-value triplets of detailed clinical models using a natural language generation system. The nursing documentation system provides nurses with a set of nursing narratives arranged around the recommendations extracted from clinical practice guidelines. An electronic nursing records system based on detailed clinical models and clinical practice guidelines was successfully implemented in a hospital in Korea. The next-generation electronic nursing records system can support nursing practice and nursing documentation, which in turn will improve data quality.

  7. A First Standardized Swiss Electronic Maternity Record.

    PubMed

    Murbach, Michel; Martin, Sabine; Denecke, Kerstin; Nüssli, Stephan

    2017-01-01

    During the nine months of pregnancy, women have to regularly visit several physicians for continuous monitoring of the health and development of the fetus and mother. Comprehensive examination results of different types are generated in this process; documentation and data transmission standards are still unavailable or not in use. Relevant information is collected in a paper-based maternity record carried by the pregnant women. To improve availability and transmission of data, we aim at developing a first prototype for an electronic maternity record for Switzerland. By analyzing the documentation workflow during pregnancy, we determined a maternity record data set. Further, we collected requirements towards a digital maternity record. As data exchange format, the Swiss specific exchange format SMEEX (swiss medical data exchange) was exploited. Feedback from 27 potential users was collected to identify further improvements. The relevant data is extracted from the primary care information system as SMEEX file, stored in a database and made available in a web and a mobile application, developed as prototypes of an electronic maternity record. The user confirmed the usefulness of the system and provided multiple suggestions for an extension. An electronical maternity record as developed in this work could be in future linked to the electronic patient record.

  8. 12 CFR 609.945 - Records retention.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 6 2011-01-01 2011-01-01 false Records retention. 609.945 Section 609.945 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM ELECTRONIC COMMERCE Standards for Boards and Management § 609.945 Records retention. Records stored electronically must be accurate, accessible...

  9. 75 FR 64403 - Privacy Act of 1974, as Amended

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-19

    ... records in the system: Storage: Paper records and electronic media. Retrievability: By individual's name... information. (12) Disclose to the Office of Personnel Management the identity and status of disciplinary cases... Records in the System: Storage: Paper records and electronic media. Retrievability: By individual's name...

  10. 36 CFR § 1222.26 - What are the general recordkeeping requirements for agency programs?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Property NATIONAL ARCHIVES AND RECORDS ADMINISTRATION RECORDS MANAGEMENT CREATION AND MAINTENANCE OF... be created and maintained to document program policies, procedures, functions, activities, and... electronic records; (c) Related records series and systems; (d) The relationship between paper and electronic...

  11. 12 CFR 609.945 - Records retention.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Records retention. 609.945 Section 609.945 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM ELECTRONIC COMMERCE Standards for Boards and Management § 609.945 Records retention. Records stored electronically must be accurate, accessible...

  12. Relationships between Electronic Information Media and Records Management Practices: Results of a Survey of United Nations Organizations. A Rand Note.

    ERIC Educational Resources Information Center

    Bikson, T. K.; Schieber, L.

    A Technical Panel on Electronic Records Management (TP/REM), which was established by the Advisory Committee for the Co-ordination of Information Systems (ACCIS), conducted a survey of existing electronic records management practices and standards related to new information and communication technologies and their interrelationships within the…

  13. Exploring the Relationships between the Electronic Health Record System Components and Patient Outcomes in an Acute Hospital Setting

    ERIC Educational Resources Information Center

    Wiggley, Shirley L.

    2011-01-01

    Purpose: The purpose of this study was to examine the relationship between the electronic health record system components and patient outcomes in an acute hospital setting, given that the current presidential administration has earmarked nearly $50 billion to the implementation of the electronic health record. The relationship between the…

  14. Ten tips for successful electronic health records deployment.

    PubMed

    Gasch, Art

    2012-01-01

    As healthcare providers are increasingly compelled to adopt electronic health records (EHRs) and paper records migrate to electronic files provided to dozens of healthcare intermediaries, breeches of protected health information are skyrocketing, and so are dissatisfaction rates with EHR solutions. This article provides 10 practical tips to ensure a successful EHR system deployment an circumvent EHR land mines.

  15. The Impact of Electronic Health Records on Healthcare Professional's Beliefs and Attitudes toward Face to Face Communication

    ERIC Educational Resources Information Center

    Nickles, Kenneth Patrick

    2012-01-01

    The impact of electronic health records on healthcare professional's beliefs and attitudes toward face to face communication during patient and provider interactions was examined. Quantitative survey research assessed user attitudes towards an electronic health record system and revealed that healthcare professionals from a wide range of…

  16. 77 FR 7562 - Electronic On-Board Recorders and Hours of Service Supporting Documents

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-13

    ..., and 395 [Docket No. FMCSA-2010-0167] RIN 2126-AB20 Electronic On-Board Recorders and Hours of Service... intent. SUMMARY: FMCSA announces its intent to move forward with the Electronic On-Board Recorders and... Appeals for the Seventh Circuit. OOIDA raised several concerns relating to EOBRs and their potential use...

  17. 19 CFR 163.1 - Definitions.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...; electronically stored or transmitted information or data; books; papers; correspondence; accounts; financial... electronic records or paper documents; (2) Electronic information which is in a readable format such as a facsimile paper format or an electronic or hardcopy spreadsheet; (3) In the case of a paper record that is...

  18. Atomic scale dynamics of a solid state chemical reaction directly determined by annular dark-field electron microscopy.

    PubMed

    Pennycook, Timothy J; Jones, Lewys; Pettersson, Henrik; Coelho, João; Canavan, Megan; Mendoza-Sanchez, Beatriz; Nicolosi, Valeria; Nellist, Peter D

    2014-12-22

    Dynamic processes, such as solid-state chemical reactions and phase changes, are ubiquitous in materials science, and developing a capability to observe the mechanisms of such processes on the atomic scale can offer new insights across a wide range of materials systems. Aberration correction in scanning transmission electron microscopy (STEM) has enabled atomic resolution imaging at significantly reduced beam energies and electron doses. It has also made possible the quantitative determination of the composition and occupancy of atomic columns using the atomic number (Z)-contrast annular dark-field (ADF) imaging available in STEM. Here we combine these benefits to record the motions and quantitative changes in the occupancy of individual atomic columns during a solid-state chemical reaction in manganese oxides. These oxides are of great interest for energy-storage applications such as for electrode materials in pseudocapacitors. We employ rapid scanning in STEM to both drive and directly observe the atomic scale dynamics behind the transformation of Mn3O4 into MnO. The results demonstrate we now have the experimental capability to understand the complex atomic mechanisms involved in phase changes and solid state chemical reactions.

  19. Particle displacement tracking applied to air flows

    NASA Technical Reports Server (NTRS)

    Wernet, Mark P.

    1991-01-01

    Electronic Particle Image Velocimeter (PIV) techniques offer many advantages over conventional photographic PIV methods such as fast turn around times and simplified data reduction. A new all electronic PIV technique was developed which can measure high speed gas velocities. The Particle Displacement Tracking (PDT) technique employs a single cw laser, small seed particles (1 micron), and a single intensified, gated CCD array frame camera to provide a simple and fast method of obtaining two-dimensional velocity vector maps with unambiguous direction determination. Use of a single CCD camera eliminates registration difficulties encountered when multiple cameras are used to obtain velocity magnitude and direction information. An 80386 PC equipped with a large memory buffer frame-grabber board provides all of the data acquisition and data reduction operations. No array processors of other numerical processing hardware are required. Full video resolution (640x480 pixel) is maintained in the acquired images, providing high resolution video frames of the recorded particle images. The time between data acquisition to display of the velocity vector map is less than 40 sec. The new electronic PDT technique is demonstrated on an air nozzle flow with velocities less than 150 m/s.

  20. Ultrafast Carrier dynamics of InxGa1-xN nanostructures grown directly on Si(111)

    NASA Astrophysics Data System (ADS)

    Kumar, Praveen; Devi, Pooja; Rodriguez⁠, P. E. D. S.; Kumar, Manish; Shivling, V. D.; Noetzel, Richard; Sharma, Chhavi; Sinha, R. K.; Kumar, Mahesh

    2018-05-01

    We show a flux dependence changes in structural, optical and electronic properties of InxGa1-xN nanostructures (NSs) namely nanocolumns (NCs), nanoflakes (NFs) and nanowall network (NWN) grown directly on Si(111) surface. Field emission scanning electron microscopy (FESEM) images were recorded to see morphological changes from NFs to NCs and NWNc etc, while high-resolution X-ray diffraction (HRXRD) ω-2θ scans were used to determine In incorporation. The maximum In incorporation was observed to be 20, 33 and 38% for the sharp transition from NFs to NCs and NWNs, respectively. The charge carrier dynamics of these grown NSs were probed using Ultrafast Femtosecond Transient Absorption Spectroscopy (UFTAS) with excitation at 350 nm pump wavelength. The UFTAS studies show the comparative charge carriers dynamics of the NWS, NCs and NFs. The charge carrier studies show a higher lifetime in NWNs as compare to NCs and NFs. Further, to examine electronic structure and level of degeneracy of these NSs, core-level and valence band spectra were analyzed by X-ray photoelectron spectroscopy (XPS), which manifest the upward band bending ranging from 0.2 eV to 0.4 eV.

  1. Exploiting the speckle-correlation scattering matrix for a compact reference-free holographic image sensor

    PubMed Central

    Lee, KyeoReh; Park, YongKeun

    2016-01-01

    The word ‘holography' means a drawing that contains all of the information for light—both amplitude and wavefront. However, because of the insufficient bandwidth of current electronics, the direct measurement of the wavefront of light has not yet been achieved. Though reference-field-assisted interferometric methods have been utilized in numerous applications, introducing a reference field raises several fundamental and practical issues. Here we demonstrate a reference-free holographic image sensor. To achieve this, we propose a speckle-correlation scattering matrix approach; light-field information passing through a thin disordered layer is recorded and retrieved from a single-shot recording of speckle intensity patterns. Self-interference via diffusive scattering enables access to impinging light-field information, when light transport in the diffusive layer is precisely calibrated. As a proof-of-concept, we demonstrate direct holographic measurements of three-dimensional optical fields using a compact device consisting of a regular image sensor and a diffusor. PMID:27796290

  2. Exploiting the speckle-correlation scattering matrix for a compact reference-free holographic image sensor.

    PubMed

    Lee, KyeoReh; Park, YongKeun

    2016-10-31

    The word 'holography' means a drawing that contains all of the information for light-both amplitude and wavefront. However, because of the insufficient bandwidth of current electronics, the direct measurement of the wavefront of light has not yet been achieved. Though reference-field-assisted interferometric methods have been utilized in numerous applications, introducing a reference field raises several fundamental and practical issues. Here we demonstrate a reference-free holographic image sensor. To achieve this, we propose a speckle-correlation scattering matrix approach; light-field information passing through a thin disordered layer is recorded and retrieved from a single-shot recording of speckle intensity patterns. Self-interference via diffusive scattering enables access to impinging light-field information, when light transport in the diffusive layer is precisely calibrated. As a proof-of-concept, we demonstrate direct holographic measurements of three-dimensional optical fields using a compact device consisting of a regular image sensor and a diffusor.

  3. Present and Future Applications of Digital Electronics in Nuclear Science - a Commercial Prospective

    NASA Astrophysics Data System (ADS)

    Tan, Hui

    2011-10-01

    Digital readout electronics instrumenting radiation detectors have experienced significant advancements in the last decade or so. This on one hand can be attributed to the steady improvements in commercial digital processing components such as analog-to-digital converters (ADCs), digital-to-analog converters (DACs), field-programmable-gate-arrays (FPGAs), and digital-signal-processors (DSPs), and on the other hand can also be attributed to the increasing needs for improved time, position, and energy resolution in nuclear physics experiments, which have spurred the rapid development of commercial off-the-shelf high speed, high resolution digitizers or spectrometers. Absent from conventional analog electronics, the capability to record fast decaying pulses from radiation detectors in digital readout electronics has profoundly benefited nuclear physics researchers since they now can perform detailed pulse processing for applications such as gamma-ray tracking and decay-event selection and reconstruction. In this talk, present state-of-the-art digital readout electronics and its applications in a variety of nuclear science fields will be discussed, and future directions in hardware development for digital electronics will also be outlined, all from the prospective of a commercial manufacturer of digital electronics.

  4. Mesh electronics: a new paradigm for tissue-like brain probes.

    PubMed

    Hong, Guosong; Yang, Xiao; Zhou, Tao; Lieber, Charles M

    2018-06-01

    Existing implantable neurotechnologies for understanding the brain and treating neurological diseases have intrinsic properties that have limited their capability to achieve chronically-stable brain interfaces with single-neuron spatiotemporal resolution. These limitations reflect what has been dichotomy between the structure and mechanical properties of living brain tissue and non-living neural probes. To bridge the gap between neural and electronic networks, we have introduced the new concept of mesh electronics probes designed with structural and mechanical properties such that the implant begins to 'look and behave' like neural tissue. Syringe-implanted mesh electronics have led to the realization of probes that are neuro-attractive and free of the chronic immune response, as well as capable of stable long-term mapping and modulation of brain activity at the single-neuron level. This review provides a historical overview of a 10-year development of mesh electronics by highlighting the tissue-like design, syringe-assisted delivery, seamless neural tissue integration, and single-neuron level chronic recording stability of mesh electronics. We also offer insights on unique near-term opportunities and future directions for neuroscience and neurology that now are available or expected for mesh electronics neurotechnologies. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  5. Design and implementation of an affordable, public sector electronic medical record in rural Nepal.

    PubMed

    Raut, Anant; Yarbrough, Chase; Singh, Vivek; Gauchan, Bikash; Citrin, David; Verma, Varun; Hawley, Jessica; Schwarz, Dan; Harsha Bangura, Alex; Shrestha, Biplav; Schwarz, Ryan; Adhikari, Mukesh; Maru, Duncan

    2017-06-23

    Globally, electronic medical records are central to the infrastructure of modern healthcare systems. Yet the vast majority of electronic medical records have been designed for resource-rich environments and are not feasible in settings of poverty. Here we describe the design and implementation of an electronic medical record at a public sector district hospital in rural Nepal, and its subsequent expansion to an additional public sector facility.DevelopmentThe electronic medical record was designed to solve for the following elements of public sector healthcare delivery: 1) integration of the systems across inpatient, surgical, outpatient, emergency, laboratory, radiology, and pharmacy sites of care; 2) effective data extraction for impact evaluation and government regulation; 3) optimization for longitudinal care provision and patient tracking; and 4) effectiveness for quality improvement initiatives. For these purposes, we adapted Bahmni, a product built with open-source components for patient tracking, clinical protocols, pharmacy, laboratory, imaging, financial management, and supply logistics. In close partnership with government officials, we deployed the system in February of 2015, added on additional functionality, and iteratively improved the system over the following year. This experience enabled us then to deploy the system at an additional district-level hospital in a different part of the country in under four weeks. We discuss the implementation challenges and the strategies we pursued to build an electronic medical record for the public sector in rural Nepal.DiscussionOver the course of 18 months, we were able to develop, deploy and iterate upon the electronic medical record, and then deploy the refined product at an additional facility within only four weeks. Our experience suggests the feasibility of an integrated electronic medical record for public sector care delivery even in settings of rural poverty.

  6. Design and implementation of an affordable, public sector electronic medical record in rural Nepal

    PubMed Central

    Raut, Anant; Yarbrough, Chase; Singh, Vivek; Gauchan, Bikash; Citrin, David; Verma, Varun; Hawley, Jessica; Schwarz, Dan; Harsha, Alex; Shrestha, Biplav; Schwarz, Ryan; Adhikari, Mukesh; Maru, Duncan

    2018-01-01

    Introduction Globally, electronic medical records are central to the infrastructure of modern healthcare systems. Yet the vast majority of electronic medical records have been designed for resource-rich environments and are not feasible in settings of poverty. Here we describe the design and implementation of an electronic medical record at a public sector district hospital in rural Nepal, and its subsequent expansion to an additional public sector facility. Development The electronic medical record was designed to solve for the following elements of public sector healthcare delivery: 1) integration of the systems across inpatient, surgical, outpatient, emergency, laboratory, radiology, and pharmacy sites of care; 2) effective data extraction for impact evaluation and government regulation; 3) optimization for longitudinal care provision and patient tracking; and 4) effectiveness for quality improvement initiatives. Application For these purposes, we adapted Bahmni, a product built with open-source components for patient tracking, clinical protocols, pharmacy, laboratory, imaging, financial management, and supply logistics. In close partnership with government officials, we deployed the system in February of 2015, added on additional functionality, and iteratively improved the system over the following year. This experience enabled us then to deploy the system at an additional district-level hospital in a different part of the country in under four weeks. We discuss the implementation challenges and the strategies we pursued to build an electronic medical record for the public sector in rural Nepal. Discussion Over the course of 18 months, we were able to develop, deploy and iterate upon the electronic medical record, and then deploy the refined product at an additional facility within only four weeks. Our experience suggests the feasibility of an integrated electronic medical record for public sector care delivery even in settings of rural poverty. PMID:28749321

  7. Electronic Transfer of School Records.

    ERIC Educational Resources Information Center

    Yeagley, Raymond

    2001-01-01

    Describes the electronic transfer of student records, notably the use of a Web-server named CHARLOTTE sponsored by the National Forum on Education Statistics and an Electronic Data Exchange system named SPEEDE/ExPRESS. (PKP)

  8. A study on agent-based secure scheme for electronic medical record system.

    PubMed

    Chen, Tzer-Long; Chung, Yu-Fang; Lin, Frank Y S

    2012-06-01

    Patient records, including doctors' diagnoses of diseases, trace of treatments and patients' conditions, nursing actions, and examination results from allied health profession departments, are the most important medical records of patients in medical systems. With patient records, medical staff can instantly understand the entire medical information of a patient so that, according to the patient's conditions, more accurate diagnoses and more appropriate in-depth treatments can be provided. Nevertheless, in such a modern society with booming information technologies, traditional paper-based patient records have faced a lot of problems, such as lack of uniform formats, low data mobility, slow data transfer, illegible handwritings, enormous and insufficient storage space, difficulty of conservation, being easily damaged, and low transferability. To improve such drawbacks, reduce medical costs, and advance medical quality, paper-based patient records are modified into electronic medical records and reformed into electronic patient records. However, since electronic patient records used in various hospitals are diverse and different, in consideration of cost, it is rather difficult to establish a compatible and complete integrated electronic patient records system to unify patient records from heterogeneous systems in hospitals. Moreover, as the booming of the Internet, it is no longer necessary to build an integrated system. Instead, doctors can instantly look up patients' complete information through the Internet access to electronic patient records as well as avoid the above difficulties. Nonetheless, the major problem of accessing to electronic patient records cross-hospital systems exists in the security of transmitting and accessing to the records in case of unauthorized medical personnels intercepting or stealing the information. This study applies the Mobile Agent scheme to cope with the problem. Since a Mobile Agent is a program, which can move among hosts and automatically disperse arithmetic processes, and moves from one host to another in heterogeneous network systems with the characteristics of autonomy and mobility, decreasing network traffic, reducing transfer lag, encapsulating protocol, availability on heterogeneous platforms, fault-tolerance, high flexibility, and personalization. However, since a Mobile Agent contacts and exchanges information with other hosts or agents on the Internet for rapid exchange and access to medical information, the security is threatened. In order to solve the problem, this study proposes a key management scheme based on Lagrange interpolation formulas and hierarchical management structure to make Mobile Agents a more secure and efficient access control scheme for electronic patient record systems when applied to the access of patients' personal electronic patient records cross hospitals. Meanwhile, with the comparison of security and efficacy analyses being the feasibility of validation scheme and the basis of better efficiency, the security of Mobile Agents in the process of operation can be guaranteed, key management efficacy can be advanced, and the security of the Mobile Agent system can be protected.

  9. High agreement between the new Mongolian electronic immunization register and written immunization records: a health centre based audit

    PubMed Central

    Mungun, Tuya; Dorj, Narangerel; Volody, Baigal; Chuluundorj, Uranjargal; Munkhbat, Enkhtuya; Danzan, Gerelmaa; Nguyen, Cattram D; La Vincente, Sophie; Russell, Fiona

    2017-01-01

    Introduction Monitoring of vaccination coverage is vital for the prevention and control of vaccine-preventable diseases. Electronic immunization registers have been increasingly adopted to assist with the monitoring of vaccine coverage; however, there is limited literature about the use of electronic registers in low- and middle-income countries such as Mongolia. We aimed to determine the accuracy and completeness of the newly introduced electronic immunization register for calculating vaccination coverage and determining vaccine effectiveness within two districts in Mongolia in comparison to written health provider records. Methods We conducted a cross-sectional record review among children 2–23 months of age vaccinated at immunization clinics within the two districts. We linked data from written records with the electronic immunization register using the national identification number to determine the completeness and accuracy of the electronic register. Results Both completeness (90.9%; 95% CI: 88.4–93.4) and accuracy (93.3%; 95% CI: 84.1–97.4) of the electronic immunization register were high when compared to written records. The increase in completeness over time indicated a delay in data entry. Conclusion Through this audit, we have demonstrated concordance between a newly introduced electronic register and health provider records in a middle-income country setting. Based on this experience, we recommend that electronic registers be accompanied by routine quality assurance procedures for the monitoring of vaccination programmes in such settings. PMID:29051836

  10. Electron microscopic evidence for the myosin head lever arm mechanism in hydrated myosin filaments using the gas environmental chamber

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Minoda, Hiroki; CREST, Japan Science and Technology Agency, Kawaguchi, Saitama 332-0012; Okabe, Tatsuhiro

    2011-02-25

    Research highlights: {yields} We succeeded in recording structural changes of hydrated myosin cross-bridges. {yields} We succeeded in position-marking the cross-bridges with site-directed antibodies. {yields} We recorded cross-bridge movement at different regions in individual cross-bridge. {yields} The movement was smallest at the cross-bridge-subfragment two boundary. {yields} The results provide evidence for the cross-bridge lever arm mechanism. -- Abstract: Muscle contraction results from an attachment-detachment cycle between the myosin heads extending from myosin filaments and the sites on actin filaments. The myosin head first attaches to actin together with the products of ATP hydrolysis, performs a power stroke associated with release ofmore » hydrolysis products, and detaches from actin upon binding with new ATP. The detached myosin head then hydrolyses ATP, and performs a recovery stroke to restore its initial position. The strokes have been suggested to result from rotation of the lever arm domain around the converter domain, while the catalytic domain remains rigid. To ascertain the validity of the lever arm hypothesis in muscle, we recorded ATP-induced movement at different regions within individual myosin heads in hydrated myosin filaments, using the gas environmental chamber attached to the electron microscope. The myosin head were position-marked with gold particles using three different site-directed antibodies. The amplitude of ATP-induced movement at the actin binding site in the catalytic domain was similar to that at the boundary between the catalytic and converter domains, but was definitely larger than that at the regulatory light chain in the lever arm domain. These results are consistent with the myosin head lever arm mechanism in muscle contraction if some assumptions are made.« less

  11. Assessing electronic health record systems in emergency departments: Using a decision analytic Bayesian model.

    PubMed

    Ben-Assuli, Ofir; Leshno, Moshe

    2016-09-01

    In the last decade, health providers have implemented information systems to improve accuracy in medical diagnosis and decision-making. This article evaluates the impact of an electronic health record on emergency department physicians' diagnosis and admission decisions. A decision analytic approach using a decision tree was constructed to model the admission decision process to assess the added value of medical information retrieved from the electronic health record. Using a Bayesian statistical model, this method was evaluated on two coronary artery disease scenarios. The results show that the cases of coronary artery disease were better diagnosed when the electronic health record was consulted and led to more informed admission decisions. Furthermore, the value of medical information required for a specific admission decision in emergency departments could be quantified. The findings support the notion that physicians and patient healthcare can benefit from implementing electronic health record systems in emergency departments. © The Author(s) 2015.

  12. Clinical Assistant Diagnosis for Electronic Medical Record Based on Convolutional Neural Network.

    PubMed

    Yang, Zhongliang; Huang, Yongfeng; Jiang, Yiran; Sun, Yuxi; Zhang, Yu-Jin; Luo, Pengcheng

    2018-04-20

    Automatically extracting useful information from electronic medical records along with conducting disease diagnoses is a promising task for both clinical decision support(CDS) and neural language processing(NLP). Most of the existing systems are based on artificially constructed knowledge bases, and then auxiliary diagnosis is done by rule matching. In this study, we present a clinical intelligent decision approach based on Convolutional Neural Networks(CNN), which can automatically extract high-level semantic information of electronic medical records and then perform automatic diagnosis without artificial construction of rules or knowledge bases. We use collected 18,590 copies of the real-world clinical electronic medical records to train and test the proposed model. Experimental results show that the proposed model can achieve 98.67% accuracy and 96.02% recall, which strongly supports that using convolutional neural network to automatically learn high-level semantic features of electronic medical records and then conduct assist diagnosis is feasible and effective.

  13. [From planning to realization of an electronic patient record].

    PubMed

    Krämer, T; Rapp, R; Krämer, K L

    1999-03-01

    The high complex requirements on information and information flow in todays hospitals can only be accomplished by the use of modern Information Systems (IS). In order to achieve this, the Stiftung Orthopädische Universitätsklinik has carried out first the Project "Strategic Informations System Planning" in 1993. Then realizing the necessary infrastructure (network; client-server) from 1993 to 1997, and finally started the introduction of modern IS (SAP R/3 and IXOS-Archive) in the clinical area. One of the approved goal was the replacement of the paper medical record by an up-to-date electronical medical record. In this article the following three topics will be discussed: the difference between the up-to-date electronical medical record and the electronically archived finished cases, steps performed by our clinic to realize the up-to-date electronical medical record and the problems occurred during this process.

  14. From planning to realisation of an electronic patient record.

    PubMed

    Krämer, T; Rapp, R; Krämer, K-L

    1999-03-01

    The high complex requirements on information and information flow in todays hospitals can only be accomplished by the use of modern Information Systems (IS). In order to achieve this, the Stiftung Orthopädische Universitätsklinik has carried out first the Project "Strategic Informations System Planning" in 1993. Then realizing the neccessary infrastructure (network; client-server) from 1993 to 1997, and finally started the introduction of modern IS (SAP R/3 and IXOS-Archive) in the clinical area. One of the approved goal was the replacement of the paper medical record by an up-to-date electronical medical record. In this article the following three topics will be discussed: the difference between the up-to-date electronical medical record and the electronically archived finished cases, steps performed by our clinic to realize the up-to-date electronical medical record and the problems occured during this process.

  15. Direct observation of small cluster mobility and ripening. [during annealing of metal films on amorphous substrates

    NASA Technical Reports Server (NTRS)

    Heinemann, K.; Poppa, H.

    1975-01-01

    Direct evidence is reported for the simultaneous occurrence of Ostwald ripening and short-distance cluster mobility during annealing of discontinuous metal films on clean amorphous substrates. The annealing characteristics of very thin particulate deposits of silver on amorphized clean surfaces of single crystalline thin graphite substrates were studied by in-situ transmission electron microscopy (TEM) under controlled environmental conditions (residual gas pressure of 10 to the minus 9th power torr) in the temperature range from 25 to 450 C. Sputter cleaning of the substrate surface, metal deposition, and annealing were monitored by TEM observation. Pseudostereographic presentation of micrographs in different annealing stages, the observation of the annealing behavior at cast shadow edges, and measurements with an electronic image analyzing system were employed to aid the visual perception and the analysis of changes in deposit structure recorded during annealing. Slow Ostwald ripening was found to occur in the entire temperature range, but the overriding surface transport mechanism was short-distance cluster mobility.

  16. Using the eXtensible Markup Language (XML) in a regional electronic patient record for patients with malignant diseases.

    PubMed

    Wolff, A C; Mludek, V; van der Haak, M; Bork, W; Bülzebruck, H; Drings, P; Schmücker, P; Wannenmacher, M; Haux, R

    2001-01-01

    Communication between different institutions which are responsible for the treatment of the same patient is of outstanding significance, especially in the field of tumor diseases. Regional electronic patient records could support the co-operation of different institutions by providing ac-cess to all necessary information whether it belongs to the own institution or to a partner. The Department of Medical Informatics, University of Heidelberg is performing a project in co-operation with the Thoraxclinic-Heidelberg and the Department of Clinical Radiology, University of Heidelberg with the goal: to define an architectural concept for interlinking the electronic patient record of the two clinical institutions to build a common virtual electronic patient record and carry out an exemplary implementation, to examine composition, structure and content of medical documents for tumor patients with the aim of defining an XML-based markup language allowing summarizing overviews and suitable granularities, and to integrate clinical practice guidelines and other external knowledge with the electronic patient record using XML-technologies to support the physician in the daily decision process. This paper will show, how a regional electronic patient record could be built on an architectural level and describe elementary steps towards a on content-oriented structuring of medical records.

  17. 10 CFR 61.80 - Maintenance of records, reports, and transfers.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... receipt and disposal of radioactive waste in an electronic recordkeeping system. (1) The manifest... RADIOACTIVE WASTE Records, Reports, Tests, and Inspections § 61.80 Maintenance of records, reports, and.... The record may also be stored in electronic media with the capability for producing legible, accurate...

  18. 77 FR 65913 - Privacy Act of 1974: Systems of Records.

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-31

    ... performing clerical, stenographic, or data analysis functions, or by reproduction of records by electronic or... performing clerical, stenographic, or data analysis functions, or by reproduction of records by electronic or... Services (OGIS) National Archives and Records Administration, in connection with mediation of FOIA requests...

  19. Energetic electron acceleration observed by MMS in the vicinity of an X-line crossing

    DOE PAGES

    Jaynes, A. N.; Turner, D. L.; Wilder, F. D.; ...

    2016-07-25

    During the first months of observations, the Magnetospheric Multiscale Fly's Eye Energetic Particle Spectrometer instrument has observed several instances of electron acceleration up to >100 keV while in the vicinity of the dayside reconnection region. While particle acceleration associated with magnetic reconnection has been seen to occur up to these energies in the tail region, it had not yet been reported at the magnetopause. This study reports on observations of electron acceleration up to hundreds of keV that were recorded on 19 September 2015 around 1000 UT, in the midst of an X-line crossing. In the region surrounding the X-line,more » whistler-mode and broadband electrostatic waves were observed simultaneously with the appearance of highly energetic electrons which exhibited significant energization in the perpendicular direction. The mechanisms by which particles may be accelerated via reconnection-related processes are intrinsic to understanding particle dynamics among a wide range of spatial scales and plasma environments.« less

  20. Polarization of K-shell Dielectronic Recombination Satellite Lines of Fe XIX–XXV and Its Application for Diagnostics of Anisotropies of Hot Plasmas

    NASA Astrophysics Data System (ADS)

    Shah, Chintan; Amaro, Pedro; Steinbrügge, René; Bernitt, Sven; Crespo López-Urrutia, José R.; Tashenov, Stanislav

    2018-02-01

    We present a systematic measurement of the X-ray emission asymmetries in the K-shell dielectronic, trielectronic, and quadruelectronic recombination of free electrons into highly charged ions. Iron ions in He-like through O-like charge states were produced in an electron beam ion trap, and the electron–ion collision energy was scanned over the recombination resonances. Two identical X-ray detectors mounted head-on and side-on with respect to the electron beam propagation recorded X-rays emitted in the decay of resonantly populated states. The degrees of linear polarization of X-rays inferred from observed emission asymmetries benchmark distorted-wave predictions of the Flexible Atomic Code for several dielectronic recombination satellite lines. The present method also demonstrates its applicability for diagnostics of energy and direction of electron beams inside hot anisotropic plasmas. Both experimental and theoretical data can be used for modeling of hot astrophysical and fusion plasmas.

  1. Record Low NEP in the Hot-Electron Titanium Nanobolometers

    NASA Technical Reports Server (NTRS)

    Karasik, Boris S.; Olaya, David; Wei, Jian; Pereverzev, Sergey; Gershenson, Michael E.; Kawamura, Jonathan H.; McGrath, William R.; Sergeev, Andrei V.

    2006-01-01

    We are developing hot-electron superconducting transition-edge sensors (TES) capable of counting THz photons and operating at T = 0.3K. We fabricated superconducting Ti nanosensors with Nb contacts with a volume of approx. 3x10(exp -3) cu microns on planar Si substrate and have measured the thermal conductance due to the weak electron-phonon coupling in the material G = 4x10(exp -14) W/K at 0.3 K. The corresponding phonon-noise NEP = 3x10(exp -19) W/Hz(sup 1/2). Detection of single optical photons (1550nm and 670nm wavelength) has been demonstrated for larger devices and yielded the thermal time constants of 30 microsec at 145 mK and of 25 microsec at 190 mK. This Hot-Electron Direct Detector (HEDD) is expected to have a sufficient energy resolution for detecting individual photons with (nu) > 1 THz where NEP approx. 3x10(exp -20) W/Hz(sup 1/2) is needed for spectroscopy in space.

  2. Study of Damage and Recovery of Electron Irradiated Polyimide using EPR and NMR Spectroscopy

    NASA Astrophysics Data System (ADS)

    Humagain, Sunita; Jhonson, Jessica; Stallworth, Phillip; Engelhart, Daniel; Plis, Elena; Ferguson, Dale; Cooper, Russell; Hoffmann, Ryan; Greenbaum, Steve

    The main objective of this research is to probe radical concentrations in electron irradiated polyimide (PI, Kapton®) and to examine the impact on the electrical properties using EPR and NMR spectroscopy. PI is an electrical insulator used in space missions as a thermal management blanketing material, it is therefore critical for spacecraft designers to understand the nature of electron transport (electrical conductivity) within the bulk of the material. The recovery mechanism (radical evolution) of PI in vacuum, argon and air after having been subjected to 90 KeV electron irradiation, was studied. The formation and subsequent exponential decay of the radical concentrations was recorded using EPR. This signal decay agrees well with the recovery mechanism being probed by electrical conductivity measurements and implies a strong relation between the two. To investigate the distribution of radicals in the polymer, 1H NMR relaxation time (T1) were measured at 300MHz. Additional NMR experiments, in particular 13C, were performed to search for direct evidence of structural defects.

  3. Smart Technology in Lung Disease Clinical Trials.

    PubMed

    Geller, Nancy L; Kim, Dong-Yun; Tian, Xin

    2016-01-01

    This article describes the use of smart technology by investigators and patients to facilitate lung disease clinical trials and make them less costly and more efficient. By "smart technology" we include various electronic media, such as computer databases, the Internet, and mobile devices. We first describe the use of electronic health records for identifying potential subjects and then discuss electronic informed consent. We give several examples of using the Internet and mobile technology in clinical trials. Interventions have been delivered via the World Wide Web or via mobile devices, and both have been used to collect outcome data. We discuss examples of new electronic devices that recently have been introduced to collect health data. While use of smart technology in clinical trials is an exciting development, comparison with similar interventions applied in a conventional manner is still in its infancy. We discuss advantages and disadvantages of using this omnipresent, powerful tool in clinical trials, as well as directions for future research. Published by Elsevier Inc.

  4. Energetic Electron Acceleration Observed by MMS in the Vicinity of an X-Line Crossing

    NASA Technical Reports Server (NTRS)

    Jaynes, A. N.; Turner, D. L.; Wilder, F. D.; Osmane, A.; Baker, D. N.; Blake, J. B.; Fennell, J. F.; Cohen, I. J.; Mauk, B. H.; Reeves, G. D.; hide

    2016-01-01

    During the first months of observations, the Magnetospheric Multiscale Fly's Eye Energetic Particle Spectrometer instrument has observed several instances of electron acceleration up to greater than 100 keV while in the vicinity of the dayside reconnection region. While particle acceleration associated with magnetic reconnection has been seen to occur up to these energies in the tail region, it had not yet been reported at the magnetopause. This study reports on observations of electron acceleration up to hundreds of keV that were recorded on 19 September 2015 around 1000 UT, in the midst of an X-line crossing. In the region surrounding the X-line, whistler-mode and broadband electrostatic waves were observed simultaneously with the appearance of highly energetic electrons which exhibited significant energization in the perpendicular direction. The mechanisms by which particles may be accelerated via reconnection-related processes are intrinsic to understanding particle dynamics among a wide range of spatial scales and plasma environments.

  5. How physician electronic health record screen sharing affects patient and doctor non-verbal communication in primary care.

    PubMed

    Asan, Onur; Young, Henry N; Chewning, Betty; Montague, Enid

    2015-03-01

    Use of electronic health records (EHRs) in primary-care exam rooms changes the dynamics of patient-physician interaction. This study examines and compares doctor-patient non-verbal communication (eye-gaze patterns) during primary care encounters for three different screen/information sharing groups: (1) active information sharing, (2) passive information sharing, and (3) technology withdrawal. Researchers video recorded 100 primary-care visits and coded the direction and duration of doctor and patient gaze. Descriptive statistics compared the length of gaze patterns as a percentage of visit length. Lag sequential analysis determined whether physician eye-gaze influenced patient eye gaze, and vice versa, and examined variations across groups. Significant differences were found in duration of gaze across groups. Lag sequential analysis found significant associations between several gaze patterns. Some, such as DGP-PGD ("doctor gaze patient" followed by "patient gaze doctor") were significant for all groups. Others, such DGT-PGU ("doctor gaze technology" followed by "patient gaze unknown") were unique to one group. Some technology use styles (active information sharing) seem to create more patient engagement, while others (passive information sharing) lead to patient disengagement. Doctors can engage patients in communication by using EHRs in the visits. EHR training and design should facilitate this. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  6. Differing perspectives on parent access to their child's electronic medical record during neonatal intensive care hospitalization: a pilot study.

    PubMed

    Chung, Rebecca K; Kim, Una Olivia; Basir, Mir Abdul

    2018-04-01

    To improve informed medical decision-making, principles for family-centered neonatal care recommend that parents have access to their child's medical record on an ongoing basis during neonatal intensive unit care (NICU) hospitalization. Currently, many NICUs do not allow independent parent access to their child's electronic medical record (EMR) during hospitalization. We undertook a cross-sectional survey pilot study of medical professionals and parents to explore opinions regarding this practice. Inclusion criteria: 18-years old, English-literate, legal guardian of patients admitted to the NICU for 14 days. NICU medical professionals included physicians, nurse practitioners, nurses, and respiratory therapists. Medical professionals believed parent access would make their work more difficult, increase time documenting and updating families, making them more liable to litigation and hesitant to chart sensitive information. However, parents felt that they lacked control over their child's care and desired direct access to the EMR. Parents believed this would improve accuracy of their child's medical chart, and increase advocacy and understanding of their child's illness. NICU parents and medical professionals have differing perspectives on independent parental access to their child's EMR. More research is needed to explore the potential of independent parental EMR access to further improve family-centered neonatal care.

  7. Electronic health records in an occupational health setting-Part II. Global deployment.

    PubMed

    Bey, Jean M; de Magalhães, Josiane S; Bojórquez, Lorena; Lin, Karen

    2013-03-01

    Electronic medical record systems are being used by more multi-national corporations. This article describes one corporation's considerations and process in successfully deploying a global electronic medical record system to international facilities in Brazil, Mexico, Singapore, and Taiwan. This article summarizes feedback from the experiences of occupational health nurse superusers in these countries. Copyright 2013, SLACK Incorporated.

  8. 29 CFR 2520.107-1 - Use of electronic media for maintenance and retention of records.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 9 2014-07-01 2014-07-01 false Use of electronic media for maintenance and retention of....107-1 Use of electronic media for maintenance and retention of records. (a) Scope and purpose... media for the maintenance and retention of records required to be kept under sections 107 and 209 of...

  9. 29 CFR 2520.107-1 - Use of electronic media for maintenance and retention of records.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 9 2010-07-01 2010-07-01 false Use of electronic media for maintenance and retention of....107-1 Use of electronic media for maintenance and retention of records. (a) Scope and purpose... media for the maintenance and retention of records required to be kept under sections 107 and 209 of...

  10. 29 CFR 2520.107-1 - Use of electronic media for maintenance and retention of records.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 9 2011-07-01 2011-07-01 false Use of electronic media for maintenance and retention of....107-1 Use of electronic media for maintenance and retention of records. (a) Scope and purpose... media for the maintenance and retention of records required to be kept under sections 107 and 209 of...

  11. 29 CFR 2520.107-1 - Use of electronic media for maintenance and retention of records.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 9 2012-07-01 2012-07-01 false Use of electronic media for maintenance and retention of....107-1 Use of electronic media for maintenance and retention of records. (a) Scope and purpose... media for the maintenance and retention of records required to be kept under sections 107 and 209 of...

  12. 29 CFR 2520.107-1 - Use of electronic media for maintenance and retention of records.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 9 2013-07-01 2013-07-01 false Use of electronic media for maintenance and retention of....107-1 Use of electronic media for maintenance and retention of records. (a) Scope and purpose... media for the maintenance and retention of records required to be kept under sections 107 and 209 of...

  13. Moving electronic medical records upstream: incorporating social determinants of health.

    PubMed

    Gottlieb, Laura M; Tirozzi, Karen J; Manchanda, Rishi; Burns, Abby R; Sandel, Megan T

    2015-02-01

    Knowledge of the biological pathways and mechanisms connecting social factors with health has increased exponentially over the past 25 years, yet in most clinical settings, screening and intervention around social determinants of health are not part of standard clinical care. Electronic medical records provide new opportunities for assessing and managing social needs in clinical settings, particularly those serving vulnerable populations. To illustrate the feasibility of capturing information and promoting interventions related to social determinants of health in electronic medical records. Three case studies were examined in which electronic medical records have been used to collect data and address social determinants of health in clinical settings. From these case studies, we identified multiple functions that electronic medical records can perform to facilitate the integration of social determinants of health into clinical systems, including screening, triaging, referring, tracking, and data sharing. If barriers related to incentives, training, and privacy can be overcome, electronic medical record systems can improve the integration of social determinants of health into healthcare delivery systems. More evidence is needed to evaluate the impact of such integration on health care outcomes before widespread adoption can be recommended. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  14. Electronic Health Record Implementation: A SWOT Analysis.

    PubMed

    Shahmoradi, Leila; Darrudi, Alireza; Arji, Goli; Farzaneh Nejad, Ahmadreza

    2017-10-01

    Electronic Health Record (EHR) is one of the most important achievements of information technology in healthcare domain, and if deployed effectively, it can yield predominant results. The aim of this study was a SWOT (strengths, weaknesses, opportunities, and threats) analysis in electronic health record implementation. This is a descriptive, analytical study conducted with the participation of a 90-member work force from Hospitals affiliated to Tehran University of Medical Sciences (TUMS). The data were collected by using a self-structured questionnaire and analyzed by SPSS software. Based on the results, the highest priority in strength analysis was related to timely and quick access to information. However, lack of hardware and infrastructures was the most important weakness. Having the potential to share information between different sectors and access to a variety of health statistics was the significant opportunity of EHR. Finally, the most substantial threats were the lack of strategic planning in the field of electronic health records together with physicians' and other clinical staff's resistance in the use of electronic health records. To facilitate successful adoption of electronic health record, some organizational, technical and resource elements contribute; moreover, the consideration of these factors is essential for HER implementation.

  15. Feasibility of utilizing a commercial eye tracker to assess electronic health record use during patient simulation.

    PubMed

    Gold, Jeffrey Allen; Stephenson, Laurel E; Gorsuch, Adriel; Parthasarathy, Keshav; Mohan, Vishnu

    2016-09-01

    Numerous reports describe unintended consequences of electronic health record implementation. Having previously described physicians' failures to recognize patient safety issues within our electronic health record simulation environment, we now report on our use of eye and screen-tracking technology to understand factors associated with poor error recognition during an intensive care unit-based electronic health record simulation. We linked performance on the simulation to standard eye and screen-tracking readouts including number of fixations, saccades, mouse clicks and screens visited. In addition, we developed an overall Composite Eye Tracking score which measured when, where and how often each safety item was viewed. For 39 participants, the Composite Eye Tracking score correlated with performance on the simulation (p = 0.004). Overall, the improved performance was associated with a pattern of rapid scanning of data manifested by increased number of screens visited (p = 0.001), mouse clicks (p = 0.03) and saccades (p = 0.004). Eye tracking can be successfully integrated into electronic health record-based simulation and provides a surrogate measure of cognitive decision making and electronic health record usability. © The Author(s) 2015.

  16. Integrating an Academic Electronic Health Record: Challenges and Success Strategies.

    PubMed

    Herbert, Valerie M; Connors, Helen

    2016-08-01

    Technology is increasing the complexity in the role of today's nurse. Healthcare organizations are integrating more health information technologies and relying on the electronic health record for data collection, communication, and decision making. Nursing faculty need to prepare graduates for this environment and incorporate an academic electronic health record into a nursing curriculum to meet student-program outcomes. Although the need exists for student preparation, some nursing programs are struggling with implementation, whereas others have been successful. To better understand these complexities, this project was intended to identify current challenges and success strategies of effective academic electronic health record integration into nursing curricula. Using Rogers' 1962 Diffusion of Innovation theory as a framework for technology adoption, a descriptive survey design was used to gain insights from deans and program directors of nursing schools involved with the national Health Informatics & Technology Scholars faculty development program or Cerner's Academic Education Solution Consortium, working to integrate an academic electronic health record in their respective nursing schools. The participants' experiences highlighted approaches used by these schools to integrate these technologies. Data from this project provide nursing education with effective strategies and potential challenges that should be addressed for successful academic electronic health record integration.

  17. Interconnection of electronic medical record with clinical data management system by CDISC ODM.

    PubMed

    Matsumura, Yasushi; Hattori, Atsushi; Manabe, Shiro; Takeda, Toshihiro; Takahashi, Daiyo; Yamamoto, Yuichiro; Murata, Taizo; Mihara, Naoki

    2014-01-01

    EDC system has been used in the field of clinical research. The current EDC system does not connect with electronic medical record system (EMR), thus a medical staff has to transcribe the data in EMR to EDC system manually. This redundant process causes not only inefficiency but also human error. We developed an EDC system cooperating with EMR, in which the data required for a clinical research form (CRF) is transcribed automatically from EMR to electronic CRF (eCRF) and is sent via network. We call this system as "eCRF reporter". The interface module of eCRF reporter can retrieves the data in EMR database including patient biography data, laboratory test data, prescription data and data entered by template in progress notes. The eCRF reporter also enables users to enter data directly to eCRF. The eCRF reporter generates CDISC ODM file and PDF which is a translated form of Clinical data in ODM. After storing eCRF in EMR, it is transferred via VPN to a clinical data management system (CDMS) which can receive the eCRF files and parse ODM. We started some clinical research by using this system. This system is expected to promote clinical research efficiency and strictness.

  18. DOE Office of Scientific and Technical Information (OSTI.GOV)

    Doukas, S.; Madesis, I.; Dimitriou, A.

    We present SIMION 8.1 Monte Carlo type simulations of the response function and detection solid angle for long lived Auger states (lifetime τ ∼ 10{sup −9} − 10{sup −5} s) recorded by a hemispherical spectrograph with injection lens and position sensitive detector used for high resolution Auger spectroscopy of ion beams. Also included in these simulations for the first time are kinematic effects particular to Auger emission from fast moving projectile ions such as line broadening and solid angle limitations allowing for a more accurate and realistic line shape modeling. Our results are found to be in excellent agreement withmore » measured electron line shapes of both long lived 1s2s2p{sup 4}P and prompt Auger projectile states formed by electron capture in collisions of 25.3 MeV F{sup 7+} with H{sub 2} and 12.0 MeV C{sup 4+} with Ne recorded at 0{sup ∘} to the beam direction. These results are important for the accurate evaluation of the 1s2s2p {sup 4}P/{sup 2}P ratio of K-Auger cross sections whose observed non-statistical production by electron capture into He-like ions, recently a field of interesting interpretations, awaits further resolution.« less

  19. Tamper indicating bolt

    DOEpatents

    Blagin, Sergei V.; Barkanov, Boris P.

    2004-09-14

    A tamper-indicating fastener has a cylindrical body with threads extending from one end along a portion of the body, and a tamper indicating having a transducer for converting physical properties of the body into electronic data; electronics for recording the electronic data; and means for communicating the recorded information to a remote location from said fastener. The electronics includes a capacitor that varies as a function of force applied by the fastener, and non-volatile memory for recording instances when the capacitance varies, providing an indication of unauthorized access.

  20. New High Energy Electron Component of Earth Radiation Belt

    NASA Astrophysics Data System (ADS)

    Dmitrenko, V. V.; Galper, A. M.; Gratchev, V. M.; Kirillov-Ugryumov, V. G.; Ulin, S. E.; Voronov, S. A.

    The Earth Radiation Belt (ERB) was discovered in the course of the first flights of Russian and American satellites with conventional instruments (gas discharge and scintillation counters), which made it possible to investigate many characteristics of trapped particles and simulate adequate radiation belt models. However, the experimental and theoretical evidence accumulated over recent time, needs more elaborate measurements for its interpretation. These measurements became feasible after the development of devices based on more perfect detectors (solid and gas-filled Cherenkov detectors, magnetic spectrometer, scintillation time-of-flight systems). The evidence requiring new direct measurements in the ERB was obtained in the late 1960s in the course of balloon flights carried out by Cosmophysics Laboratory of the Moscow Engineering and Physics Institute. In these flights a correlation between the high energy electron flux in the upper atmosphere and perturbations ofthe Earth's magnetosphere was established. This phenomenon could be explained assuming there exist high energy electron fluxes in the ERB. High energy electron fluxes in the ERB were recorded for the first time in the direct experiments carried out on board orbital station 'Salyut-6' (orbit altitude - 350 km, inclination 51.6 deg). A scintillation-Cherenkov telescope 'Elena' controlled by cosmonauts was preset to different programmed positions. The measurements were made in the periphery of the ERB, namely, in the part which goes as low as several hundred km in the Brazil Anomaly Region (BRA). The flux of electrons with energies above 30 MeV was up to 104 (m2s sr)-1.

  1. Electronic Medical Records and the Technological Imperative: The Retrieval of Dialogue in Community-Based Primary Care.

    PubMed

    Franz, Berkeley; Murphy, John W

    2015-01-01

    Electronic medical records are regarded as an important tool in primary health-care settings. Because these records are thought to standardize medical information, facilitate provider communication, and improve office efficiency, many practices are transitioning to these systems. However, much of the concern with improving the practice of record keeping has related to technological innovations and human-computer interaction. Drawing on the philosophical reflection raised in Jacques Ellul's work, this article questions the technological imperative that may be supporting medical record keeping. Furthermore, given the growing emphasis on community-based care, this article discusses important non-technological aspects of electronic medical records that might bring the use of these records in line with participatory primary-care medicine.

  2. Observation of a large-scale anisotropy in the arrival directions of cosmic rays above 8 × 10 18 eV

    DOE PAGES

    Aab, Alexander; et al.

    2017-09-22

    We report that cosmic rays are atomic nuclei arriving from outer space that reach the highest energies observed in nature. Clues to their origin come from studying the distribution of their arrival directions. Usingmore » $$3 \\times 10^4$$ cosmic rays above $$8 \\times 10^{18}$$ electron volts, recorded with the Pierre Auger Observatory from a total exposure of 76,800 square kilometers steradian year, we report an anisotropy in the arrival directions. The anisotropy, detected at more than the 5.2$$\\sigma$$ level of significance, can be described by a dipole with an amplitude of $$6.5_{-0.9}^{+1.3}$$% towards right ascension $$\\alpha_{d} = 100 \\pm 10$$ degrees and declination $$\\delta_{d} = -24_{-13}^{+12}$$ degrees. Lastly, that direction indicates an extragalactic origin for these ultra-high energy particles.« less

  3. Observation of a large-scale anisotropy in the arrival directions of cosmic rays above 8 × 10 18 eV

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Aab, Alexander; et al.

    We report that cosmic rays are atomic nuclei arriving from outer space that reach the highest energies observed in nature. Clues to their origin come from studying the distribution of their arrival directions. Usingmore » $$3 \\times 10^4$$ cosmic rays above $$8 \\times 10^{18}$$ electron volts, recorded with the Pierre Auger Observatory from a total exposure of 76,800 square kilometers steradian year, we report an anisotropy in the arrival directions. The anisotropy, detected at more than the 5.2$$\\sigma$$ level of significance, can be described by a dipole with an amplitude of $$6.5_{-0.9}^{+1.3}$$% towards right ascension $$\\alpha_{d} = 100 \\pm 10$$ degrees and declination $$\\delta_{d} = -24_{-13}^{+12}$$ degrees. Lastly, that direction indicates an extragalactic origin for these ultra-high energy particles.« less

  4. Statistical process control for electron beam monitoring.

    PubMed

    López-Tarjuelo, Juan; Luquero-Llopis, Naika; García-Mollá, Rafael; Quirós-Higueras, Juan David; Bouché-Babiloni, Ana; Juan-Senabre, Xavier Jordi; de Marco-Blancas, Noelia; Ferrer-Albiach, Carlos; Santos-Serra, Agustín

    2015-07-01

    To assess the electron beam monitoring statistical process control (SPC) in linear accelerator (linac) daily quality control. We present a long-term record of our measurements and evaluate which SPC-led conditions are feasible for maintaining control. We retrieved our linac beam calibration, symmetry, and flatness daily records for all electron beam energies from January 2008 to December 2013, and retrospectively studied how SPC could have been applied and which of its features could be used in the future. A set of adjustment interventions designed to maintain these parameters under control was also simulated. All phase I data was under control. The dose plots were characterized by rising trends followed by steep drops caused by our attempts to re-center the linac beam calibration. Where flatness and symmetry trends were detected they were less-well defined. The process capability ratios ranged from 1.6 to 9.3 at a 2% specification level. Simulated interventions ranged from 2% to 34% of the total number of measurement sessions. We also noted that if prospective SPC had been applied it would have met quality control specifications. SPC can be used to assess the inherent variability of our electron beam monitoring system. It can also indicate whether a process is capable of maintaining electron parameters under control with respect to established specifications by using a daily checking device, but this is not practical unless a method to establish direct feedback from the device to the linac can be devised. Copyright © 2015 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  5. The Future of the Perfusion Record: Automated Data Collection vs. Manual Recording

    PubMed Central

    Ottens, Jane; Baker, Robert A.; Newland, Richard F.; Mazzone, Annette

    2005-01-01

    Abstract: The perfusion record, whether manually recorded or computer generated, is a legal representation of the procedure. The handwritten perfusion record has been the most common method of recording events that occur during cardiopulmonary bypass. This record is of significant contrast to the integrated data management systems available that provide continuous collection of data automatically or by means of a few keystrokes. Additionally, an increasing number of monitoring devices are available to assist in the management of patients on bypass. These devices are becoming more complex and provide more data for the perfusionist to monitor and record. Most of the data from these can be downloaded automatically into online data management systems, allowing more time for the perfusionist to concentrate on the patient while simultaneously producing a more accurate record. In this prospective report, we compared 17 cases that were recorded using both manual and electronic data collection techniques. The perfusionist in charge of the case recorded the perfusion using the manual technique while a second perfusionist entered relevant events on the electronic record generated by the Stockert S3 Data Management System/Data Bahn (Munich, Germany). Analysis of the two types of perfusion records showed significant variations in the recorded information. Areas that showed the most inconsistency included measurement of the perfusion pressures, flow, blood temperatures, cardioplegia delivery details, and the recording of events, with the electronic record superior in the integrity of the data. In addition, the limitations of the electronic system were also shown by the lack of electronic gas flow data in our hardware. Our results confirm the importance of accurate methods of recording of perfusion events. The use of an automated system provides the opportunity to minimize transcription error and bias. This study highlights the limitation of spot recording of perfusion events in the overall record keeping for perfusion management. PMID:16524151

  6. GSFC specification electronic data processing magnetic recording tape

    NASA Technical Reports Server (NTRS)

    Tinari, D. F.; Perry, J. L.

    1980-01-01

    The design requirements are given for magnetic oxide coated, electronic data processing tape, wound on reels. Magnetic recording tape types covered by this specification are intended for use on digital tape transports using the Non-Return-to-Zero-change-on-ones (NRZI) recording method for recording densities up to and including 800 characters per inch (cpi) and the Phase-Encoding (PE) recording method for a recording density of 1600 cpi.

  7. The EGRET high energy gamma ray telescope

    NASA Technical Reports Server (NTRS)

    Hartman, R. C.; Bertsch, D. L.; Fichtel, C. E.; Hunter, S. D.; Kanbach, G.; Kniffen, D. A.; Kwok, P. W.; Lin, Y. C.; Mattox, J. R.; Mayer-Hasselwander, H. A.

    1992-01-01

    The Energetic Gamma Ray Experiment Telescope (EGRET) on the Compton Gamma Ray Observatory (GRO) is sensitive in the energy range from about 20 MeV to about 30,000 MeV. Electron-positron pair production by incident gamma photons is utilized as the detection mechanism. The pair production occurs in tantalum foils interleaved with the layers of a digital spark chamber system; the spark chamber records the tracks of the electron and positron, allowing the reconstruction of the arrival direction of the gamma ray. If there is no signal from the charged particle anticoincidence detector which surrounds the upper part of the detector, the spark chamber array is triggered by two hodoscopes of plastic scintillators. A time of flight requirement is included to reject events moving backward through the telescope. The energy of the gamma ray is primarily determined by absorption of the energies of the electron and positron in a 20 cm deep NaI(Tl) scintillator.

  8. The EGRET high energy gamma ray telescope

    NASA Astrophysics Data System (ADS)

    Hartman, R. C.; Bertsch, D. L.; Fichtel, C. E.; Hunter, S. D.; Kanbach, G.; Kniffen, D. A.; Kwok, P. W.; Lin, Y. C.; Mattox, J. R.; Mayer-Hasselwander, H. A.; Michelson, P. F.; von Montigny, C.; Nolan, P. L.; Pinkau, K.; Rothermel, H.; Schneid, E.; Sommer, M.; Sreekumar, P.; Thompson, D. J.

    1992-02-01

    The Energetic Gamma Ray Experiment Telescope (EGRET) on the Compton Gamma Ray Observatory (GRO) is sensitive in the energy range from about 20 MeV to about 30,000 MeV. Electron-positron pair production by incident gamma photons is utilized as the detection mechanism. The pair production occurs in tantalum foils interleaved with the layers of a digital spark chamber system; the spark chamber records the tracks of the electron and positron, allowing the reconstruction of the arrival direction of the gamma ray. If there is no signal from the charged particle anticoincidence detector which surrounds the upper part of the detector, the spark chamber array is triggered by two hodoscopes of plastic scintillators. A time of flight requirement is included to reject events moving backward through the telescope. The energy of the gamma ray is primarily determined by absorption of the energies of the electron and positron in a 20 cm deep NaI(Tl) scintillator.

  9. Electron-proton spectrometer: Summary for critical design review

    NASA Technical Reports Server (NTRS)

    1972-01-01

    The electron-proton spectrometer (EPS) is mounted external to the Skylab module complex on the command service module. It is designed to make a 2 pi omni-directional measurement of electrons and protons which result from solar flares or enhancement of the radiation belts. The EPS data will provide accurate radiation dose information so that uncertain Relative biological effectiveness factors are eliminated by measuring the external particle spectra. Astronaut radiation safety, therefore, can be ensured, as the EPS data can be used to correct or qualify radiation dose measurements recorded by other radiation measuring instrumentation within the Skylab module complex. The EPS has the capability of measuring and extremely wide dynamic radiation dose rate range, approaching 10 to the 7th power. Simultaneously the EPS has the capability to process data from extremely high radiation fields such as might be encountered in the wake of an intense solar flare.

  10. System for tomographic determination of the power distribution in electron beams

    DOEpatents

    Elmer, J.W.; Teruya, A.T.; O'Brien, D.W.

    1995-01-17

    A tomographic technique is disclosed for measuring the current density distribution in electron beams using electron beam profile data acquired from a modified Faraday cup to create an image of the current density in high and low power beams. The modified Faraday cup includes a narrow slit and is rotated by a stepper motor and can be moved in the x, y and z directions. The beam is swept across the slit perpendicular thereto and controlled by deflection coils, and the slit rotated such that waveforms are taken every few degrees form 0[degree] to 360[degree] and the waveforms are recorded by a digitizing storage oscilloscope. Two-dimensional and three-dimensional images of the current density distribution in the beam can be reconstructed by computer tomography from this information, providing quantitative information about the beam focus and alignment. 12 figures.

  11. Printable elastic conductors with a high conductivity for electronic textile applications

    PubMed Central

    Matsuhisa, Naoji; Kaltenbrunner, Martin; Yokota, Tomoyuki; Jinno, Hiroaki; Kuribara, Kazunori; Sekitani, Tsuyoshi; Someya, Takao

    2015-01-01

    The development of advanced flexible large-area electronics such as flexible displays and sensors will thrive on engineered functional ink formulations for printed electronics where the spontaneous arrangement of molecules aids the printing processes. Here we report a printable elastic conductor with a high initial conductivity of 738 S cm−1 and a record high conductivity of 182 S cm−1 when stretched to 215% strain. The elastic conductor ink is comprised of Ag flakes, a fluorine rubber and a fluorine surfactant. The fluorine surfactant constitutes a key component which directs the formation of surface-localized conductive networks in the printed elastic conductor, leading to a high conductivity and stretchability. We demonstrate the feasibility of our inks by fabricating a stretchable organic transistor active matrix on a rubbery stretchability-gradient substrate with unimpaired functionality when stretched to 110%, and a wearable electromyogram sensor printed onto a textile garment. PMID:26109453

  12. Design, construction and performance evaluation of the target tissue thickness measurement system in intraoperative radiotherapy for breast cancer

    NASA Astrophysics Data System (ADS)

    Yazdani, Mohammad Reza; Setayeshi, Saeed; Arabalibeik, Hossein; Akbari, Mohammad Esmaeil

    2017-05-01

    Intraoperative electron radiation therapy (IOERT), which uses electron beams for irradiating the target directly during the surgery, has the advantage of delivering a homogeneous dose to a controlled layer of tissue. Since the dose falls off quickly below the target thickness, the underlying normal tissues are spared. In selecting the appropriate electron energy, the accuracy of the target tissue thickness measurement is critical. In contrast to other procedures applied in IOERT, the routine measurement method is considered to be completely traditional and approximate. In this work, a novel mechanism is proposed for measuring the target tissue thickness with an acceptable level of accuracy. An electronic system has been designed and manufactured with the capability of measuring the tissue thickness based on the recorded electron density under the target. The results indicated the possibility of thickness measurement with a maximum error of 2 mm for 91.35% of data. Aside from system limitation in estimating the thickness of 5 mm phantom, for 88.94% of data, maximum error is 1 mm.

  13. Measuring Conformational Dynamics of Single Biomolecules Using Nanoscale Electronic Devices

    NASA Astrophysics Data System (ADS)

    Akhterov, Maxim V.; Choi, Yongki; Sims, Patrick C.; Olsen, Tivoli J.; Gul, O. Tolga; Corso, Brad L.; Weiss, Gregory A.; Collins, Philip G.

    2014-03-01

    Molecular motion can be a rate-limiting step of enzyme catalysis, but motions are typically too quick to resolve with fluorescent single molecule techniques. Recently, we demonstrated a label-free technique that replaced fluorophores with nano-electronic circuits to monitor protein motions. The solid-state electronic technique used single-walled carbon nanotube (SWNT) transistors to monitor conformational motions of a single molecule of T4 lysozyme while processing its substrate, peptidoglycan. As lysozyme catalyzes the hydrolysis of glycosidic bonds, two protein domains undergo 8 Å hinge bending motion that generates an electronic signal in the SWNT transistor. We describe improvements to the system that have extended our temporal resolution to 2 μs . Electronic recordings at this level of detail directly resolve not just transitions between open and closed conformations but also the durations for those transition events. Statistical analysis of many events determines transition timescales characteristic of enzyme activity and shows a high degree of variability within nominally identical chemical events. The high resolution technique can be readily applied to other complex biomolecules to gain insights into their kinetic parameters and catalytic function.

  14. Accuracy of parent-reported measles-containing vaccination status of children with measles.

    PubMed

    Liu, G; Liao, Z; Xu, X; Liang, Y; Xiong, Y; Ni, J

    2017-03-01

    The validity of parent-reported measles-containing vaccination history in children with measles has not been assessed. This study evaluated the accuracy of parental recall of measles-containing vaccination histories in Shenzhen, China. A retrospective study was performed to compare the data from the electronic records with parental recall. The electronic records were regarded as accurate data about the children's measles-containing vaccination status. We collected data from the National Notifiable Diseases Surveillance System and the Immunization Program Information Management System in Shenzhen city, China. Between 2009 and 2014, there were 163 children with measles who had electronic vaccination records; the vaccination status of these cases was reported by the parents in the field epidemiological investigation. We validated parental recall with electronic records. The agreement between parental recall and electronic records was 78.7%. The kappa value was 0.57. The parent-reported measles-containing vaccination rate was higher than the electronic record (48.5% vs 41.7%, χ 2  = 53.64, P < 0.001). The true positive rate for parental recall was 82.4%, and the true negative rate was 75.8%. The positive predictive value was 70.9%, and the negative predictive value was 76.6%. In children with measles, parental recall slightly overestimated the measles vaccination rate, and the vaccination status recalled by parents was in moderate agreement with the electronic record. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  15. ELECTRONIC BIVANE WIND DIRECTION INDICATOR

    DOEpatents

    Moses, H.

    1961-05-01

    An apparatus is described for determining and recording three dimensional wind vectors. The apparatus comprises a rotatably mounted azimuthal wind component sensing head and an elevational wind component sensing head mounted to the azimuthal head and adapted to rotate therewith in the azimuthal plane and independently in the elevational plane. A heat source and thermocouples disposed thereabout are mounted within each of the sensing heads, the thermocouples providing electrical signals responsive to the temperature differential created by the passage of air through the sensing tuhes. The thermocouple signals are applied to drive mechanisms which position the sensing heads to a null wind position. Recording means are provided responsive to positional data from the drive mechanisms which are a measurement of the three dimensional wind vectors.

  16. Public Health in an Era of Personal Health Records: Opportunities for Innovation and New Partnerships

    PubMed Central

    Gates, Suzanne

    2010-01-01

    In the near future, citizens will be able to control and manage their own health information through electronic personal health record systems and tools. The clinical benefits of this innovation, such as cost savings, error reduction, and improved communication, have been discussed in the literature and public forums, as have issues related to privacy and confidentiality. Receiving little attention are the benefits these will have for public health. The benefits and potential for innovation are broad and speak directly to core public health functions such as health monitoring, outbreak management, empowerment, linking to services, and research. Coupled with this is a new relationship with citizens as key partners in protecting and promoting the public’s health. PMID:20699216

  17. Investigation of grafted ETFE-based polymer membranes as alternative electrolyte for direct methanol fuel cells

    NASA Astrophysics Data System (ADS)

    Aricò, A. S.; Baglio, V.; Cretı̀, P.; Di Blasi, A.; Antonucci, V.; Brunea, J.; Chapotot, A.; Bozzi, A.; Schoemans, J.

    Low cost ethylene-tetrafluoroethylene (ETFE)-based grafted membranes have been prepared by a process based on electron beam irradiation, subsequent grafting, cross-linking and sulfonation procedure. Two different grafted membranes varying by their grafting and cross-linking levels have been investigated for applications in direct methanol fuel cells (DMFCs) operating between 90 and 130 °C. DMFC assemblies based on these membranes showed cell resistance and performance values comparable to Nafion 117. Stable electrochemical performance was recorded during 1 month of cycled operation. Tailoring of grafting and cross-linking properties allows a significant reduction of methanol cross-over while maintaining suitable conductivity and performance levels.

  18. Can electronic search engines optimize screening of search results in systematic reviews: an empirical study.

    PubMed

    Sampson, Margaret; Barrowman, Nicholas J; Moher, David; Clifford, Tammy J; Platt, Robert W; Morrison, Andra; Klassen, Terry P; Zhang, Li

    2006-02-24

    Most electronic search efforts directed at identifying primary studies for inclusion in systematic reviews rely on the optimal Boolean search features of search interfaces such as DIALOG and Ovid. Our objective is to test the ability of an Ultraseek search engine to rank MEDLINE records of the included studies of Cochrane reviews within the top half of all the records retrieved by the Boolean MEDLINE search used by the reviewers. Collections were created using the MEDLINE bibliographic records of included and excluded studies listed in the review and all records retrieved by the MEDLINE search. Records were converted to individual HTML files. Collections of records were indexed and searched through a statistical search engine, Ultraseek, using review-specific search terms. Our data sources, systematic reviews published in the Cochrane library, were included if they reported using at least one phase of the Cochrane Highly Sensitive Search Strategy (HSSS), provided citations for both included and excluded studies and conducted a meta-analysis using a binary outcome measure. Reviews were selected if they yielded between 1000-6000 records when the MEDLINE search strategy was replicated. Nine Cochrane reviews were included. Included studies within the Cochrane reviews were found within the first 500 retrieved studies more often than would be expected by chance. Across all reviews, recall of included studies into the top 500 was 0.70. There was no statistically significant difference in ranking when comparing included studies with just the subset of excluded studies listed as excluded in the published review. The relevance ranking provided by the search engine was better than expected by chance and shows promise for the preliminary evaluation of large results from Boolean searches. A statistical search engine does not appear to be able to make fine discriminations concerning the relevance of bibliographic records that have been pre-screened by systematic reviewers.

  19. Use of electronic health records can improve the health care industry's environmental footprint.

    PubMed

    Turley, Marianne; Porter, Catherine; Garrido, Terhilda; Gerwig, Kathy; Young, Scott; Radler, Linda; Shaber, Ruth

    2011-05-01

    Electronic health records have the potential to improve the environmental footprint of the health care industry. We estimate that Kaiser Permanente's electronic health record system, which covers 8.7 million beneficiaries, eliminated 1,000 tons of paper records and 68 tons of x-ray film, and that it has lowered gasoline consumption among patients who otherwise would have made trips to the doctor by at least three million gallons per year. However, the use of personal computers resulted in higher energy consumption and generated an additional 250 tons of waste. We conclude that electronic health records have a positive net effect on the environment, and that our model for evaluating their impact can be used to determine whether their use can improve communities' health.

  20. Use of Electronic Medication Administration Records to Reduce Perceived Stress and Risk of Medication Errors in Nursing Homes.

    PubMed

    Alenius, Malin; Graf, Peter

    2016-07-01

    Concerns have been raised about the effects of current medication administration processes on the safety of many of the aspects of medication administration. Keeping electronic medication administration records could decrease many of these problems. Unfortunately, there has not been much research on this topic, especially in nursing homes. A prospective case-control survey was consequently performed at two nursing homes; the electronic record system was introduced in one, whereas the other continued to use paper records. The personnel were asked to fill in a questionnaire of their perceptions of stress and risk of medication errors at baseline (n = 66) and 20 weeks after the intervention group had started recording medication administration electronically (n = 59). There were statistically significant decreases in the perceived risk of omitting a medication, of medication errors occurring because of communication problems, and of medication errors occurring because of inaccurate medication administration records in the intervention group (all P < .01 vs the control group). The perceived overall daily stress levels were also reduced in the intervention group (P < .05). These results indicate that the utilization of electronic medication administration records will reduce many of the concerns regarding the medication administration process.

  1. Experimental study of hard photon radiation processes at HERA

    NASA Astrophysics Data System (ADS)

    Ahmed, T.; Aid, S.; Andreev, V.; Andrieu, B.; Appuhn, R.-D.; Arpagaus, M.; Babaev, A.; Baehr, J.; Bán, J.; Baranov, P.; Barrelet, E.; Bartel, W.; Barth, M.; Bassler, U.; Beck, H. P.; Behrend, H.-J.; Belousov, A.; Berger, Ch.; Bergstein, H.; Bernardi, G.; Bernet, R.; Bertrand-Coremans, G.; Besançon, M.; Beyer, R.; Biddulph, P.; Bizot, J. C.; Blobel, V.; Borras, K.; Botterweck, F.; Boudry, V.; Braemer, A.; Brasse, F.; Braunschweig, W.; Brisson, V.; Bruncko, D.; Brune, C.; Buchholz, R.; Büngener, L.; Bürger, J.; Büsser, F. W.; Buniatian, A.; Burke, S.; Buschhorn, G.; Campbell, A. J.; Carli, T.; Charles, F.; Clarke, D.; Clegg, A. B.; Clerbaux, B.; Colombo, M.; Contreras, J. G.; Cormack, C.; Coughlan, J. A.; Courau, A.; Coutures, Ch.; Cozzika, G.; Criegee, L.; Cussans, D. G.; Cvach, J.; Dagoret, S.; Dainton, J. B.; Danilov, M.; Dau, W. D.; Daum, K.; David, M.; Deffur, E.; Delcourt, B.; Del Buono, L.; de Roeck, A.; de Wolf, E. A.; di Nezza, P.; Dollfus, C.; Dowell, J. D.; Dreis, H. B.; Droutskoi, A.; Duboc, J.; Düllmann, D.; Dünger, O.; Duhm, H.; Ebert, J.; Ebert, T. R.; Eckerlin, G.; Efremenko, V.; Egli, S.; Ehrlichmann, H.; Eichenberger, S.; Eichler, R.; Eisele, F.; Eisenhandler, E.; Ellison, R. J.; Elsen, E.; Erdmann, M.; Erdmann, W.; Evrard, E.; Favart, L.; Fedotov, A.; Feeken, D.; Felst, R.; Feltesse, J.; Ferencei, J.; Ferrarotto, F.; Flamm, K.; Fleischer, M.; Flieser, M.; Flügge, G.; Fomenko, A.; Fominykh, B.; Forbush, M.; Formánek, J.; Foster, J. M.; Franke, G.; Fretwurst, E.; Gabathuler, E.; Gabathuler, K.; Gamerdinger, K.; Garvey, J.; Gayler, J.; Gebauer, M.; Gellrich, A.; Genzel, H.; Gerhards, R.; Goerlach, U.; Goerlich, L.; Gogitidze, N.; Goldberg, M.; Goldner, D.; Gonzalez-Pineiro, B.; Gorelov, I.; Goritchev, P.; Grab, C.; Grässler, H.; Grässler, R.; Greenshaw, T.; Grindhammer, G.; Gruber, A.; Gruber, C.; Haack, J.; Haidt, D.; Hajduk, L.; Hamon, O.; Hampel, M.; Hanlon, E. M.; Hapke, M.; Haynes, W. J.; Heatherington, J.; Heinzelmann, G.; Henderson, R. C. W.; Henschel, H.; Herma, R.; Herynek, I.; Hess, M. F.; Hildesheim, W.; Hill, P.; Hiller, K. H.; Hilton, C. D.; Hladký, J.; Hoeger, K. C.; Höppner, M.; Horisberger, R.; Hudgson, V. L.; Huet, Ph.; Hütte, M.; Hufnagel, H.; Ibbotson, M.; Itterbeck, H.; Jabiol, M.-A.; Jacholkowska, A.; Jacobsson, C.; Jaffre, M.; Janoth, J.; Jansen, T.; Jönsson, L.; Johannsen, K.; Johnson, D. P.; Johnson, L.; Jung, H.; Kalmus, P. I. P.; Kant, D.; Kaschowitz, R.; Kasselmann, P.; Kathage, U.; Katzy, J.; Kaufmann, H. H.; Kazarian, S.; Kenyon, I. R.; Kermiche, S.; Keuker, C.; Kiesling, C.; Klein, M.; Kleinwort, C.; Knies, G.; Ko, W.; Köhler, T.; Köhne, J.; Kolanoski, H.; Kole, F.; Kolya, S. D.; Korbel, V.; Korn, M.; Kostka, P.; Kotelnikov, S. K.; Krämerkämper, T.; Krasny, M. W.; Krehbiel, H.; Krücker, D.; Krüger, U.; Krüner-Marquis, U.; Kubenka, J. P.; Küster, H.; Kuhlen, M.; Kurča, T.; Kurzhöfer, J.; Kuznik, B.; Lacour, D.; Lamarche, F.; Lander, R.; Landon, M. P. J.; Lange, W.; Lanius, P.; Laporte, J.-F.; Lebedev, A.; Leverenz, C.; Levonian, S.; Ley, Ch.; Lindner, A.; Lindström, G.; Linsel, F.; Lipinski, J.; List, B.; Loch, P.; Lohmander, H.; Lopez, G. C.; Lubimov, V.; Lüke, D.; Magnussen, N.; Malinovski, E.; Mani, S.; Maraček, R.; Marage, P.; Marks, J.; Marshall, R.; Martens, J.; Martin, R.; Martyn, H.-U.; Martyniak, J.; Masson, S.; Mavroidis, T.; Maxfield, S. J.; McMahon, S. J.; Mehta, A.; Meier, K.; Mercer, D.; Merz, T.; Meyer, C. A.; Meyer, H.; Meyer, J.; Mikocki, S.; Milstead, D.; Moreau, F.; Morris, J. V.; Mroczko, E.; Müller, G.; Müller, K.; Murín, P.; Nagovizin, V.; Nahnhauer, R.; Naroska, B.; Naumann, Th.; Newman, P. R.; Newton, D.; Neyret, D.; Nguyen, H. K.; Nicholls, T. C.; Niebergall, F.; Niebuhr, C.; Nisius, R.; Nowak, G.; Noyes, G. W.; Nyberg-Werther, M.; Oakden, M.; Oberlack, H.; Obrock, U.; Olsson, J. E.; Ozerov, D.; Panaro, E.; Panitch, A.; Pascaud, C.; Patel, G. D.; Peppel, E.; Perez, E.; Phillips, J. P.; Pichler, Ch.; Pitzl, D.; Pope, G.; Prell, S.; Prosi, R.; Rädel, G.; Raupach, F.; Reimer, P.; Reinshagen, S.; Ribarics, P.; Rick, H.; Riech, V.; Riedlberger, J.; Riess, S.; Rietz, M.; Rizvi, E.; Robertson, S. M.; Robmann, P.; Roloff, H. E.; Roosen, R.; Rosenbauer, K.; Rostovtsev, A.; Rouse, F.; Royon, C.; Rüter, K.; Rusakov, S.; Rybicki, K.; Rylko, R.; Sahlmann, N.; Sanchez, E.; Sankey, D. P. C.; Savitsky, M.; Schacht, P.; Schiek, S.; Schleper, P.; von Schlippe, W.; Schmidt, C.; Schmidt, D.; Schmidt, G.; Schöning, A.; Schröder, V.; Schuhmann, E.; Schwab, B.; Schwind, A.; Seehausen, U.; Sefkow, F.; Seidel, M.; Sell, R.; Semenov, A.; Shekelyan, V.; Sheviakov, I.; Shooshtari, H.; Shtarkov, L. N.; Siegmon, G.; Siewert, U.; Sirois, Y.; Skillicorn, I. O.; Smirnov, P.; Smith, J. R.; Solochenko, V.; Soloviev, Y.; Spiekermann, J.; Spitzer, H.; Starosta, R.; Steenbock, M.; Steffen, P.; Steinberg, R.; Stella, B.; Stephens, K.; Stier, J.; Stiewe, J.; Stösslein, U.; Stolze, K.; Strachota, J.; Straumann, U.; Struczinski, W.; Sutton, J. P.; Tapprogge, S.; Taylor, R. E.; Tchernyshov, V.; Thiebaux, C.; Thompson, G.; Truöl, P.; Turnau, J.; Tutas, J.; Uelkes, P.; Usik, A.; Valkár, S.; Valkárová, A.; Vallée, C.; van Esch, P.; van Mechelen, P.; Vartapetian, A.; Vazdik, Y.; Vecko, M.; Verrecchia, P.; Villet, G.; Wacker, K.; Wagener, A.; Wagener, M.; Walker, I. W.; Walther, A.; Weber, G.; Weber, M.; Wegener, D.; Wegner, A.; Wellisch, H. P.; West, L. R.; Willard, S.; Winde, M.; Winter, G.-G.; Wright, A. E.; Wünsch, E.; Wulff, N.; Yiou, T. P.; Žáček, J.; Zarbock, D.; Zhang, Z.; Zhokin, A.; Zimmer, M.; Zimmermann, W.; Zomer, F.; Zuber, K.

    1995-12-01

    We present an experimental study of the ep→ eγ+ p and ep→ eγ+ X processes using data recorded by the H1 detector in 1993 at the electron-proton collider HERA. These processes are employed to measure the luminosity with an accuracy of 4.5 %. A subsample of the ep→ eγ+ X events in which the hard photon is detected at angles θ{γ/'} ≤ 0.45 mrad with respect to the incident electron direction is used to verify experimentally the size of radiative corrections to the ep→ eX inclusive cross section and to investigate the structure of the proton in the Q 2 domain down to 2 GeV2, lower than previously attained at HERA.

  2. The use of electronic health records in Spanish hospitals.

    PubMed

    Marca, Guillem; Perez, Angel; Blanco-Garcia, Martin German; Miravalles, Elena; Soley, Pere; Ortiga, Berta

    The aims of this study were to describe the level of adoption of electronic health records in Spanish hospitals and to identify potential barriers and facilitators to this process. We used an observational cross-sectional design. The survey was conducted between September and December 2011, using an electronic questionnaire distributed through email. We obtained a 30% response rate from the 214 hospitals contacted, all belonging to the Spanish National Health Service. The level of adoption of electronic health records in Spanish hospitals was found to be high: 39.1% of hospitals surveyed had a comprehensive EHR system while a basic system was functioning in 32.8% of the cases. However, in 2011 one third of the hospitals did not have a basic electronic health record system, although some have since implemented electronic functionalities, particularly those related to clinical documentation and patient administration. Respondents cited the acquisition and implementation costs as the main barriers to implementation. Facilitators for EHR implementation were: the possibility to hire technical support, both during and post implementation; security certification warranty; and objective third-party evaluations of EHR products. In conclusion, the number of hospitals that have electronic health records is in general high, being relatively higher in medium-sized hospitals.

  3. The electronic medical record in dermatology.

    PubMed

    Grosshandler, Joshua A; Tulbert, Brittain; Kaufmann, Mark D; Bhatia, Ashish; Brodell, Robert T

    2010-09-01

    Governmental incentives to stimulate the "meaningful use" of electronic medical records and future disincentives for Medicaid and Medicare provide an impetus for dermatologists to consider adding this technology to their clinical practice. Dermatologists should carefully weigh the pros and cons of establishing an electronic medical record system before incorporating this expensive technology. This article reviews available scientific and economic data required for dermatologists to help make an informed choice.

  4. EMERSE: The Electronic Medical Record Search Engine

    PubMed Central

    Hanauer, David A.

    2006-01-01

    EMERSE (The Electronic Medical Record Search Engine) is an intuitive, powerful search engine for free-text documents in the electronic medical record. It offers multiple options for creating complex search queries yet has an interface that is easy enough to be used by those with minimal computer experience. EMERSE is ideal for retrospective chart reviews and data abstraction and may have potential for clinical care as well.

  5. Developing a point-of-care electronic medical record system for TB/HIV co-infected patients: experiences from Lighthouse Trust, Lilongwe, Malawi.

    PubMed

    Tweya, Hannock; Feldacker, Caryl; Gadabu, Oliver Jintha; Ng'ambi, Wingston; Mumba, Soyapi L; Phiri, Dave; Kamvazina, Luke; Mwakilama, Shawo; Kanyerere, Henry; Keiser, Olivia; Mwafilaso, Johnbosco; Kamba, Chancy; Egger, Matthias; Jahn, Andreas; Simwaka, Bertha; Phiri, Sam

    2016-03-05

    Implementation of user-friendly, real-time, electronic medical records for patient management may lead to improved adherence to clinical guidelines and improved quality of patient care. We detail the systematic, iterative process that implementation partners, Lighthouse clinic and Baobab Health Trust, employed to develop and implement a point-of-care electronic medical records system in an integrated, public clinic in Malawi that serves HIV-infected and tuberculosis (TB) patients. Baobab Health Trust, the system developers, conducted a series of technical and clinical meetings with Lighthouse and Ministry of Health to determine specifications. Multiple pre-testing sessions assessed patient flow, question clarity, information sequencing, and verified compliance to national guidelines. Final components of the TB/HIV electronic medical records system include: patient demographics; anthropometric measurements; laboratory samples and results; HIV testing; WHO clinical staging; TB diagnosis; family planning; clinical review; and drug dispensing. Our experience suggests that an electronic medical records system can improve patient management, enhance integration of TB/HIV services, and improve provider decision-making. However, despite sufficient funding and motivation, several challenges delayed system launch including: expansion of system components to include of HIV testing and counseling services; changes in the national antiretroviral treatment guidelines that required system revision; and low confidence to use the system among new healthcare workers. To ensure a more robust and agile system that met all stakeholder and user needs, our electronic medical records launch was delayed more than a year. Open communication with stakeholders, careful consideration of ongoing provider input, and a well-functioning, backup, paper-based TB registry helped ensure successful implementation and sustainability of the system. Additional, on-site, technical support provided reassurance and swift problem-solving during the extended launch period. Even when system users are closely involved in the design and development of an electronic medical record system, it is critical to allow sufficient time for software development, solicitation of detailed feedback from both users and stakeholders, and iterative system revisions to successfully transition from paper to point-of-care electronic medical records. For those in low-resource settings, electronic medical records for integrated care is a possible and positive innovation.

  6. Physicians in nonprimary care and small practices and those age 55 and older lag in adopting electronic health record systems.

    PubMed

    Decker, Sandra L; Jamoom, Eric W; Sisk, Jane E

    2012-05-01

    By 2011 more than half of all office-based physicians were using electronic health record systems, but only about one-third of those physicians had systems with basic features such as the abilities to record information on patient demographics, view laboratory and imaging results, maintain problem lists, compile clinical notes, or manage computerized prescription ordering. Basic features are considered important to realize the potential of these systems to improve health care. We found that although trends in adoption of electronic health record systems across geographic regions converged from 2002 through 2011, adoption continued to lag for non-primary care specialists, physicians age fifty-five and older, and physicians in small (1-2 providers) and physician-owned practices. Federal policies are specifically aimed at encouraging primary care providers and small practices to achieve widespread use of electronic health records. To achieve their nationwide adoption, federal policies may also have to focus on encouraging adoption among non-primary care specialists, as well as addressing persistent gaps in the use of electronic record systems by practice size, physician age, and ownership status.

  7. The Research Implications of Prostate Specific Antigen Registry Errors: Data from the Veterans Health Administration.

    PubMed

    Guo, David P; Thomas, I-Chun; Mittakanti, Harsha R; Shelton, Jeremy B; Makarov, Danil V; Skolarus, Ted A; Cooperberg, Mathew R; Sonn, Geoffrey A; Chung, Benjamin I; Brooks, James D; Leppert, John T

    2018-04-06

    We sought to characterize the effects of prostate specific antigen registry errors on clinical research by comparing cohorts based on cancer registry prostate specific antigen values with those based directly on results in the electronic health record. We defined sample cohorts of men with prostate cancer using data from the VHA (Veterans Health Administration), including those with a prostate specific antigen value less than 4.0, 4.0 to 10.0, 10.0 to 20.0 and 20.0 to 98.0 ng/ml, respectively. We compared the composition of each cohort and overall patient survival when using PSA values from the VACCR (Veteran Affairs Central Cancer Registry) vs the gold standard electronic health record laboratory file results. There was limited agreement among cohorts when defined by cancer registry PSA values vs the laboratory file of the electronic health record. The least agreement of 58% was seen in patients with PSA less than 4.0 ng/ml and greatest agreement of 89% was noted among patients with PSA between 4.0 and 10.0 ng/ml. In each cohort patients assigned to a cohort based only on the cancer registry PSA value had significantly different overall survival when compared with patients assigned based on registry and laboratory file PSA values. Cohorts based exclusively on cancer registry PSA values may have high rates of misclassification that can introduce concerning differences in key characteristics and result in measurable differences in clinical outcomes. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  8. Biomechanisms of Comorbidity: Reviewing Integrative Analyses of Multi-omics Datasets and Electronic Health Records.

    PubMed

    Pouladi, N; Achour, I; Li, H; Berghout, J; Kenost, C; Gonzalez-Garay, M L; Lussier, Y A

    2016-11-10

    Disease comorbidity is a pervasive phenomenon impacting patients' health outcomes, disease management, and clinical decisions. This review presents past, current and future research directions leveraging both phenotypic and molecular information to uncover disease similarity underpinning the biology and etiology of disease comorbidity. We retrieved ~130 publications and retained 59, ranging from 2006 to 2015, that comprise a minimum number of five diseases and at least one type of biomolecule. We surveyed their methods, disease similarity metrics, and calculation of comorbidities in the electronic health records, if present. Among the surveyed studies, 44% generated or validated disease similarity metrics in context of comorbidity, with 60% being published in the last two years. As inputs, 87% of studies utilized intragenic loci and proteins while 13% employed RNA (mRNA, LncRNA or miRNA). Network modeling was predominantly used (35%) followed by statistics (28%) to impute similarity between these biomolecules and diseases. Studies with large numbers of biomolecules and diseases used network models or naïve overlap of disease-molecule associations, while machine learning, statistics, and information retrieval were utilized in smaller and moderate sized studies. Multiscale computations comprising shared function, network topology, and phenotypes were performed exclusively on proteins. This review highlighted the growing methods for identifying the molecular mechanisms underpinning comorbidities that leverage multiscale molecular information and patterns from electronic health records. The survey unveiled that intergenic polymorphisms have been overlooked for similarity imputation compared to their intragenic counterparts, offering new opportunities to bridge the mechanistic and similarity gaps of comorbidity.

  9. Comparison of intracellular water content measurements by dark-field imaging and EELS in medium voltage TEM

    NASA Astrophysics Data System (ADS)

    Terryn, C.; Michel, J.; Kilian, L.; Bonhomme, P.; Balossier, G.

    2000-09-01

    Knowledge of the water content at the subcellular level is important to evaluate the intracellular concentration of either diffusible or non-diffusible elements in the physiological state measured by the electron microprobe methods. Water content variations in subcellular compartments are directly related to secretion phenomena and to transmembrane exchange processes, which could be attributed to pathophysiological states. In this paper we will describe in details and compare two local water measurement methods using analytical electron microscopy. The first one is based on darkfield imaging. It is applied on freeze-dried biological cryosections; it allows indirect measurement of the water content at the subcellular level from recorded maps of darkfield intensity. The second method uses electron energy loss spectroscopy. It is applied to hydrated biological cryosections. It is based on the differences that appear in the electron energy loss spectra of macromolecular assemblies and vitrified ice in the 0-30 eV range. By a multiple least squares (MLS) fit between an experimental energy loss spectrum and reference spectra of both frozen-hydrated ice and macromolecular assemblies we can deduce directly the local water concentration in biological cryosections at the subcellular level. These two methods are applied to two test specimens: human erythrocytes in plasma, and baker's yeast (Saccharomyses Cerevisiae) cryosections. We compare the water content measurements obtained by these two methods and discuss their advantages and drawbacks.

  10. Experiments to trap dust particles by a wire simulating an electron beam

    NASA Astrophysics Data System (ADS)

    Saeki, Hiroshi; Momose, Takashi; Ishimaru, Hajime

    1991-11-01

    Motion of trapped dust particles has been previously analyzed using high-energy bremsstrahlung data obtained during dust trapping in the TRISTAN accumulation ring. Because it is difficult to observe the actual motions of dust particles trapped in an electron beam due to the strong synchrotron light background, we carried out experiments to trap sample dust particles with a Cu wire simulating an electron beam. A negative potential was slowly applied to the wire using a high voltage dc power supply. Motions of dust particles trapped by the wire were recorded with a video camera system. In an experiment using a Cu wire (1.5 mm in diameter) with no magnetic field, the charged dust particle made vertical oscillation about the wire. In another experiment using the same wire but with a vertical magnetic field (0.135 T) simulating a bending magnetic field, both vertical and horizontal oscillating motions perpendicular to the wire were observed. Furthermore, it was found that the dust particle moved in the longitudinal direction of the wire in the bending magnetic field. Therefore, it is expected that charged dust particles trapped by the electric field of the electron beam oscillate vertically where there is no magnetic field in the TRISTAN accumulation ring. It is also expected that trapped dust particles where there is a bending magnetic field oscillate horizontally and vertically as the particle drifts in a longitudinal direction along the ring.

  11. 29 CFR 1209.08 - Transcripts, recordings or minutes of closed meetings; retention; public availability.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... provisions of 5 U.S.C. 552b(c), copies of transcripts or minutes, or transcriptions of electronic recordings... transcription. Requests for copies of transcripts or minutes, or transcriptions of electronic recordings of...

  12. 78 FR 21314 - Medicare and State Health Care Programs: Fraud and Abuse; Electronic Health Records Safe Harbor...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-04-10

    ... health records software or information technology and training services. The final rule for this safe... health records software or information technology and training services. In the same issue of the Federal..., licenses, and intellectual property related to electronic health records software; connectivity services...

  13. Hospital information systems: experience at the fully digitized Seoul National University Bundang Hospital.

    PubMed

    Yoo, Sooyoung; Hwang, Hee; Jheon, Sanghoon

    2016-08-01

    The different levels of health information technology (IT) adoption and its integration into hospital workflow can affect the maximization of the benefits of using of health IT. We aimed at sharing our experiences and the journey to the successful adoption of health IT over 13 years at a tertiary university hospital in South Korea. The integrated system of comprehensive applications for direct care, support care, and smart care has been implemented with the latest IT and a rich user information platform, achieving the fully digitized hospital. The users experience design methodology, barcode and radio-frequency identification (RFID) technologies, smartphone and mobile technologies, and data analytics were integrated into hospital workflow. Applications for user-centered electronic medical record (EMR) and clinical decision support (CDS), closed loop medication administration (CLMA), mobile EMR and dashboard system for care coordination, clinical data warehouse (CDW) system, and patient engagement solutions were designed and developed to improve quality of care, work efficiency, and patient safety. We believe that comprehensive electronic health record systems and patient-centered smart hospital applications will go a long way in ensuring seamless patient care and experience.

  14. Security evaluation and assurance of electronic health records.

    PubMed

    Weber-Jahnke, Jens H

    2009-01-01

    Electronic Health Records (EHRs) maintain information of sensitive nature. Security requirements in this context are typically multilateral, encompassing the viewpoints of multiple stakeholders. Two main research questions arise from a security assurance point of view, namely how to demonstrate the internal correctness of EHRs and how to demonstrate their conformance in relation to multilateral security regulations. The above notions of correctness and conformance directly relate to the general concept of system verification, which asks the question "are we building the system right?" This should not be confused with the concept of system validation, which asks the question "are we building the right system?" Much of the research in the medical informatics community has been concerned with the latter aspect (validation). However, trustworthy security requires assurances that standards are followed and specifications are met. The objective of this paper is to contribute to filling this gap. We give an introduction to fundamentals of security assurance, summarize current assurance standards, and report on experiences with using security assurance methodology applied to the EHR domain, specifically focusing on case studies in the Canadian context.

  15. Display methods of electronic patient record screens: patient privacy concerns.

    PubMed

    Niimi, Yukari; Ota, Katsumasa

    2013-01-01

    To provide adequate care, medical professionals have to collect not only medical information but also information that may be related to private aspects of the patient's life. With patients' increasing awareness of information privacy, healthcare providers have to pay attention to the patients' right of privacy. This study aimed to clarify the requirements of the display method of electronic patient record (EPR) screens in consideration of both patients' information privacy concerns and health professionals' information needs. For this purpose, semi-structured group interviews were conducted of 78 medical professionals. They pointed out that partial concealment of information to meet patients' requests for privacy could result in challenges in (1) safety in healthcare, (2) information sharing, (3) collaboration, (4) hospital management, and (5) communication. They believed that EPRs should (1) meet the requirements of the therapeutic process, (2) have restricted access, (3) provide convenient access to necessary information, and (4) facilitate interprofessional collaboration. This study provides direction for the development of display methods that balance the sharing of vital information and protection of patient privacy.

  16. Estimating Wisconsin asthma prevalence using clinical electronic health records and public health data.

    PubMed

    Tomasallo, Carrie D; Hanrahan, Lawrence P; Tandias, Aman; Chang, Timothy S; Cowan, Kelly J; Guilbert, Theresa W

    2014-01-01

    We compared a statewide telephone health survey with electronic health record (EHR) data from a large Wisconsin health system to estimate asthma prevalence in Wisconsin. We developed frequency tables and logistic regression models using Wisconsin Behavioral Risk Factor Surveillance System and University of Wisconsin primary care clinic data. We compared adjusted odds ratios (AORs) from each model. Between 2007 and 2009, the EHR database contained 376,000 patients (30,000 with asthma), and 23,000 (1850 with asthma) responded to the Behavioral Risk Factor Surveillance System telephone survey. AORs for asthma were similar in magnitude and direction for the majority of covariates, including gender, age, and race/ethnicity, between survey and EHR models. The EHR data had greater statistical power to detect associations than did survey data, especially in pediatric and ethnic populations, because of larger sample sizes. EHRs can be used to estimate asthma prevalence in Wisconsin adults and children. EHR data may improve public health chronic disease surveillance using high-quality data at the local level to better identify areas of disparity and risk factors and guide education and health care interventions.

  17. Morphology and Viability of Pleistocene Microbiota from the CRREL Permafrost Tunnel Near Fox, Alaska

    NASA Technical Reports Server (NTRS)

    Hoover, Richard B.

    2000-01-01

    The U. S. Army Cold Regions Research and Engineering Laboratory maintains the CRREL Permafrost Tunnel at Fox, Alaska (-10 miles north of Fairbanks.) The active microbial ecosystems and the cryopreserved anabiotic viable microorganisms and dead microbial remains and biomarkers frozen within the permafrost and ice of the CRREL Permafrost Tunnel are of direct relevance to Astrobiology. Microbial extremophiles from permafrost and ice provide information concerning where and how should we search for evidence of life elsewhere in the Cosmos. The permafrost and ice wedges of the Fox tunnel preserves a magnificent of record of Pliocene, Pleistocene and Holocene life on Earth spanning more than 2.5 million years. This record includes frozen fossil bacteria, archaea, algae, mosses, higher plants, insects and mammals. In this paper we present the preliminary results of studies of the morphology, ultramicrostructure and elemental distributions of Fox tunnel microbiota as determined in-situ by the Environmental Scanning Electron Microscope (ESEM) and the Field Emission Scanning Electron Microscope (FESEM) investigations. The long-term viability of cryopreserved microbiota and potential implications to Astrobiology will be discussed.

  18. Development of a high-speed H-alpha camera system for the observation of rapid fluctuations in solar flares

    NASA Technical Reports Server (NTRS)

    Kiplinger, Alan L.; Dennis, Brian R.; Orwig, Larry E.; Chen, P. C.

    1988-01-01

    A solid-state digital camera was developed for obtaining H alpha images of solar flares with 0.1 s time resolution. Beginning in the summer of 1988, this system will be operated in conjunction with SMM's hard X-ray burst spectrometer (HXRBS). Important electron time-of-flight effects that are crucial for determining the flare energy release processes should be detectable with these combined H alpha and hard X-ray observations. Charge-injection device (CID) cameras provide 128 x 128 pixel images simultaneously in the H alpha blue wing, line center, and red wing, or other wavelength of interest. The data recording system employs a microprocessor-controlled, electronic interface between each camera and a digital processor board that encodes the data into a serial bitstream for continuous recording by a standard video cassette recorder. Only a small fraction of the data will be permanently archived through utilization of a direct memory access interface onto a VAX-750 computer. In addition to correlations with hard X-ray data, observations from the high speed H alpha camera will also be correlated and optical and microwave data and data from future MAX 1991 campaigns. Whether the recorded optical flashes are simultaneous with X-ray peaks to within 0.1 s, are delayed by tenths of seconds or are even undetectable, the results will have implications on the validity of both thermal and nonthermal models of hard X-ray production.

  19. Velocity-Map Imaging for Emittance Characterization of Multiphoton Electron Emission from a Gold Surface

    NASA Astrophysics Data System (ADS)

    Ye, Hong; Trippel, Sebastian; Di Fraia, Michele; Fallahi, Arya; Mücke, Oliver D.; Kärtner, Franz X.; Küpper, Jochen

    2018-04-01

    A velocity-map-imaging spectrometer is demonstrated to characterize the normalized emittance (root-mean-square, rms) of photoemitted electron bunches. Both the two-dimensional spatial distribution and the projected velocity distribution images of photoemitted electrons are recorded by the detection system and analyzed to obtain the normalized emittance (rms). With the presented distribution function of the electron photoemission angles, a mathematical method is implemented to reconstruct the three-dimensional velocity distribution. As a first example, multiphoton emission from a planar Au surface is studied via irradiation at a glancing angle by intense 45-fs laser pulses at a central wavelength of 800 nm. The reconstructed energy distribution agrees very well with the Berglund-Spicer theory of photoemission. The normalized emittance (rms) of the intrinsic electron bunch is characterized to be 128 and 14 nm rad in the X and Y directions, respectively. The demonstrated imaging spectrometer has the ability to characterize the normalized emittance (rms) in a few minutes with a fine energy resolution of 0.2 meV in the image center and will, thereby, foster the further development of x-ray free-electron-laser injectors and ultrafast electron diffraction, and it opens up opportunities for studying correlated electron emission from surfaces and vacuum nanoelectronic devices.

  20. [Cooperation with the electronic medical record and accounting system of an actual dose of drug given by a radiology information system].

    PubMed

    Yamamoto, Hideo; Yoneda, Tarou; Satou, Shuji; Ishikawa, Toru; Hara, Misako

    2009-12-20

    By input of the actual dose of a drug given into a radiology information system, the system converting with an accounting system into a cost of the drug from the actual dose in the electronic medical record was built. In the drug master, the first unit was set as the cost of the drug, and we set the second unit as the actual dose. The second unit in the radiology information system was received by the accounting system through electronic medical record. In the accounting system, the actual dose was changed into the cost of the drug using the dose of conversion to the first unit. The actual dose was recorded on a radiology information system and electronic medical record. The actual dose was indicated on the accounting system, and the cost for the drug was calculated. About the actual dose of drug, cooperation of the information in a radiology information system and electronic medical record were completed. It was possible to decide the volume of drug from the correct dose of drug at the previous inspection. If it is necessary for the patient to have another treatment of medicine, it is important to know the actual dose of drug given. Moreover, authenticity of electronic medical record based on a statute has also improved.

  1. Barriers to physicians' adoption of healthcare information technology: an empirical study on multiple hospitals.

    PubMed

    Lin, Chihung; Lin, I-Chun; Roan, Jinsheng

    2012-06-01

    Prior research on technology usage had largely overlooked the issue of user resistance or barriers to technology acceptance. Prior research on the Electronic Medical Records had largely focused on technical issues but rarely on managerial issues. Such oversight prevented a better understanding of users' resistance to new technologies and the antecedents of technology rejection. Incorporating the enablers and the inhibitors of technology usage intention, this study explores physicians' reactions towards the electronic medical record. The main focus is on the barriers, perceived threat and perceived inequity. 115 physicians from 6 hospitals participated in the questionnaire survey. Structural Equation Modeling was employed to verify the measurement scale and research hypotheses. According to the results, perceived threat shows a direct and negative effect on perceived usefulness and behavioral intentions, as well as an indirect effect on behavioral intentions via perceived usefulness. Perceived inequity reveals a direct and positive effect on perceived threat, and it also shows a direct and negative effect on perceived usefulness. Besides, perceived inequity reveals an indirect effect on behavioral intentions via perceived usefulness with perceived threat as the inhibitor. The research finding presents a better insight into physicians' rejection and the antecedents of such outcome. For the healthcare industry understanding the factors contributing to physicians' technology acceptance is important as to ensure a smooth implementation of any new technology. The results of this study can also provide change managers reference to a smooth IT introduction into an organization. In addition, our proposed measurement scale can be applied as a diagnostic tool for them to better understand the status quo within their organizations and users' reactions to technology acceptance. By doing so, barriers to physicians' acceptance can be identified earlier and more effectively before leading to technology rejection.

  2. Effect of electronic report writing on the quality of nursing report recording

    PubMed Central

    Heidarizadeh, Khadijeh; Rassouli, Maryam; Manoochehri, Houman; Tafreshi, Mansoureh Zagheri; Ghorbanpour, Reza Kashef

    2017-01-01

    Background and Aim Recording performed nursery actions is one of the main chores of nurses. The findings have shown that recorded reports are not qualitatively valid. Since electronic reports can be regarded as a base to write reports, this study aims at determining the effect of utilizing electronic nursing reports on the quality of the records. Methods This quasi-experimental study was conducted with the aim of applying an electronic system of nursing recording in the heart department of Shahid Rahimi Medical Center, Lorestan University of Medical Science. The samples were nursing reports on the hospitalized patients in the heart department, the basis of complete enumeration (census) during the fall of 2014. The subjects were sixteen employed nurses. To do the study, the software of nursing records was set based on the Clinical Care Classification system (CCC). The research’s tool was the checklist of the Standards of Nursing Documentation. Results The findings indicated that before and after the intervention, the amount of reports’ adaption with the written standards, respectively, was (21.8%) and (71.3%), and the most complete recording was medicine status (58%) and (100%). The worst complete recording before the intervention, acute changes was (99.1%) and nursing processes was (78%) and after, the medicine status, intake and output status and patient’s education (100%); while the nursing report structure was regarded in all cases (100%). The results showed that there is a significant difference in the quality of reporting before and after using CCC (p<0.001). Conclusions Since the necessary parameters for recording a standard report do exist in electronic reporting (CCC), from one point, nurses are reminded to record the necessary parts and from the other point, the system does not allow the user to shut it down unless the necessary parameters are recorded. For this reason, the quality of recorded reports with electronic reporting improves. PMID:29238481

  3. Electronic palliative care coordination systems: Devising and testing a methodology for evaluating documentation

    PubMed Central

    Allsop, Matthew J; Kite, Suzanne; McDermott, Sarah; Penn, Naomi; Millares-Martin, Pablo; Bennett, Michael I

    2016-01-01

    Background: The need to improve coordination of care at end of life has driven electronic palliative care coordination systems implementation across the United Kingdom and internationally. No approaches for evaluating electronic palliative care coordination systems use in practice have been developed. Aim: This study outlines and applies an evaluation framework for examining how and when electronic documentation of advance care planning is occurring in end of life care services. Design: A pragmatic, formative process evaluation approach was adopted. The evaluation drew on the Project Review and Objective Evaluation methodology to guide the evaluation framework design, focusing on clinical processes. Setting/participants: Data were extracted from electronic palliative care coordination systems for 82 of 108 general practices across a large UK city. All deaths (n = 1229) recorded on electronic palliative care coordination systems between April 2014 and March 2015 were included to determine the proportion of all deaths recorded, median number of days prior to death that key information was recorded and observations about routine data use. Results: The evaluation identified 26.8% of all deaths recorded on electronic palliative care coordination systems. The median number of days to death was calculated for initiation of an electronic palliative care coordination systems record (31 days), recording a patient’s preferred place of death (8 days) and entry of Do Not Attempt Cardiopulmonary Resuscitation decisions (34 days). Where preferred and actual place of death was documented, these were matching for 75% of patients. Anomalies were identified in coding used during data entry on electronic palliative care coordination systems. Conclusion: This study reports the first methodology for evaluating how and when electronic palliative care coordination systems documentation is occurring. It raises questions about what can be drawn from routine data collected through electronic palliative care coordination systems and outlines considerations for future evaluation. Future evaluations should consider work processes of health professionals using electronic palliative care coordination systems. PMID:27507636

  4. Electronic palliative care coordination systems: Devising and testing a methodology for evaluating documentation.

    PubMed

    Allsop, Matthew J; Kite, Suzanne; McDermott, Sarah; Penn, Naomi; Millares-Martin, Pablo; Bennett, Michael I

    2017-05-01

    The need to improve coordination of care at end of life has driven electronic palliative care coordination systems implementation across the United Kingdom and internationally. No approaches for evaluating electronic palliative care coordination systems use in practice have been developed. This study outlines and applies an evaluation framework for examining how and when electronic documentation of advance care planning is occurring in end of life care services. A pragmatic, formative process evaluation approach was adopted. The evaluation drew on the Project Review and Objective Evaluation methodology to guide the evaluation framework design, focusing on clinical processes. Data were extracted from electronic palliative care coordination systems for 82 of 108 general practices across a large UK city. All deaths ( n = 1229) recorded on electronic palliative care coordination systems between April 2014 and March 2015 were included to determine the proportion of all deaths recorded, median number of days prior to death that key information was recorded and observations about routine data use. The evaluation identified 26.8% of all deaths recorded on electronic palliative care coordination systems. The median number of days to death was calculated for initiation of an electronic palliative care coordination systems record (31 days), recording a patient's preferred place of death (8 days) and entry of Do Not Attempt Cardiopulmonary Resuscitation decisions (34 days). Where preferred and actual place of death was documented, these were matching for 75% of patients. Anomalies were identified in coding used during data entry on electronic palliative care coordination systems. This study reports the first methodology for evaluating how and when electronic palliative care coordination systems documentation is occurring. It raises questions about what can be drawn from routine data collected through electronic palliative care coordination systems and outlines considerations for future evaluation. Future evaluations should consider work processes of health professionals using electronic palliative care coordination systems.

  5. Demonstration of Confined Electron Gas and Steep-Slope Behavior in Delta-Doped GaAs-AlGaAs Core-Shell Nanowire Transistors.

    PubMed

    Morkötter, S; Jeon, N; Rudolph, D; Loitsch, B; Spirkoska, D; Hoffmann, E; Döblinger, M; Matich, S; Finley, J J; Lauhon, L J; Abstreiter, G; Koblmüller, G

    2015-05-13

    Strong surface and impurity scattering in III-V semiconductor-based nanowires (NW) degrade the performance of electronic devices, requiring refined concepts for controlling charge carrier conductivity. Here, we demonstrate remote Si delta (δ)-doping of radial GaAs-AlGaAs core-shell NWs that unambiguously exhibit a strongly confined electron gas with enhanced low-temperature field-effect mobilities up to 5 × 10(3) cm(2) V(-1) s(-1). The spatial separation between the high-mobility free electron gas at the NW core-shell interface and the Si dopants in the shell is directly verified by atom probe tomographic (APT) analysis, band-profile calculations, and transport characterization in advanced field-effect transistor (FET) geometries, demonstrating powerful control over the free electron gas density and conductivity. Multigated NW-FETs allow us to spatially resolve channel width- and crystal phase-dependent variations in electron gas density and mobility along single NW-FETs. Notably, dc output and transfer characteristics of these n-type depletion mode NW-FETs reveal excellent drain current saturation and record low subthreshold slopes of 70 mV/dec at on/off ratios >10(4)-10(5) at room temperature.

  6. Direct observation of children's preferences and activity levels during interactive and online electronic games.

    PubMed

    Sit, Cindy H P; Lam, Jessica W K; McKenzie, Thomas L

    2010-07-01

    Interactive electronic games have recently been popularized and are believed to help promote children's physical activity (PA). The purpose of the study was to examine preferences and PA levels during interactive and online electronic games among overweight and nonoverweight boys and girls. Using a modification of the SOFIT, we systematically observed 70 Hong Kong Chinese children (35 boys, 35 girls; 50 nonoverweight, 20 overweight), age 9 to 12 years, during 2 60-minute recreation sessions and recorded their game mode choices and PA levels. During Session One children could play either an interactive or an online electronic bowling game and during Session Two they could play an interactive or an online electronic running game. Children chose to play the games during 94% of session time and split this time between interactive (52%) and online (48%) versions. They engaged in significantly more moderate-to-vigorous physical activity (MVPA) during interactive games than their online electronic versions (70% vs. 2% of game time). Boys and nonoverweight children expended relatively more energy during the interactive games than girls and overweight children, respectively. New-generation interactive games can facilitate physical activity in children, and given the opportunity children may select them over sedentary versions.

  7. 40 CFR 35.6705 - Records retention.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    .... This requirement applies to all financial and programmatic records, supporting documents, statistical... ten-year period, whichever is later. (c) Substitution of an unalterable electronic format. An unalterable electronic format, acceptable to EPA, may be substituted for the original records. The copying of...

  8. 40 CFR 35.6705 - Records retention.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    .... This requirement applies to all financial and programmatic records, supporting documents, statistical... ten-year period, whichever is later. (c) Substitution of an unalterable electronic format. An unalterable electronic format, acceptable to EPA, may be substituted for the original records. The copying of...

  9. 40 CFR 35.6705 - Records retention.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    .... This requirement applies to all financial and programmatic records, supporting documents, statistical... ten-year period, whichever is later. (c) Substitution of an unalterable electronic format. An unalterable electronic format, acceptable to EPA, may be substituted for the original records. The copying of...

  10. 40 CFR 35.6705 - Records retention.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    .... This requirement applies to all financial and programmatic records, supporting documents, statistical... ten-year period, whichever is later. (c) Substitution of an unalterable electronic format. An unalterable electronic format, acceptable to EPA, may be substituted for the original records. The copying of...

  11. 40 CFR 35.6705 - Records retention.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    .... This requirement applies to all financial and programmatic records, supporting documents, statistical... ten-year period, whichever is later. (c) Substitution of an unalterable electronic format. An unalterable electronic format, acceptable to EPA, may be substituted for the original records. The copying of...

  12. Spectroscopy of the simplest Criegee intermediate CH2OO: simulation of the first bands in its electronic and photoelectron spectra.

    PubMed

    Lee, Edmond P F; Mok, Daniel K W; Shallcross, Dudley E; Percival, Carl J; Osborn, David L; Taatjes, Craig A; Dyke, John M

    2012-09-24

    CH(2)OO, the simplest Criegee intermediate, and ozone are isoelectronic. They both play very important roles in atmospheric chemistry. Whilst extensive experimental studies have been made on ozone, there were no direct gas-phase studies on CH(2)OO until very recently when its photoionization spectrum was recorded and kinetics studies were made of some reactions of CH(2)OO with a number of molecules of atmospheric importance, using photoionization mass spectrometry to monitor CH(2)OO. In order to encourage more direct studies on CH(2)OO and other Criegee intermediates, the electronic and photoelectron spectra of CH(2)OO have been simulated using high level electronic structure calculations and Franck-Condon factor calculations, and the results are presented here. Adiabatic and vertical excitation energies of CH(2)OO were calculated with TDDFT, EOM-CCSD, and CASSCF methods. Also, DFT, QCISD and CASSCF calculations were performed on neutral and low-lying ionic states, with single energy calculations being carried out at higher levels to obtain more reliable ionization energies. The results show that the most intense band in the electronic spectrum of CH(2) OO corresponds to the B(1)A' ← X(1)A' absorption. It is a broad band in the region 250-450 nm showing extensive structure in vibrational modes involving O-O stretching and C-O-O bending. Evidence is presented to show that the electronic absorption spectrum of CH(2)OO has probably been recorded in earlier work, albeit at low resolution. We suggest that CH(2)OO was prepared in this earlier work from the reaction of CH(2)I with O(2) and that the assignment of the observed spectrum solely to CH(2)IOO is incorrect. The low ionization energy region of the photoelectron spectrum of CH(2)OO consists of two overlapping vibrationally structured bands corresponding to one-electron ionizations from the highest two occupied molecular orbitals of the neutral molecule. In each case, the adiabatic component is the most intense and the adiabatic ionization energies of these bands are expected to be very close, at 9.971 and 9.974 eV at the highest level of theory used. Copyright © 2012 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  13. Customization of electronic medical record templates to improve end-user satisfaction.

    PubMed

    Gardner, Carrie Lee; Pearce, Patricia F

    2013-03-01

    Since 2004, increasing importance has been placed on the adoption of electronic medical records by healthcare providers for documentation of patient care. Recent federal regulations have shifted the focus from adoption alone to meaningful use of an electronic medical record system. As proposed by the Technology Acceptance Model, the behavioral intention to use technology is determined by the person's attitude toward usage. The purpose of this quality improvement project was to devise and implement customized templates into an existent electronic medical record system in a single clinic and measure the satisfaction of the clinic providers with the system before and after implementation. Provider satisfaction with the electronic medical record system was evaluated prior to and following template implementation using the current version 7.0 of the Questionnaire for User Interaction Satisfaction tool. Provider comments and improvement in the Questionnaire for User Interaction Satisfaction levels of rankings following template implementation indicated a positive perspective by the providers in regard to the templates and customization of the system.

  14. Electronic reporting of all reference laboratory results: An important step toward a truly all-encompassing, integrated health record.

    PubMed

    Kratz, Alexander

    2016-09-01

    Results from reference laboratories are often not easily available in electronic health records. This article describes a multi-pronged, long-term approach that includes bringing send-out tests in-house, upgrading the laboratory information system, interfacing more send-out tests and more reference laboratories, utilizing the "miscellaneous assay" option offered by some reference laboratories, and scanning all remaining paper reports from reference laboratories for display in the electronic health record. This allowed all laboratory results obtained in association with a patient visit, whether performed in-house or at a reference laboratory, to be available in the integrated electronic health record. This was achieved without manual data entry of reference laboratory results, thereby avoiding the risk of transcription errors. A fully integrated electronic health record that contains all laboratory results can be achieved by maximizing the number of interfaced reference laboratory assays and making all non-interfaced results available as scanned documents. © The Author(s) 2015.

  15. Measurement of the energy distribution of electrons escaping minimum-B ECR plasmas

    NASA Astrophysics Data System (ADS)

    Izotov, I.; Tarvainen, O.; Skalyga, V.; Mansfeld, D.; Kalvas, T.; Koivisto, H.; Kronholm, R.

    2018-02-01

    The measurement of the electron energy distribution (EED) of electrons escaping axially from a minimum-B electron cyclotron resonance ion source (ECRIS) is reported. The experimental data were recorded with a room-temperature 14 GHz ECRIS at the JYFL accelerator laboratory. The electrons escaping through the extraction mirror of the ion source were detected with a secondary electron amplifier placed downstream from a dipole magnet serving as an electron spectrometer with 500 eV resolution. It was discovered that the EED in the range of 5-250 keV is strongly non-Maxwellian and exhibits several local maxima below 20 keV energy. It was observed that the most influential ion source operating parameter on the EED is the magnetic field strength, which affected the EED predominantly at energies less than 100 keV. The effects of the microwave power and frequency, ranging from 100 to 600 W and 11 to 14 GHz, respectively, on the EED were found to be less significant. The presented technique and experiments enable the comparison between direct measurement of the EED and results derived from Bremsstrahlung diagnostics, the latter being severely complicated by the non-Maxwellian nature of the EED reported here. The role of RF pitch angle scattering on electron losses and the relation between the EED of the axially escaping electrons and the EED of the confined electrons are discussed.

  16. Annotations for the Collaboration of the Health Professionals

    PubMed Central

    Bringay, Sandra; Barry, Catherine; Charlet, Jean

    2006-01-01

    In the French DocPatient project, we work on documentary functionalities to improve the use of the electronic medical record. We suggest that integration of specific uses for paper medical documents in the design of the electronic medical record will improve its utility, use and acceptance. We propose in this paper to add a functionality of annotations in the electronic medical record to reinforce collaboration, coordination and awareness. PMID:17238309

  17. EMERSE: The Electronic Medical Record Search Engine

    PubMed Central

    Hanauer, David A.

    2006-01-01

    EMERSE (The Electronic Medical Record Search Engine) is an intuitive, powerful search engine for free-text documents in the electronic medical record. It offers multiple options for creating complex search queries yet has an interface that is easy enough to be used by those with minimal computer experience. EMERSE is ideal for retrospective chart reviews and data abstraction and may have potential for clinical care as well. PMID:17238560

  18. Electronic health record tools' support of nurses' clinical judgment and team communication.

    PubMed

    Kossman, Susan P; Bonney, Leigh Ann; Kim, Myoung Jin

    2013-11-01

    Nurses need to quickly process information to form clinical judgments, communicate with the healthcare team, and guide optimal patient care. Electronic health records not only offer potential for enhanced care but also introduce unintended consequences through changes in workflow, clinical judgment, and communication. We investigated nurses' use of improvised (self-made) and electronic health record-generated cognitive artifacts on clinical judgment and team communication. Tanner's Clinical Judgment Model provided a framework and basis for questions in an online survey and focus group interviews. Findings indicated that (1) nurses rated self-made work lists and medication administration records highest for both clinical judgment and communication, (2) tools aided different dimensions of clinical judgment, and (3) interdisciplinary tools enhance team communication. Implications are that electronic health record tool redesign could better support nursing work.

  19. Electronic medical records for otolaryngology office-based practice.

    PubMed

    Chernobilsky, Boris; Boruk, Marina

    2008-02-01

    Pressure is mounting on physicians to adopt electronic medical records. The field of health information technology is evolving rapidly with innovations and policies often outpacing science. We sought to review research and discussions about electronic medical records from the past year to keep abreast of these changes. Original scientific research, especially from otolaryngologists, is lacking in this field. Adoption rates are slowly increasing, but more of the burden is shouldered by physicians despite policy efforts and the clear benefits to third-party payers. Scientific research from the past year suggests lack of improvements and even decreasing quality of healthcare with electronic medical record adoption in the ambulatory care setting. The increasing prevalence and standardization of electronic medical record systems results in a new set of problems including rising costs, audits, difficulties in transition and public concerns about security of information. As major players in healthcare continue to push for adoption, increased effort must be made to demonstrate actual improvements in patient care in the ambulatory care setting. More scientific studies are needed to demonstrate what features of electronic medical records actually improve patient care. Otolaryngologists should help each other by disseminating research about improvement in patient outcomes with their systems since current adoption and outcomes policies do not apply to specialists.

  20. Benefits of Implementing and Improving Collection of Sexual Orientation and Gender Identity Data in Electronic Health Records.

    PubMed

    Bosse, Jordon D; Leblanc, Raeann G; Jackman, Kasey; Bjarnadottir, Ragnhildur I

    2018-06-01

    Individuals in lesbian, gay, bisexual, and transgender communities experience several disparities in physical and mental health (eg, cardiovascular disease and depression), as well as difficulty accessing care that is compassionate and relevant to their unique needs. Access to care is compromised in part due to inadequate information systems that fail to capture identity data. Beginning in January 2018, meaningful use criteria dictate that electronic health records have the capability to collect data related to sexual orientation and gender identity of patients. Nurse informaticists play a vital role in the process of developing new electronic health records that are sensitive to the needs and identities of the lesbian, gay, bisexual, and transgender communities. Improved collection of sexual orientation and gender identity data will advance the identification of health disparities experienced by lesbian, gay, bisexual, and transgender populations. More inclusive electronic health records will allow providers to monitor risk behavior, assess progress toward the reduction of disparities, and provide healthcare that is patient and family centered. Concrete suggestions for the modification of electronic health record systems are presented, as well as how nurse informaticists may be able to bridge gaps in provider knowledge and discomfort through interprofessional collaboration when implementing changes in electronic health records.

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