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Sample records for ehr educational portal

  1. From prototype to production: lessons learned from the evolution of an EHR educational portal.

    PubMed

    Borycki, Elizabeth M; Armstrong, Brian; Kushniruk, Andre W

    2009-01-01

    The use of electronic health records is rapidly increasing. However, the integration of this technology into the education of health professionals and health informaticians has largely remained to be explored. In this paper we describe an approach to providing remote access to electronic health records for use in health professional and health informatics education at the undergraduate and graduate levels. The University of Victoria EHR Educational Portal was designed by the authors to allow for remote Web-based access by students to a range of systems hosted on the portal. Architectural considerations and the evolution of the portal structure from prototype to production system are described. The paper also describes our initial applications of the approach in integrating EHRs into nursing, medical and health informatics educational programs.

  2. Towards Educational Electronic Health Records (EHRs): A Design Process for Integrating EHRs, Simulation, and Video Tutorials.

    PubMed

    Shachak, Aviv; Elamrousy, Samer; Borycki, Elizabeth M; Domb, Sharon; Kushniruk, Andre W

    2016-01-01

    Electronic health records (EHRs) are becoming ubiquitous in healthcare practice. However, their use in medical education has been slower to catch on and a new category of EHRs is beginning to emerge known as eduEHRs. These systems allow learners to explore and experiment with EHRs in the context of medical education. However, current eduEHRs have limitations, such as a lack of dynamic interaction built-in that would mimic real-world use of these tools. To overcome this, the integration of eduEHRs with software and tools such as video simulations and tutorials has considerable promise. In this paper we describe a new design process for integrating EHRs, simulations, and video tutorials. PMID:27577459

  3. Towards Educational Electronic Health Records (EHRs): A Design Process for Integrating EHRs, Simulation, and Video Tutorials.

    PubMed

    Shachak, Aviv; Elamrousy, Samer; Borycki, Elizabeth M; Domb, Sharon; Kushniruk, Andre W

    2016-01-01

    Electronic health records (EHRs) are becoming ubiquitous in healthcare practice. However, their use in medical education has been slower to catch on and a new category of EHRs is beginning to emerge known as eduEHRs. These systems allow learners to explore and experiment with EHRs in the context of medical education. However, current eduEHRs have limitations, such as a lack of dynamic interaction built-in that would mimic real-world use of these tools. To overcome this, the integration of eduEHRs with software and tools such as video simulations and tutorials has considerable promise. In this paper we describe a new design process for integrating EHRs, simulations, and video tutorials.

  4. Ethical Considerations about EHR-Mediated Results Disclosure and Pathology Information Presented via Patient Portals.

    PubMed

    Davis, Kristina A; Smith, Lauren B

    2016-01-01

    Electronic health records (EHR) now include patient portals where patients can obtain clinical reports, including notes, radiology reports, and laboratory/anatomic pathology results. Although portals increase patient access to information, no guidelines have been developed for hospitals about appropriate delays in posting different types of pathology reports to the EHR. Delays exist as a matter of policy to allow physicians time to answer questions and provide emotional support when discussing sensitive results with patients. Some types of results are more sensitive than others, however, including results of cancer, genetic, and HIV testing. Ethical questions about patient access to test results online are discussed. PMID:27550567

  5. Methods for Linking EHR Notes to Education Materials

    PubMed Central

    Zheng, Jiaping; Yu, Hong

    2015-01-01

    It has been shown that providing patients with access to their own electronic health records (EHR) can enhance their medical understanding and provide clinically relevant benefits. However, languages that are difficult for non-medical professionals to comprehend are prevalent in the EHR notes, including medical terms, abbreviations, and domain-specific language patterns. Furthermore, limited average health literacy forms a barrier for patients to understand their health condition, impeding their ability to actively participate in managing their health. Therefore, we are developing a system to retrieve EHR note-tailored online consumer-oriented health education materials to improve patients’ health knowledge of their own clinical conditions. Our experiments show that queries combining key concepts and other medical concepts present in the EHR notes significantly outperform (more than doubled) a baseline system of using the phrases from topic models. PMID:26306273

  6. Implementation of Certified EHR, Patient Portal, and "Direct" Messaging Technology in a Radiology Environment Enhances Communication of Radiology Results to Both Referring Physicians and Patients.

    PubMed

    Reicher, Joshua Jay; Reicher, Murray Aaron

    2016-06-01

    Since 2009, the Federal government distributed over $29 billion to providers who were adopting compliant electronic health record (EHR) technology. With a focus on radiology, we explore how EHR technology impacts interoperability with referring clinicians' EHRs and patient engagement. We also discuss the high-level details of contributing supporting frameworks, specifically Direct messaging and health information service provider (HISP) technology. We characterized Direct messaging, a secure e-mail-like protocol built to allow exchange of encrypted health information online, and the new supporting HISP infrastructure. Statistics related to both the testing and active use of this framework were obtained from DirectTrust.org, an organization whose framework supports Direct messaging use by healthcare organizations. To evaluate patient engagement, we obtained usage data from a radiology-centric patient portal between 2014 and 2015, which in some cases included access to radiology reports. Statistics from 2013 to 2015 showed a rise in issued secure Direct addresses from 8724 to 752,496; a rise in the number of participating healthcare organizations from 667 to 39,751; and a rise in the secure messages sent from 122,842 to 27,316,438. Regarding patient engagement, an average of 234,679 patients per month were provided portal access, with 86,400 patients per month given access to radiology reports. Availability of radiology reports online was strongly associated with increased system usage, with a likelihood ratio of 2.63. The use of certified EHR technology and Direct messaging in the practice of radiology allows for the communication of patient information and radiology results with referring clinicians and increases patient use of patient portal technology, supporting bidirectional radiologist-patient communication. PMID:26588906

  7. Health Literacy, Education Levels, and Patient Portal Usage During Hospitalizations

    PubMed Central

    Davis, Sharon E.; Osborn, Chandra Y.; Kripalani, Sunil; Goggins, Kathryn M.; Jackson, Gretchen Purcell

    2015-01-01

    Patient portal adoption has rapidly increased, and portal usage has been associated with patients’ sociodemographics, health literacy, and education. Research on patient portals has primarily focused on the outpatient setting. We explored whether health literacy and education were associated with portal usage in an inpatient population. Among 60,159 admissions in 2012–2013, 23.3% of patients reported limited health literacy; 50.4% reported some post-secondary education; 34.4% were registered for the portal; and 23.4% of registered patients used the portal during hospitalization. Probability of registration and inpatient portal use increased with educational attainment. Health literacy was associated with registration but not inpatient use. Among admissions with inpatient use, educational attainment was associated with viewing health record data, and health literacy was associated use of appointment and health education tools. The inpatient setting may provide an opportunity to overcome barriers to patient portal adoption and reduce disparities in use of health information technologies. PMID:26958286

  8. Teachers' Acceptance and Use of an Educational Portal

    ERIC Educational Resources Information Center

    Pynoo, Bram; Tondeur, Jo; van Braak, Johan; Duyck, Wouter; Sijnave, Bart; Duyck, Philippe

    2012-01-01

    In this study, teachers' acceptance and use of an educational portal is assessed based on data from two sources: usage data (number of logins, downloads, uploads, reactions and pages viewed) and an online acceptance questionnaire. The usage data is extracted on two occasions from the portal's database: at survey completion (T1) and twenty-two…

  9. A virtual platform for electronic health record (EHR) education for nursing students: moving from in-house solutions to the cloud.

    PubMed

    Kushniruk, Andre W; Kuo, Mu-Hsing; Parapini, Eric; Borycki, Elizabeth M

    2014-01-01

    There is a need to develop cost effective ways to bring hands-on education about essential information technologies, such as electronic health record (EHR) systems to nursing students, nursing faculty and practitioners. This is especially the case as worldwide there is an increased deployment of these systems and they are transforming the practice of healthcare. However, due to technical, financial and knowledge limitations, many nursing schools and programs do not have an adequate way to bring such technology into their classes and curricula. In this paper we describe an approach to developing Web-based EHR education that allows students from any Web-accessible location to access and work with real EHR systems remotely over the Internet for learning purposes. In this paper we describe our work in moving this approach to a cloud-based solution to allow access to EHRs for educational purposes from any location with Web access and to do so in a way that is both educationally sound and cost effective. PMID:24943524

  10. A virtual platform for electronic health record (EHR) education for nursing students: moving from in-house solutions to the cloud.

    PubMed

    Kushniruk, Andre W; Kuo, Mu-Hsing; Parapini, Eric; Borycki, Elizabeth M

    2014-01-01

    There is a need to develop cost effective ways to bring hands-on education about essential information technologies, such as electronic health record (EHR) systems to nursing students, nursing faculty and practitioners. This is especially the case as worldwide there is an increased deployment of these systems and they are transforming the practice of healthcare. However, due to technical, financial and knowledge limitations, many nursing schools and programs do not have an adequate way to bring such technology into their classes and curricula. In this paper we describe an approach to developing Web-based EHR education that allows students from any Web-accessible location to access and work with real EHR systems remotely over the Internet for learning purposes. In this paper we describe our work in moving this approach to a cloud-based solution to allow access to EHRs for educational purposes from any location with Web access and to do so in a way that is both educationally sound and cost effective.

  11. Quantitative Analysis of the Usage of the COSMOS Science Education Portal

    ERIC Educational Resources Information Center

    Sotiriou, Sofoklis; Bogner, Franz X.; Neofotistos, George

    2011-01-01

    A quantitative method of mapping the web usage of an innovative educational portal is applied to analyze the behaviour of users of the COSMOS Science Education Portal. The COSMOS Portal contains user-generated resources (that are uploaded by its users). It has been designed to support a science teacher's search, retrieval and access to both,…

  12. Quantitative Analysis of the Usage of the COSMOS Science Education Portal

    NASA Astrophysics Data System (ADS)

    Sotiriou, Sofoklis; Bogner, Franz X.; Neofotistos, George

    2011-08-01

    A quantitative method of mapping the web usage of an innovative educational portal is applied to analyze the behaviour of users of the COSMOS Science Education Portal. The COSMOS Portal contains user-generated resources (that are uploaded by its users). It has been designed to support a science teacher's search, retrieval and access to both, scientific and educational resources. It also aims to introduce in and familiarize teachers with an innovative methodology for designing, expressing and representing educational practices in a commonly understandable way through the use of user-friendly authoring tools that are available through the portal. As a new science education portal that includes user-generated content, the COSMOS Portal encounters the well-known "new product/service challenge": to convince the users to use its tools, which facilitate quite fast lesson planning and lesson preparation activities. To respond to this challenge, the COSMOS Portal operators implemented a validation process by analyzing the usage data of the portal in a 10 month time-period. The data analyzed comprised: (a) the temporal evolution of the number of contributors and the amount of content uploaded to the COSMOS Portal; (b) the number of portal visitors (categorized as all-visitors, new-visitors, and returning-visitors) and (c) visitor loyalty parameters (such as page-views; pages/visit; average time on site; depth of visit; length of visit). The data is augmented with data associated with the usage context (e.g. the time of day when most of the activities in the portal take place). The quantitative results indicate that the exponential growth of the contributors to the COSMOS Portal is followed by an exponential growth of the uploaded content. Furthermore, the web usage statistics demonstrate significant changes in users' behaviour during the period under study, with returning visitors using the COSMOS Portal more frequently, mainly for lesson planning and preparation (in the

  13. Some Emphases and Resources for the A.I.D. Education Sector. Network Series: EHR-01.

    ERIC Educational Resources Information Center

    Agency for International Development (Dept. of State), Washington, DC. Office of Education and Human Resources.

    This paper elaborates on the Agency for International Development's (AID) new strategies for educational assistance to developing nations, with special reference to available, centrally funded technical assistance resources and the means for procuring them. Section one provides a brief introduction and lists the kinds of resources available and…

  14. Simulated electronic health record (Sim-EHR) curriculum: teaching EHR skills and use of the EHR for disease management and prevention.

    PubMed

    Milano, Christina E; Hardman, Joseph A; Plesiu, Adeline; Rdesinski, Rebecca E; Biagioli, Frances E

    2014-03-01

    Electronic health records (EHRs) can improve many aspects of patient care, yet few formal EHR curricula exist to teach optimal use to students and other trainees. The Simulated EHR (Sim-EHR) curriculum was introduced in January 2011 at Oregon Health & Science University (OHSU) to provide learners with a safe hands-on environment in which to apply evidence-based guidelines while learning EHR skills. Using an EHR training platform identical to the OHSU EHR system, learners review and correct a simulated medical chart for a complex virtual patient with chronic diseases and years of fragmented care. They write orders and prescriptions, create an evidence-based plan of care for indicated disease prevention and management, and review their work in a small-group setting. Third-year students complete the Sim-EHR curriculum as part of the required family medicine clerkship; their chart work is assessed using a rubric tied to the curriculum's general and specific objectives. As of January 2014, 406 third-year OHSU medical students, on campus or at remote clerkship sites, and 21 OHSU internal medicine interns had completed simulated charts.In this article, the authors describe the development and implementation of the Sim-EHR curriculum, with a focus on use of the curriculum in the family medicine clerkship. They also share preliminary findings and lessons learned. They suggest that the Sim-EHR curriculum is an effective, interactive method for providing learners with EHR skills education while demonstrating how a well-organized chart helps ensure safe, efficient, and quality patient care. PMID:24448035

  15. Simulated electronic health record (Sim-EHR) curriculum: teaching EHR skills and use of the EHR for disease management and prevention.

    PubMed

    Milano, Christina E; Hardman, Joseph A; Plesiu, Adeline; Rdesinski, Rebecca E; Biagioli, Frances E

    2014-03-01

    Electronic health records (EHRs) can improve many aspects of patient care, yet few formal EHR curricula exist to teach optimal use to students and other trainees. The Simulated EHR (Sim-EHR) curriculum was introduced in January 2011 at Oregon Health & Science University (OHSU) to provide learners with a safe hands-on environment in which to apply evidence-based guidelines while learning EHR skills. Using an EHR training platform identical to the OHSU EHR system, learners review and correct a simulated medical chart for a complex virtual patient with chronic diseases and years of fragmented care. They write orders and prescriptions, create an evidence-based plan of care for indicated disease prevention and management, and review their work in a small-group setting. Third-year students complete the Sim-EHR curriculum as part of the required family medicine clerkship; their chart work is assessed using a rubric tied to the curriculum's general and specific objectives. As of January 2014, 406 third-year OHSU medical students, on campus or at remote clerkship sites, and 21 OHSU internal medicine interns had completed simulated charts.In this article, the authors describe the development and implementation of the Sim-EHR curriculum, with a focus on use of the curriculum in the family medicine clerkship. They also share preliminary findings and lessons learned. They suggest that the Sim-EHR curriculum is an effective, interactive method for providing learners with EHR skills education while demonstrating how a well-organized chart helps ensure safe, efficient, and quality patient care.

  16. Web Portals & Higher Education: Technologies To Make IT Personal. The Jossey-Bass Higher and Adult Education Series.

    ERIC Educational Resources Information Center

    Katz, Richard N., Ed.

    The chapters of this collection examine a full range of issues that any educational institution must consider before beginning to develop a Web portal, including business challenges, organizational implications, policy choices, and technology concerns. The chapters are: (1) "It's a Bird! It's a Plane! It's a Portal?" (Richard N. Katz); (2)…

  17. Barriers to implement Electronic Health Records (EHRs)

    PubMed Central

    Ajami, Sima; Arab-Chadegani, Razieh

    2013-01-01

    Introduction: During the past 20 years, with huge advances in information technology and particularly in the areas of health, various forms of electronic records have been studied, analyzed, designed or implemented. An Electronic Health Records (EHRs) is defined as digitally stored healthcare information throughout an individual’s lifetime with the purpose of supporting continuity of care, education, and research. The EHRs may include such things as observations, laboratory tests, medical images, treatments, therapies; drugs administered, patient identifying information, legal permissions, and so on. Despite of the potential benefits of electronic health records, implement of this project facing with barriers and restriction ,that the most of these limitations are cost constraints, technical limitations, standardization limits, attitudinal constraints–behavior of individuals and organizational constraints. Aim: The aim of this study was to express the main barriers to implement EHRs. Methods: This study was unsystematic-review study. The literature was searched on main barriers to implement EHRs with the help of library, books, conference proceedings, data bank, and also searches engines available at Google, Google scholar. For our searches, we employed the following keywords and their combinations: Electronic health record, implement, obstacle, and information technology in the searching areas of title, keywords, abstract, and full text. Results and discussion: In this study, more than 43 articles and reports were collected and 32 of them were selected based on their relevancy. Many studies indicate that the most important factor than other limitations to implement the EHR are resistance to change. PMID:24167440

  18. Quality evaluation of portal sites in health system, as a tool for education and learning

    PubMed Central

    Hejazi, Sayed Mehdi; Sarmadi, Sima

    2013-01-01

    Background: The main objective of creating a portal is to make information service available for users who need them for performance of duties and responsibilities regardless of the sources. This article is attempted to consider the parameters that can evaluate these sites since these criteria can be effective in designing and implementing such portals. On the other hand, portal sites in health systems of every country make it possible for leaders, policy makers, and directors to system education as a tool for new learning technologies. One of the main decisions each manager has to make is precise selection of appropriate portal sites. Materials and Methods: This is a descriptive and qualitative study. The research sample was 53 computer professional working in the area of computer programming and design. In the first part of the study a questionnaire was send to the participants and in the second part of the study based on their response to the questionnaire the participant was interviewed and the main themes of the studies were formulated. The validity and the reliability of the questionnaire were confirmed. Results: The study results were summarized in 10 themes and 50 sub-categories. The main themes included were portal requirements, security, management, and efficiency, user friendliness, built-in applications, portal flexibility, interoperability, and support systems. Conclusion: Portal sites in any education systems make it possible for health system leaders and policy makers to manage their organization information system efficiently and effectively. One of the major decisions each manager has to make is precise selection of an appropriate portal sites design and development. The themes and sub-categories of this study could help health system managers and policy makers and information technology professionals to make appropriate decisions regarding portal design and development. PMID:24520554

  19. MedEdPORTAL: a report on oral health resources for health professions educators.

    PubMed

    Chickmagalur, Nithya S; Allareddy, Veerasathpurush; Sandmeyer, Sue; Valachovic, Richard W; Candler, Christopher S; Saleh, Michael; Cahill, Emily; Karimbux, Nadeem Y

    2013-09-01

    MedEdPORTAL is a unique web-based peer-reviewed publication venue for clinical health educators sponsored by the Association of American Medical Colleges (AAMC). The open exchange of educational resources promotes professional collaboration across health professions. In 2008, the American Dental Education Association (ADEA) collaborated with AAMC to allow dental educators to use the platform to publish dental curriculum resources. Oral health is integral to general health; hence, collaboration among health care professionals brings enormous value to patient-centered care. The aim of this study was to conduct a current survey of metrics and submission statistics of MedEdPORTAL resources. The data were collected using the MedEdPORTAL search engine and ADEA and AAMC staff. The data collected were categorized and reported in tables and charts. Results showed that at the time of this study there were over 2,000 medical and dental resources available to anyone worldwide. Oral health resources constituted approximately 30 percent of the total resources, which included cross-indexing with information relevant to both medical and dental audiences. There were several types of dental resources available; the most common were the ones focusing on critical thinking. The usage of MedEdPORTAL has been growing, with participation from over 190 countries and 10,000 educational institutions around the world. The findings of this report suggest that MedEdPORTAL is succeeding in its aim to foster global collaborative education, professional education, and educational scholarship. As such, MedEdPORTAL is providing a new forum for collaboration and opens venues for promising future work in professional education.

  20. An Evaluation of Teachers' Perceptions of a State Developed Educational Portal

    ERIC Educational Resources Information Center

    Caraccio, Beth Katz

    2009-01-01

    The purpose of this study was to investigate teachers' perceptions use of a state developed educational portal. The research evaluated the differences in the quality, usefulness, and relevance of learning objects found on the website based on teachers' gender and grade level they taught. Grade level taught referred to those grades that are the…

  1. Examining the Influence of Personality Traits on Intranet Portal Adoption by Faculty in Higher Education

    ERIC Educational Resources Information Center

    Shambare, Narcissus

    2013-01-01

    The problem examined in the proposed study was the underutilization of the intranet portals (IP) by faculty in institutions of higher education (IHE). Despite the time and investment allocated to the IP, the technology remains underutilized to improve productivity, efficiency, and justify its investment yet there is lack of understanding of why…

  2. Towards a portal and search engine to facilitate academic and research collaboration in engineering and education

    NASA Astrophysics Data System (ADS)

    Bonilla Villarreal, Isaura Nathaly

    While international academic and research collaborations are of great importance at this time, it is not easy to find researchers in the engineering field that publish in languages other than English. Because of this disconnect, there exists a need for a portal to find Who's Who in Engineering Education in the Americas. The objective of this thesis is to built an object-oriented architecture for this proposed portal. The Unified Modeling Language (UML) model developed in this thesis incorporates the basic structure of a social network for academic purposes. Reverse engineering of three social networks portals yielded important aspects of their structures that have been incorporated in the proposed UML model. Furthermore, the present work includes a pattern for academic social networks..

  3. e-meducation.org: an open access medical education web portal

    PubMed Central

    Alexiou, Vangelis G; Falagas, Matthew E

    2008-01-01

    Background Internet can serve in opening the door to a brand new world of high quality medical information. However, the chaotic size of data available in the WWW is often misleading. We sought to provide the world medical community with a web portal that may be used as a clearinghouse providing the outlet for dissemination of high quality WWW educational products. Methods Directories of the relevant WWW resources have been compiled and others are being currently under development to cover most medical fields. A custom-built medical search engine was created. Really Simple Syndication (RSS) feeds and video sharing services were reviewed for their quality and were presented along with case-based educational presentations through a user-friendly web portal interface. A directory of guidelines database is currently under development. Results The educational portal "e-meducation" available at has been launched in December 2006 and at the moment, provides links to more than 800 educational web-pages, more than 2100 clinical practice guidelines, 32 news feeds, and 14 educational videos. The web site also hosts 40 case-based presentations and a custom medical search engine. Conclusion Based on the incorporation of simple and tested educational strategies such as case based instruction and interactive learning, e-meducation.org aims to become a prototype platform that offers a more convenient interface to existing products, resources and medical contents. PMID:18218119

  4. The New Physics and Astronomy Education Portal of the Smithsonian/NASA Astrophysics Data System

    NASA Astrophysics Data System (ADS)

    Kurtz, Michael J.; Eichhorn, G.; Accomazzi, A.; Grant, C.; Henneken, E.; Thompson, D.; Bohlen, E.; Murray, S. S.

    2006-12-01

    The ADS announces the beta release of a new portal into the technical literature for physics and astronomy education. This project is being done in collaboration with ComPADRE. Currently the collection contains about 30,000 articles covering the Science Education literature; key journals in the collection include Research in Science Education, Physical Review Special Topics Physics Education Research, The Physics Teacher, The American Journal of Physics, Physics Education, Journal of Research in Science Teaching, The International Journal of Science Education. Several other journals are also included, including some from nearby fields, such as computer science and chemistry education. The system easily has the ability to include any individual article from the research literature of physics and astronomy (such as from the Physical Review or the Astrophysical Journal) either from current or historical research. We encourage educators to suggest such articles to us. This is the beta release of a new system; we encourage comments, critisms and suggestions.

  5. Fostering Outreach, Education and Exploration of the Moon Using the Lunar Mapping & Modeling Portal

    NASA Astrophysics Data System (ADS)

    Dodge, K.; Law, E.; Malhotra, S.; Chang, G.; Kim, R. M.; Bui, B.; Sadaqathullah, S.; Day, B. H.

    2014-12-01

    The Lunar Mapping and Modeling Portal (LMMP)[1], is a web-based Portal and a suite of interactive visualization and analysis tools for users to access mapped lunar data products (including image mosaics, digital elevation models, etc.) from past and current lunar missions (e.g., Lunar Reconnaissance Orbiter, Apollo, etc.). Originally designed as a mission planning tool for the Constellation Program, LMMP has grown into a generalized suite of tools facilitating a wide range of activities in support of lunar exploration including public outreach, education, lunar mission planning and scientific research. LMMP fosters outreach, education, and exploration of the Moon by educators, students, amateur astronomers, and the general public. These efforts are enhanced by Moon Tours, LMMP's mobile application, which makes LMMP's information accessible to people of all ages, putting opportunities for real lunar exploration in the palms of their hands. Our talk will include an overview of LMMP and a demonstration of its technologies (web portals, mobile apps), to show how it serves NASA data as commodities for use by advanced visualization facilities (e.g., planetariums) and how it contributes to improving teaching and learning, increasing scientific literacy of the general public, and enriching STEM efforts. References:[1] http://www.lmmp.nasa.gov

  6. The SERC K12 Educators Portal to Teaching Activities and Pedagogic Approaches

    NASA Astrophysics Data System (ADS)

    Larsen, K.; Kirk, K. B.; Manduca, C. A.; Ledley, T. S.; Schmitt, L.

    2013-12-01

    The Science Education Resource Center (SERC) has created a portal to information for K12 educators to provide high-quality grade level appropriate materials from a wide variety of projects and topics. These materials were compiled across the SERC site, showcasing materials that were created for, or easily adaptable to, K12 classrooms. This resource will help support implementation of Next Generation Science Standards by assisting educators in finding innovative resources to address areas of instruction that are conceptually different than previous national and state science standards. Specifically, the K12 portal assists educators in learning about approaches that address the cross-cutting nature of science concepts, increasing students quantitative reasoning and numeracy skills, incorporating technology such as GIS in the classroom, and by assisting educators of all levels of K12 instruction in using relevant and meaningful ways to teach science concepts. The K12 portal supports educators by providing access to hundreds of teaching activities covering a wide array of science topics and grade levels many of which have been rigorously reviewed for pedagogic quality and scientific accuracy. The portal also provides access to web pages that enhance teaching practices that help increase student's system thinking skills, make lectures interactive, assist instructors in conducting safe and effective indoor and outdoor labs, providing support for teaching energy and climate literacy principles, assisting educators in addressing controversial content, provide guidance in engaging students affective domain, and provides a collection of tools for making teaching relevant in 21st century classrooms including using GIS, Google Earth, videos, visualizations and simulations to model and describe scientific concepts. The portal also provides access to material for specific content and audiences by (1) Supporting AGIs 'Map your World' week to specifically highlight teaching

  7. An educational portal to facilitate statistical literacy for the Malaysian community

    NASA Astrophysics Data System (ADS)

    Bahardin, Nadiah; Ismail, Zaleha; Abidin, Nur Liyana Zainal

    2015-02-01

    In the last decades, a considerable number of studies investigated the teaching and learning of statistics. The implications of these studies have changed the content and structure of statistics. Hence, the applications of statistics to understand the world around us should be followed by the learning of statistical concepts so that the students are aware that statistics is an important tool to solve practical life problems. There must be some platform such as materials or articles that discuss explicitly the applications of statistics in various area that reach of students. An educational web portal by the name of Dunia Matematik has been delegated to meet this need. Apart from the sections which provide numerous articles that portray statistics in real life, the portal also provides articles on history in mathematics, popular mathematicians, online quizzes, technology in mathematics education and arts in mathematics. Based on ARCS model on motivation, the four components of the model, namely attention, relevance, confidence and satisfaction are integrated in the design of the articles and activities. A rich collection of such resources which present authentic data could supplement text book materials which heavily focus onto statistical concepts and procedures. Besides motivating learning, it is expected that the web portal has the potential to develop statistical literacy, an ability to comprehend and infer the data. The final part of the paper will describe some resources that have been developed.

  8. Learning Portals: Analyzing Threshold Concept Theory for LIS Education

    ERIC Educational Resources Information Center

    Tucker, Virginia M.; Weedman, Judith; Bruce, Christine S.; Edwards, Sylvia L.

    2014-01-01

    This paper explores the theoretical framework of threshold concepts and its potential for LIS education. Threshold concepts are key ideas, often troublesome and counterintuitive, that are critical to profound understanding of a domain. Once understood, they allow mastery of significant aspects of the domain, opening up new, previously inaccessible…

  9. Shared Decision Making in Education Governance Using Business Portals

    ERIC Educational Resources Information Center

    Peoples, Adrian L.

    2009-01-01

    The purpose of this study was to address a high-volume problem for the Delaware Department of Education Office of Professional Accountability (OPA). This problem was addressed by sharing the certification decision with qualified personnel located at each of the four teacher preparation programs located in Delaware at Delaware State University…

  10. StarBRITE: the Vanderbilt University Biomedical Research Integration, Translation and Education portal.

    PubMed

    Harris, Paul A; Swafford, Jonathan A; Edwards, Terri L; Zhang, Minhua; Nigavekar, Shraddha S; Yarbrough, Tonya R; Lane, Lynda D; Helmer, Tara; Lebo, Laurie A; Mayo, Gail; Masys, Daniel R; Bernard, Gordon R; Pulley, Jill M

    2011-08-01

    StarBRITE is a one-stop, web-based research portal designed to meet the day-to-day needs of the Vanderbilt University and Meharry Medical College research community during the planning and conduct of research studies. StarBRITE serves as the main online location for research support addressing issues such as identification and location of resources, identification of experts, guidance for regulatory applications and approvals, regulatory assistance, funding requests, research data planning and collection, and serves as a central repository for educational offerings. To date, there have been more than 590,038 StarBRITE hits by more than 6582 cumulative users. We present here StarBRITE design objectives, details about technical infrastructure and system components, status report and activity metrics for the first 2.75-years of operation, and a report of lessons learned during organizing, launching and refining the portal. PMID:21310264

  11. Intelligent Simulation Model To Facilitate EHR Training

    PubMed Central

    Mohan, Vishnu; Scholl, Gretchen; Gold, Jeffrey A.

    2015-01-01

    Despite the rapid growth of EHR use, there are currently no standardized protocols for EHR training. A simulation EHR environment may offer significant advantages with respect to EHR training, but optimizing the training paradigm requires careful consideration of the simulation model itself, and how it is to be deployed during training. In this paper, we propose Six Principles that are EHR-agnostic and provide the framework for the development of an intelligent simulation model that can optimize EHR training by replicating real-world clinical conditions and appropriate cognitive loads. PMID:26958229

  12. Giovanni Data Portals and Resources Support Student Problem-Based Learning for Climate Change Education

    NASA Astrophysics Data System (ADS)

    Acker, J. G.; Zalles, D. R.; Krumhansl, R. A.

    2012-12-01

    The Data-Enhanced Investigations for Climate Change Education (DICCE) project, funded by NASA, is providing dedicated climate data portals in the NASA Giovanni data system for the use of teachers and students. The central content of the DICCE-Giovanni data portals is a reduced set of climate-relevant data parameters drawn from the available Giovanni data sets, with accessible meanings, such as surface temperature, precipitation amount, snow cover, phytoplankton chlorophyll concentration, vegetation indices, and aerosol optical depth. Information resources explain the significance of the data to climate research, how to interpret climate data trends, and address uncertainties in both data visualizations and the interpretation of data plotting output. "How-to" videos and plotting tips facilitate the utilization of the data portals, so that teachers can create problem-based projects based on actual satellite observational data. The use of satellite data in a problem-based framework enhances the relevance and immediacy of the project content to the student, improves their understanding of Earth climate system interrelationships, and also improves pattern recognition, math skills, and interpretation of data representations.;

  13. ResearchEHR: use of semantic web technologies and archetypes for the description of EHRs.

    PubMed

    Robles, Montserrat; Fernández-Breis, Jesualdo Tomás; Maldonado, Jose A; Moner, David; Martínez-Costa, Catalina; Bosca, Diego; Menárguez-Tortosa, Marcos

    2010-01-01

    In this paper, we present the ResearchEHR project. It focuses on the usability of Electronic Health Record (EHR) sources and EHR standards for building advanced clinical systems. The aim is to support healthcare professional, institutions and authorities by providing a set of generic methods and tools for the capture, standardization, integration, description and dissemination of health related information. ResearchEHR combines several tools to manage EHR at two different levels. The internal level that deals with the normalization and semantic upgrading of exiting EHR by using archetypes and the external level that uses Semantic Web technologies to specify clinical archetypes for advanced EHR architectures and systems.

  14. EHR Big Data Deep Phenotyping

    PubMed Central

    Lenert, L.; Lopez-Campos, G.

    2014-01-01

    Summary Objectives Given the quickening speed of discovery of variant disease drivers from combined patient genotype and phenotype data, the objective is to provide methodology using big data technology to support the definition of deep phenotypes in medical records. Methods As the vast stores of genomic information increase with next generation sequencing, the importance of deep phenotyping increases. The growth of genomic data and adoption of Electronic Health Records (EHR) in medicine provides a unique opportunity to integrate phenotype and genotype data into medical records. The method by which collections of clinical findings and other health related data are leveraged to form meaningful phenotypes is an active area of research. Longitudinal data stored in EHRs provide a wealth of information that can be used to construct phenotypes of patients. We focus on a practical problem around data integration for deep phenotype identification within EHR data. The use of big data approaches are described that enable scalable markup of EHR events that can be used for semantic and temporal similarity analysis to support the identification of phenotype and genotype relationships. Conclusions Stead and colleagues’ 2005 concept of using light standards to increase the productivity of software systems by riding on the wave of hardware/processing power is described as a harbinger for designing future healthcare systems. The big data solution, using flexible markup, provides a route to improved utilization of processing power for organizing patient records in genotype and phenotype research. PMID:25123744

  15. The portal of geriatrics online education: a 21st-century resource for teaching geriatrics.

    PubMed

    Ramaswamy, Ravishankar; Leipzig, Rosanne M; Howe, Carol L; Sauvigne, Karen; Usiak, Craig; Soriano, Rainier P

    2015-02-01

    The way students are taught and evaluated is changing, with greater emphasis on flexible, individualized, learner-centered education, including the use of technology. The goal of assessment is also shifting from what students know to how they perform in practice settings. Developing educational materials for teaching in these ways is time-consuming and can be expensive. The Portal of Geriatrics Online Education (POGOe) was developed to aid educators in meeting these needs and become quicker, better-prepared teachers of geriatrics. POGOe contains more than 950 geriatrics educational materials that faculty at 45% of allopathic and 7% of osteopathic U.S. medical schools and the Centers for Geriatric Nursing Excellence have created. These materials include various instructional and assessment methodologies, including virtual and standardized patients, games, tutorials, case-based teaching, self-directed learning, and traditional lectures. Materials with common goals and resource types are available as selected educational series. Learner assessments comprise approximately 10% of the educational materials. POGOe also includes libraries of videos, images, and questions extracted from its educational materials to encourage educators to repurpose content components to create new resources and to align their teaching better with their learners' needs. Web-Geriatric Education Modules, a peer-reviewed online modular curriculum for medical students, is a prime example of this repurposing. The existence of a robust compendium of instructional and assessment materials allows educators to concentrate more on improving learner performance in practice and not simply on knowledge acquisition. It also makes it easier for nongeriatricians to teach the care of older adults in their respective disciplines. PMID:25644187

  16. The portal of geriatrics online education: a 21st-century resource for teaching geriatrics.

    PubMed

    Ramaswamy, Ravishankar; Leipzig, Rosanne M; Howe, Carol L; Sauvigne, Karen; Usiak, Craig; Soriano, Rainier P

    2015-02-01

    The way students are taught and evaluated is changing, with greater emphasis on flexible, individualized, learner-centered education, including the use of technology. The goal of assessment is also shifting from what students know to how they perform in practice settings. Developing educational materials for teaching in these ways is time-consuming and can be expensive. The Portal of Geriatrics Online Education (POGOe) was developed to aid educators in meeting these needs and become quicker, better-prepared teachers of geriatrics. POGOe contains more than 950 geriatrics educational materials that faculty at 45% of allopathic and 7% of osteopathic U.S. medical schools and the Centers for Geriatric Nursing Excellence have created. These materials include various instructional and assessment methodologies, including virtual and standardized patients, games, tutorials, case-based teaching, self-directed learning, and traditional lectures. Materials with common goals and resource types are available as selected educational series. Learner assessments comprise approximately 10% of the educational materials. POGOe also includes libraries of videos, images, and questions extracted from its educational materials to encourage educators to repurpose content components to create new resources and to align their teaching better with their learners' needs. Web-Geriatric Education Modules, a peer-reviewed online modular curriculum for medical students, is a prime example of this repurposing. The existence of a robust compendium of instructional and assessment materials allows educators to concentrate more on improving learner performance in practice and not simply on knowledge acquisition. It also makes it easier for nongeriatricians to teach the care of older adults in their respective disciplines.

  17. Quality requirements for EHR archetypes.

    PubMed

    Kalra, Dipak; Tapuria, Archana; Austin, Tony; De Moor, Georges

    2012-01-01

    The realisation of semantic interoperability, in which any EHR data may be communicated between heterogeneous systems and fully understood by computers as well as people on receipt, is a challenging goal. Despite the use of standardised generic models for the EHR and standard terminology systems, too much optionality and variability exists in how particular clinical entries may be represented. Clinical archetypes provide a means of defining how generic models should be shaped and bound to terminology for specific kinds of clinical data. However, these will only contribute to semantic interoperability if libraries of archetypes can be built up consistently. This requires the establishment of design principles, editorial and governance policies, and further research to develop ways for archetype authors to structure clinical data and to use terminology consistently. Drawing on several years of work within communities of practice developing archetypes and implementing systems from them, this paper presents quality requirements for the development of archetypes. Clinical engagement on a wide scale is also needed to help grow libraries of good quality archetypes that can be certified. Vendor and eHealth programme engagement is needed to validate such archetypes and achieve safe, meaningful exchange of EHR data between systems. PMID:22874150

  18. Quality requirements for EHR archetypes.

    PubMed

    Kalra, Dipak; Tapuria, Archana; Austin, Tony; De Moor, Georges

    2012-01-01

    The realisation of semantic interoperability, in which any EHR data may be communicated between heterogeneous systems and fully understood by computers as well as people on receipt, is a challenging goal. Despite the use of standardised generic models for the EHR and standard terminology systems, too much optionality and variability exists in how particular clinical entries may be represented. Clinical archetypes provide a means of defining how generic models should be shaped and bound to terminology for specific kinds of clinical data. However, these will only contribute to semantic interoperability if libraries of archetypes can be built up consistently. This requires the establishment of design principles, editorial and governance policies, and further research to develop ways for archetype authors to structure clinical data and to use terminology consistently. Drawing on several years of work within communities of practice developing archetypes and implementing systems from them, this paper presents quality requirements for the development of archetypes. Clinical engagement on a wide scale is also needed to help grow libraries of good quality archetypes that can be certified. Vendor and eHealth programme engagement is needed to validate such archetypes and achieve safe, meaningful exchange of EHR data between systems.

  19. WormClassroom.org: An Inquiry-Rich Educational Web Portal for Research Resources of "Caenorhabditis elegans"

    ERIC Educational Resources Information Center

    Lu, Fong-Mei; Eliceiri, Kevin W.; Stewart, James; White, John G.

    2007-01-01

    The utilization of biology research resources, coupled with a "learning by inquiry" approach, has great potential to aid students in gaining an understanding of fundamental biological principles. To help realize this potential, we have developed a Web portal for undergraduate biology education, WormClassroom.org, based on current research…

  20. Portability and Usability of Open Educational Resources on Mobile Devices: A Study in the Context of Brazilian Educational Portals and Android-Based Devices

    ERIC Educational Resources Information Center

    da Silva, André Constantino; Freire, Fernanda Maria Pereira; Mourão, Vitor Hugo Miranda; da Cruz, Márcio Diógenes de Oliveira; da Rocha, Heloísa Vieira

    2014-01-01

    Open Educational Resources (OER) are freely accessible, openly licensed hypertext, audio, video, simulations, games and animations that are useful for teaching and learning purposes. In order to facilitate the location of such resources, educational content portals are being created, crowding contents that were produced by different teams with…

  1. Portal Hypertension

    MedlinePlus

    ... Chronic Hepatitis C Additional Content Medical News Portal Hypertension By Steven K. Herrine, MD NOTE: This is ... Hepatic Encephalopathy Jaundice in Adults Liver Failure Portal Hypertension Portal hypertension is abnormally high blood pressure in ...

  2. Portal Schools. Final Report.

    ERIC Educational Resources Information Center

    Lutonsky, Linda, Ed.

    The Portal School concept envisions a group of schools established in school systems that work closely with a university and that desire to participate in teacher education. This monograph represents a collection of experiences shared by initial developers of the Portal School strategy -- Florida State University, the University of Georgia, and…

  3. Technical and architectural issues in deploying electronic health records (EHRs) over the WWW.

    PubMed

    Armstrong, Brian; Kushniruk, Andre; Joe, Ron; Borycki, Elizabeth

    2009-01-01

    In this paper technical and architectural issues are described in deploying electronic health records (EHRs) over the WWW. The project described involved deployment of EHRs that have been designed to serve in the education of health professionals and health/biomedical informaticians. In order to allow for ubiquitous access to a range of EHRs remotely an architecture was designed with three layers: (a) the "Internet" or remote user access layer (2) the "Perimeter Network", or middle firewall security and authentication layer (3) the "HINF EHR Network", consisting of the internal servers hosting EHR applications and databases. The approaches allow for a large number of remote users running a range of operating systems to access the educational EHRs from any location remotely. Virtual machine (VM) technology is employed to allow multiple versions and platforms of operating systems to be installed side-by-side on a single server. Security, technical and budgetary considerations are described as well as past and current applications of the architecture for a number of projects for the education of health professionals in the area of electronic health records. PMID:19380921

  4. eHR: An Introduction. IES Report.

    ERIC Educational Resources Information Center

    Kettley, P.; Reilly, P.

    This document introduces the concept of electronic human resources (eHR) and its application. Chapter 1 presents a brief overview of the guide's development, purpose, and structure. Chapter 2 defines the concept of eHR as "the application of conventional, Web, and voice technologies to improve HR administration, transactions, and process…

  5. Improving EHR Usability Using LEAN Methodology.

    PubMed

    Bosse, Corbin; Kelly, Kandace

    2016-01-01

    Electronic health record (EHR) usability concerns continue to reduce EHR effectiveness. LEAN methodology, which focuses on waste elimination, may provide an effective method to address efficiency related usability deficiencies. We aimed to improve the usability of an inpatient seclusion and restraint (SR) EHR module using LEAN methodology. A multidisciplinary team convened to evaluate and redesign clinical and technological SR workflows using LEAN techniques, including process mapping and time-series analyses. SR module modifications addressed 40 of the 60 efficiency related usability deficiencies identified in the initial SR module. Usability enhancements included elimination of 10 nonessential inputs, 21 redundancies, and nine overhead functions. Process steps were reduced from 74 to 47. Improving EHR usability is critical to assure safe, effective, and efficient care1. We demonstrated that LEAN methodology is an effective method to address efficiency related EHR usability deficiencies. More research is needed to determine how these improvements impact care quality. PMID:27332384

  6. Improving Rates of Influenza Vaccination Through Electronic Health Record Portal Messages, Interactive Voice Recognition Calls and Patient-Enabled Electronic Health Record Updates: Protocol for a Randomized Controlled Trial

    PubMed Central

    Sreedhara, Meera; Goff, Sarah L; Fisher, Lloyd D; Preusse, Peggy; Jackson, Madeline; Sundaresan, Devi; Garber, Lawrence D; Mazor, Kathleen M

    2016-01-01

    Background Clinical decision support (CDS), including computerized reminders for providers and patients, can improve health outcomes. CDS promoting influenza vaccination, delivered directly to patients via an electronic health record (EHR) patient portal and interactive voice recognition (IVR) calls, offers an innovative approach to improving patient care. Objective To test the effectiveness of an EHR patient portal and IVR outreach to improve rates of influenza vaccination in a large multispecialty group practice in central Massachusetts. Methods We describe a nonblinded, randomized controlled trial of EHR patient portal messages and IVR calls designed to promote influenza vaccination. In our preparatory phase, we conducted qualitative interviews with patients, providers, and staff to inform development of EHR portal messages with embedded questionnaires and IVR call scripts. We also provided practice-wide education on influenza vaccines to all physicians and staff members, including information on existing vaccine-specific EHR CDS. Outreach will target adult patients who remain unvaccinated for more than 2 months after the start of the influenza season. Using computer-generated randomization and a factorial design, we will assign 20,000 patients who are active users of electronic patient portals to one of the 4 study arms: (1) receipt of a portal message promoting influenza vaccines and offering online appointment scheduling; (2) receipt of an IVR call with similar content but without appointment facilitation; (3) both (1) and (2); or (4) neither (1) nor (2) (usual care). We will randomize patients without electronic portals (10,000 patients) to (1) receipt of IVR call or (2) usual care. Both portal messages and IVR calls promote influenza vaccine completion. Our primary outcome is percentage of eligible patients with influenza vaccines administered at our group practice during the 2014-15 influenza season. Both outreach methods also solicit patient self

  7. Accelerating U.S. EHR Adoption: How to Get There From Here. Recommendations Based on the 2004 ACMI Retreat

    PubMed Central

    Middleton, Blackford; Hammond, W. Ed; Brennan, Patricia F.; Cooper, Gregory F.

    2005-01-01

    Despite growing support for the adoption of electronic health records (EHR) to improve U.S. healthcare delivery, EHR adoption in the United States is slow to date due to a fundamental failure of the healthcare information technology marketplace. Reasons for the slow adoption of healthcare information technology include a misalignment of incentives, limited purchasing power among providers, variability in the viability of EHR products and companies, and limited demonstrated value of EHRs in practice. At the 2004 American College of Medical Informatics (ACMI) Retreat, attendees discussed the current state of EHR adoption in this country and identified steps that could be taken to stimulate adoption. In this paper, based upon the ACMI retreat, and building upon the experiences of the authors developing EHR in academic and commercial settings we identify a set of recommendations to stimulate adoption of EHR, including financial incentives, promotion of EHR standards, enabling policy, and educational, marketing, and supporting activities for both the provider community and healthcare consumers. PMID:15492028

  8. Disparities in Primary Care EHR Adoption Rates

    PubMed Central

    Mack, Dominic; Zhang, Shun; Douglas, Megan; Sow, Charles; Strothers, Harry; Rust, George

    2016-01-01

    This study evaluates electronic health record (EHR) adoption by primary care providers in Georgia to assess adoption disparities according to practice size and type, payer mix, and community characteristics. Frequency variances of EHR “Go Live” status were estimated. Odds ratios were calculated by univariate and multivariate logistic regression models. Large practices and community health centers (CHCs) were more likely to Go Live (>80% EHR adoption) than rural health clinics and other underserved settings (53%). A significantly lower proportion (68.9%) of Medicaid predominant providers had achieved Go Live status and had a 47% higher risk of not achieving Go Live status than private insurance predominant practices. Disparities in EHR adoption rates may exacerbate existing disparities in health outcomes of patients served by these practices. Targeted support such as that provided to CHCs would level the playing field for practices now at a disadvantage. PMID:27587942

  9. Developing a Web 2.0 telemedical education system: the AJAX-Cocoon portal.

    PubMed

    Mohammed, S; Orabi, A; Fiaidhi, J; Orabi, M

    2008-01-01

    Web 2.0 technologies such as wikis, podcasts/vodcasting, blogs and semantic portals could be quite effective tools in e-learning for health professionals. If effectively deployed, such tools can offer a way to enhance students', clinicians' and patients' learning experiences, and deepens levels of learners' engagement and collaboration within medical learning environments. However, Web 2.0 requires simplicity of use as well as integration with modern web technologies. This article presents a Web 2.0 telemedical portal, which provides a social community-learning paradigm from the desk of the physician, the student, the hospital administrator, or the insurer. The presented portal utilises RESTful web services and techniques like content syndication, mushups and Asynchronous JavaScript API and XML (AJAX). The designed portal is based on the Apache Cocoon RESTful framework for sharing Digital Imaging and Communications in Medicine (DICOM) medical case studies. Central to this article is the integration between Cocoon and AJAX. The proposed AJAX-Cocoon portal utilises a JSP portlet architecture, which manages the interaction dynamics and overcomes the shortcomings of the JSR 168 and WSRP 1.0 standards. PMID:18583294

  10. WormClassroom.org: An Inquiry-rich Educational Web Portal for Research Resources of Caenorhabditis elegans

    PubMed Central

    Lu, Fong-Mei; Stewart, James; White, John G.

    2007-01-01

    The utilization of biology research resources, coupled with a “learning by inquiry” approach, has great potential to aid students in gaining an understanding of fundamental biological principles. To help realize this potential, we have developed a Web portal for undergraduate biology education, WormClassroom.org, based on current research resources of a model research organism, Caenorhabditis elegans. This portal is intended to serve as a resource gateway for students to learn biological concepts using C. elegans research material. The driving forces behind the WormClassroom website were the strengths of C. elegans as a teaching organism, getting researchers and educators to work together to develop instructional materials, and the 3 P's (problem posing, problem solving, and peer persuasion) approach for inquiry learning. Iterative assessment is an important aspect of the WormClassroom site development because it not only ensures that content is up-to-date and accurate, but also verifies that it does, in fact, aid student learning. A primary assessment was performed to refine the WormClassroom website utilizing undergraduate biology students and nonstudent experts such as C. elegans researchers; results and comments were used for site improvement. We are actively encouraging continued resource contributions from the C. elegans research and education community for the further development of WormClassroom. PMID:17548872

  11. Cost Effective Staffing for an EHR Implementation.

    PubMed

    Bullard, Katherine L

    2016-01-01

    This case study explores costs of electronic health record (EHR) implementation with the nursing super-user role in a metropolitan, not-for-profit health care system. Tapping the local pool of unemployed newly graduated nurses as half the required super-user workforce leveraged the technology skills of novice registered nurses (RNs) as trainers of experienced nurses in five hospitals. The novel workforce migrated from hospital to hospital, thereby reducing the number of experienced nurses reassigned to super-user duties in each hospital. This strategy reduced the amount of contract labor required to backfill nurse super-users' clinical shifts. Employment of the recently graduated nurses as RN residents upon completion of the EHR implementation enabled the organization to augment its clinical workforce with expert users of its EHR. The proposed innovative model increases super-users, minimizes disruption of core staffing, and dramatically reduces expense. PMID:27265948

  12. A secure EHR system based on hybrid clouds.

    PubMed

    Chen, Yu-Yi; Lu, Jun-Chao; Jan, Jinn-Ke

    2012-10-01

    Consequently, application services rendering remote medical services and electronic health record (EHR) have become a hot topic and stimulating increased interest in studying this subject in recent years. Information and communication technologies have been applied to the medical services and healthcare area for a number of years to resolve problems in medical management. Sharing EHR information can provide professional medical programs with consultancy, evaluation, and tracing services can certainly improve accessibility to the public receiving medical services or medical information at remote sites. With the widespread use of EHR, building a secure EHR sharing environment has attracted a lot of attention in both healthcare industry and academic community. Cloud computing paradigm is one of the popular healthIT infrastructures for facilitating EHR sharing and EHR integration. In this paper, we propose an EHR sharing and integration system in healthcare clouds and analyze the arising security and privacy issues in access and management of EHRs. PMID:22351166

  13. A secure EHR system based on hybrid clouds.

    PubMed

    Chen, Yu-Yi; Lu, Jun-Chao; Jan, Jinn-Ke

    2012-10-01

    Consequently, application services rendering remote medical services and electronic health record (EHR) have become a hot topic and stimulating increased interest in studying this subject in recent years. Information and communication technologies have been applied to the medical services and healthcare area for a number of years to resolve problems in medical management. Sharing EHR information can provide professional medical programs with consultancy, evaluation, and tracing services can certainly improve accessibility to the public receiving medical services or medical information at remote sites. With the widespread use of EHR, building a secure EHR sharing environment has attracted a lot of attention in both healthcare industry and academic community. Cloud computing paradigm is one of the popular healthIT infrastructures for facilitating EHR sharing and EHR integration. In this paper, we propose an EHR sharing and integration system in healthcare clouds and analyze the arising security and privacy issues in access and management of EHRs.

  14. 45 CFR 170.450 - EHR module testing and certification.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Temporary Certification Program for HIT § 170.450 EHR... (as defined in 45 CFR 170.102), and one or more of the constituent EHR Modules is/are...

  15. 45 CFR 170.450 - EHR module testing and certification.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Temporary Certification Program for HIT § 170.450 EHR... (as defined in 45 CFR 170.102), and one or more of the constituent EHR Modules is/are...

  16. 45 CFR 170.450 - EHR module testing and certification.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Temporary Certification Program for HIT § 170.450 EHR... (as defined in 45 CFR 170.102), and one or more of the constituent EHR Modules is/are...

  17. 45 CFR 170.450 - EHR module testing and certification.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Temporary Certification Program for HIT § 170.450 EHR... (as defined in 45 CFR 170.102), and one or more of the constituent EHR Modules is/are...

  18. 45 CFR 170.450 - EHR module testing and certification.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Temporary Certification Program for HIT § 170.450 EHR... (as defined in 45 CFR 170.102), and one or more of the constituent EHR Modules is/are...

  19. Electronic Health Record Patient Portal Adoption by Health Care Consumers: An Acceptance Model and Survey

    PubMed Central

    2016-01-01

    Background The future of health care delivery is becoming more citizen centered, as today’s user is more active, better informed, and more demanding. Worldwide governments are promoting online health services, such as electronic health record (EHR) patient portals and, as a result, the deployment and use of these services. Overall, this makes the adoption of patient-accessible EHR portals an important field to study and understand. Objective The aim of this study is to understand the factors that drive individuals to adopt EHR portals. Methods We applied a new adoption model using, as a starting point, Ventkatesh's Unified Theory of Acceptance and Use of Technology in a consumer context (UTAUT2) by integrating a new construct specific to health care, a new moderator, and new relationships. To test the research model, we used the partial least squares (PLS) causal modelling approach. An online questionnaire was administrated. We collected 360 valid responses. Results The statistically significant drivers of behavioral intention are performance expectancy (beta=.200; t=3.619), effort expectancy (beta=.185; t=2.907), habit (beta=.388; t=7.320), and self-perception (beta=.098; t=2.285). The predictors of use behavior are habit (beta=0.206; t=2.752) and behavioral intention (beta=0.258; t=4.036). The model explained 49.7% of the variance in behavioral intention and 26.8% of the variance in use behavior. Conclusions Our research helps to understand the desired technology characteristics of EHR portals. By testing an information technology acceptance model, we are able to determine what is more valued by patients when it comes to deciding whether to adopt EHR portals or not. The inclusion of specific constructs and relationships related to the health care consumer area also had a significant impact on understanding the adoption of EHR portals. PMID:26935646

  20. Dynamic CDM strategies in an EHR environment.

    PubMed

    Bieker, Michael; Bailey, Spencer

    2012-02-01

    A dynamic charge description master (CDM) integrates information from clinical ancillary systems into the charge-capture process, so an organization can reduce its reliance on the patient accounting system as the sole source of billing information. By leveraging the information from electronic ancillary systems, providers can eliminate the need for paper charge-capture forms and see increased accuracy and efficiency in the maintenance of billing information. Before embarking on a dynamic CDM strategy, organizations should first determine their goals for implementing an EHR system, include revenue cycle leaders on the EHR implementation team, and carefully weigh the pros and cons of CDM design decisions.

  1. Dynamic CDM strategies in an EHR environment.

    PubMed

    Bieker, Michael; Bailey, Spencer

    2012-02-01

    A dynamic charge description master (CDM) integrates information from clinical ancillary systems into the charge-capture process, so an organization can reduce its reliance on the patient accounting system as the sole source of billing information. By leveraging the information from electronic ancillary systems, providers can eliminate the need for paper charge-capture forms and see increased accuracy and efficiency in the maintenance of billing information. Before embarking on a dynamic CDM strategy, organizations should first determine their goals for implementing an EHR system, include revenue cycle leaders on the EHR implementation team, and carefully weigh the pros and cons of CDM design decisions. PMID:22372294

  2. 42 CFR 495.210 - Meaningful EHR user attestation.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 5 2013-10-01 2013-10-01 false Meaningful EHR user attestation. 495.210 Section... INCENTIVE PROGRAM Requirements Specific to Medicare Advantage (MA) Organizations § 495.210 Meaningful EHR... EHR user. (b) Qualifying MA organizations are required to attest within 2 months after the close of...

  3. 42 CFR 495.210 - Meaningful EHR user attestation.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 5 2014-10-01 2014-10-01 false Meaningful EHR user attestation. 495.210 Section... INCENTIVE PROGRAM Requirements Specific to Medicare Advantage (MA) Organizations § 495.210 Meaningful EHR... EHR user. (b) Qualifying MA organizations are required to attest within 2 months after the close of...

  4. 42 CFR 495.210 - Meaningful EHR user attestation.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 5 2012-10-01 2012-10-01 false Meaningful EHR user attestation. 495.210 Section... INCENTIVE PROGRAM Requirements Specific to Medicare Advantage (MA) Organizations § 495.210 Meaningful EHR... EHR user. (b) Qualifying MA organizations are required to attest within 60 days after the close of...

  5. 45 CFR 170.545 - Complete EHR certification.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... INFORMATION TECHNOLOGY STANDARDS, IMPLEMENTATION SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY ONC HIT Certification Program § 170.545 Complete EHR... Complete EHRs is also authorized to certify all EHR Modules under the ONC HIT Certification Program....

  6. 45 CFR 170.545 - Complete EHR certification.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... INFORMATION TECHNOLOGY STANDARDS, IMPLEMENTATION SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Permanent Certification Program for HIT § 170.545 Complete EHR... Complete EHRs is also authorized to certify all EHR Modules under the permanent certification program....

  7. 45 CFR 170.545 - Complete EHR certification.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... INFORMATION TECHNOLOGY STANDARDS, IMPLEMENTATION SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY ONC HIT Certification Program § 170.545 Complete EHR... Complete EHRs is also authorized to certify all EHR Modules under the ONC HIT Certification Program....

  8. 45 CFR 170.545 - Complete EHR certification.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... INFORMATION TECHNOLOGY STANDARDS, IMPLEMENTATION SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Permanent Certification Program for HIT § 170.545 Complete EHR... Complete EHRs is also authorized to certify all EHR Modules under the permanent certification program....

  9. Providers' perceived facilitators and barriers to EHR screen sharing in outpatient settings.

    PubMed

    Asan, Onur

    2017-01-01

    As health care becomes more patient-centered, some scholars and policy makers propose shifting use of electronic health records (EHRs) to a tool to educate and engage patients. Physician-patient screen sharing may provide a way to achieve this. However, the barriers and facilitators that physicians experience with screen sharing are unknown. In this study, we explored providers' facilitators and barriers to using EHR as a primary care communication tool. We conducted an interview study with 14 primary care providers to discover their views on screen sharing. We used the work system model as a conceptual framework to classify emergent factors. Content analysis yielded 28 facilitators and 56 barriers to patient-centered screen sharing in primary care. We linked these to work system elements. We outline suggestions for more patient-centered EHR systems, and for provider communication training. Finally, we consider the role screen sharing might play in the development of physician-patient situation awareness. PMID:27633226

  10. Portal biliopathy.

    PubMed

    Khuroo, Mohammad S; Rather, Ajaz A; Khuroo, Naira S; Khuroo, Mehnaaz S

    2016-09-21

    Portal biliopathy refers to cholangiographic abnormalities which occur in patients with portal cavernoma. These changes occur as a result of pressure on bile ducts from bridging tortuous paracholedochal, epicholedochal and cholecystic veins. Bile duct ischemia may occur due prolonged venous pressure effect or result from insufficient blood supply. In addition, encasement of ducts may occur due fibrotic cavernoma. Majority of patients are asymptomatic. Portal biliopathy is a progressive disease and patients who have long standing disease and more severe bile duct abnormalities present with recurrent episodes of biliary pain, cholangitis and cholestasis. Serum chemistry, ultrasound with color Doppler imaging, magnetic resonance imaging with magnetic resonance cholangiopancreatography and magnetic resonance portovenography are modalities of choice for evaluation of portal biliopathy. Endoscopic retrograde cholangiography being an invasive procedure is indicated for endotherapy only. Management of portal biliopathy is done in a stepwise manner. First, endotherapy is done for dilation of biliary strictures, placement of biliary stents to facilitate drainage and removal of bile duct calculi. Next portal venous pressure is reduced by formation of surgical porto-systemic shunt or transjugular intrahepatic portosystemic shunt. This causes significant resolution of biliary changes. Patients who persist with biliary symptoms and bile duct changes may benefit from surgical biliary drainage procedures (hepaticojejunostomy or choledechoduodenostomy). PMID:27672292

  11. Portal biliopathy

    PubMed Central

    Khuroo, Mohammad S; Rather, Ajaz A; Khuroo, Naira S; Khuroo, Mehnaaz S

    2016-01-01

    Portal biliopathy refers to cholangiographic abnormalities which occur in patients with portal cavernoma. These changes occur as a result of pressure on bile ducts from bridging tortuous paracholedochal, epicholedochal and cholecystic veins. Bile duct ischemia may occur due prolonged venous pressure effect or result from insufficient blood supply. In addition, encasement of ducts may occur due fibrotic cavernoma. Majority of patients are asymptomatic. Portal biliopathy is a progressive disease and patients who have long standing disease and more severe bile duct abnormalities present with recurrent episodes of biliary pain, cholangitis and cholestasis. Serum chemistry, ultrasound with color Doppler imaging, magnetic resonance imaging with magnetic resonance cholangiopancreatography and magnetic resonance portovenography are modalities of choice for evaluation of portal biliopathy. Endoscopic retrograde cholangiography being an invasive procedure is indicated for endotherapy only. Management of portal biliopathy is done in a stepwise manner. First, endotherapy is done for dilation of biliary strictures, placement of biliary stents to facilitate drainage and removal of bile duct calculi. Next portal venous pressure is reduced by formation of surgical porto-systemic shunt or transjugular intrahepatic portosystemic shunt. This causes significant resolution of biliary changes. Patients who persist with biliary symptoms and bile duct changes may benefit from surgical biliary drainage procedures (hepaticojejunostomy or choledechoduodenostomy).

  12. Portal biliopathy

    PubMed Central

    Khuroo, Mohammad S; Rather, Ajaz A; Khuroo, Naira S; Khuroo, Mehnaaz S

    2016-01-01

    Portal biliopathy refers to cholangiographic abnormalities which occur in patients with portal cavernoma. These changes occur as a result of pressure on bile ducts from bridging tortuous paracholedochal, epicholedochal and cholecystic veins. Bile duct ischemia may occur due prolonged venous pressure effect or result from insufficient blood supply. In addition, encasement of ducts may occur due fibrotic cavernoma. Majority of patients are asymptomatic. Portal biliopathy is a progressive disease and patients who have long standing disease and more severe bile duct abnormalities present with recurrent episodes of biliary pain, cholangitis and cholestasis. Serum chemistry, ultrasound with color Doppler imaging, magnetic resonance imaging with magnetic resonance cholangiopancreatography and magnetic resonance portovenography are modalities of choice for evaluation of portal biliopathy. Endoscopic retrograde cholangiography being an invasive procedure is indicated for endotherapy only. Management of portal biliopathy is done in a stepwise manner. First, endotherapy is done for dilation of biliary strictures, placement of biliary stents to facilitate drainage and removal of bile duct calculi. Next portal venous pressure is reduced by formation of surgical porto-systemic shunt or transjugular intrahepatic portosystemic shunt. This causes significant resolution of biliary changes. Patients who persist with biliary symptoms and bile duct changes may benefit from surgical biliary drainage procedures (hepaticojejunostomy or choledechoduodenostomy). PMID:27672292

  13. Archetype Model-Driven Development Framework for EHR Web System

    PubMed Central

    Kimura, Eizen; Ishihara, Ken

    2013-01-01

    Objectives This article describes the Web application framework for Electronic Health Records (EHRs) we have developed to reduce construction costs for EHR sytems. Methods The openEHR project has developed clinical model driven architecture for future-proof interoperable EHR systems. This project provides the specifications to standardize clinical domain model implementations, upon which the ISO/CEN 13606 standards are based. The reference implementation has been formally described in Eiffel. Moreover C# and Java implementations have been developed as reference. While scripting languages had been more popular because of their higher efficiency and faster development in recent years, they had not been involved in the openEHR implementations. From 2007, we have used the Ruby language and Ruby on Rails (RoR) as an agile development platform to implement EHR systems, which is in conformity with the openEHR specifications. Results We implemented almost all of the specifications, the Archetype Definition Language parser, and RoR scaffold generator from archetype. Although some problems have emerged, most of them have been resolved. Conclusions We have provided an agile EHR Web framework, which can build up Web systems from archetype models using RoR. The feasibility of the archetype model to provide semantic interoperability of EHRs has been demonstrated and we have verified that that it is suitable for the construction of EHR systems. PMID:24523991

  14. Protection of electronic health records (EHRs) in cloud.

    PubMed

    Alabdulatif, Abdulatif; Khalil, Ibrahim; Mai, Vu

    2013-01-01

    EHR technology has come into widespread use and has attracted attention in healthcare institutions as well as in research. Cloud services are used to build efficient EHR systems and obtain the greatest benefits of EHR implementation. Many issues relating to building an ideal EHR system in the cloud, especially the tradeoff between flexibility and security, have recently surfaced. The privacy of patient records in cloud platforms is still a point of contention. In this research, we are going to improve the management of access control by restricting participants' access through the use of distinct encrypted parameters for each participant in the cloud-based database. Also, we implement and improve an existing secure index search algorithm to enhance the efficiency of information control and flow through a cloud-based EHR system. At the final stage, we contribute to the design of reliable, flexible and secure access control, enabling quick access to EHR information. PMID:24110656

  15. Protection of electronic health records (EHRs) in cloud.

    PubMed

    Alabdulatif, Abdulatif; Khalil, Ibrahim; Mai, Vu

    2013-01-01

    EHR technology has come into widespread use and has attracted attention in healthcare institutions as well as in research. Cloud services are used to build efficient EHR systems and obtain the greatest benefits of EHR implementation. Many issues relating to building an ideal EHR system in the cloud, especially the tradeoff between flexibility and security, have recently surfaced. The privacy of patient records in cloud platforms is still a point of contention. In this research, we are going to improve the management of access control by restricting participants' access through the use of distinct encrypted parameters for each participant in the cloud-based database. Also, we implement and improve an existing secure index search algorithm to enhance the efficiency of information control and flow through a cloud-based EHR system. At the final stage, we contribute to the design of reliable, flexible and secure access control, enabling quick access to EHR information.

  16. Higher Education Web Portals: Serving State and Student Transfer Needs. Research Brief

    ERIC Educational Resources Information Center

    McGill, Mollie

    2010-01-01

    Students need access to web-based resources where they can easily learn about the transfer options available to them--so they can save time and money as they strive to meet their educational goals. This study, conducted by the Western Interstate Commission for Higher Education Cooperative for Educational Technologies (WCET), is one component of…

  17. The Wired Patient: Patterns of Electronic Patient Portal Use Among Patients With Cardiac Disease or Diabetes

    PubMed Central

    Weiner, Jonathan P; Shah, Nirav R; Stewart, Walter F

    2015-01-01

    Background As providers develop an electronic health record–based infrastructure, patients are increasingly using Web portals to access their health information and participate electronically in the health care process. Little is known about how such portals are actually used. Objective In this paper, our goal was to describe the types and patterns of portal users in an integrated delivery system. Methods We analyzed 12 months of data from Web server log files on 2282 patients using a Web-based portal to their electronic health record (EHR). We obtained data for patients with cardiovascular disease and/or diabetes who had a Geisinger Clinic primary care provider and were registered “MyGeisinger” Web portal users. Hierarchical cluster analysis was applied to longitudinal data to profile users based on their frequency, intensity, and consistency of use. User types were characterized by basic demographic data from the EHR. Results We identified eight distinct portal user groups. The two largest groups (41.98%, 948/2258 and 24.84%, 561/2258) logged into the portal infrequently but had markedly different levels of engagement with their medical record. Other distinct groups were characterized by tracking biometric measures (10.54%, 238/2258), sending electronic messages to their provider (9.25%, 209/2258), preparing for an office visit (5.98%, 135/2258), and tracking laboratory results (4.16%, 94/2258). Conclusions There are naturally occurring groups of EHR Web portal users within a population of adult primary care patients with chronic conditions. More than half of the patient cohort exhibited distinct patterns of portal use linked to key features. These patterns of portal access and interaction provide insight into opportunities for electronic patient engagement strategies. PMID:25707036

  18. 45 CFR 170.550 - EHR Module certification.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... TECHNOLOGY STANDARDS, IMPLEMENTATION SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY ONC HIT Certification Program § 170.550 EHR Module certification....

  19. 45 CFR 170.550 - EHR Module certification.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... TECHNOLOGY STANDARDS, IMPLEMENTATION SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Permanent Certification Program for HIT § 170.550 EHR...

  20. 45 CFR 170.550 - EHR Module certification.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... TECHNOLOGY STANDARDS, IMPLEMENTATION SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Permanent Certification Program for HIT § 170.550 EHR...

  1. Temoa: An Open Educational Resources Portal to Seek, Investigate and Inquire

    ERIC Educational Resources Information Center

    Gómez-Zermeño, Marcela Georgina; de la Garza, Lorena Yadira Alemán

    2015-01-01

    Temoa is a distributor of knowledge that provides a multilingual public catalog of collections of Open Educational Resources (OER). Temoa seeks to support the educational community to find the resources and materials that meet their needs for teaching and learning, through a specialized search system and collaborative social tools. Temoa was…

  2. Secure portal.

    SciTech Connect

    Nelson, Cynthia Lee

    2007-09-01

    There is a need in security systems to rapidly and accurately grant access of authorized personnel to a secure facility while denying access to unauthorized personnel. In many cases this role is filled by security personnel, which can be very costly. Systems that can perform this role autonomously without sacrificing accuracy or speed of throughput are very appealing. To address the issue of autonomous facility access through the use of technology, the idea of a ''secure portal'' is introduced. A secure portal is a defined zone where state-of-the-art technology can be implemented to grant secure area access or to allow special privileges for an individual. Biometric technologies are of interest because they are generally more difficult to defeat than technologies such as badge swipe and keypad entry. The biometric technologies selected for this concept were facial and gait recognition. They were chosen since they require less user cooperation than other biometrics such as fingerprint, iris, and hand geometry and because they have the most potential for flexibility in deployment. The secure portal concept could be implemented within the boundaries of an entry area to a facility. As a person is approaching a badge and/or PIN portal, face and gait information can be gathered and processed. The biometric information could be fused for verification against the information that is gathered from the badge. This paper discusses a facial recognition technology that was developed for the purposes of providing high verification probabilities with low false alarm rates, which would be required of an autonomous entry control system. In particular, a 3-D facial recognition approach using Fisher Linear Discriminant Analysis is described. Gait recognition technology, based on Hidden Markov Models has been explored, but those results are not included in this paper. Fusion approaches for combining the results of the biometrics would be the next step in realizing the secure portal

  3. Towards the Implementation of an openEHR-based Open Source EHR Platform (a vision paper).

    PubMed

    Pazos Gutiérrez, Pablo

    2015-01-01

    Healthcare Information Systems are a big business. Currently there is an explosion of EHR/EMR products available on the market, and the best tools are really expensive. Many developing countries and healthcare providers cannot access such tools, and for those who can, there is not a clear strategy for the evolution, scaling, and cost of these electronic health products. The lack of standard-based implementations conduct to the creation of isolated information silos that cannot be exploited (i.e. shared between providers to promote a holistic view of each patient's medical history). This paper exposes the main elements behind a Standard-based Open Source EHR Platform that is future-proof and allows to evolve and scale with minimal cost. The proposed EHR Architecture is based on openEHR specifications, adding elements emerged from research and development experiences, leading to a design that can be implemented in any modern technology. Different implementations will be interoperable by design. This Platform will leverage contexts of scarce resources, reusing clinical knowledge, a common set of software components and services.

  4. EHR based Genetic Testing Knowledge Base (iGTKB) Development

    PubMed Central

    2015-01-01

    Background The gap between a large growing number of genetic tests and a suboptimal clinical workflow of incorporating these tests into regular clinical practice poses barriers to effective reliance on advanced genetic technologies to improve quality of healthcare. A promising solution to fill this gap is to develop an intelligent genetic test recommendation system that not only can provide a comprehensive view of genetic tests as education resources, but also can recommend the most appropriate genetic tests to patients based on clinical evidence. In this study, we developed an EHR based Genetic Testing Knowledge Base for Individualized Medicine (iGTKB). Methods We extracted genetic testing information and patient medical records from EHR systems at Mayo Clinic. Clinical features have been semi-automatically annotated from the clinical notes by applying a Natural Language Processing (NLP) tool, MedTagger suite. To prioritize clinical features for each genetic test, we compared odds ratio across four population groups. Genetic tests, genetic disorders and clinical features with their odds ratios have been applied to establish iGTKB, which is to be integrated into the Genetic Testing Ontology (GTO). Results Overall, there are five genetic tests operated with sample size greater than 100 in 2013 at Mayo Clinic. A total of 1,450 patients who was tested by one of the five genetic tests have been selected. We assembled 243 clinical features from the Human Phenotype Ontology (HPO) for these five genetic tests. There are 60 clinical features with at least one mention in clinical notes of patients taking the test. Twenty-eight clinical features with high odds ratio (greater than 1) have been selected as dominant features and deposited into iGTKB with their associated information about genetic tests and genetic disorders. Conclusions In this study, we developed an EHR based genetic testing knowledge base, iGTKB. iGTKB will be integrated into the GTO by providing relevant

  5. Supporting Geoscientists in Partnerships for K-12 Education at NSF

    NASA Astrophysics Data System (ADS)

    Leinen, M.

    2001-12-01

    NSF Directorate for Geosciences (GEO) education activities have evolved over the last decade based on advice from a broad segment of the geosciences community. These activities gained momentum when a Geosciences Education Working Group (GEWG, 1996) recognized the shift from traditional priorities that emphasized only research, to those that support education in geosciences as well. The GEWG report embraced this increased emphasis on education as a component of NSF's role in assuring the long-term health of the geosciences and endorsed the principle that research and education should be well integrated. While many geosciences education activities are funded by the Education and Human Resources Directorate (EHR) of NSF, the GEWG report highlighted the need to have more active participation by research geoscientists in K-12 education activities, and the need to train them to be able to do so. While some roles in education are clearly best left to educational professionals (e.g. large-scale systemic reform projects, pedagogical development at the K-12 level, and many teacher enhancement projects), activities such as undergraduate research, technology advancement, curriculum content development and informal science are ones in which GEO should actively seek to collaborate with programs in EHR. The GEO education program has expanded over the last decade. Our first education activity, Awards to Facilitate Geoscience Education (AFGE), was very successful in attracting some of the leading researchers in geosciences. This program evolved to become the Geoscience Education Program. An important program funded by GEO that developed from community activity is the Digital Library for Earth System Education (DLESE). This program grew out of a joint EHR/GEO award and a series of community workshops. The program will establish an Internet portal for geoscience curricular materials and other teacher resources that will enable further collaboration between the research and education

  6. Same organization, same electronic health records (EHRs) system, different use: exploring the linkage between practice member communication patterns and EHR use patterns in an ambulatory care setting

    PubMed Central

    Leykum, Luci K; McDaniel, Reuben R

    2011-01-01

    Objective Despite efforts made by ambulatory care organizations to standardize the use of electronic health records (EHRs), practices often incorporate these systems into their work differently from each other. One potential factor contributing to these differences is within-practice communication patterns. The authors explore the linkage between within-practice communication patterns and practice-level EHR use patterns. Design Qualitative study of six practices operating within the same multi-specialty ambulatory care organization using the same EHR system. Semistructured interviews and direct observation were conducted with all physicians, nurses, medical assistants, practice managers, and non-clinical staff from each practice. Measurements An existing model of practice relationships was used to analyze communication patterns within the practices. Practice-level EHR use was defined and analyzed as the ways in which a practice uses an EHR as a collective or a group—including the degree of feature use, level of EHR-enabled communication, and frequency that EHR use changes in a practice. Interview and observation data were analyzed for themes. Based on these themes, within-practice communication patterns were categorized as fragmented or cohesive, and practice-level EHR use patterns were categorized as heterogeneous or homogeneous. Practices where EHR use was uniformly high across all users were further categorized as having standardized EHR use. Communication patterns and EHR use patterns were compared across the six practices. Results Within-practice communication patterns were associated with practice-level EHR use patterns. In practices where communication patterns were fragmented, EHR use was heterogeneous. In practices where communication patterns were cohesive, EHR use was homogeneous. Additional analysis revealed that practices that had achieved standardized EHR use (uniformly high EHR use across all users) exhibited high levels of mindfulness and

  7. The openEHR Java reference implementation project.

    PubMed

    Chen, Rong; Klein, Gunnar

    2007-01-01

    The openEHR foundation has developed an innovative design for interoperable and future-proof Electronic Health Record (EHR) systems based on a dual model approach with a stable reference information model complemented by archetypes for specific clinical purposes.A team from Sweden has implemented all the stable specifications in the Java programming language and donated the source code to the openEHR foundation. It was adopted as the openEHR Java Reference Implementation in March 2005 and released under open source licenses. This encourages early EHR implementation projects around the world and a number of groups have already started to use this code. The early Java implementation experience has also led to the publication of the openEHR Java Implementation Technology Specification. A number of design changes to the specifications and important minor corrections have been directly initiated by the implementation project over the last two years. The Java Implementation has been important for the validation and improvement of the openEHR design specifications and provides building blocks for future EHR systems.

  8. A qualitative analysis of EHR clinical document synthesis by clinicians.

    PubMed

    Farri, Oladimeji; Pieckiewicz, David S; Rahman, Ahmed S; Adam, Terrence J; Pakhomov, Serguei V; Melton, Genevieve B

    2012-01-01

    Clinicians utilize electronic health record (EHR) systems during time-constrained patient encounters where large amounts of clinical text must be synthesized at the point of care. Qualitative methods may be an effective approach for uncovering cognitive processes associated with the synthesis of clinical documents within EHR systems. We utilized a think-aloud protocol and content analysis with the goal of understanding cognitive processes and barriers involved as medical interns synthesized patient clinical documents in an EHR system to accomplish routine clinical tasks. Overall, interns established correlations of significance and meaning between problem, symptom and treatment concepts to inform hypotheses generation and clinical decision-making. Barriers identified with synthesizing EHR documents include difficulty searching for patient data, poor readability, redundancy, and unfamiliar specialized terms. Our study can inform recommendations for future designs of EHR clinical document user interfaces to aid clinicians in providing improved patient care. PMID:23304398

  9. Supporting openEHR Java desktop application developers.

    PubMed

    Kashfi, Hajar; Torgersson, Olof

    2011-01-01

    The openEHR community suggests that an appropriate approach for creating a graphical user interface for an openEHR-based application is to generate forms from the underlying archetypes and templates. However, current generation techniques are not mature enough to be able to produce high quality interfaces with good usability. Therefore, developing efficient ways to combine manually designed and developed interfaces to openEHR backends is an interesting alternative. In this study, a framework for binding a pre-designed graphical user interface to an openEHR-based backend is proposed. The proposed framework contributes to the set of options available for developers. In particular we believe that the approach of combining user interface components with an openEHR backend in the proposed way might be useful in situations where the quality of the user interface is essential and for creating small scale and experimental systems.

  10. A framework for predicting EHR adoption attitudes: a physician survey.

    PubMed

    Morton, Mary E; Wiedenbeck, Susan

    2009-09-16

    With a focus on improving the quality of patient care, the President George W. Bush called for electronic health records (EHRs) for all Americans by the year 2014; however, recent estimates for EHR adoption in the ambulatory care environment are just over 10 percent. The objective of this study was to determine the individual characteristics and the social and technical factors that may contribute to physician acceptance of EHRs. This first paper of a two-part study presents a framework grounded in Diffusion of Innovations theory and the Technology Acceptance Model, which was developed using case study and survey methods, and tested using structural equation modeling (SEM). Model variables explained over 73 percent of the variance in attitude toward EHRs, and acceptable model fit was achieved. Lack of user acceptance continues to impede diffusion of EHRs, and this analysis supports the impact that leadership and other organizational changes have on user adoption.

  11. Serna v. Portales: The Plight of Bilingual Education Four Years Later.

    ERIC Educational Resources Information Center

    Martinez, Paul E.

    1979-01-01

    A class action suit brought against a New Mexico school district claiming discrimination against Mexican Americans is reviewed. Accounts of interviews and opinions presented by the district superintendent and other educators and researchers regarding the lack of progress toward improving opportunities for Chicanos through court ordered programs…

  12. Toward the Knowledge Portal: Public Broadcasting and University Continuing Education in the Internet Age.

    ERIC Educational Resources Information Center

    Vedro, Steven R.

    1999-01-01

    Discusses digital technology convergence and its effects on the information and entertainment industries and on public television. Highlights include media-based educational organizations and their place in the knowledge marketplace; relationships between content providers and their suppliers and customers; competition; distance and continuing…

  13. A Portal of Educational Resources: Providing Evidence for Matching Pedagogy with Technology

    ERIC Educational Resources Information Center

    Di Blas, Nicoletta; Fiore, Alessandro; Mainetti, Luca; Vergallo, Roberto; Paolini, Paolo

    2014-01-01

    The TPACK (Technology, Pedagogy and Content Knowledge) model presents the three types of knowledge that are necessary to implement a successful technology-based educational activity. It highlights how the intersections between TPK (Technological Pedagogical Knowledge), PCK (Pedagogical Content Knowledge) and TCK (Technological Content Knowledge)…

  14. The education on landslides through the "BE-SAFE-NET" web-portal on Disaster Awareness.

    NASA Astrophysics Data System (ADS)

    Maquaire, O.; Castaldini, D.; Malet, J.-P.; von Elverfeldt, K.; Pla, F.; Soldati, M.; Greco, R.; Pasuto, A.

    2009-04-01

    The website on Disaster Awareness with the use of the internet "BE-SAFE-NET" is developed within the framework of the FORM-OSE programme (European Training Programme for South, East and West) of the EUR-OPA Major Hazards Agreement, hosted by the European Centre for Disaster Awareness with the use of the internet (BE-SAFE-NET, Nicosia, Cyprus). The website is dedicated for school actors (school-level children, teachers, administrative and technical staff, families and local authorities) in order to: - Inform on regulations, on tools for raising awareness for natural and man-made risks and on preventative measures; - Train children, teachers, administrative and technical staff and local authorities; - Produce interactive figures, photographs, videos and games; - Interact with newsgroups and electronic conferences. Together with the EUR-OPA Centre of Nicosia, the project associates several centres of the Major Hazards Agreement network: the European University for the Cultural Heritage (CUEBC) of Ravello (Italy) the European Centre for Risk Prevention (ECRP) of Sofia (Bulgaria), and the European Centre on Geomorphological Hazards (CERG) of Strasbourg (France). "BE-SAFE-NET" is defined as a network among European countries in order to provide e-learning material on natural hazards and risks primarily for schools (secondary school teachers), but also for the public in general. On the webpage, teachers, pupils and the interested public should find information on disaster prevention, preparation, immediate reaction and rehabilitation. The aim of the paper is to present the structure and the organisation of the web-portal following the pilot project focused on landslides and managed by CERG. Some examples of landslides pedagogical material are also presented. The website is structured in five main sections: 1. About the initiative; 2. Definition of common concepts (e.g. hazard (natural and man made), vulnerability, risk, disaster); 3. Pedagogical material (e.g. case

  15. Characteristics of Patient Portals Developed in the Context of Health Information Exchanges: Early Policy Effects of Incentives in the Meaningful Use Program in the United States

    PubMed Central

    de Bont, Antoinette; van de Klundert, Joris; Rundall, Thomas G

    2014-01-01

    Background In 2014, the Centers for Medicare & Medicaid Services in the United States launched the second stage of its Electronic Health Record (EHR) Incentive Program, providing financial incentives to providers to meaningfully use their electronic health records to engage patients online. Patient portals are electronic means to engage patients by enabling secure access to personal medical records, communication with providers, various self-management tools, and administrative functionalities. Outcomes of patient portals have mainly been reported in large integrated health systems. This may now change as the EHR Incentive Program enables and supports the use of patient portals in other types of health systems. In this paper, we focus on Health Information Exchanges (HIE): entities that facilitate data exchange within networks of independent providers. Objective In response to the EHR Incentive Program, some Health Information Exchanges in the United States are developing patient portals and offering them to their network of providers. Such patient portals hold high value for patients, especially in fragmented health system contexts, due to the portals’ ability to integrate health information from an array of providers and give patients one access point to this information. Our aim was to report on the early effects of the EHR incentives on patient portal development by HIEs. Specifically, we describe the characteristics of these portals, identify factors affecting adoption by providers during the 2013-2014 time frame, and consider what may be the primary drivers of providers’ adoption of patient portals in the future. Methods We identified four HIEs that were developing patient portals as of spring 2014. We collected relevant documents and conducted interviews with six HIE leaders as well as two providers that were implementing the portals in their practices. We performed content analysis on these data to extract information pertinent to our study objectives

  16. Educational Web Portals: Guidelines for Selection and Use. A Guide To Help School District Administrators Assess the Quality, Usefulness and Reliability of Commercially Provided Educational Web Portals Designed for Schools.

    ERIC Educational Resources Information Center

    Burke, Jennifer

    This document describes what a Web portal is (i.e., a Web site that allows access to many resources and services, such as instructional materials, lessons plans, news about current events, instant messaging and e-mail, and the ability to conduct controlled searches). Several questions that school administrators need to consider related to the…

  17. Factors Influencing Student Acceptance and Use of Academic Portals

    ERIC Educational Resources Information Center

    Presley, Adrien; Presley, Theresa

    2009-01-01

    Institutions of higher education have increasing turned to web portals as a way to connect with students. These portals are designed to provide students a centralized point of access to information and services. In spite of the efforts put into developing and maintaining these portals, their use by students can be disappointing. The study…

  18. Considering User Satisfaction in Designing Web-Based Portals.

    ERIC Educational Resources Information Center

    Zazelenchuk, Todd W.; Boling, Elizabeth

    2003-01-01

    Discusses how Web portals can best serve higher education institutions if portal designers first understand and satisfy user needs. Shares findings from a usability study of an Indiana University enterprise portal application, which indicated that many existing interaction design principles still apply. (EV)

  19. 45 CFR 170.550 - EHR Module certification.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... Public Welfare Department of Health and Human Services HEALTH INFORMATION TECHNOLOGY HEALTH INFORMATION TECHNOLOGY STANDARDS, IMPLEMENTATION SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY ONC HIT Certification Program § 170.550 EHR Module...

  20. Using EHR-Linked Biobank Data to Study Metformin Pharmacogenomics

    PubMed Central

    Breitenstein, Matthew K.; Simon, Gyorgy; Ryu, Euijung; Armasu, Sebastian M.; Weinshilboum, Richard M.; Wang, Liewei; Pathak, Jyotishman

    2016-01-01

    Metformin is a commonly prescribed diabetes medication whose mechanism of action is poorly understood. In this study we utilized EHR-linked biobank data to elucidate the impact of genomic variation on glycemic response to metformin. Our study found significant gene- and SNP-level associations within the beta-2 subunit of the heterotrimeric adenosine monophosphate-activated protein kinase complex. Using EHR phenotypes where were able to add additional clarity to ongoing metformin pharmacogenomic dialogue. PMID:25991289

  1. A migration to an openEHR-based clinical application.

    PubMed

    Kashfi, Hajar; Torgersson, Olof

    2009-01-01

    MedView is a suit of clinical applications for recording, retrieving and visualizing patient records, which has been developed and in use for more than ten years. By the introduction of the openEHR architecture, the MedView project started an investigation to migrate from its locally developed framework to openEHR. Issues related to this process, have been discussed in this paper.

  2. 45 CFR 170.470 - Effect of revocation on the certifications issued to complete EHRs and EHR Modules.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Temporary Certification Program for HIT § 170.470 Effect of revocation on the certifications issued to complete EHRs...

  3. 45 CFR 170.570 - Effect of revocation on the certifications issued to Complete EHRs and EHR Module(s).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY ONC HIT Certification Program § 170.570 Effect of revocation on the certifications issued to Complete EHRs and...

  4. 45 CFR 170.470 - Effect of revocation on the certifications issued to complete EHRs and EHR Modules.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Temporary Certification Program for HIT § 170.470 Effect of revocation on the certifications issued to complete EHRs...

  5. 45 CFR 170.470 - Effect of revocation on the certifications issued to complete EHRs and EHR Modules.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Temporary Certification Program for HIT § 170.470 Effect of revocation on the certifications issued to complete EHRs...

  6. 45 CFR 170.570 - Effect of revocation on the certifications issued to Complete EHRs and EHR Module(s).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Permanent Certification Program for HIT § 170.570 Effect of revocation on the certifications issued to Complete EHRs...

  7. 45 CFR 170.470 - Effect of revocation on the certifications issued to complete EHRs and EHR Modules.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Temporary Certification Program for HIT § 170.470 Effect of revocation on the certifications issued to complete EHRs...

  8. 45 CFR 170.570 - Effect of revocation on the certifications issued to Complete EHRs and EHR Module(s).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Permanent Certification Program for HIT § 170.570 Effect of revocation on the certifications issued to Complete EHRs...

  9. 45 CFR 170.470 - Effect of revocation on the certifications issued to complete EHRs and EHR Modules.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Temporary Certification Program for HIT § 170.470 Effect of revocation on the certifications issued to complete EHRs...

  10. 45 CFR 170.570 - Effect of revocation on the certifications issued to Complete EHRs and EHR Module(s).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY ONC HIT Certification Program § 170.570 Effect of revocation on the certifications issued to Complete EHRs and...

  11. App Store for EHRs and Patients Both.

    PubMed

    Franckle, Travers; Haas, Daniel; Mandl, Kenneth D

    2013-01-01

    The Substitutable Medical Applications, Reusable Technologies (SMART) Platforms project ( www.smartplatforms.org ) seeks to develop an iPhone-like health information technology platform with substitutable apps constructed around core services. It is funded by a grant from the Office of the National Coordinator of Health Information Technology's Strategic Health IT Advanced Research Projects (SHARP) Program. SMART technologies enable existing electronic health records and HIT platforms to run substitutable apps. Substitutability is the capability inherent in a system of replacing one application with another of similar functionality. We created a patient-facing SMART instance using the open source Indivo personally controlled health record (PCHR). The SMART "read-only" API has been deployed on multiple systems, including the Cerner installation at Boston Children's Hospital and the World Vista EHR. We sought to SMART-enable Indivo, the open source reference PCHR upon which HealthVault and other PCHRs were modeled. PCHRs provide patients with a secure repository of their health information that can be exposed to apps across a programming interface. We updated the open source Indivo PCHR to support the SMART API, enabling Indivo to act as a patient-facing apps platform, running the same or similar versions of apps that face clinicians.

  12. App Store for EHRs and Patients Both.

    PubMed

    Franckle, Travers; Haas, Daniel; Mandl, Kenneth D

    2013-01-01

    The Substitutable Medical Applications, Reusable Technologies (SMART) Platforms project ( www.smartplatforms.org ) seeks to develop an iPhone-like health information technology platform with substitutable apps constructed around core services. It is funded by a grant from the Office of the National Coordinator of Health Information Technology's Strategic Health IT Advanced Research Projects (SHARP) Program. SMART technologies enable existing electronic health records and HIT platforms to run substitutable apps. Substitutability is the capability inherent in a system of replacing one application with another of similar functionality. We created a patient-facing SMART instance using the open source Indivo personally controlled health record (PCHR). The SMART "read-only" API has been deployed on multiple systems, including the Cerner installation at Boston Children's Hospital and the World Vista EHR. We sought to SMART-enable Indivo, the open source reference PCHR upon which HealthVault and other PCHRs were modeled. PCHRs provide patients with a secure repository of their health information that can be exposed to apps across a programming interface. We updated the open source Indivo PCHR to support the SMART API, enabling Indivo to act as a patient-facing apps platform, running the same or similar versions of apps that face clinicians. PMID:24303239

  13. EHR and data protection issues in Italy.

    PubMed

    Virone, Maria Gabriella

    2012-01-01

    Technological progresses and the changed way to collect, access and use data are at the bottom of the European Commission proposal for a "General Data Protection Regulation" (25 January 2012). Implications of safeguarding privacy and harmonization of existing rules are extremely important also for national Health Systems. Mobility of patients and health professionals as well as cross-border healthcare connected with the increasing use of Information and Communication Technologies in Healthcare Services are modifying traditional medical approaches and applications. New tools, as Electronic Health Records, provide significant benefits as empowering health consumers and minimizing health costs. Anyway, EHRs have limits: for example, they should cause risks for individuals, professionals and institutions in terms of personal injuries and liabilities. In this scenario, it's evident that technical aspects (as health standards and interoperability) are as important as legal and regulatory privacy issues. Presently, mandatory acts on the protection of individuals with regard to the processing of health e-Data still missing at all levels. Italy is adopting binding and non-binding legal documents to tackle the problem. Are they enough?

  14. Assessing the relationship between patient safety culture and EHR strategy.

    PubMed

    Ford, Eric W; Silvera, Geoffrey A; Kazley, Abby S; Diana, Mark L; Huerta, Timothy R

    2016-07-11

    Purpose - The purpose of this paper is to explore the relationship between hospitals' electronic health record (EHR) adoption characteristics and their patient safety cultures. The "Meaningful Use" (MU) program is designed to increase hospitals' adoption of EHR, which will lead to better care quality, reduce medical errors, avoid unnecessary cost, and promote a patient safety culture. To reduce medical errors, hospital leaders have been encouraged to promote safety cultures common to high-reliability organizations. Expecting a positive relationship between EHR adoption and improved patient safety cultures appears sound in theory, but it has yet to be empirically demonstrated. Design/methodology/approach - Providers' perceptions of patient safety culture and counts of patient safety incidents are explored in relationship to hospital EHR adoption patterns. Multi-level modeling is employed to data drawn from the Agency for Healthcare Research and Quality's surveys on patient safety culture (level 1) and the American Hospital Association's survey and healthcare information technology supplement (level 2). Findings - The findings suggest that the early adoption of EHR capabilities hold a negative association to the number of patient safety events reported. However, this relationship was not present in providers' perceptions of overall patient safety cultures. These mixed results suggest that the understanding of the EHR-patient safety culture relationship needs further research. Originality/value - Relating EHR MU and providers' care quality attitudes is an important leading indicator for improved patient safety cultures. For healthcare facility managers and providers, the ability to effectively quantify the impact of new technologies on efforts to change organizational cultures is important for pinpointing clinical areas for process improvements.

  15. Improving HIV/AIDS Knowledge Management Using EHRs

    PubMed Central

    Malmberg, Erik D.; Phan, Thao M.; Harmon, Glynn; Nauert, Richard F.

    2012-01-01

    Background A primary goal for the development of EHRs and EHR-related technologies should be to facilitate greater knowledge management for improving individual and community health outcomes associated with HIV / AIDS. Most of the current developments of EHR have focused on providing data for research, patient care and prioritization of healthcare provider resources in other areas. More attention should be paid to using information from EHRs to assist local, state, national, and international entities engaged in HIV / AIDS care, research and prevention strategies. Unfortunately the technology and standards for HIV-specific reporting modules are still being developed. Methods: A literature search and review supplemented by the author’s own experiences with electronic health records and HIV / AIDS prevention strategies will be used. This data was used to identify both opportunities and challenges for improving public health informatics primarily through the use of latest innovations in EHRs. Qualitative analysis and suggestions are offered for how EHRs can support knowledge management and prevention strategies associated with HIV infection. Results: EHR information, including demographics, medical history, medication and allergies, immunization status, and other vital statistics can help public health practitioners to more quickly identify at-risk populations or environments; allocate scarce resources in the most efficient way; share information about successful, evidenced-based prevention strategies; and increase longevity and quality of life. Conclusion: Local, state, and federal entities need to work more collaboratively with NGOs, community-based organizations, and the private sector to eliminate barriers to implementation including cost, interoperability, accessibility, and information security. PMID:23569643

  16. Assessing the relationship between patient safety culture and EHR strategy.

    PubMed

    Ford, Eric W; Silvera, Geoffrey A; Kazley, Abby S; Diana, Mark L; Huerta, Timothy R

    2016-07-11

    Purpose - The purpose of this paper is to explore the relationship between hospitals' electronic health record (EHR) adoption characteristics and their patient safety cultures. The "Meaningful Use" (MU) program is designed to increase hospitals' adoption of EHR, which will lead to better care quality, reduce medical errors, avoid unnecessary cost, and promote a patient safety culture. To reduce medical errors, hospital leaders have been encouraged to promote safety cultures common to high-reliability organizations. Expecting a positive relationship between EHR adoption and improved patient safety cultures appears sound in theory, but it has yet to be empirically demonstrated. Design/methodology/approach - Providers' perceptions of patient safety culture and counts of patient safety incidents are explored in relationship to hospital EHR adoption patterns. Multi-level modeling is employed to data drawn from the Agency for Healthcare Research and Quality's surveys on patient safety culture (level 1) and the American Hospital Association's survey and healthcare information technology supplement (level 2). Findings - The findings suggest that the early adoption of EHR capabilities hold a negative association to the number of patient safety events reported. However, this relationship was not present in providers' perceptions of overall patient safety cultures. These mixed results suggest that the understanding of the EHR-patient safety culture relationship needs further research. Originality/value - Relating EHR MU and providers' care quality attitudes is an important leading indicator for improved patient safety cultures. For healthcare facility managers and providers, the ability to effectively quantify the impact of new technologies on efforts to change organizational cultures is important for pinpointing clinical areas for process improvements. PMID:27298060

  17. Representing knowledge, data and concepts for EHRS using DCM.

    PubMed

    Goossen, William

    2011-01-01

    With the move towards next generations of Electronic Health Record Systems (EHRS), the focus changes from administrative and data retrieval and data entry system capabilities towards clinical functions. The representation of the clinical knowledge and evidence base into EHRS becomes an important asset for health care, with its own challenges. Clinician's do want EHRS support but do not want to standardize care, they do want unified terminology and structured data entry but also free text. In addition, information modelers challenge each other for the best solution, and care pathways and other workflows seem to differ for each situation. Such diverging approaches add complexity to the already difficult situation around Information Technology in health care, the EHRS in particular. This paper argues that a change is necessary to adopt Detailed Clinical Modeling as a method to organize clinical knowledge, represent concepts and define data in such a manner that it allows for semantics to be exchanged without being trapped in a specific technology. DCM help to fulfill the requirements for the enter data once, reuse multiple times paradigm for EHRS. PMID:21893852

  18. Analysis of the process of representing clinical statements for decision-support applications: a comparison of openEHR archetypes and HL7 virtual medical record.

    PubMed

    González-Ferrer, A; Peleg, M; Marcos, M; Maldonado, J A

    2016-07-01

    Delivering patient-specific decision-support based on computer-interpretable guidelines (CIGs) requires mapping CIG clinical statements (data items, clinical recommendations) into patients' data. This is most effectively done via intermediate data schemas, which enable querying the data according to the semantics of a shared standard intermediate schema. This study aims to evaluate the use of HL7 virtual medical record (vMR) and openEHR archetypes as intermediate schemas for capturing clinical statements from CIGs that are mappable to electronic health records (EHRs) containing patient data and patient-specific recommendations. Using qualitative research methods, we analyzed the encoding of ten representative clinical statements taken from two CIGs used in real decision-support systems into two health information models (openEHR archetypes and HL7 vMR instances) by four experienced informaticians. Discussion among the modelers about each case study example greatly increased our understanding of the capabilities of these standards, which we share in this educational paper. Differing in content and structure, the openEHR archetypes were found to contain a greater level of representational detail and structure while the vMR representations took fewer steps to complete. The use of openEHR in the encoding of CIG clinical statements could potentially facilitate applications other than decision-support, including intelligent data analysis and integration of additional properties of data items from existing EHRs. On the other hand, due to their smaller size and fewer details, the use of vMR potentially supports quicker mapping of EHR data into clinical statements.

  19. Analysis of the process of representing clinical statements for decision-support applications: a comparison of openEHR archetypes and HL7 virtual medical record.

    PubMed

    González-Ferrer, A; Peleg, M; Marcos, M; Maldonado, J A

    2016-07-01

    Delivering patient-specific decision-support based on computer-interpretable guidelines (CIGs) requires mapping CIG clinical statements (data items, clinical recommendations) into patients' data. This is most effectively done via intermediate data schemas, which enable querying the data according to the semantics of a shared standard intermediate schema. This study aims to evaluate the use of HL7 virtual medical record (vMR) and openEHR archetypes as intermediate schemas for capturing clinical statements from CIGs that are mappable to electronic health records (EHRs) containing patient data and patient-specific recommendations. Using qualitative research methods, we analyzed the encoding of ten representative clinical statements taken from two CIGs used in real decision-support systems into two health information models (openEHR archetypes and HL7 vMR instances) by four experienced informaticians. Discussion among the modelers about each case study example greatly increased our understanding of the capabilities of these standards, which we share in this educational paper. Differing in content and structure, the openEHR archetypes were found to contain a greater level of representational detail and structure while the vMR representations took fewer steps to complete. The use of openEHR in the encoding of CIG clinical statements could potentially facilitate applications other than decision-support, including intelligent data analysis and integration of additional properties of data items from existing EHRs. On the other hand, due to their smaller size and fewer details, the use of vMR potentially supports quicker mapping of EHR data into clinical statements. PMID:27209183

  20. Portal radiation monitor

    DOEpatents

    Kruse, Lyle W.

    1985-01-01

    A portal radiation monitor combines 0.1% FAR with high sensitivity to special nuclear material. The monitor utilizes pulse shape discrimination, dynamic compression of the photomultiplier output and scintillators sized to maintain efficiency over the entire portal area.

  1. Portal radiation monitor

    DOEpatents

    Kruse, L.W.

    1982-03-23

    A portal radiation monitor combines .1% FAR with high sensitivity to special nuclear material. The monitor utilizes pulse shape discrimination, dynamic compression of the photomultiplier output and scintillators sized to maintain efficiency over the entire portal area.

  2. Cirrhosis and Portal Hypertension

    MedlinePlus

    MENU Return to Web version Cirrhosis and Portal Hypertension Overview What is cirrhosis? In people who have ... lead to coma and death. What is portal hypertension? Normally, blood is carried to the liver by ...

  3. Secondary Use of EHR: Data Quality Issues and Informatics Opportunities.

    PubMed

    Botsis, Taxiarchis; Hartvigsen, Gunnar; Chen, Fei; Weng, Chunhua

    2010-03-01

    Given the large-scale deployment of Electronic Health Records (EHR), secondary use of EHR data will be increasingly needed in all kinds of health services or clinical research. This paper reports some data quality issues we encountered in a survival analysis of pancreatic cancer patients. Using the clinical data warehouse at Columbia University Medical Center in the City of New York, we mined EHR data elements collected between 1999 and 2009 for a cohort of pancreatic cancer patients. Of the 3068 patients who had ICD-9-CM diagnoses for pancreatic cancer, only 1589 had corresponding disease documentation in pathology reports. Incompleteness was the leading data quality issue; many study variables had missing values to various degrees. Inaccuracy and inconsistency were the next common problems. In this paper, we present the manifestations of these data quality issues and discuss some strategies for using emerging informatics technologies to solve these problems.

  4. The Advent of Portals.

    ERIC Educational Resources Information Center

    Jackson, Mary E.

    2002-01-01

    Explains portals as tools that gather a variety of electronic information resources, including local library resources, into a single Web page. Highlights include cross-database searching; integration with university portals and course management software; the ARL (Association of Research Libraries) Scholars Portal Initiative; and selected vendors…

  5. Evaluating Open Source Portals

    ERIC Educational Resources Information Center

    Goh, Dion; Luyt, Brendan; Chua, Alton; Yee, See-Yong; Poh, Kia-Ngoh; Ng, How-Yeu

    2008-01-01

    Portals have become indispensable for organizations of all types trying to establish themselves on the Web. Unfortunately, there have only been a few evaluative studies of portal software and even fewer of open source portal software. This study aims to add to the available literature in this important area by proposing and testing a checklist for…

  6. Emotion and ambulatory EHR in the ARRA era.

    PubMed

    Berlin, Amy

    2010-01-01

    There is a growing focus in change management literature on the role of emotion in managing change. Barriers to adoption and effective implementation of ambulatory EHR-ranging from technical to financial to logistical-are well-described in the health-care IT literature. In the ARRA era, ambulatory practices are under increasing pressure to overcome these barriers. This article explores the emotional barriers to EHR adoption and implementation in ambulatory settings, synthesizing ideas drawn from business and psychology literature on emotion in organizational change. Key strategies for assessing and addressing these barriers are outlined.

  7. Don't take your EHR to heaven, donate it to science: legal and research policies for EHR post mortem.

    PubMed

    Huser, Vojtech; Cimino, James J

    2013-01-01

    Electronic Health Records (EHR) represent a valuable research source. We explore legal and research policies governing EHR use after a patient's death. We describe how the EHR is used after patient's death and how deceased status impacts laws and regulations governing such record. We explore the patient consent mechanism that would support creation of a separate deceased subject integrated data repository (dsIDR) and discuss potential benefit of such repository in comparison with existing query tools, such as the i2b2 cohort estimation query tool, which operate under IRB exemption for reviews preparatory for research. Governance of dsIDR data is compared to regulatory frameworks governing post-mortem management of tissues, organs and corpses as well as digital afterlife of non-healthcare private data. PMID:24303243

  8. Don't take your EHR to heaven, donate it to science: legal and research policies for EHR post mortem.

    PubMed

    Huser, Vojtech; Cimino, James J

    2014-01-01

    Recently, an important public debate emerged about the digital afterlife of any personal data stored in the cloud. Such debate brings also to attention the importance of transparent management of electronic health record (EHR) data of deceased patients. In this perspective paper, we look at legal and regulatory policies for EHR data post mortem. We analyze observational research situations using EHR data that do not require institutional review board approval. We propose creation of a deceased subject integrated data repository (dsIDR) as an effective tool for piloting certain types of research projects. We highlight several dsIDR challenges in proving death status, informed consent, obtaining data from payers and healthcare providers and the involvement of next of kin. PMID:23966483

  9. Noncirrhotic Portal Hypertension

    PubMed Central

    Rajekar, Harshal; Vasishta, Rakesh K; Chawla, Yogesh K; Dhiman, Radha K

    2011-01-01

    Portal hypertension is characterized by an increase in portal pressure (> 10 mmHg) and could be a result of cirrhosis of the liver or of noncirrhotic diseases. When portal hypertension occurs in the absence of liver cirrhosis, noncirrhotic portal hypertension (NCPH) must be considered. The prognosis of this disease is much better than that of cirrhosis. Noncirrhotic diseases are the common cause of portal hypertension in developing countries, especially in Asia. NCPH is a heterogeneous group of diseases that is due to intrahepatic or extrahepatic etiologies. In general, the lesions in NCPH are vascular in nature and can be classified based on the site of resistance to blood flow. In most cases, these disorders can be explained by endothelial cell lesions, intimal thickening, thrombotic obliterations, or scarring of the intrahepatic portal or hepatic venous circulation. Many different conditions can determine NCPH through the association of these various lesions in various degrees. Many clinical manifestations of NCPH result from the secondary effects of portal hypertension. Patients with NCPH present with upper gastrointestinal bleeding, splenomegaly, ascites after gastrointestinal bleeding, features of hypersplenism, growth retardation, and jaundice due to portal hypertensive biliopathy. Other sequelae include hyperdynamic circulation, pulmonary complications, and other effects of portosystemic collateral circulation like portosystemic encephalopathy. At present, pharmacologic and endoscopic treatments are the treatments of choice for portal hypertension. The therapy of all disorders causing NCPH involves the reduction of portal pressure by pharmacotherapy or portosystemic shunting, apart from prevention and treatment of complications of portal hypertension. PMID:25755321

  10. Remote Sensing, New Media and Scientific Literacy for Competence Oriented School Education - A New Integrated Learning Portal

    NASA Astrophysics Data System (ADS)

    Hodam, H.; Goetzke, R.; Rinow, A.; Voß, K.

    2012-04-01

    The project FIS - Fernerkundung in Schulen (German for "Remote Sensing in Schools") - aims at a better integration of remote sensing in school lessons. Respectively, the overall ob-jective is to teach pupils from primary school up to high-school graduation basics and fields of application of remote sensing. Working with remote sensing data opens up new and modern ways of teaching. Therefore many teachers have great interest in the subject "remote sensing", being motivated to integrate this topic into teaching, provided that the curriculum is con-sidered. In many cases, this encouragement fails because of confusing information, which ruins all good intentions. For this reason, a comprehensive and well structured learning portal on the subject remote sensing is developed. This will allow teachers and pupils to have a structured initial understanding of the topic. Recognizing that in-depth use of satellite imagery can only be achieved by the means of computer aided learning methods, a sizeable number of e-Learning contents have been created throughout the last 5 years since the project's kickoff which are now integrated into the learning portal. Three main sections form the backbone of the developed learning portal. 1. The "Teaching Materials" section provides registered teachers with interactive lessons to convey curriculum relevant topics through remote sensing. They are able to use the implemented management system to create classes and enregister pupils, keep track of their progresses and control results of the conducted lessons. Abandoning the functio-nalities of the management system the lessons are also available to non-registered us-ers. 2. Pupils and Teachers can investigate further into remote sensing in the "Research" sec-tion, where a knowledge base alongside a satellite image gallery offer general back-ground information on remote sensing and the provided lessons in a semi interactive manner. 3. The "Analysis Tools" section offers means to further

  11. Flexible information storage in MUDR(II) EHR.

    PubMed

    Spidlen, Josef; Hanzlícek, Petr; Ríha, Antonin; Zvárová, Jana

    2006-01-01

    An important research task of the EuroMISE Centre is the applied research in the field of electronic health record (EHR) design including electronic medical guidelines and intelligent systems for data mining and decision support. The research in this field was inspired by several European projects. We have proposed a mathematical meta-description of a flexible information storage model based on the experience gathered in cooperation in those projects. In this model, we use two basic structures called a knowledge base and data files. We describe those two structures using the graph theory concepts. Furthermore, we use logical formulas to express conditions that should be valid. Additionally, we present a description of a global system architecture of a 3-tier EHR application with interfaces based on the latest technologies; predominately on Web Services, SOAP, XML, HTTP, CORBA, etc. According to our experience and test results gained from the MUDR EHR usage, we describe an open universal solution, which can be applied as the EHR kernel of hospital information systems. To realize this approach in a daily practice for health professionals we have started a co-operative project with clinical information systems developers. Within that project we are developing a new system for continual shared health care.

  12. Analysis of Search on Clinical Narrative within the EHR

    ERIC Educational Resources Information Center

    Natarajan, Karthik

    2012-01-01

    Electronic Health Records (EHRs) are used increasingly in the hospital and outpatient settings, and patients are amassing digitized clinical information. On one hand, aggregating all the patient's clinical information can greatly assist health care workers in making sound decisions. On the other hand, it can result in information overload,…

  13. Utilization and outcomes of Missouri Medicaid's EHR: CyberAccess.

    PubMed

    Berringer, Robert A; Smith, Jeff C; Smith, Jeffrey Charles; Brokaw, Deborah K; Oestreich, George L

    2008-11-06

    CyberAccess is MO HealthNet's web-based electronic health record solution. Our objective is to characterize the utilization of CyberAccess by physicians caring for MO HealthNet recipients. Our results demonstrate that the CyberAccess EHR solution for MO HealthNet has been a highly utilized tool in the care of its recipients.

  14. 42 CFR 495.210 - Meaningful EHR user attestation.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Meaningful EHR user attestation. 495.210 Section 495.210 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD...

  15. 42 CFR 495.210 - Meaningful EHR user attestation.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... INCENTIVE PROGRAM Requirements Specific to Medicare Advantage (MA) Organizations § 495.210 Meaningful EHR user attestation. (a) Qualifying MA organizations are required to attest, in a form and manner specified by CMS, that each qualifying MA EP and qualifying MA-affiliated eligible hospitals is a...

  16. Bringing electronic patient records into health professional education: towards an integrative framework.

    PubMed

    Kushniruk, Andre W; Borycki, Elizabeth M; Armstrong, Brian; Joe, Ron; Otto, Tony

    2009-01-01

    In this paper we discuss our approach for integrating electronic patient records into health professional education. Electronic patient record (EPR) use is increasing globally. The EPR is considered the cornerstone of the modernization and streamlining of healthcare worldwide. However, despite the importance of the EPR, health professional education in much of the world provides health professional students (who will become the practicing health professionals of the future) with limited access or knowledge about the EPR. New ways of exposing students to EPRs will be needed in order to ensure that health professionals will adopt and use this complex technology wisely and effect the positive benefits EPRs are expected to bring to healthcare globally. In this paper we describe: (a) a framework we have developed for integrating EPRs into health professional education and (b) an innovative Web portal, known as the University of Victoria Electronic Health Record (EHR) Educational Portal (which houses a number of EPRs) that can be used to explore the integration of EPRs in health professional education. It is hoped that adoption and use of EPRs will ultimately be improved through the use of the portal to allow students virtual and ubiquitous access to example EPRs, coupled with principled educational approaches for integrating EPR technology into health professional curricula.

  17. A Graph Based Methodology for Temporal Signature Identification from EHR

    PubMed Central

    Wang, Fei; Liu, Chuanren; Wang, Yajuan; Hu, Jianying; Yu, Guoqiang

    2015-01-01

    Data driven technology is believed to be a promising technique for transforming the current status of healthcare. Electronic Health Records (EHR) is one of the main carriers for conducting the data driven healthcare research, where the goal is to derive insights from healthcare data and utilize such insights to improve the quality of care delivery. Due to the progression nature of human disease, one important aspect for analyzing healthcare data is temporality, which suggests the temporal relationships among different healthcare events and how their values evolve over time. Sequential pattern mining is a popular tool to extract time-invariant patterns from discrete sequences and has been applied in analyzing EHR before. However, due to the complexity of EHR, those approaches usually suffers from the pattern explosion problem, which means that a huge number of patterns will be detected with improper setting of the support threshold. To address this challenge, in this paper, we develop a novel representation, namely the temporal graph, for event sequences like EHR, wherein the nodes are medical events and the edges indicate the temporal relationships among those events in patient EHRs. Based on the temporal graph representation, we further develop an approach for temporal signature identification to identify the most significant and interpretable graph bases as temporal signatures, and the expressing coefficients can be treated as the embeddings of the patients in such temporal signature space. Our temporal signature identification framework is also flexible to incorporate semi-supervised/supervised information. We validate our framework on two real-world tasks. One is predicting the onset risk of heart failure. The other is predicting the risk of heart failure related hospitalization for patients with COPD pre-condition. Our results show that the prediction performance in both tasks can be improved by the proposed approaches. PMID:26958267

  18. EHR query language (EQL)--a query language for archetype-based health records.

    PubMed

    Ma, Chunlan; Frankel, Heath; Beale, Thomas; Heard, Sam

    2007-01-01

    OpenEHR specifications have been developed to standardise the representation of an international electronic health record (EHR). The language used for querying EHR data is not as yet part of the specification. To fill in this gap, Ocean Informatics has developed a query language currently known as EHR Query Language (EQL), a declarative language supporting queries on EHR data. EQL is neutral to EHR systems, programming languages and system environments and depends only on the openEHR archetype model and semantics. Thus, in principle, EQL can be used in any archetype-based computational context. In the EHR context described here, particular queries mention concepts from the openEHR EHR Reference Model (RM). EQL can be used as a common query language for disparate archetype-based applications. The use of a common RM, archetypes, and a companion query language, such as EQL, semantic interoperability of EHR information is much closer. This paper introduces the EQL syntax and provides example clinical queries to illustrate the syntax. Finally, current implementations and future directions are outlined.

  19. Intercomprehension: A Portal to Teachers' Intercultural Sensitivity

    ERIC Educational Resources Information Center

    Pinho, Ana Sofia

    2015-01-01

    The development of opportunities for teachers' professional development in plurilingual and intercultural education is a key issue in language teacher education and "intercomprehension" (IC) can provide a potential portal for the development of teachers' intercultural sensitivity. Particularly relevant to this is the creation of powerful…

  20. The Effect of a Learning Environment Using an Electronic Health Record (EHR) on Undergraduate Nursing Students' Behaviorial Intention to Use an EHR

    ERIC Educational Resources Information Center

    Foley, Shawn

    2011-01-01

    The purpose of this study was to explore the effect of a learning environment using an Electronic Health Record (EHR) on undergraduate nursing students' behavioral intention (BI) to use an EHR. BI is defined by Davis (1989) in the Technology Acceptance Model (TAM) as the degree to which a person has formulated conscious plans to perform or not…

  1. Automated Transformation of openEHR Data Instances to OWL.

    PubMed

    Haarbrandt, Birger; Jack, Thomas; Marschollek, Michael

    2016-01-01

    Standard-based integration and semantic enrichment of clinical data originating from electronic medical records has shown to be critical to enable secondary use. To facilitate the utilization of semantic technologies on clinical data, we introduce a methodology to enable automated transformation of openEHR-based data to Web Ontology Language (OWL) individuals. To test the correctness of the implementation, de-identified data of 229 patients of the pediatric intensive care unit of Hannover Medical School has been transformed into 2.983.436 individuals. Querying of the resulting ontology for symptoms of the systemic inflammatory response syndrome (SIRS) yielded the same result set as a SQL query on an openEHR-based clinical data repository.

  2. Automated Transformation of openEHR Data Instances to OWL.

    PubMed

    Haarbrandt, Birger; Jack, Thomas; Marschollek, Michael

    2016-01-01

    Standard-based integration and semantic enrichment of clinical data originating from electronic medical records has shown to be critical to enable secondary use. To facilitate the utilization of semantic technologies on clinical data, we introduce a methodology to enable automated transformation of openEHR-based data to Web Ontology Language (OWL) individuals. To test the correctness of the implementation, de-identified data of 229 patients of the pediatric intensive care unit of Hannover Medical School has been transformed into 2.983.436 individuals. Querying of the resulting ontology for symptoms of the systemic inflammatory response syndrome (SIRS) yielded the same result set as a SQL query on an openEHR-based clinical data repository. PMID:27139386

  3. The Sydney West Knowledge Portal: Evaluating the Growth of a Knowledge Portal to Support Translational Research

    PubMed Central

    2016-01-01

    Background The Sydney West Translational Cancer Research Centre is an organization funded to build capacity for translational research in cancer. Translational research is essential for ensuring the integration of best available evidence into practice and for improving patient outcomes. However, there is a low level of awareness regarding what it is and how to conduct it optimally. One solution to addressing this gap is the design and deployment of web-based knowledge portals to disseminate new knowledge and engage with and connect dispersed networks of researchers. A knowledge portal is an web-based platform for increasing knowledge dissemination and management in a specialized area. Objective To measure the design and growth of an web-based knowledge portal for increasing individual awareness of translational research and to build organizational capacity for the delivery of translational research projects in cancer. Methods An adaptive methodology was used to capture the design and growth of an web-based knowledge portal in cancer. This involved stakeholder consultations to inform initial design of the portal. Once the portal was live, site analytics were reviewed to evaluate member usage of the portal and to measure growth in membership. Results Knowledge portal membership grew consistently for the first 18 months after deployment, before leveling out. Analysis of site metrics revealed members were most likely to visit portal pages with community-generated content, particularly pages with a focus on translational research. This was closely followed by pages that disseminated educational material about translational research. Conclusions Preliminary data from this study suggest that knowledge portals may be beneficial tools for translating new evidence and fostering an environment of communication and collaboration. PMID:27357641

  4. The EHR evolution: new priorities and implementation challenges.

    PubMed

    Daly, Rich

    2016-02-01

    Five types of key leadership decisions can help smooth the process of selecting and implementing EHR systems and upgrades: Balancing choices with population health priorities. Considering approaches to reduce costs and ease implementation. Prioritizing steps to ease physicians' first six months with the system. Implementing all at once to eliminate "clunky" workflows. Staggering a launch to identify quick-to-value features and functions. PMID:26999976

  5. Semantic processing of EHR data for clinical research.

    PubMed

    Sun, Hong; Depraetere, Kristof; De Roo, Jos; Mels, Giovanni; De Vloed, Boris; Twagirumukiza, Marc; Colaert, Dirk

    2015-12-01

    There is a growing need to semantically process and integrate clinical data from different sources for clinical research. This paper presents an approach to integrate EHRs from heterogeneous resources and generate integrated data in different data formats or semantics to support various clinical research applications. The proposed approach builds semantic data virtualization layers on top of data sources, which generate data in the requested semantics or formats on demand. This approach avoids upfront dumping to and synchronizing of the data with various representations. Data from different EHR systems are first mapped to RDF data with source semantics, and then converted to representations with harmonized domain semantics where domain ontologies and terminologies are used to improve reusability. It is also possible to further convert data to application semantics and store the converted results in clinical research databases, e.g. i2b2, OMOP, to support different clinical research settings. Semantic conversions between different representations are explicitly expressed using N3 rules and executed by an N3 Reasoner (EYE), which can also generate proofs of the conversion processes. The solution presented in this paper has been applied to real-world applications that process large scale EHR data.

  6. Using EHRs and Machine Learning for Heart Failure Survival Analysis

    PubMed Central

    Panahiazar, Maryam; Taslimitehrani, Vahid; Pereira, Naveen; Pathak, Jyotishman

    2016-01-01

    “Heart failure (HF) is a frequent health problem with high morbidity and mortality, increasing prevalence and escalating healthcare costs” [1]. By calculating a HF survival risk score based on patient-specific characteristics from Electronic Health Records (EHRs), we can identify high-risk patients and apply individualized treatment and healthy living choices to potentially reduce their mortality risk. The Seattle Heart Failure Model (SHFM) is one of the most popular models to calculate HF survival risk that uses multiple clinical variables to predict HF prognosis and also incorporates impact of HF therapy on patient outcomes. Although the SHFM has been validated across multiple cohorts [1–5], these studies were primarily done using clinical trials databases that do not reflect routine clinical care in the community. Further, the impact of contemporary therapeutic interventions, such as beta-blockers or defibrillators, was incorporated in SHFM by extrapolation from external trials. In this study, we assess the performance of SHFM using EHRs at Mayo Clinic, and sought to develop a risk prediction model using machine learning techiniques that applies routine clinical care data. Our results shows the models which were built using EHR data are more accurate (11% improvement in AUC) with the convenience of being more readily applicable in routine clinical care. Furthermore, we demonstrate that new predictive markers (such as co-morbidities) when incorporated into our models improve prognostic performance significantly (8% improvement in AUC). PMID:26262006

  7. Semantic processing of EHR data for clinical research.

    PubMed

    Sun, Hong; Depraetere, Kristof; De Roo, Jos; Mels, Giovanni; De Vloed, Boris; Twagirumukiza, Marc; Colaert, Dirk

    2015-12-01

    There is a growing need to semantically process and integrate clinical data from different sources for clinical research. This paper presents an approach to integrate EHRs from heterogeneous resources and generate integrated data in different data formats or semantics to support various clinical research applications. The proposed approach builds semantic data virtualization layers on top of data sources, which generate data in the requested semantics or formats on demand. This approach avoids upfront dumping to and synchronizing of the data with various representations. Data from different EHR systems are first mapped to RDF data with source semantics, and then converted to representations with harmonized domain semantics where domain ontologies and terminologies are used to improve reusability. It is also possible to further convert data to application semantics and store the converted results in clinical research databases, e.g. i2b2, OMOP, to support different clinical research settings. Semantic conversions between different representations are explicitly expressed using N3 rules and executed by an N3 Reasoner (EYE), which can also generate proofs of the conversion processes. The solution presented in this paper has been applied to real-world applications that process large scale EHR data. PMID:26515501

  8. Barriers for Adopting Electronic Health Records (EHRs) by Physicians

    PubMed Central

    Ajami, Sima

    2013-01-01

    CONFLICT OF INTEREST: NONE DECLARED Introduction Electronic Medical Records (EMRs) are computerized medical information systems that collect, store and display patient information. They are means to create legible and organized recordings and to access clinical information about individual patients. Despite of the positive effects of the EMRs usage in medical practices, the adoption rate of such systems is still low and meets resistance from physicians. The EHRs represent an essential tool for improving both in the safety and quality of health care, though physicians must actively use these systems to accrue the benefits. This study was unsystematic-review. Aim The aim of this study was to express barriers perceived y physicians to the adoption of the EHRs. Method of the study This study was non-systematic reviewed which the literature was searched on barriers perceived by physicians to the adoption of Electronic Health Records (EHRs) with the help of library, books, conference proceedings, data bank, and also searches engines available at Google, Google scholar. Discussion For our searches, we employed the following keywords and their combinations: physicians, electronic medical record, electronic health record, barrier, and adoption in the searching areas of title, keywords, abstract, and full text. In this study, more than 100 articles and reports were collected and 27 of them were selected based on their relevancy. Electronic health record use requires the presence of certain user and system attributes, support from others, and numerous organizational and environment facilitators. PMID:24058254

  9. Portal: Your Door to World Languages and Cultures

    ERIC Educational Resources Information Center

    Elliott, Don; Lawton, Rachele

    2009-01-01

    Portal: Your Door to World Languages and Cultures was a series of public cultural events, in a variety of formats, created through a new partnership between the credit and continuing education (noncredit) foreign language programs at the Community College of Baltimore County (CCBC). Portal was designed to cultivate interest in foreign languages…

  10. Understanding Patient Portal Use: Implications for Medication Management

    PubMed Central

    Mayberry, Lindsay Satterwhite; Wallston, Kenneth A; Johnson, Kevin B; Elasy, Tom A

    2013-01-01

    Background The Internet can be leveraged to provide disease management support, including medication adherence promotion that, when tailored, can effectively improve adherence to medications. The growing adoption of patient portals represents an opportunity to support medication management and adherence more broadly, but virtually no data exist about the real and potential impact of existing portals on these outcomes. Objective We sought to (1) understand who uses an existing patient portal and reasons for use and nonuse, (2) understand how portal users are using a portal to manage their medications, and (3) explore participants’ ideas for improving portal functionality for medication management and adherence support. Methods A total of 75 adults with type 2 diabetes participated in a mixed-methods study involving focus groups, a survey, and a medical chart review. We used quantitative data to identify differences between portal users and nonusers, and to test the relationship between the frequency of portal use and glycemic control among users. We used qualitative methods to understand how and why participants use a portal and their ideas for improving its medication management functionality. Results Of the enrolled participants, 81% (61/75) attended a focus group and/or completed a survey; portal users were more likely than nonusers to participate in that capacity (Fisher exact test; P=.01). Users were also more likely than nonusers to be Caucasian/white (Fisher exact test; P<.001), have higher incomes (Fisher exact test; P=.005), and be privately insured (Fisher exact test; P<.001). Users also tended to have more education than nonusers (Mann–Whitney U; P=.05), although this relationship was not significant at P<.05. Among users, more frequent use of a portal was associated with better A1C (Spearman rho =–0.30; P=.02). Reasons for nonuse included not knowing about the portal (n=3), not having access to a computer (n=3), or having a family member serve as

  11. The use of open source and Web2.0 in developing an integrated EHR and e-learning system for the Greek Smoking Cessation Network.

    PubMed

    Konstantinidis, Stathis Th; Konstantinidis, Evdokimos; Nikolaidou, Maria M; Boutou, Afroditi K; Havouzis, Nikos; Argyropoulou, Paraskevi; Bamidis, Panagiotis D

    2009-01-01

    Technologies of information and communication are incrementally integrated with all facets of healthcare practice and education. Although Electronic Health Records (EHRs) have long been used in healthcare the introduction of open source tools has empowered their further expansion of use. Simultaneously the use of Web 2.0 tools has opened up new ways of enhancing both healthcare practice and education. In this paper, we describe our approach towards the development of an integrated system supporting the smoking cessation network initiatives in the Greek public hospitals. The system combines the availability of an open source, web based EHR subsystem, with a Web 2.0 facilitated e-learning component for supporting continuing medical education and promoting public awareness.

  12. Portal Vein Thrombosis

    PubMed Central

    Chawla, Yogesh K.; Bodh, Vijay

    2015-01-01

    Portal vein thrombosis is an important cause of portal hypertension. PVT occurs in association with cirrhosis or as a result of malignant invasion by hepatocellular carcinoma or even in the absence of associated liver disease. With the current research into its genesis, majority now have an underlying prothrombotic state detectable. Endothelial activation and stagnant portal blood flow also contribute to formation of the thrombus. Acute non-cirrhotic PVT, chronic PVT (EHPVO), and portal vein thrombosis in cirrhosis are the three main variants of portal vein thrombosis with varying etiological factors and variability in presentation and management. Procoagulant state should be actively investigated. Anticoagulation is the mainstay of therapy for acute non-cirrhotic PVT, with supporting evidence for its use in cirrhotic population as well. Chronic PVT (EHPVO) on the other hand requires the management of portal hypertension as such and with role for anticoagulation in the setting of underlying prothrombotic state, however data is awaited in those with no underlying prothrombotic states. TIPS and liver transplant may be feasible even in the setting of PVT however proper selection of candidates and type of surgery is warranted. Thrombolysis and thrombectomy have some role. TARE is a new modality for management of HCC with portal vein invasion. PMID:25941431

  13. Tools for Data-Driven Decision Making in Teacher Education: Designing a Portal to Conduct Field Observation Inquiry

    ERIC Educational Resources Information Center

    Swan, Gerry

    2009-01-01

    Knowledge management (KM) and data-driven decision making (DDDM) are terms that are used with more frequency in teacher education. Although accreditation expectations and the increased focus on accountability have pushed these ideas to the forefront, the tools that support them are still not robust. Electronic portfolio assessment has been one…

  14. Space Development Grid Portal

    NASA Technical Reports Server (NTRS)

    Vaziri, Arsi

    2004-01-01

    This viewgraph presentation provides information on the development of a portal to provide secure and distributed grid computing for Payload Operations Integrated Center and Mission Control Center ground services.

  15. Physician Beliefs about the Impact of Meaningful use of the EHR

    PubMed Central

    Ting, D.Y.; Healey, M.; Lipsitz, S.R.; Karson, A.S.; Einbinder, J. S.; Leinen, L.; Suric, V.; Bates, D.W.

    2014-01-01

    Summary Background As adoption and use of electronic health records (EHRs) grows in the United States, there is a growing need in the field of applied clinical informatics to evaluate physician perceptions and beliefs about the impact of EHRs. The meaningful use of EHR incentive program provides a suitable context to examine physician beliefs about the impact of EHRs. Objective Contribute to the sparse literature on physician beliefs about the impact of EHRs in areas such as quality of care, effectiveness of care, and delivery of care. Methods A cross-sectional online survey of physicians at two academic medical centers (AMCs) in the northeast who were preparing to qualify for the meaningful use of EHR incentive program. Results Of the 1,797 physicians at both AMCs who were preparing to qualify for the incentive program, 967 completed the survey for an overall response rate of 54%. Only 23% and 27% of physicians agreed or strongly agreed that meaningful use of the EHR will help them improve the care they personally deliver and improve quality of care respectively. Physician specialty was significantly associated with beliefs; e.g., 35% of primary care physicians agreed or strongly agreed that meaningful use will improve quality of care compared to 26% of medical specialists and 21% of surgical specialists (p=0.009). Satisfaction with outpatient EHR was also significantly related to all belief items. Conclusions Only about a quarter of physicians in our study responded positively that meaningful use of the EHR will improve quality of care and the care they personally provide. These findings are similar to and extend findings from qualitative studies about negative perceptions that physicians hold about the impact of EHRs. Factors outside of the regulatory context, such as physician beliefs, need to be considered in the implementation of the meaningful use of the EHR incentive program. PMID:25298817

  16. Building Your Campus Portal: Advice from the Field.

    ERIC Educational Resources Information Center

    Krebs, Arlene

    2001-01-01

    Discusses portal technology in higher education, including planning, design, technical, and financial issues. Highlights include determining the customers; marketing possibilities for the university; ownership issues; data design; effective cost structuring; security issues; adaptability; content; and customer input and feedback. (LRW)

  17. Validating EHR documents: automatic schematron generation using archetypes.

    PubMed

    Pfeiffer, Klaus; Duftschmid, Georg; Rinner, Christoph

    2014-01-01

    The goal of this study was to examine whether Schematron schemas can be generated from archetypes. The openEHR Java reference API was used to transform an archetype into an object model, which was then extended with context elements. The model was processed and the constraints were transformed into corresponding Schematron assertions. A prototype of the generator for the reference model HL7 v3 CDA R2 was developed and successfully tested. Preconditions for its reusability with other reference models were set. Our results indicate that an automated generation of Schematron schemas is possible with some limitations.

  18. Healthcare professionals' experiences with EHR-system access control mechanisms.

    PubMed

    Faxvaag, Arild; Johansen, Trond S; Heimly, Vigdis; Melby, Line; Grimsmo, Anders

    2011-01-01

    Access control mechanisms might influence on the information seeking and documentation behavior of clinicians. In this study, we have surveyed healthcare professionals in nursing homes and hospitals on their attitudes to, and experiences with using access control mechanisms. In some situations, the access control mechanisms of the EHR system made clinicians postpone documentation work. Their practice of reading what others have documented was also influenced. Not all clinicians logged out of the system when they left a workstation, and some clinicians reported to do some of their documentation work in the name of others. The reported practices might have implications for the safety of the patient.

  19. Validating EHR documents: automatic schematron generation using archetypes.

    PubMed

    Pfeiffer, Klaus; Duftschmid, Georg; Rinner, Christoph

    2014-01-01

    The goal of this study was to examine whether Schematron schemas can be generated from archetypes. The openEHR Java reference API was used to transform an archetype into an object model, which was then extended with context elements. The model was processed and the constraints were transformed into corresponding Schematron assertions. A prototype of the generator for the reference model HL7 v3 CDA R2 was developed and successfully tested. Preconditions for its reusability with other reference models were set. Our results indicate that an automated generation of Schematron schemas is possible with some limitations. PMID:24825691

  20. 77 FR 8217 - Evaluating the Usability of Electronic Health Record (EHR) Systems

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-14

    ... develop a framework for assessing the usability of health information technology (HIT) systems, EHRs in particular, and performance-oriented user interface design guidelines for EHRs. Manufacturers interested in... invited to contact NIST for information regarding participation, Letters of Understanding and...

  1. National Science Foundation Facilitation of AGU Scientists' K-14 Education and Outreach Activities

    NASA Astrophysics Data System (ADS)

    Leinen, M.; Prendeville, J.

    2002-12-01

    The National Science Foundation encourages the participation of geoscientists in K-14 education and outreach and provides support for that participation through a wide variety of programs. At the most general level, NSF requires that scientists describe the broader impacts of their research in their proposals. While broader impacts are not restricted to education and outreach, this requirement has encouraged many scientists to consider opportunities for K-14 education and outreach. Many NSF-wide programs provide financial support for K-14 education and outreach. Some are long-standing programs like Research Experiences for Undergraduates (REU), which have been used effectively by the geoscience community to introduce undergraduates to our field. Other programs, like CAREER, encourage faculty to develop innovative teaching and curricular approaches and to relate them to their research program. The Education and Human Resources Directorate (EHR) of NSF provides funds for a variety of undergraduate education improvements, and for elementary and secondary education activities. EHR also provides opportunities for informal education that have been used by the geoscience community to develop museum exhibits, IMAX films, television programs, and other high visibility outreach activities. The Directorate for Geosciences (GEO) holds competitions in the Geoscience Education Program and Opportunities to Enhance Diversity in the Geosciences that provide funds focused on development in our own field. Other specialized competitions, like awards associated with the Center for Ocean Science Education Excellence, have targeted the specific K-14 education and outreach needs of portions of our community. Finally, GEO has facilitated the development of the Digital Library for Earth System Education (DLESE) that has established a digital portal to age-appropriate, peer-reviewed curricular material for teachers.

  2. Generation of ELGA-compatible radiology reports from the Vienna Hospital Association's EHR system.

    PubMed

    Haider, Jasmin; Hölzl, Konrad; Toth, Herlinde; Duftschmid, Georg

    2014-01-01

    In the course of setting up the upcoming Austrian national shared EHR system ELGA, adaptors will have to be implemented for the local EHR systems of all participating healthcare providers. These adaptors must be able to transform EHR data from the internal format of the particular local EHR system to the specified format of the ELGA document types and vice versa. In the course of an ongoing diploma thesis we are currently developing a transformation application that shall allow the generation of ELGA-compatible radiology reports from the local EHR system of the Vienna Hospital Association. Up to now a first prototype has been developed that was tested with six radiology reports. It generates technically valid ELGA radiology reports apart from two errors yielded by the ELGA online validator that rather seem to be bugs of the validator. A medical validation of the reports remains to be done. PMID:24825707

  3. Reading and Writing: Qualitative Analysis of Pharmacists’ Use of the EHR when Preparing for Team Rounds

    PubMed Central

    Nelson, Scott D.; LaFleur, Joanne; Fiol, Guilherme Del; Evans, R. Scott; Weir, Charlene R.

    2015-01-01

    In the collaborative hospital environment, pharmacists are important members of the healthcare team, yet compared to physicians and nurses, little is known about pharmacists’ information needs or how they interact with the electronic health record (EHR). We directly observed seven clinical inpatient pharmacists as they interacted with the EHR preparing for clinical rounds using an eye-tracking camera and contextual inquiry. Pharmacists spent 50% of their time reading information from the EHR, such as notes and medication lists, and 27% of their time copying EHR data onto paper, such as patient history and laboratory results. In an environment where minutes count, the results of this study can help inform the development of CDS tools and/or EHR designs to facilitate the information needs of the pharmacists in providing care for their patients. PMID:26958231

  4. Building a logical EHR architecture based on ISO 13606 standard and semantic web technologies.

    PubMed

    Santos, Marcelo R; Bax, Marcello P; Kalra, Dipak

    2010-01-01

    Among the existing patterns of EHR interoperability, the ISO 13606 standard is an important consideration. It is believed that the use of this norm, in conjunction with semantic technologies, may aid in the construction of a robust architecture, keeping in mind the challenges of semantic interoperability. The objective of this paper is to present a proposal for an EHR architecture, based on ISO 13606 and on the utilization of semantic technologies, for a real EHR scenario. In order to accomplish that, a real EHR scenario is described, as well as its main interoperability requirements and a candidate architecture is proposed to solve the presented challenges of interoperability. The ability of the ISO 13606 EHR reference model to accommodate the scenario was highlighted, together with the support provided by the use of the ontology specification languages--RDF and OWL--in respect to the maintenance of a controlled vocabulary.

  5. 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…

  6. It's a Bird. It's a Plane. It's a...Portal?: What Is a Campus Portal Strategy and Why Do You Need One?

    ERIC Educational Resources Information Center

    Katz, Richard N.

    2000-01-01

    Describes the results of a recent forum, and subsequent conference, on the subject of portals and e-business in higher education. Participants, who included financial and information technology professionals, agreed that implementation of portal strategy is necessary, perilous, and difficult in higher education. Colleges and universities will have…

  7. Radioisotopic flow scanning for portal blood flow and portal hypertension

    SciTech Connect

    Hesdorffer, C.S.; Bezwoda, W.R.; Danilewitz, M.D.; Esser, J.D.; Tobias, M.

    1987-08-01

    The use of a simple, noninvasive, isotope scanning technique for the determination of relative portal blood flow and detection of portal hypertension is described. Using this technique the presence of portal hypertension was demonstrated in seven of nine patients known to have elevated portal venous pressure. By contrast, esophageal varices were demonstrated in only five of these patients, illustrating the potential value of the method. Furthermore, this technique has been adapted to the study of portal blood flow in patients with myeloproliferative disorders with splenomegaly but without disturbances in hepatic architecture. Results demonstrate that the high relative splenic flow resulting from the presence of splenomegaly may in turn be associated with elevated relative portal blood flow and portal hypertension. The theoretic reasons for the development of flow-related portal hypertension and its relationship to splenic blood flow are discussed.

  8. 8. EAST PORTAL AND DECK VIEW, FROM EAST, SHOWING PORTAL ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    8. EAST PORTAL AND DECK VIEW, FROM EAST, SHOWING PORTAL CONFIGURATION AND LATERAL BRACING, STEEL MESH FLOOR, METAL RAILINGS, AND PORTION OF EAST APPROACH - Glendale Road Bridge, Spanning Deep Creek Lake on Glendale Road, McHenry, Garrett County, MD

  9. 7. WEST PORTAL AND DECK VIEW, FROM WEST, SHOWING PORTAL ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    7. WEST PORTAL AND DECK VIEW, FROM WEST, SHOWING PORTAL CONFIGURATION AND LATERAL BRACING, STEEL MESH FLOOR, AND METAL RAILINGS - Glendale Road Bridge, Spanning Deep Creek Lake on Glendale Road, McHenry, Garrett County, MD

  10. Perspective view of south portal. Note how portal angles about ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Perspective view of south portal. Note how portal angles about 5' forward over the approach. - Red Oak Creek Bridge, Spanning (Big) Red Oak Creek, Huel Brown Road (Covered Bridge Road), Woodbury, Meriwether County, GA

  11. Elevation, west portal. Sign on portal reads Watson Mill Bridge, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Elevation, west portal. Sign on portal reads Watson Mill Bridge, est. 1885. - Watson Mill Bridge, Spanning South Fork Broad River, Watson Mill Road, Watson Mill Bridge State Park, Comer, Madison County, GA

  12. Shared Medical Appointments: A Portal for Nutrition and Culinary Education in Primary Care—A Pilot Feasibility Project

    PubMed Central

    Hauser, Michelle E.; Burgess, Jonathan D.; Eisenberg, David M.

    2015-01-01

    Introduction: Diseases linked to obesity such as cardiovascular disease, diabetes, degenerative joint disease, gastroesophageal reflux, and sleep apnea constitute a large portion of primary care visits. Patients with these conditions often lack knowledge, skills, and support needed to maintain health. Shared medical appointments (SMAs) that include culinary skills and nutrition education offer a novel, cost-effective way to address these diseases in primary care. Methods: Adult patients in a primary care practice at a large academic hospital in Boston, Massachusetts, who had at least 1 cardiovascular risk factor were invited to participate in SMAs that included cooking demonstrations and teaching about nutrition in addition to medical management of their conditions. Sessions were conducted by a physician and an assistant in a conference room of a traditional primary care practice as part of a pilot feasibility project. Results: Seventy patients, contributing a total of 156 patient visits, attended 17 nutrition-focused SMAs over a 4-year period. Patients were surveyed after each visit and indicated that they enjoyed the SMAs, would consider alternating SMAs with traditional one-on-one visits, and would recommend SMAs to others. Half would pay out of pocket or a higher copay to attend SMAs. Financially, the practice broke even compared with traditional one-onone office visits. Conclusion: In this feasibility study, chronic disease SMAs conducted with a culinary/nutrition focus were feasible, cost-effective, and well received by patients. Follow-up studies are needed to evaluate short- and long-term outcomes of this SMA model on obesity-related diseases. PMID:26665019

  13. Pregnancy with Portal Hypertension

    PubMed Central

    Aggarwal, Neelam; Negi, Neha; Aggarwal, Aakash; Bodh, Vijay; Dhiman, Radha K.

    2014-01-01

    Even though pregnancy is rare with cirrhosis and advanced liver disease, but it may co-exist in the setting of non-cirrhotic portal hypertension as liver function is preserved but whenever encountered together is a complex clinical dilemma. Pregnancy in a patient with portal hypertension presents a special challenge to the obstetrician as so-called physiological hemodynamic changes associated with pregnancy, needed for meeting demands of the growing fetus, worsen the portal hypertension thereby putting mother at risk of potentially life-threatening complications like variceal hemorrhage. Risks of variceal bleed and hepatic decompensation increase many fold during pregnancy. Optimal management revolves round managing the portal hypertension and its complications. Thus management of such cases requires multi-speciality approach involving obstetricians experienced in dealing with high risk cases, hepatologists, anesthetists and neonatologists. With advancement in medical field, pregnancy is not contra-indicated in these women, as was previously believed. This article focuses on the different aspects of pregnancy with portal hypertension with special emphasis on specific cause wise treatment options to decrease the variceal bleed and hepatic decompensation. Based on extensive review of literature, management from pre-conceptional period to postpartum is outlined in order to have optimal maternal and perinatal outcomes. PMID:25755552

  14. Bilharzial portal fibrosis: an important cause of portal hypertension.

    PubMed Central

    Carruthers, R. H.; Sinha, P.

    1978-01-01

    Thirty consecutive cases of portal hypertension seen in a surgical unit in Lusaka, Zambia, are reported. Of these cases 70% were due to portal fibrosis caused by Schistosoma mansoni infestation. Portacaval shunting was undertaken in most cases. Patients with portal fibrosis responded more favourably to portal decompression than did patients with cirrhosis. It is probable that the condition is more common than is generally reconigzed in areas where S. mansoni infestation is endemic. Images Fig. 1 Fig. 2 PMID:626472

  15. Transforming Education for Electronic Health Record Implementation.

    PubMed

    Nicklaus, Jennifer; Kusser, Janet; Zessin, Julie; Amaya, Michael

    2015-08-01

    Outcomes are an integral part of health care. Over the years, the educational team at the authors' hospital has sought effective, realistic options for electronic health record (EHR) training that ensures standardized documentation of patient data by nursing personnel. Thus, providers will have easily available access and clinicians will experience confidence in the proficiency of their skills to use the EHR. This article describes the transformation from an instructor-led classroom training plan into a focused clinician workflow training pathway using Benner's novice-to-expert model and Lowe's five Key Principles for Successful EHR Training. Multiple teaching strategies have been incorporated into the education plan, including a computer skills assessment test, an EHR proficiency tool, web-based training modules, clinical (or specialty) scenarios, followed by practice in learning laboratories. The educational plan has produced individualized EHR learning, confident nursing performance, and overall unit management satisfaction. PMID:26247658

  16. Target detection portal

    DOEpatents

    Linker, Kevin L.; Brusseau, Charles A.

    2002-01-01

    A portal apparatus for screening persons or objects for the presence of trace amounts of target substances such as explosives, narcotics, radioactive materials, and certain chemical materials. The portal apparatus can have a one-sided exhaust for an exhaust stream, an interior wall configuration with a concave-shape across a horizontal cross-section for each of two facing sides to result in improved airflow and reduced washout relative to a configuration with substantially flat parallel sides; air curtains to reduce washout; ionizing sprays to collect particles bound by static forces, as well as gas jet nozzles to dislodge particles bound by adhesion to the screened person or object. The portal apparatus can be included in a detection system with a preconcentrator and a detector.

  17. Clinical Manifestations of Portal Hypertension

    PubMed Central

    Al-Busafi, Said A.; McNabb-Baltar, Julia; Farag, Amanda; Hilzenrat, Nir

    2012-01-01

    The portal hypertension is responsible for many of the manifestations of liver cirrhosis. Some of these complications are the direct consequences of portal hypertension, such as gastrointestinal bleeding from ruptured gastroesophageal varices and from portal hypertensive gastropathy and colopathy, ascites and hepatorenal syndrome, and hypersplenism. In other complications, portal hypertension plays a key role, although it is not the only pathophysiological factor in their development. These include spontaneous bacterial peritonitis, hepatic encephalopathy, cirrhotic cardiomyopathy, hepatopulmonary syndrome, and portopulmonary hypertension. PMID:23024865

  18. A Librarian's Perspective on Portals.

    ERIC Educational Resources Information Center

    Little, John R.

    2001-01-01

    Explains what Web portals are and discusses the benefits of a strategic alliance in portal building among campus information technology, libraries, and other campus groups. Suggests that by using robust channel capabilities, an enterprise portal can provide content from various parts of the university and promote resource discovery. (EV)

  19. Ten Keys to the Portal

    ERIC Educational Resources Information Center

    Schaffhauser, Dian

    2011-01-01

    Successful web portals help users stay informed, in touch, and up to speed. They are also a telling window into the efficiency of one's institution. To develop a cutting-edge portal takes planning, communication, and research. In this article, the author presents and discusses 10 keys to portal success: (1) make critical info visible; (2) make the…

  20. Architecture and tools for open, interoperable and portable EHRs.

    PubMed

    Blobel, Bernd

    2003-01-01

    Electronic Health Record (EHR) systems provide the kernel application of health information systems and health networks which should be independent of complexity, localisation constraints, platforms, protocols, etc. Based on shared care information systems' requirements for high level interoperability, a generic component architecture has been introduced. For implementing, running and maintaining acceptable and useable health information systems components, all views of the ISO Reference Model--Open Distributed Processing have to be considered. Following the Model Driven Architecture paradigm, a reference model as well as concept-representing domain models both independent of platforms must be specified, which are combined and harmonised as well as automatically transferred into platform-specific models using appropriate tools. PMID:15537227

  1. How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings

    PubMed Central

    2009-01-01

    Background Adoption of EHRs by U.S. ambulatory practices has been slow despite the perceived benefits of their use. Most evaluations of EHR implementations in the literature apply to large practice settings. While there are similarities relating to EHR implementation in large and small practice settings, the authors argue that scale is an important differentiator. Focusing on small ambulatory practices, this paper outlines the benefits and barriers to EHR use in this setting, and provides a "field guide" for these practices to facilitate successful EHR implementation. Discussion The benefits of EHRs in ambulatory practices include improved patient care and office efficiency, and potential financial benefits. Barriers to EHRs include costs; lack of standardization of EHR products and the design of vendor systems for large practice environments; resistance to change; initial difficulty of system use leading to productivity reduction; and perceived accrual of benefits to society and payers rather than providers. The authors stress the need for developing a flexible change management strategy when introducing EHRs that is relevant to the small practice environment; the strategy should acknowledge the importance of relationship management and the role of individual staff members in helping the entire staff to manage change. Practice staff must create an actionable vision outlining realistic goals for the implementation, and all staff must buy into the project. The authors detail the process of implementing EHRs through several stages: decision, selection, pre-implementation, implementation, and post-implementation. They stress the importance of identifying a champion to serve as an advocate of the value of EHRs and provide direction and encouragement for the project. Other key activities include assessing and redesigning workflow; understanding financial issues; conducting training that is well-timed and meets the needs of practice staff; and evaluating the

  2. Standard-based EHR-enabled applications for clinical research and patient safety: CDISC – IHE QRPH – EHR4CR & SALUS collaboration

    PubMed Central

    Daniel, Christel; Sinaci, Anil; Ouagne, David; Sadou, Eric; Declerck, Gunnar; Kalra, Dipak; Charlet, Jean; Forsberg, Kerstin; Bain, Landen; Mead, Charlie; Hussain, Sajjad; Laleci Erturkmen, Gokce B.

    2014-01-01

    Integration profiles collaboratively developed by CDISC and IHE for integrating data from Electronic Health Records (EHRs) with clinical research and pharmacovigilance are limited to resolving lexical/syntactic data integration issues and do not address semantic barriers. This paper describes the collaboration between two European projects – EHR4CR and SALUS – in implementing ISO/IEC 11179-based metadata registries (MDRs) and semantically integrated cross-platform data access. A common “semantic MDR” provides a framework for bidirectional/cross-MDR mapping and federated queries are enabled using the newly-defined IHE Data Exchange (DEX) profile. In the pilot implementation, mappings for 178 EHR4CR and 199 SALUS metadata elements were persisted in the semantic MDR. The DEX profile was then used to access semantically equivalent data elements in SALUS or EHR4CR participating EHR systems. ISO/IEC 11179-based MDRs and DEX integration profile address the goal of developing pan-EU computable semantic integration of data from clinical care, clinical research, and patient safety platforms. PMID:25954572

  3. “I Want to Keep the Personal Relationship With My Doctor”: Understanding Barriers to Portal Use among African Americans and Latinos

    PubMed Central

    Allen, Jill Y; Poole, Dolly; Tieu, Lina; Kanter, Michael H; Garrido, Terhilda

    2016-01-01

    Background Despite the widespread implementation of electronic health records (EHRs), there is growing evidence that racial/ethnic minority patients do not use portals as frequently as non-Hispanic whites to access their EHR information online. This differential portal use could be problematic for health care disparities since early evidence links portal use to better outcomes. Objective We sought to understand specific barriers to portal use among African American and Latino patients at Kaiser Permanente, which has had a portal in place for over a decade, and broad uptake among the patient population at large. Methods We conducted 10 focus groups with 87 participants in 2012 and 2013 among African American and Latino Kaiser Permanente members in the mid-Atlantic, Georgia, and Southern California regions. Members were eligible to participate if they were not registered for portal access. Focus groups were conducted within each racial/ethnic group, and each included individuals who were older, had a chronic disease, or were parents (as these are the three biggest users of the portal at Kaiser Permanente overall). We videotaped each focus group and transcribed the discussion for analysis. We used general inductive coding to develop themes for major barriers to portal use, overall and separately by racial/ethnic group. Results We found that lack of support was a key barrier to initiating portal use in our sample—both in terms of technical assistance as well as the fear of the portal eroding existing personal relationships with health care providers. This held true across a range of focus groups representing a mix of age, income, health conditions, and geographic regions. Conclusions Our study was among the first qualitative explorations of barriers to portal use among racial/ethnic subgroups. Our findings suggest that uniform adoption of portal use across diverse patient groups requires more usable and personalized websites, which may be particularly important for

  4. Cross border semantic interoperability for clinical research: the EHR4CR semantic resources and services.

    PubMed

    Daniel, Christel; Ouagne, David; Sadou, Eric; Forsberg, Kerstin; Gilchrist, Mark Mc; Zapletal, Eric; Paris, Nicolas; Hussain, Sajjad; Jaulent, Marie-Christine; Md, Dipka Kalra

    2016-01-01

    With the development of platforms enabling the use of routinely collected clinical data in the context of international clinical research, scalable solutions for cross border semantic interoperability need to be developed. Within the context of the IMI EHR4CR project, we first defined the requirements and evaluation criteria of the EHR4CR semantic interoperability platform and then developed the semantic resources and supportive services and tooling to assist hospital sites in standardizing their data for allowing the execution of the project use cases. The experience gained from the evaluation of the EHR4CR platform accessing to semantically equivalent data elements across 11 European participating EHR systems from 5 countries demonstrated how far the mediation model and mapping efforts met the expected requirements of the project. Developers of semantic interoperability platforms are beginning to address a core set of requirements in order to reach the goal of developing cross border semantic integration of data. PMID:27570649

  5. Standardized and flexible health data management with an archetype driven EHR system (EHRflex).

    PubMed

    Brass, Anton; Moner, David; Hildebrand, Claudia; Robles, Montserrat

    2010-01-01

    To build a semantically interoperable Electronic Health Record is one of the most challenging research fields in health informatics. In order to reach this objective, EHR standards that formally describe health data structures have to be used. CEN EN13606 is one of the most promising approaches. It covers the technical needs for semantic interoperability and, at the same time, it incorporates a mechanism (archetype model) that enables clinical domain experts to participate in building an EHR system. In this paper we present EHRflex, a generic system based on archetypes. It empowers the clinician and allows him to manage his own EHR system in a simple and generic way, assuring that the user works with underlying standardized data structures. These can be exchanged with other people and systems when needed. EHRflex introduces EHR standards into the clinical routine delivering a technical platform which works directly on archetype based data.

  6. A framework for privacy-preserving access to next-generation EHRs.

    PubMed

    Koufi, Vassiliki; Malamateniou, Flora; Tsohou, Aggeliki; Vassilacopoulos, George

    2014-01-01

    Although personalized medicine is optimizing the discovery, development and application of therapeutic advances, its full impact on patient and population healthcare management has yet to be realized. Electronic health Records (EHRs), integrated with data from other sources, such as social care data, Personal Healthcare Record (PHR) data and genetic information, are envisaged as having a pivotal role in realizing this individualized approach to healthcare. Thus, a new generation of EHRs will emerge which, in addition to supporting healthcare professionals in making well-informed clinical decisions, shows potential for novel discovery of associations between disease and genetic, environmental or process measures. However, a broad range of ethical, legal and technical reasons may hinder the realization of future EHRs due to potential security and privacy breaches. This paper presents a HIPAA-compliant framework that enables privacy-preserving access to next-generation EHRs.

  7. Implementing EHRs: An Exploratory Study to Examine Current Practices in Migrating Physician Practice.

    PubMed

    Dolezel, Diane; Moczygemba, Jackie

    2015-01-01

    Implementation of electronic health record (EHR) systems in physician practices is challenging and complex. In the past, physicians had little incentive to move from paper-based records. With the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, Medicare and Medicaid incentive payments are now available for physicians who implement EHRs for meaningful use. The Office of the National Coordinator for Health Information Technology (ONC) has ample detail on clinical data needed for meaningful use in order to assess the quality of patient care. Details are lacking, however, on how much clinical data, if any, should be transferred from the old paper records during an EHR implementation project. The purpose of this exploratory study was to investigate and document the elements of longitudinal clinical data that are essential for inclusion in the EHR of physicians in a clinical practice setting, as reported by the office managers of the physicians in the study group. PMID:26807077

  8. Leveraging EHR Data for Outcomes and Comparative Effectiveness Research in Oncology

    PubMed Central

    Harris, Marcelline R.; Buyuktur, Ayse G.; Clark, Patricia M.; An, Lawrence C.; Hanauer, David A.

    2012-01-01

    Along with the increasing adoption of electronic health records (EHRs) are expectations that data collected within EHRs will be readily available for outcomes and comparative effectiveness research. Yet the ability to effectively share and reuse data depends on implementing and configuring EHRs with these goals in mind from the beginning. Data sharing and integration must be planned both locally as well as nationally. The rich data transmission and semantic infrastructure developed by the National Cancer Institute (NCI) for research provides an excellent example of moving beyond paper-based paradigms and exploiting the power of semantically robust, network-based systems, and engaging both domain and informatics expertise. Similar efforts are required to address current challenges in sharing EHR data. PMID:22948276

  9. Cross border semantic interoperability for clinical research: the EHR4CR semantic resources and services

    PubMed Central

    Daniel, Christel; Ouagne, David; Sadou, Eric; Forsberg, Kerstin; Gilchrist, Mark Mc; Zapletal, Eric; Paris, Nicolas; Hussain, Sajjad; Jaulent, Marie-Christine; MD, Dipka Kalra

    2016-01-01

    With the development of platforms enabling the use of routinely collected clinical data in the context of international clinical research, scalable solutions for cross border semantic interoperability need to be developed. Within the context of the IMI EHR4CR project, we first defined the requirements and evaluation criteria of the EHR4CR semantic interoperability platform and then developed the semantic resources and supportive services and tooling to assist hospital sites in standardizing their data for allowing the execution of the project use cases. The experience gained from the evaluation of the EHR4CR platform accessing to semantically equivalent data elements across 11 European participating EHR systems from 5 countries demonstrated how far the mediation model and mapping efforts met the expected requirements of the project. Developers of semantic interoperability platforms are beginning to address a core set of requirements in order to reach the goal of developing cross border semantic integration of data. PMID:27570649

  10. Implementing EHRs: An Exploratory Study to Examine Current Practices in Migrating Physician Practice

    PubMed Central

    Dolezel, Diane; Moczygemba, Jackie

    2015-01-01

    Implementation of electronic health record (EHR) systems in physician practices is challenging and complex. In the past, physicians had little incentive to move from paper-based records. With the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, Medicare and Medicaid incentive payments are now available for physicians who implement EHRs for meaningful use. The Office of the National Coordinator for Health Information Technology (ONC) has ample detail on clinical data needed for meaningful use in order to assess the quality of patient care. Details are lacking, however, on how much clinical data, if any, should be transferred from the old paper records during an EHR implementation project. The purpose of this exploratory study was to investigate and document the elements of longitudinal clinical data that are essential for inclusion in the EHR of physicians in a clinical practice setting, as reported by the office managers of the physicians in the study group. PMID:26807077

  11. A framework for privacy-preserving access to next-generation EHRs.

    PubMed

    Koufi, Vassiliki; Malamateniou, Flora; Tsohou, Aggeliki; Vassilacopoulos, George

    2014-01-01

    Although personalized medicine is optimizing the discovery, development and application of therapeutic advances, its full impact on patient and population healthcare management has yet to be realized. Electronic health Records (EHRs), integrated with data from other sources, such as social care data, Personal Healthcare Record (PHR) data and genetic information, are envisaged as having a pivotal role in realizing this individualized approach to healthcare. Thus, a new generation of EHRs will emerge which, in addition to supporting healthcare professionals in making well-informed clinical decisions, shows potential for novel discovery of associations between disease and genetic, environmental or process measures. However, a broad range of ethical, legal and technical reasons may hinder the realization of future EHRs due to potential security and privacy breaches. This paper presents a HIPAA-compliant framework that enables privacy-preserving access to next-generation EHRs. PMID:25160285

  12. Method to integrate clinical guidelines into the electronic health record (EHR) by applying the archetypes approach.

    PubMed

    Garcia, Diego; Moro, Claudia Maria Cabral; Cicogna, Paulo Eduardo; Carvalho, Deborah Ribeiro

    2013-01-01

    Clinical guidelines are documents that assist healthcare professionals, facilitating and standardizing diagnosis, management, and treatment in specific areas. Computerized guidelines as decision support systems (DSS) attempt to increase the performance of tasks and facilitate the use of guidelines. Most DSS are not integrated into the electronic health record (EHR), ordering some degree of rework especially related to data collection. This study's objective was to present a method for integrating clinical guidelines into the EHR. The study developed first a way to identify data and rules contained in the guidelines, and then incorporate rules into an archetype-based EHR. The proposed method tested was anemia treatment in the Chronic Kidney Disease Guideline. The phases of the method are: data and rules identification; archetypes elaboration; rules definition and inclusion in inference engine; and DSS-EHR integration and validation. The main feature of the proposed method is that it is generic and can be applied toany type of guideline. PMID:23920682

  13. Case Study: Applying OpenEHR Archetypes to a Clinical Data Repository in a Chinese Hospital.

    PubMed

    Min, Lingtong; Wang, Li; Lu, Xudong; Duan, Huilong

    2015-01-01

    openEHR is a flexible and scalable modeling methodology for clinical information and has been widely adopted in Europe and Australia. Due to the reasons of differences in clinical process and management, there are few research projects involving openEHR in China. To investigate the feasibility of openEHR methodology for clinical information modelling in China, this paper carries out a case study to apply openEHR archetypes to Clinical Data Repository (CDR) in a Chinese hospital. The results show that a set of 26 archetypes are found to cover all the concepts used in the CDR. Of all these, 9 (34.6%) are reused without change, 10 are modified and/or extended, and 7 are newly defined. The reasons for modification, extension and newly definition have been discussed, including granularity of archetype, metadata-level versus data-level modelling, and the representation of relationships between archetypes. PMID:26262040

  14. Educator Uses of Data-Enhanced Investigations for Climate Change Education (DICCE), An Online System for Accessing a Vast Portal of NASA Earth System Data Known As the Goddard Interactive Online Visualization and Analysis Infrastructure (GIOVANNI)

    NASA Astrophysics Data System (ADS)

    Zalles, D. R.; Acker, J. G.

    2015-12-01

    Data-enhanced Investigations for Climate Change Education (DICCE) has made it easier and more technologically feasible for secondary and post-secondary instructors and students to study climate change and related Earth system phenomena using data products from the Goddard Interactive Online Visualization and Analysis Infrastructure (GIOVANNI), a powerful portal of Earth observation data that provides access to numerous data products on Earth system phenomena representing the land biosphere, physical land, ocean biosphere, physical ocean, physical atmosphere, atmospheric gases, and energy and radiation system. These data products are derived from remote-sensing instruments on satellites, ground stations, and data assimilation models. Instructors and students can query the GIOVANNI data archive, then save the results as map images, time series plots, vertical profiles of the atmosphere, and data tables. Any part of the world can be selected for analysis. The project has also produced a tool for instructors to author and adapt standards-based lesson plans, student data investigation activities, and presentations around visualizations they make available to their students via DICCE-G. Supports are provided to students and teachers about how to interpret trends in data products of their choice at the regional level and a schema has been developed to help them understand how those data products fit into current scientific thinking about the certainties and uncertainties of climate change. The presentation will (1) describe the features of DICCE, (2) examples of curricula developed to make use of DICCE in classrooms, (3) how these curricula align to Next Generation Science Standards, and (4) how they align to science education research literature about how to make school science more engaging. Recently-analyzed teacher and student outcomes from DICCE use will also be reported.

  15. Importance-satisfaction analysis for primary care physicians' perspective on EHRs in Taiwan.

    PubMed

    Ho, Cheng-Hsun; Wene, Hsyien-Chia; Chu, Chi-Ming; Wu, Yi-Syuan; Wang, Jen-Leng

    2014-06-01

    The Taiwan government has been promoting Electronic Health Records (EHRs) to primary care physicians. How to extend EHRs adoption rate by measuring physicians' perspective of importance and performance of EHRs has become one of the critical issues for healthcare organizations. We conducted a comprehensive survey in 2010 in which a total of 1034 questionnaires which were distributed to primary care physicians. The project was sponsored by the Department of Health to accelerate the adoption of EHRs. 556 valid responses were analyzed resulting in a valid response rate of 53.77%. The data were analyzed based on a data-centered analytical framework (5-point Likert scale). The mean of importance and satisfaction of four dimensions were 4.16, 3.44 (installation and maintenance), 4.12, 3.51 (product effectiveness), 4.10, 3.31 (system function) and 4.34, 3.70 (customer service) respectively. This study provided a direction to government by focusing on attributes which physicians found important but were dissatisfied with, to close the gap between actual and expected performance of the EHRs. The authorities should emphasize the potential advantages in meaningful use and provide training programs, conferences, technical assistance and incentives to enhance the national level implementation of EHRs for primary physicians. PMID:24914640

  16. Electronic Health Record (EHR) As a Vehicle for Successful Health Care Best Practice

    PubMed Central

    Ghazisaeedi, Marjan; Mohammadzadeh, Niloofar; Safdari, Reza

    2014-01-01

    Objective: application of EHR in journey toward the development and adaptation of best practice approach in health care has particular importance. The aim of this review article is survey of successful best practice through EHR. Methods: In this literature review articles were searched with keywords like Electronic Health Record, Best Practice in Science Direct, Google Scholar and Pub Med databases since 1999. Results: best practice in health care through some services like utilization management, case management, and information technology tools can perform. Utilization management in combination with evidence based medicine facilitate determine best decision. Health records are based on evidence medicine and be the richest source of health information. Definitely use of EHR has play pivotal role in journey toward the development and adaptation of best practice approach. Conclusion: Because of potential capabilities, EHR can be regarded as a main core and fundamental element in best practice approach. Success implementation of EHR relies on many factors that should be considered. Some critical success factors for EHR implementation that should be noted are change management, Physicians, nurses and key stakeholders involvement, leadership, provide reliable information technology infrastructure, system design, privacy and security, right budget, support high level management, clear communicate, determine goals and user needs, and define roles and responsibilities, interoperability standards. PMID:25648601

  17. HITECH spurs EHR vendor competition and innovation, resulting in increased adoption.

    PubMed

    Joseph, Seth; Sow, Max; Furukawa, Michael F; Posnack, Steven; Chaffee, Mary Ann

    2014-09-01

    The Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted to increase electronic health record (EHR) adoption by providers and hospitals. Experts expressed skepticism about whether the program would indeed hasten adoption and could be implemented in time for the initial reporting period. Could EHR vendors meet the certification requirements, and could the industry innovate to meet small-practice needs? This study, in addition to documenting increased provider adoption, provides the first evidence of increased competitiveness and innovation in the EHR industry spurred by HITECH. For example, the number of EHR vendors certified for e-prescribing with Surescripts increased from 96 to 229 over the program's first 3 years. We also find that prescribers in small practices increasingly adopted lower-cost, Web-based e-prescribing and EHR applications at significantly higher rates (15%-35%) than did large practices (3%-4%), which generally have more human and capital resources to make significant investments. These findings suggest that EHR vendors were highly responsive to HITECH requirements and have been adapting their strategies to meet nuanced market needs, providing reason to be optimistic about the Programs' future. PMID:25365748

  18. Importance-satisfaction analysis for primary care physicians' perspective on EHRs in Taiwan.

    PubMed

    Ho, Cheng-Hsun; Wene, Hsyien-Chia; Chu, Chi-Ming; Wu, Yi-Syuan; Wang, Jen-Leng

    2014-06-01

    The Taiwan government has been promoting Electronic Health Records (EHRs) to primary care physicians. How to extend EHRs adoption rate by measuring physicians' perspective of importance and performance of EHRs has become one of the critical issues for healthcare organizations. We conducted a comprehensive survey in 2010 in which a total of 1034 questionnaires which were distributed to primary care physicians. The project was sponsored by the Department of Health to accelerate the adoption of EHRs. 556 valid responses were analyzed resulting in a valid response rate of 53.77%. The data were analyzed based on a data-centered analytical framework (5-point Likert scale). The mean of importance and satisfaction of four dimensions were 4.16, 3.44 (installation and maintenance), 4.12, 3.51 (product effectiveness), 4.10, 3.31 (system function) and 4.34, 3.70 (customer service) respectively. This study provided a direction to government by focusing on attributes which physicians found important but were dissatisfied with, to close the gap between actual and expected performance of the EHRs. The authorities should emphasize the potential advantages in meaningful use and provide training programs, conferences, technical assistance and incentives to enhance the national level implementation of EHRs for primary physicians.

  19. SNOMED CT survey: an assessment of implementation in EMR/EHR applications.

    PubMed

    Giannangelo, Kathy; Fenton, Susan H

    2008-01-01

    A descriptive study of health information technology (HIT) vendors was conducted to identify which EMR/EHR vendors currently work or anticipate working with SNOMED CT, determine the prevalence of SNOMED CT integration in electronic medical record (EMR) and electronic health record (EHR) products, identify the available and potential future applications for SNOMED CT in EMR/EHR systems, and learn what prompts vendors to include SNOMED CT in EMR/EHR systems. The Web-based survey consisting of 25 questions was fielded in November-December 2006. Seventy-two responses were received. The results from this survey on SNOMED CT show a mixed message from respondents with regard to the prevalence of SNOMED CT integration in EMR/EHR products. Those with plans for implementation cited strategic reasons most often. However, HIT vendors who have not yet obtained a SNOMED CT license are waiting for market forces to drive deployment in their systems. Finally, survey respondents currently working with SNOMED CT indicated an expected increase over the next three years in EMR/EHR applications where SNOMED CT will be implemented.

  20. Importance-Satisfaction Analysis for Primary Care Physicians’ Perspective on EHRs in Taiwan †

    PubMed Central

    Ho, Cheng-Hsun; Wen, Hsyien-Chia; Chu, Chi-Ming; Wu, Yi-Syuan; Wang, Jen-Leng

    2014-01-01

    The Taiwan government has been promoting Electronic Health Records (EHRs) to primary care physicians. How to extend EHRs adoption rate by measuring physicians’ perspective of importance and performance of EHRs has become one of the critical issues for healthcare organizations. We conducted a comprehensive survey in 2010 in which a total of 1034 questionnaires which were distributed to primary care physicians. The project was sponsored by the Department of Health to accelerate the adoption of EHRs. 556 valid responses were analyzed resulting in a valid response rate of 53.77%. The data were analyzed based on a data-centered analytical framework (5-point Likert scale). The mean of importance and satisfaction of four dimensions were 4.16, 3.44 (installation and maintenance), 4.12, 3.51 (product effectiveness), 4.10, 3.31 (system function) and 4.34, 3.70 (customer service) respectively. This study provided a direction to government by focusing on attributes which physicians found important but were dissatisfied with, to close the gap between actual and expected performance of the EHRs. The authorities should emphasize the potential advantages in meaningful use and provide training programs, conferences, technical assistance and incentives to enhance the national level implementation of EHRs for primary physicians. PMID:24914640

  1. HITECH spurs EHR vendor competition and innovation, resulting in increased adoption.

    PubMed

    Joseph, Seth; Sow, Max; Furukawa, Michael F; Posnack, Steven; Chaffee, Mary Ann

    2014-09-01

    The Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted to increase electronic health record (EHR) adoption by providers and hospitals. Experts expressed skepticism about whether the program would indeed hasten adoption and could be implemented in time for the initial reporting period. Could EHR vendors meet the certification requirements, and could the industry innovate to meet small-practice needs? This study, in addition to documenting increased provider adoption, provides the first evidence of increased competitiveness and innovation in the EHR industry spurred by HITECH. For example, the number of EHR vendors certified for e-prescribing with Surescripts increased from 96 to 229 over the program's first 3 years. We also find that prescribers in small practices increasingly adopted lower-cost, Web-based e-prescribing and EHR applications at significantly higher rates (15%-35%) than did large practices (3%-4%), which generally have more human and capital resources to make significant investments. These findings suggest that EHR vendors were highly responsive to HITECH requirements and have been adapting their strategies to meet nuanced market needs, providing reason to be optimistic about the Programs' future.

  2. Using High-Fidelity Simulation and Eye Tracking to Characterize EHR Workflow Patterns among Hospital Physicians

    PubMed Central

    Doberne, Julie W.; He, Ze; Mohan, Vishnu; Gold, Jeffrey A.; Marquard, Jenna; Chiang, Michael F.

    2015-01-01

    Modern EHR systems are complex, and end-user behavior and training are highly variable. The need for clinicians to access key clinical data is a critical patient safety issue. This study used a mixed methods approach employing a high-fidelity EHR simulation environment, eye and screen tracking, surveys, and semi-structured interviews to characterize typical EHR usage by hospital physicians (hospitalists) as they encounter a new patient. The main findings were: 1) There were strong similarities across the groups in the information types the physicians looked at most frequently, 2) While there was no overall difference in case duration between the groups, we observed two distinct workflow types between the groups with respect to gathering information in the EHR and creating a note, and 3) A majority of the case time was devoted to note composition in both groups. This has implications for EHR interface design and raises further questions about what individual user workflows exist in the EHR. PMID:26958287

  3. Portal systemic encephalopathy.

    PubMed

    Schenker, S; Bay, M K

    1997-05-01

    The goal of this article is to update the status of Portal systemic encephalopathy (PSE) in the light of new data. First, PSE is the context of other types of hepatic encephalopathy. Subsequently, current views of the pathogenesis of the disorder are discussed, followed by an analysis of therapeutic options. Diagnosis will not be considered, as no major new developments have recently been documented in this area.

  4. Portal Annular Pancreas

    PubMed Central

    Harnoss, Jonathan M.; Harnoss, Julian C.; Diener, Markus K.; Contin, Pietro; Ulrich, Alexis B.; Büchler, Markus W.; Schmitz-Winnenthal, Friedrich H.

    2014-01-01

    Abstract Portal annular pancreas (PAP) is an asymptomatic congenital pancreas anomaly, in which portal and/or mesenteric veins are encased by pancreas tissue. The aim of the study was to determine the role of PAP in pancreatic surgery as well as its management and potential complication, specifically, postoperative pancreatic fistula (POPF). On the basis of a case report, the MEDLINE and ISI Web of Science databases were systematically reviewed up to September 2012. All articles describing a case of PAP were considered. In summary, 21 studies with 59 cases were included. The overall prevalence of PAP was 2.4% and the patients' mean (SD) age was 55.9 (16.2) years. The POPF rate in patients with PAP (12 pancreaticoduodenectomies and 3 distal pancreatectomies) was 46.7% (in accordance with the definition of the International Study Group of Pancreatic Surgery). Portal annular pancreas is a quite unattended pancreatic variant with high prevalence and therefore still remains a clinical challenge to avoid postoperative complications. To decrease the risk for POPF, attentive preoperative diagnostics should also focus on PAP. In pancreaticoduodenectomy, a shift of the resection plane to the pancreas tail should be considered; in extensive pancreatectomy, coverage of the pancreatic remnant by the falciform ligament could be a treatment option. PMID:25207658

  5. Transjugular Portal Venous Stenting in Inflammatory Extrahepatic Portal Vein Stenosis

    SciTech Connect

    Schaible, Rolf; Textor, Jochen; Decker, Pan; Strunk, Holger; Schild, Hans

    2002-12-15

    We report the case of a 37-year-old man with necrotizing pancreatitis associated with inflammatory extrahepatic portal vein stenosis and progressive ascites. Four months after the acute onset, when no signs of infection were present, portal decompression was performed to treat refractory ascites. Transjugulartranshepatic venoplasty failed to dilate the stenosis in the extrahepatic portion of the portal vein sufficiently. Therefore a Wallstent was implanted, resulting in almost normal diameter of the vessel. In follow-up imaging studies the stent and the portal vein were still patent 12 months after the intervention and total resolution of the ascites was observed.

  6. 77 FR 33774 - Agency Information Collection Activities: Comment Request; Education and Human Resources Project...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-07

    ... Agency Information Collection Activities: Comment Request; Education and Human Resources Project... of Collection: Education and Human Resources Project Monitoring Clearance. OMB Approval Number: 3145... States and internationally. The Directorate for Education and Human Resources (EHR), a unit within...

  7. A portal for the ocean biogeographic information system

    USGS Publications Warehouse

    Zhang, Yunqing; Grassle, J. F.

    2002-01-01

    Since its inception in 1999 the Ocean Biogeographic Information System (OBIS) has developed into an international science program as well as a globally distributed network of biogeographic databases. An OBIS portal at Rutgers University provides the links and functional interoperability among member database systems. Protocols and standards have been established to support effective communication between the portal and these functional units. The portal provides distributed data searching, a taxonomy name service, a GIS with access to relevant environmental data, biological modeling, and education modules for mariners, students, environmental managers, and scientists. The portal will integrate Census of Marine Life field projects, national data archives, and other functional modules, and provides for network-wide analyses and modeling tools.

  8. Inferring the Interactions of Risk Factors from EHRs

    PubMed Central

    Goodwin, Travis; Harabagiu, Sanda M.

    2016-01-01

    The wealth of clinical information provided by the advent of electronic health records offers an exciting opportunity to improve the quality of patient care. Of particular importance are the risk factors, which indicate possible diagnoses, and the medications which treat them. By analysing which risk factors and medications were mentioned at different times in patients’ EHRs, we are able to construct a patient’s clinical chronology. This chronology enables us to not only predict how new patient’s risk factors may progress, but also to discover patterns of interactions between risk factors and medications. We present a novel probabilistic model of patients’ clinical chronologies and demonstrate how this model can be used to (1) predict the way a new patient’s risk factors may evolve over time, (2) identify patients with irregular chronologies, and (3) discovering the interactions between pairs of risk factors, and between risk factors and medications over time. Moreover, the model proposed in this paper does not rely on (nor specify) any prior knowledge about any interactions between the risk factors and medications it represents. Thus, our model can be easily applied to any arbitrary set of risk factors and medications derived from a new dataset.

  9. Inferring the Interactions of Risk Factors from EHRs

    PubMed Central

    Goodwin, Travis; Harabagiu, Sanda M.

    2016-01-01

    The wealth of clinical information provided by the advent of electronic health records offers an exciting opportunity to improve the quality of patient care. Of particular importance are the risk factors, which indicate possible diagnoses, and the medications which treat them. By analysing which risk factors and medications were mentioned at different times in patients’ EHRs, we are able to construct a patient’s clinical chronology. This chronology enables us to not only predict how new patient’s risk factors may progress, but also to discover patterns of interactions between risk factors and medications. We present a novel probabilistic model of patients’ clinical chronologies and demonstrate how this model can be used to (1) predict the way a new patient’s risk factors may evolve over time, (2) identify patients with irregular chronologies, and (3) discovering the interactions between pairs of risk factors, and between risk factors and medications over time. Moreover, the model proposed in this paper does not rely on (nor specify) any prior knowledge about any interactions between the risk factors and medications it represents. Thus, our model can be easily applied to any arbitrary set of risk factors and medications derived from a new dataset. PMID:27595044

  10. Inferring the Interactions of Risk Factors from EHRs.

    PubMed

    Goodwin, Travis; Harabagiu, Sanda M

    2016-01-01

    The wealth of clinical information provided by the advent of electronic health records offers an exciting opportunity to improve the quality of patient care. Of particular importance are the risk factors, which indicate possible diagnoses, and the medications which treat them. By analysing which risk factors and medications were mentioned at different times in patients' EHRs, we are able to construct a patient's clinical chronology. This chronology enables us to not only predict how new patient's risk factors may progress, but also to discover patterns of interactions between risk factors and medications. We present a novel probabilistic model of patients' clinical chronologies and demonstrate how this model can be used to (1) predict the way a new patient's risk factors may evolve over time, (2) identify patients with irregular chronologies, and (3) discovering the interactions between pairs of risk factors, and between risk factors and medications over time. Moreover, the model proposed in this paper does not rely on (nor specify) any prior knowledge about any interactions between the risk factors and medications it represents. Thus, our model can be easily applied to any arbitrary set of risk factors and medications derived from a new dataset. PMID:27595044

  11. Collateral Pathways in Portal Hypertension

    PubMed Central

    Sharma, Malay; Rameshbabu, Chittapuram S.

    2012-01-01

    Presence of portosystemic collateral veins (PSCV) is common in portal hypertension due to cirrhosis. Physiologically, normal portosystemic anastomoses exist which exhibit hepatofugal flow. With the development of portal hypertension, transmission of backpressure leads to increased flow in these patent normal portosystemic anastomoses. In extrahepatic portal vein obstruction collateral circulation develops in a hepatopetal direction and portoportal pathways are frequently found. The objective of this review is to illustrate the various PSCV and portoportal collateral vein pathways pertinent to portal hypertension in liver cirrhosis and EHPVO. PMID:25755456

  12. Animal models of portal hypertension

    PubMed Central

    Abraldes, Juan G; Pasarín, Marcos; García-Pagán, Juan Carlos

    2006-01-01

    Animal models have allowed detailed study of hemodynamic alterations typical of portal hypertension and the molecular mechanisms involved in abnormalities in splanchnic and systemic circulation associated with this syndrome. Models of prehepatic portal hypertension can be used to study alterations in the splanchnic circulation and the pathophysiology of the hyperdynamic circulation. Models of cirrhosis allow study of the alterations in intrahepatic microcirculation that lead to increased resistance to portal flow. This review summarizes the currently available literature on animal models of portal hypertension and analyzes their relative utility. The criteria for choosing a particular model, depending on the specific objectives of the study, are also discussed. PMID:17075968

  13. Plug-and-play Integration of dual-model based Knowledge Artefacts into an Open Source Ehr System.

    PubMed

    Krexner, Rabea; Duftschmid, Georg

    2014-01-01

    In this paper we present our experiences with extending an existing approach for an archetype-compliant collection and export of data according to the openEHR specifications within the open source EHR system OpenMRS. It allows an automatic generation of forms from templates, which were introduced by openEHR as an extension of the dual-model approach. Data entered in these forms can be exported in form of standardized EHR extracts. The use of templates allowed us to solve problems reported for the original archetype-based version of the approach, which were caused by the high optionality within archetypes. PMID:25160154

  14. Digital Earth Portals to DLESE

    NASA Astrophysics Data System (ADS)

    Raskin, R.

    2001-05-01

    Digital Earth offers the promise to push the envelope of accessibility and usability of georeferenced digital data and reach out to non-traditional users. To realize this promise within the context of an educational digital library, the library can take advantage of existing Digital Earth components: viewers, catalogs, and data products - all of which conform to emerging open standards. Viewers vary in level of sophistication from standard web browsers to immersive or 3-D visualization tools. Datasets are currently the limiting ingredient in the mix, as providers must make data available using the open standards. However, the Earth Science Information Partnership (ESIP) Federation has developed a Digital Earth Cluster to insure that its members provide a source of compliant data products within a short time frame. A Digital Earth portal integrates all of the above components and provides the look and feel appropriate to the target educational level and classroom interests. DLESE is currently developing such an early prototype using existing components that can be used as a model for future development. A live demonstration will show the use of a Digital Earth viewer adapted for use with DLESE.

  15. Portal hypertension due to portal venous thrombosis: Etiology, clinical outcomes

    PubMed Central

    Harmanci, Ozgur; Bayraktar, Yusuf

    2007-01-01

    The thrombophilia in adult life has major implications in the hepatic vessels. The resulting portal vein thrombosis has various outcomes and complications. Esophageal varices, portal gastropathy, ascites, severe hypersplenism and liver failure needing liver transplantation are known well. The newly formed collateral venous circulation showing itself as pseudocholangicarcinoma sign and its possible clinical reflection as cholestasis are also known from a long time. The management strategies for these complications of portal vein thrombosis are not different from their counterpart which is cirrhotic portal hypertension, but the prognosis is unquestionably better in former cases. In this review we present and discuss the portal vein thrombosis, etiology and the resulting clinical pictures. There are controversial issues in nomenclature, management (including anticoagulation problems), follow up strategies and liver transplantation. In the light of the current knowledge, we discuss some controversial issues in literature and present our experience and our proposals about this group of patients. PMID:17552000

  16. All Roads Lead to Portal

    ERIC Educational Resources Information Center

    Heid, Susan D.

    2007-01-01

    Portals are taking off on campuses nationwide. According to "Campus Computing 2006," the Campus Computing Project's survey of 540 two- and four-year public and private colleges and universities across the US, portal deployment for four-year public residential universities jumped from 28 to 74 percent of responding institutions between the…

  17. NSTA Portal to Science Safety

    ERIC Educational Resources Information Center

    Roy, Ken

    2010-01-01

    The National Science Teachers Association's (NSTA) Science Safety Advisory Board recently launched the Safety in the Science Classroom portal. This portal serves as a gateway to safety resources for teachers, supervisors, and administrators. It also contains an evolving list of safety resources for elementary, middle, and high schools. The list…

  18. The Evaluation of SEPAS National Project Based on Electronic Health Record System (EHRS) Coordinates in Iran

    PubMed Central

    Asadi, Farkhondeh; Moghaddasi, Hamid; Rabiei, Reza; Rahimi, Forough; Mirshekarlou, Soheila Jahangiri

    2015-01-01

    Background: Electronic Health Records (EHRs) are secure private lifetime records that can be shared by using interoperability standards between different organizations and units. These records are created by the productive system that is called EHR system. Implementing EHR systems has a number of advantages such as facilitating access to medical records, supporting patient care, and improving the quality of care and health care decisions. The project of electronic health record system in Iran, which is the goal of this study, is called SEPAS. With respect to the importance of EHR and EHR systems the researchers investigated the project from two perspectives: determining the coordinates of the project and how it evolved, and incorporating the coordinates of EHR system in this project. Methods: In this study two evaluation tools, a checklist and a questionnaire, were developed based on texts and reliable documentation. The questionnaire and the checklist were validated using content validity by receiving the experts’ comments and the questionnaire’s reliability was estimated through Test-retest(r =87%). Data were collected through study, observation, and interviews with experts and specialists of SEPAS project. Results: This research showed that SEPAS project, like any other project, could be evaluated. It has some aims; steps, operational phases and certain start and end time, but all the resources and required facilities for the project have not been considered. Therefore it could not satisfy its specified objective and the useful and unique changes which are the other characteristics of any project have not been achieved. In addition, the findings of EHR system coordinates can be determined in 4 categories as Standards and rules, Telecommunication-Communication facilities, Computer equipment and facilities and Stakeholders. Conclusions: The findings indicated that SEPAS has the ability to use all standards of medical terminology and health classification

  19. Integration of an OWL-DL knowledge base with an EHR prototype and providing customized information.

    PubMed

    Jing, Xia; Kay, Stephen; Marley, Tom; Hardiker, Nicholas R

    2014-09-01

    When clinicians use electronic health record (EHR) systems, their ability to obtain general knowledge is often an important contribution to their ability to make more informed decisions. In this paper we describe a method by which an external, formal representation of clinical and molecular genetic knowledge can be integrated into an EHR such that customized knowledge can be delivered to clinicians in a context-appropriate manner.Web Ontology Language-Description Logic (OWL-DL) is a formal knowledge representation language that is widely used for creating, organizing and managing biomedical knowledge through the use of explicit definitions, consistent structure and a computer-processable format, particularly in biomedical fields. In this paper we describe: 1) integration of an OWL-DL knowledge base with a standards-based EHR prototype, 2) presentation of customized information from the knowledge base via the EHR interface, and 3) lessons learned via the process. The integration was achieved through a combination of manual and automatic methods. Our method has advantages for scaling up to and maintaining knowledge bases of any size, with the goal of assisting clinicians and other EHR users in making better informed health care decisions.

  20. Integration of an OWL-DL knowledge base with an EHR prototype and providing customized information.

    PubMed

    Jing, Xia; Kay, Stephen; Marley, Tom; Hardiker, Nicholas R

    2014-09-01

    When clinicians use electronic health record (EHR) systems, their ability to obtain general knowledge is often an important contribution to their ability to make more informed decisions. In this paper we describe a method by which an external, formal representation of clinical and molecular genetic knowledge can be integrated into an EHR such that customized knowledge can be delivered to clinicians in a context-appropriate manner.Web Ontology Language-Description Logic (OWL-DL) is a formal knowledge representation language that is widely used for creating, organizing and managing biomedical knowledge through the use of explicit definitions, consistent structure and a computer-processable format, particularly in biomedical fields. In this paper we describe: 1) integration of an OWL-DL knowledge base with a standards-based EHR prototype, 2) presentation of customized information from the knowledge base via the EHR interface, and 3) lessons learned via the process. The integration was achieved through a combination of manual and automatic methods. Our method has advantages for scaling up to and maintaining knowledge bases of any size, with the goal of assisting clinicians and other EHR users in making better informed health care decisions. PMID:24997857

  1. In emergency departments, radiologists' access to EHRs may influence interpretations and medical management.

    PubMed

    Franczak, Michael J; Klein, Madeline; Raslau, Flavius; Bergholte, Jo; Mark, Leighton P; Ulmer, John L

    2014-05-01

    The adoption of electronic health records (EHRs) that meet federal meaningful-use standards is a major US national policy priority. Policy makers recognize the potential of electronic communication in delivering high-quality health care, particularly in an environment of expanding remote access to medical care and the ever-increasing need to transmit health care records across institutions. To demonstrate this principle, we sought to estimate the significance of EHR access in emergent neuroradiologic interpretations. Three neuroradiologists conducted a prospective expert-rater analysis of 2,000 consecutive head computed tomography (CT) exams ordered by emergency department (ED) physicians. For each head CT exam, the neuroradiologists compared medical information generated by ED physicians to information generated by the interpreting radiologists who had access to additional EHR-derived patient data. In 6.1 percent of the head CT exams, the neuroradiologists reached consensus--meaning two out of three agreed--that the additional clinical data derived from the EHR was "very likely" to influence radiological interpretations and that the lack of that data would have adversely affected medical management in those patients. Health care providers must recognize the value of implementing EHRs and foster their widespread adoption.

  2. Using EHRs for Heart Failure Therapy Recommendation Using Multidimensional Patient Similarity Analytics.

    PubMed

    Panahiazar, Maryam; Taslimitehrani, Vahid; Pereira, Naveen L; Pathak, Jyotishman

    2015-01-01

    Electronic Health Records (EHRs) contain a wealth of information about an individual patient's diagnosis, treatment and health outcomes. This information can be leveraged effectively to identify patients who are similar to each for disease diagnosis and prognosis. In recent years, several machine learning methods have been proposed to assessing patient similarity, although the techniques have primarily focused on the use of patient diagnoses data from EHRs for the learning task. In this study, we develop a multidimensional patient similarity assessment technique that leverages multiple types of information from the EHR and predicts a medication plan for each new patient based on prior knowledge and data from similar patients. In our algorithm, patients have been clustered into different groups using a hierarchical clustering approach and subsequently have been assigned a medication plan based on the similarity index to the overall patient population. We evaluated the performance of our approach on a cohort of heart failure patients (N=1386) identified from EHR data at Mayo Clinic and achieved an AUC of 0.74. Our results suggest that it is feasible to harness population-based information from EHRs for an individual patient-specific assessment.

  3. EHR implementation in South Africa: how do we get it right?

    PubMed

    Yogeswaran, Parimalaranie; Wright, Graham

    2010-01-01

    In an environment of expanding demand on the health care system to provide equitable, accessible and safe health care, usage of information communication technology is one of the strategies identified to fulfil such expectations. Electronic Health Record (EHR) is an important tool towards achieving better health care using such technology, although, across the world EHR implementation has experienced a high failure rate. Nevertheless South Africa has made a strategic decision to implement EHR system in the public health sector. An evaluation toolkit was developed, to measure the state of readiness of health institutions in South Africa in implementing EHR based on Kaplan and Norton's work on Balanced Score Card (BSC), and the subsequent variant model developed by Protti. A Critical Success Factor (CSF) scorecard to assess the state of readiness and a Balanced Score Card matrix to be used as a strategic framework was developed. These tools were validated using critiques by a panel of experts. The toolkit developed has the potential to assist the organization towards a better EHR implementation path. PMID:20841716

  4. Segmental portal hypertension.

    PubMed Central

    Madsen, M S; Petersen, T H; Sommer, H

    1986-01-01

    Isolated obstruction of the splenic vein leads to segmental portal hypertension, which is a rare form of extrahepatic portal hypertension, but it is important to diagnose, since it can be cured by splenectomy. In a review of the English literature, 209 patients with isolated splenic vein obstruction were found. Pancreatitis caused 65% of the cases and pancreatic neoplasms 18%, whereas the rest was caused by various other diseases. Seventy-two per cent of the patients bled from gastroesophageal varices, and most often the bleeding came from isolated gastric varices. The spleen was enlarged in 71% of the patients. A correct diagnosis in connection with the first episode of bleeding was made in only 49%; 22% were operated on because of gastrointestinal bleeding, but the cause of bleeding was not found. The diagnosis should be suspected in patients with gastroesophageal varices, but without signs of a liver disease, especially if isolated gastric varices are found. The diagnosis is confirmed by portography. Images FIG. 1. FIG. 2. PMID:3729585

  5. Using OpenEHR in SICTI an electronic health record system for critical medicine

    NASA Astrophysics Data System (ADS)

    Filgueira, R.; Odriazola, A.; Simini, F.

    2007-11-01

    SICTI is a software tool for registering health records in critical medicine environments. Version 1.0 has been in use since 2003. The Biomedical Engineering Group (Núcleo de Ingeniería Biomédica), with support from the Technological Development Programme (Programa de Desarrollo Tecnológico), decided to develop a new version, to provide an aid for more critical medicine processes, based on a framework which would make the application domain change oriented. The team analyzed three alternatives: to develop an original product based on new research, to base the development on OpenEHR framework, or to use HL7 RIM as the reference model for SICTI. The team opted for OpenEHR. This work describes the use of OpenEHR, its strong and weak points, and states future work perspectives.

  6. Building a Semantic Model to Enhance the User's Perceived Functionality of the EHR.

    PubMed

    Lasierra, Nelia; Schweitzer, Marco; Gorfer, Thilo; Toma, Ioan; Hoerbst, Alexander

    2016-01-01

    In order to facilitate and increase the usability of Electronic Health Records (EHRs) for healthcare professional's daily work, we have designed a system that enables functional and flexible EHR access, based on the execution of clinical workflows and the composition of Semantic Web Services (SWS). The backbone of this system is based on an ontology. In this paper we present the strategy that we have followed for its design, and an overview of the resulting model. The designed ontology enables to model patient-centred clinical EHR workflows, the involved sequence of tasks and its associated functionality and managed clinical data. This semantic model constitutes also the main pillar for enabling dynamic service selection in our system. PMID:27577358

  7. The role of ontologies for sustainable, semantically interoperable and trustworthy EHR solutions.

    PubMed

    Blobel, Bernd; Kalra, Dipak; Koehn, Marc; Lunn, Ken; Pharow, Peter; Ruotsalainen, Pekka; Schulz, Stefan; Smith, Barry

    2009-01-01

    As health systems around the world turn towards highly distributed, specialized and cooperative structures to increase quality and safety of care as well as efficiency and efficacy of delivery processes, there is a growing need for supporting communication and collaboration of all parties involved with advanced ICT solutions. The Electronic Health Record (EHR) provides the information platform which is maturing towards the eHealth core application. To meet the requirements for sustainable, semantically interoperable, and trustworthy EHR solutions, different standards and different national strategies have been established. The workshop summarizes the requirements for such advanced EHR systems and their underlying architecture, presents different strategies and solutions advocated by corresponding protagonists, discusses pros and cons as well as harmonization and migration strategies for those approaches. It particularly highlights a turn towards ontology-driven architectures. The workshop is a joint activity of the EFMI Working Groups "Electronic Health Records" and "Security, Safety and Ethics".

  8. Building a Semantic Model to Enhance the User's Perceived Functionality of the EHR.

    PubMed

    Lasierra, Nelia; Schweitzer, Marco; Gorfer, Thilo; Toma, Ioan; Hoerbst, Alexander

    2016-01-01

    In order to facilitate and increase the usability of Electronic Health Records (EHRs) for healthcare professional's daily work, we have designed a system that enables functional and flexible EHR access, based on the execution of clinical workflows and the composition of Semantic Web Services (SWS). The backbone of this system is based on an ontology. In this paper we present the strategy that we have followed for its design, and an overview of the resulting model. The designed ontology enables to model patient-centred clinical EHR workflows, the involved sequence of tasks and its associated functionality and managed clinical data. This semantic model constitutes also the main pillar for enabling dynamic service selection in our system.

  9. The Portuguese Climate Portal

    NASA Astrophysics Data System (ADS)

    Gomes, Sandra; Deus, Ricardo; Nogueira, Miguel; Viterbo, Pedro; Miranda, Miguel; Antunes, Sílvia; Silva, Alvaro; Miranda, Pedro

    2016-04-01

    The Portuguese Local Warming Website (http://portaldoclima.pt) has been developed in order to support the society in Portugal in preparing for the adaptation to the ongoing and future effects of climate change. The climate portal provides systematic and easy access to authoritative scientific data ready to be used by a vast and diverse user community from different public and private sectors, key players and decision makers, but also to high school students, contributing to the increase in knowledge and awareness on climate change topics. A comprehensive set of regional climate variables and indicators are computed, explained and graphically presented. Variables and indicators were built in agreement with identified needs after consultation of the relevant social partners from different sectors, including agriculture, water resources, health, environment and energy and also in direct cooperation with the Portuguese National Strategy for Climate Change Adaptation (ENAAC) group. The visual interface allows the user to dynamically interact, explore, quickly analyze and compare, but also to download and import the data and graphics. The climate variables and indicators are computed from state-of-the-art regional climate model (RCM) simulations (e.g., CORDEX project), at high space-temporal detail, allowing to push the limits of the projections down to local administrative regions (NUTS3) and monthly or seasonal periods, promoting local adaptation strategies. The portal provides both historical data (observed and modelled for the 1971-2000 period) and future climate projections for different scenarios (modelled for the 2011-2100 period). A large effort was undertaken in order to quantify the impacts of the risk of extreme events, such as heavy rain and flooding, droughts, heat and cold waves, and fires. Furthermore the different climate scenarios and the ensemble of RCM models, with high temporal (daily) and spatial (~11km) detail, is taken advantage in order to

  10. The parallel virtual file system for portals.

    SciTech Connect

    Schutt, James Alan

    2004-04-01

    This report presents the result of an effort to re-implement the Parallel Virtual File System (PVFS) using Portals as the transport. This report provides short overviews of PVFS and Portals, and describes the design and implementation of PVFS over Portals. Finally, the results of performance testing of both stock PVFS and PVFS over Portals are presented.

  11. Modeling healthcare authorization and claim submissions using the openEHR dual-model approach

    PubMed Central

    2011-01-01

    Background The TISS standard is a set of mandatory forms and electronic messages for healthcare authorization and claim submissions among healthcare plans and providers in Brazil. It is not based on formal models as the new generation of health informatics standards suggests. The objective of this paper is to model the TISS in terms of the openEHR archetype-based approach and integrate it into a patient-centered EHR architecture. Methods Three approaches were adopted to model TISS. In the first approach, a set of archetypes was designed using ENTRY subclasses. In the second one, a set of archetypes was designed using exclusively ADMIN_ENTRY and CLUSTERs as their root classes. In the third approach, the openEHR ADMIN_ENTRY is extended with classes designed for authorization and claim submissions, and an ISM_TRANSITION attribute is added to the COMPOSITION class. Another set of archetypes was designed based on this model. For all three approaches, templates were designed to represent the TISS forms. Results The archetypes based on the openEHR RM (Reference Model) can represent all TISS data structures. The extended model adds subclasses and an attribute to the COMPOSITION class to represent information on authorization and claim submissions. The archetypes based on all three approaches have similar structures, although rooted in different classes. The extended openEHR RM model is more semantically aligned with the concepts involved in a claim submission, but may disrupt interoperability with other systems and the current tools must be adapted to deal with it. Conclusions Modeling the TISS standard by means of the openEHR approach makes it aligned with ISO recommendations and provides a solid foundation on which the TISS can evolve. Although there are few administrative archetypes available, the openEHR RM is expressive enough to represent the TISS standard. This paper focuses on the TISS but its results may be extended to other billing processes. A complete

  12. Cognitive Analysis of a Highly Configurable Web 2.0 EHR Interface.

    PubMed

    Senathirajah, Yalini; Kaufman, David; Bakken, Suzanne

    2010-11-13

    We summarize findings of one case from initial in-lab usability and cognitive tests of 13 clinicians using MedWISE, a widget-based electronic health record (EHR) interface, to familiarize themselves with real patient cases and verbalize their assessment and plan. Multiple methods were used to examine patterns of use, time taken, use of new functionality, user-created interfaces, and diagnostic and human-computer interaction processes. All clinicians learned MedWISE quickly, most used more than half the new functionalities and found MedWISE easy to use and useful. We discuss implications for the design of future EHRs.

  13. Climate Outreach Using Regional Coastal Ocean Observing System Portals

    NASA Astrophysics Data System (ADS)

    Anderson, D. M.; Hernandez, D. L.; Wakely, A.; Bochenek, R. J.; Bickel, A.

    2015-12-01

    Coastal oceans are dynamic, changing environments affected by processes ranging from seconds to millennia. On the east and west coast of the U.S., regional observing systems have deployed and sustained a remarkable diverse array of observing tools and sensors. Data portals visualize and provide access to real-time sensor networks. Portals have emerged as an interactive tool for educators to help students explore and understand climate. Bringing data portals to outreach events, into classrooms, and onto tablets and smartphones enables educators to address topics and phenomena happening right now. For example at the 2015 Charleston Science Technology Engineering and Math (STEM) Festival, visitors navigated the SECOORA (Southeast Coastal Ocean Observing regional Association) data portal to view the real-time marine meteorological conditions off South Carolina. Map-based entry points provide an intuitive interface for most students, an array of time series and other visualizations depict many of the essential principles of climate science manifest in the coastal zone, and data down-load/ extract options provide access to the data and documentation for further inquiry by advanced users. Beyond the exposition of climate principles, the portal experience reveals remarkable technologies in action and shows how the observing system is enabled by the activity of many different partners.

  14. The role of cognitive and learning theories in supporting successful EHR system implementation training: a qualitative study.

    PubMed

    McAlearney, Ann Scheck; Robbins, Julie; Kowalczyk, Nina; Chisolm, Deena J; Song, Paula H

    2012-06-01

    Given persistent barriers to effective electronic health record (EHR) system implementation and use, the authors investigated implementation training practices in six organizations reputed to have ambulatory care EHR system implementation "best practices." Using the lenses of social cognitive and adult learning theories, they explored themes related to EHR implementation training using qualitative data collected through 43 key informant interviews and 6 physician focus groups conducted between February 2009 and December 2010. The authors found consistent evidence that training practices across the six organizations known for exemplary implementations were congruent with the tenets of these theoretical frameworks and highlight seven best practices for training. The authors' analyses suggest that effective training programs must move beyond technical approaches and incorporate social and cultural factors to make a difference in implementation success. Taking these findings into account may increase the likelihood of successful EHR implementation, thereby helping organizations meet "meaningful use" requirements for EHR systems.

  15. Building a common ground on the clinical case: design, implementation and evaluation of an information model for a Handover EHR.

    PubMed

    Flemming, Daniel; Paul, Mareike; Hübner, Ursula

    2014-01-01

    Handovers need a common ground on the clinical cases between the members of the successive shifts to establish continuity of care. Conventional electronic patient record systems (EHR) proved to be only insufficiently suitable for supporting the grounding process. Against this background we proposed a basic concept for a handover EHR that extends general EHRs in particular openEHR based systems. The resulting handover information model was implemented in a database and evaluated based on 120 clinical cases. The information items of these cases could be mapped successfully to the model, however, the new class "anticipatory guidance" needed to be introduced. The evaluation also demonstrated the importance of highly aggregated information on the clinical case, opinions and meta-information such as the relevance of an item during handovers. Based on these findings, in particular the handover database, handover EHR applications are currently developed to support the grounding process.

  16. Hidden Magnetic Portals Around Earth

    NASA Video Gallery

    A NASA-sponsored researcher at the University of Iowa has developed a way for spacecraft to hunt down hidden magnetic portals in the vicinity of Earth. These gateways link the magnetic field of our...

  17. Kaiser/VA/DoD partnership piloting a nationwide EHR network.

    PubMed

    2010-02-01

    Sharing of relevant medical data can help prevent potentially deadly drug interactions. Storing all information in a single EHR network can be a big time-saver for providers. Using an outside vendor can help ensure objective measurement of outcomes. PMID:20162976

  18. A business case for HIT adoption: effects of "meaningful use" EHR financial incentives on clinic revenue.

    PubMed

    Behkami, Nima A; Dorr, David A; Morrice, Stuart

    2010-01-01

    The goal of this study is to describe a framework that allows decision makers to efficiently evaluate factors that affect Electronic Health Record (EHR) adoption and test suitable interventions; specifically financial incentives. The United States healthcare delivery system is experiencing a transformation to improve population health. There is strong agreement that "meaningful use" of Health Information Technology (HIT) is a major enabler in this effort. However it's also understood that the high cost of implementing an EHR is an obstacle for adoption. To help understand these complexities we developed a simulation model designed to capture the dynamic nature of policy interventions that affect the adoption of EHR. We found that "Effective" use of HIT approaches break-even-point and larger clinic revenue many times faster that "average" or "poor" use of HIT. This study uses a systems perspective to the evaluate EHR adoption process through the "meaningful use" redesign as proposed in the American Reinvestment and Recovery Act 2009 in the United States healthcare industry by utilizing the System Dynamics methodology and Scenario Analysis.

  19. On the seamless, harmonized use of ISO/IEEE11073 and openEHR.

    PubMed

    Trigo, Jesús D; Kohl, Christian D; Eguzkiza, Aitor; Martínez-Espronceda, Miguel; Alesanco, Álvaro; Serrano, Luis; García, José; Knaup, Petra

    2014-05-01

    Standardized exchange of clinical information is a key factor in the provision of high quality health care systems. In this context, the openEHR specification facilitates the management of health data in electronic health records (EHRs), while the ISO/IEEE11073 (also referred to as X73PHD) family of standards provides a reference framework for medical device interoperability. Hospitals and health care providers using openEHR require flawless integration of data coming from external sources, such as X73PHD. Hence, a harmonization process is crucial for achieving a seamless, coherent use of those specifications in real scenarios. Such harmonization is the aim of this paper. Thus, the classes and attributes of a representative number of X73PHD specializations for medical devices--weight, temperature, blood pressure, pulse and heart rate, oximetry, and electrocardiograph--along with the X73PHD core document--ISO/IEEE11073-20601--have been analyzed and mapped to openEHR archetypes. The proposed methodology reuses the existing archetypes when possible and suggests new ones--or appropriate modifications--otherwise. As a result, this paper analyzes the inconsistencies found and the implications thereof in the coordinated use of these two standards. The procedure has also shown how existing standards are able to influence the archetype development process, enhancing the existing archetype corpus.

  20. Facilitating secondary use of medical data by using openEHR archetypes.

    PubMed

    Kohl, Christian D; Garde, Sebastian; Knaup, Petra

    2010-01-01

    Clinical trials are of high importance for medical progress. But even though more and more clinical data is available in electronic patient records (EPRs) and more and more electronic data capture (EDC) systems are used in trials, there is still a gap which makes EPR / EDC interoperability difficult and hampers secondary use of medical routine data. The openEHR architecture for Electronic Health Records is based on a two level modeling approach which makes use of 'archetypes'. We want to analyze whether archetypes can help to bridge this gap by building an integrated EPR / EDC system based on openEHR archetypes. We used the 'openEHR Reference Framework and Application' (Opereffa) and existing archetypes for medical data. Furthermore, we developed dedicated archetypes to document study meta data. We developed a first prototype implementation of an archetype based integrated EPR / EDC system. Next steps will be the evaluation of an extended prototype in a real clinical trial scenario. Opereffa was a good starting point for our work. OpenEHR archetypes proved useful for secondary use of health data.

  1. EHR Documentation: The Hype and the Hope for Improving Nursing Satisfaction and Quality Outcomes.

    PubMed

    OʼBrien, Ann; Weaver, Charlotte; Settergren, Theresa Tess; Hook, Mary L; Ivory, Catherine H

    2015-01-01

    The phenomenon of "data rich, information poor" in today's electronic health records (EHRs) is too often the reality for nursing. This article proposes the redesign of nursing documentation to leverage EHR data and clinical intelligence tools to support evidence-based, personalized nursing care across the continuum. The principles consider the need to optimize nurses' documentation efficiency while contributing to knowledge generation. The nursing process must be supported by EHRs through integration of best care practices: seamless workflows that display the right tools, evidence-based content, and information at the right time for optimal clinical decision making. Design of EHR documentation must attain a balance that ensures the capture of nursing's impact on safety, quality, highly reliable care, patient engagement, and satisfaction, yet minimizes "death by data entry." In 2014, a group of diverse informatics leaders from practice, academia, and the vendor community formed to address how best to transform electronic documentation to provide knowledge at the point of care and to deliver value to front line nurses and nurse leaders. As our health care system moves toward reimbursement on the basis of quality outcomes and prevention, the value of nursing data in this business proposition will become a key differentiator for health care organizations' economic success.

  2. A Correlational Analysis: Electronic Health Records (EHR) and Quality of Care in Critical Access Hospitals

    ERIC Educational Resources Information Center

    Khan, Arshia A.

    2012-01-01

    Driven by the compulsion to improve the evident paucity in quality of care, especially in critical access hospitals in the United States, policy makers, healthcare providers, and administrators have taken the advise of researchers suggesting the integration of technology in healthcare. The Electronic Health Record (EHR) System composed of multiple…

  3. User Satisfaction Evaluation of the EHR4CR Query Builder: A Multisite Patient Count Cohort System

    PubMed Central

    Soto-Rey, Iñaki; N'Dja, Aurèle; Cunningham, James; Newe, Axel; Trinczek, Benjamin; Lafitte, Caroline; Sedlmayr, Brita; Fritz, Fleur

    2015-01-01

    The Electronic Health Records for Clinical Research (EHR4CR) project aims to develop services and technology for the leverage reuse of Electronic Health Records with the purpose of improving the efficiency of clinical research processes. A pilot program was implemented to generate evidence of the value of using the EHR4CR platform. The user acceptance of the platform is a key success factor in driving the adoption of the EHR4CR platform; thus, it was decided to evaluate the user satisfaction. In this paper, we present the results of a user satisfaction evaluation for the EHR4CR multisite patient count cohort system. This study examined the ability of testers (n = 22 and n = 16 from 5 countries) to perform three main tasks (around 20 minutes per task), after a 30-minute period of self-training. The System Usability Scale score obtained was 55.83 (SD: 15.37), indicating a moderate user satisfaction. The responses to an additional satisfaction questionnaire were positive about the design of the interface and the required procedure to design a query. Nevertheless, the most complex of the three tasks proposed in this test was rated as difficult, indicating a need to improve the system regarding complicated queries. PMID:26539525

  4. A patient centered care plan in the EHR: improving collaboration and engagement.

    PubMed

    Chunchu, Kavitha; Mauksch, Larry; Charles, Carol; Ross, Valerie; Pauwels, Judith

    2012-09-01

    Patients attempting to manage their chronic conditions require ongoing support in changing and adopting self-management behaviors. However, patient values, health goals, and action plans are not well represented in the electronic health record (EHR) impeding the ability of the team (MA and providers) to provide respectful, ongoing self-management support. We evaluated whether a team approach to using an EHR based patient centered care plan (PCCP) improved collaborative self-management planning. An experimental, prospective cohort study was conducted in a family medicine residency clinic. The experimental group included 7 physicians and a medical assistant who received 2 hr of PCCP training. The control group consisted of 7 physicians and a medical assistant. EHR charts were analyzed for evidence of 8 behavior change elements. Follow-up interviews with experimental group patients and physicians and the medical assistant assessed their experiences. We found that PCCP charts had more documented behavior change elements than control charts in all 8 domains (p < .001). Experimental group physicians valued the PCCP model and suggested ways to improve its use. Patient feedback demonstrated support for the model. A PCCP can help team members to engage patients with chronic illnesses in goal setting and action planning to support self-management. An EHR design that stores patient values, health goals, and action plans may strengthen continuity and quality of care between patients and primary care team members. (PsycINFO Database Record (c) 2012 APA, all rights reserved). PMID:22866953

  5. Security challenges in integration of a PHR-S into a standards based national EHR.

    PubMed

    Mense, Alexander; Hoheiser Pförtner, Franz; Sauermann, Stefan

    2014-01-01

    Health related data provided by patients themselves is expected to play a major role in future healthcare. Data from personal health devices, vaccination records, health diaries or observations of daily living, for instance, is stored in personal health records (PHR) which are maintained by personal health record systems (PHR-S). Combining this information with medical records provided by healthcare providers in electronic health records (EHR) is one of the next steps towards "personal care". Austria currently sets up a nationwide EHR system that incorporates all healthcare providers and is technically based on international standards (IHE, HL7, OASIS, ...). Looking at the expected potential of merging PHR and EHR data it is worth to analyse integration approaches. Although knowing that an integration requires the coordination of processes, information models and technical architectures, this paper specifically focuses on security issues by evaluating general security requirements for a PHR-S (based on HL7 PHR-S FM), comparing them with the information security specifications for the Austrian's national EHR (based on ISO/IES 27000 series) and identifying the main challenges as well as possible approaches.

  6. On the seamless, harmonized use of ISO/IEEE11073 and openEHR.

    PubMed

    Trigo, Jesús D; Kohl, Christian D; Eguzkiza, Aitor; Martínez-Espronceda, Miguel; Alesanco, Álvaro; Serrano, Luis; García, José; Knaup, Petra

    2014-05-01

    Standardized exchange of clinical information is a key factor in the provision of high quality health care systems. In this context, the openEHR specification facilitates the management of health data in electronic health records (EHRs), while the ISO/IEEE11073 (also referred to as X73PHD) family of standards provides a reference framework for medical device interoperability. Hospitals and health care providers using openEHR require flawless integration of data coming from external sources, such as X73PHD. Hence, a harmonization process is crucial for achieving a seamless, coherent use of those specifications in real scenarios. Such harmonization is the aim of this paper. Thus, the classes and attributes of a representative number of X73PHD specializations for medical devices--weight, temperature, blood pressure, pulse and heart rate, oximetry, and electrocardiograph--along with the X73PHD core document--ISO/IEEE11073-20601--have been analyzed and mapped to openEHR archetypes. The proposed methodology reuses the existing archetypes when possible and suggests new ones--or appropriate modifications--otherwise. As a result, this paper analyzes the inconsistencies found and the implications thereof in the coordinated use of these two standards. The procedure has also shown how existing standards are able to influence the archetype development process, enhancing the existing archetype corpus. PMID:24132031

  7. CDAPubMed: a browser extension to retrieve EHR-based biomedical literature

    PubMed Central

    2012-01-01

    Background Over the last few decades, the ever-increasing output of scientific publications has led to new challenges to keep up to date with the literature. In the biomedical area, this growth has introduced new requirements for professionals, e.g., physicians, who have to locate the exact papers that they need for their clinical and research work amongst a huge number of publications. Against this backdrop, novel information retrieval methods are even more necessary. While web search engines are widespread in many areas, facilitating access to all kinds of information, additional tools are required to automatically link information retrieved from these engines to specific biomedical applications. In the case of clinical environments, this also means considering aspects such as patient data security and confidentiality or structured contents, e.g., electronic health records (EHRs). In this scenario, we have developed a new tool to facilitate query building to retrieve scientific literature related to EHRs. Results We have developed CDAPubMed, an open-source web browser extension to integrate EHR features in biomedical literature retrieval approaches. Clinical users can use CDAPubMed to: (i) load patient clinical documents, i.e., EHRs based on the Health Level 7-Clinical Document Architecture Standard (HL7-CDA), (ii) identify relevant terms for scientific literature search in these documents, i.e., Medical Subject Headings (MeSH), automatically driven by the CDAPubMed configuration, which advanced users can optimize to adapt to each specific situation, and (iii) generate and launch literature search queries to a major search engine, i.e., PubMed, to retrieve citations related to the EHR under examination. Conclusions CDAPubMed is a platform-independent tool designed to facilitate literature searching using keywords contained in specific EHRs. CDAPubMed is visually integrated, as an extension of a widespread web browser, within the standard PubMed interface. It has

  8. Take Note(s): Differential EHR Satisfaction with Two Implementations under One Roof

    PubMed Central

    O'Connell, Ryan T.; Cho, Christine; Shah, Nidhi; Brown, Karen; Shiffman, Richard N.

    2004-01-01

    Objective: The aim of this study was to rigorously evaluate perceived differences in satisfaction with an electronic health record (EHR) between residents of two medical specialties who share the same health record, practice location, administration, and information technology support. Design: A cross-sectional survey was used comparing user satisfaction between pediatrics residents and internal medicine residents in an academic practice. Measurements: The survey was designed to measure baseline demographic characteristics, attitudes toward computers, general satisfaction with an EHR, and perceived practicality of use, variation from familiar practice, organizational support, and impact on delivery of care. Results: Medicine subjects were similar to pediatrics subjects in baseline demographic characteristics. Satisfaction with the EHR implementation was very high for both sets of subjects, but internal medicine residents were significantly less likely to be satisfied with the EHR implementation (relative risk [RR] = 0.84, 95% confidence interval [CI] = 0.73–0.98) and considerably less likely to believe that their colleagues were satisfied with it (RR = 0.56, 95% CI = 0.41–0.77). The only surveyed characteristic independently predicting satisfaction was medical specialty (p = 0.04). Medicine subjects were less likely to believe template-based documentation improved their efficiency (RR = 0.64, 95% CI = 0.46–0.88). They were significantly more likely to believe the system had been designed to improve billing (RR = 1.50, 95% CI = 1.05–2.04) and not to improve patient care (RR = 0.61, 95% CI = 0.44–0.85). Conclusion: The authors found a difference in satisfaction between internal medicine and pediatrics users of an EHR. Although many potential factors that influence satisfaction were similar between subjects in the two specialties, differences in previous experience may have influenced the results. Medicine residents had more previous experience with a

  9. The NSF IUSE-EHR Program: What's New (and Old) About It, and Resources for Geoscience Proposers

    NASA Astrophysics Data System (ADS)

    Singer, J.; Ryan, J. G.

    2015-12-01

    The NSF Division of Undergraduate Education recently released a new solicitation for the IUSE program -- the latest iteration in a succession of funding programs dating back over 30 years (including the Instrumentation and Laboratory Improvement Program (ILI), the Course and Curriculum Development Program (CCD), the Course Curriculum and Laboratory Improvement Program (CCLI), and the Transforming Undergraduate STEM Education Program (TUES). All of these programs sought/seek to support high quality STEM education for majors and non-majors in lower- and upper-division undergraduate courses. The current IUSE-EHR program is described in a 2-year solicitation that includes two tracks: Engaged Student Learning, and Institutional & Community Transformation. Each track has several options for funding level and project duration. A wide range of activities can be proposed for funding, and the program recognizes the varying needs across STEM disciplines. Geoscientists and other potential IUSE proposers are strongly encouraged to form collaborations with colleagues that conduct educational research and to propose projects that build upon the educational knowledge base in the discipline as well as contribute to it. Achieving this may not be immediately obvious to many geoscientists who have interests in improving student learning in their courses, but are not fluent in the scholarship of education in their field. To lower the barriers that have historically prevented larger numbers of geoscientists from developing their ideas into competitive education-related proposals, we have explored strategies for building and leveraging partnerships, sought to identify available resources for proposers, and explored a range of strategies for engaging and supporting larger numbers of potential geoscience proposers.

  10. CzechGeo/EPOS - Building a national data portal

    NASA Astrophysics Data System (ADS)

    Zednik, J.; Hejda, P.

    2012-04-01

    CzechGeo/EPOS is the consortium of seven geoscience institutions in the Czech Republic (Institute of Geophysics AS CR Prague, Institute of Rock Structure and Mechanics AS CR Prague, Institute of Geonics AS CR Ostrava, Institute of Physics of the Earth, Masaryk University Brno, Faculty of Mathematics and Physics, Charles University Prague, Faculty of Science, Charles University Prague, and Research Institute of Geodesy, Cartography and Topography Zdiby). These institutions operate a distributed system of seismic, GPS, magnetic, gravimetric and geodynamic observatories. The operational and personal costs of CzechGeo/EPOS are mostly covered by the Ministry of education, sports and youth within the support of twelve large research infrastructures in the Czech Republic. Web pages of the project www.czechgeo.cz are being built as a data portal which should integrate all the data and services provided by the involved institutions and research infrastructures. Seismic portal offers selected portions of digital data from permanent, local and temporary seismic stations, locations of seismic events in the country and worldwide, daily seismograms from permanent observatories and local seismic network Webnet, seismic bulletins and catalogs, and macroseismic observations on the territory of the Czech Republic. Magnetic portal involves besides real-time magnetograms also recent state of geomagnetic activity and its forecast for the next day. GPS portal will provide preprocessed data from regional GPS stations. Building the national portal is closely related with the development of the Preparatory phase of the EPOS (European Plate Observing System) project.

  11. EHR implementation in a new clinic: a case study of clinician perceptions.

    PubMed

    Noblin, Alice; Cortelyou-Ward, Kendall; Cantiello, John; Breyer, Thomas; Oliveira, Leonardo; Dangiolo, Mariana; Cannarozzi, Maria; Yeung, Tina; Berman, Stephen

    2013-08-01

    Driven by the Health Information Technology for Economic and Clinical Health (HITECH) Act large numbers of physicians and hospitals are now implementing electronic health records (EHR) with the general expectation that such systems will improve the quality, safety and efficiency of health care services. Studies of conversions from paper to electronic records paint a mixed picture with healthcare providers pleased with some aspects of their EHRs but dissatisfied with others. These prior studies focused on conversions from paper to electronic records. Many provider impressions, therefore, may have been influenced by reactions to the process of being required to change well established patterns. In order to help separate such reactions from true evaluations of the efficacy of the EHR, we decided to survey the providers in a new health center. To insure that the information gathered was not merely anecdotal, we used a well-established format starting with a semi-structured interview which facilitates analysis and recognition of major themes. We included questions around several important areas including workflow, communication, patient satisfaction, productivity, documentation, and quality of care. Ten main themes emerged: impeding patient flow, hindering communication in office, improving communication after the visit, improving tracking of patient care, spending less time with patients, requiring more training, wanting more features, diminishing productivity, appreciating benefits of templates, and enhancing internal communication. The need for better training appeared to be of especially high importance as it impacted several of the other themes. We believe that our study helps validate the similar concerns expressed in studies of transitions from paper to electronic record systems. Our method may be generally useful to other clinics because it facilitates timely recognition of themes, both positive and negative, that clinicians and clinic managers would want to

  12. A General Framework for Considering Selection Bias in EHR-Based Studies: What Data Are Observed and Why?

    PubMed Central

    Haneuse, Sebastien; Daniels, Michael

    2016-01-01

    Electronic health records (EHR) data are increasingly seen as a resource for cost-effective comparative effectiveness research (CER). Since EHR data are collected primarily for clinical and/or billing purposes, their use for CER requires consideration of numerous methodologic challenges including the potential for confounding bias, due to a lack of randomization, and for selection bias, due to missing data. In contrast to the recent literature on confounding bias in EHR-based CER, virtually no attention has been paid to selection bias possibly due to the belief that standard methods for missing data can be readily-applied. Such methods, however, hinge on an overly simplistic view of the available/missing EHR data, so that their application in the EHR setting will often fail to completely control selection bias. Motivated by challenges we face in an on-going EHR-based comparative effectiveness study of choice of antidepressant treatment and long-term weight change, we propose a new general framework for selection bias in EHR-based CER. Crucially, the framework provides structure within which researchers can consider the complex interplay between numerous decisions, made by patients and health care providers, which give rise to health-related information being recorded in the EHR system, as well as the wide variability across EHR systems themselves. This, in turn, provides structure within which: (i) the transparency of assumptions regarding missing data can be enhanced, (ii) factors relevant to each decision can be elicited, and (iii) statistical methods can be better aligned with the complexity of the data. PMID:27668265

  13. A General Framework for Considering Selection Bias in EHR-Based Studies: What Data Are Observed and Why?

    PubMed Central

    Haneuse, Sebastien; Daniels, Michael

    2016-01-01

    Electronic health records (EHR) data are increasingly seen as a resource for cost-effective comparative effectiveness research (CER). Since EHR data are collected primarily for clinical and/or billing purposes, their use for CER requires consideration of numerous methodologic challenges including the potential for confounding bias, due to a lack of randomization, and for selection bias, due to missing data. In contrast to the recent literature on confounding bias in EHR-based CER, virtually no attention has been paid to selection bias possibly due to the belief that standard methods for missing data can be readily-applied. Such methods, however, hinge on an overly simplistic view of the available/missing EHR data, so that their application in the EHR setting will often fail to completely control selection bias. Motivated by challenges we face in an on-going EHR-based comparative effectiveness study of choice of antidepressant treatment and long-term weight change, we propose a new general framework for selection bias in EHR-based CER. Crucially, the framework provides structure within which researchers can consider the complex interplay between numerous decisions, made by patients and health care providers, which give rise to health-related information being recorded in the EHR system, as well as the wide variability across EHR systems themselves. This, in turn, provides structure within which: (i) the transparency of assumptions regarding missing data can be enhanced, (ii) factors relevant to each decision can be elicited, and (iii) statistical methods can be better aligned with the complexity of the data.

  14. Searching for document contents in an IHE-XDS EHR architecture via archetype-based indexing of document types.

    PubMed

    Rinner, Christoph; Kohler, Michael; Saboor, Samrend; Huebner-Bloder, Gudrun; Ammenwerth, Elske; Duftschmid, Georg

    2013-01-01

    The shared EHR (electronic health record) system architecture IHE XDS is widely adopted internationally. It ensures a high level of data privacy via distributed storage of EHR documents. Its standard search capabilities, however, are limited; it only allows a retrieval of complete documents by querying a restricted set of document metadata. Existing approaches that aim to extend XDS queries to document contents typically employ a central index of document contents. Hereby they undermine XDS' basic characteristic of distributed data storage. To avoid data privacy concerns, we propose querying EHR contents in XDS by indexing document types based on Archetypes instead. We successfully tested our approach within the ISO/EN 13606 standard.

  15. MyHealthAtVanderbilt: policies and procedures governing patient portal functionality.

    PubMed

    Osborn, Chandra Y; Rosenbloom, S Trent; Stenner, Shane P; Anders, Shilo; Muse, Sue; Johnson, Kevin B; Jirjis, Jim; Jackson, Gretchen Purcell

    2011-12-01

    Explicit guidelines are needed to develop safe and effective patient portals. This paper proposes general principles, policies, and procedures for patient portal functionality based on MyHealthAtVanderbilt (MHAV), a robust portal for Vanderbilt University Medical Center. We describe policies and procedures designed to govern popular portal functions, address common user concerns, and support adoption. We present the results of our approach as overall and function-specific usage data. Five years after implementation, MHAV has over 129,800 users; 45% have used bi-directional messaging; 52% have viewed test results and 45% have viewed other medical record data; 30% have accessed health education materials; 39% have scheduled appointments; and 29% have managed a medical bill. Our policies and procedures have supported widespread adoption and use of MHAV. We believe other healthcare organizations could employ our general guidelines and lessons learned to facilitate portal implementation and usage. PMID:21807648

  16. The Reusable Astronomy Portal (TRAP)

    NASA Astrophysics Data System (ADS)

    Donaldson, T.; Rogers, A.; Wallace, G.

    2012-09-01

    The Reusable Astronomy Portal (TRAP) aims to provide a common platform for rapidly deploying Astronomy Archives to the web. TRAP is currently under development for both the VAO Data Discovery Portal and the MAST Multi-Mission Portal (Figure 1). TRAP consists of 2 major software packages: the TRAP Client and the TRAP Server. The TRAP framework allows developers to deploy the Server, connect to data resources, then focus on building custom tools for the Client. TRAP is built upon proven industry technologies including the Ext/JS JavaScript Component Library, Mono.NET Web Services, and JSON message based APIs. The multi-layered architecture of TRAP decouples each layer: Client, Service and Data Access, enabling each to evolve independently over time. Although currently deployed to provide astronomy science data access, the TRAP architecture is flexible enough to thrive in any distributed data environment.

  17. Web Portal for Multicast Delivery Management.

    ERIC Educational Resources Information Center

    Mannaert, H.; De Gruyter, B.; Adriaenssens, P.

    2003-01-01

    Presents a Web portal for multicast communication management, which provides fully automatic service management with integrated provisioning of hardware equipment. Describes the software architecture, the implementation, and the application usage of the Web portal for multicast delivery. (Author/AEF)

  18. A socio-technical analytical framework on the EHR-organizational innovation interplay: Insights from a public hospital in Greece.

    PubMed

    Emmanouilidou, Maria

    2015-01-01

    The healthcare sector globally is confronted with increasing internal and external pressures that urge for a radical reform of health systems' status quo. The role of technological innovations such as Electronic Health Records (EHR) is recognized as instrumental in this transition process as it is expected to accelerate organizational innovations. This is why the widespread uptake of EHR systems is a top priority in the global healthcare agenda. The successful co-deployment though of EHR systems and organizational innovations within the context of secondary healthcare institutions is a complex and multifaceted issue. Existing research in the field has made little progress thus emphasizing the need for further research contribution that will incorporate a holistic perspective. This paper presents insights about the EHR-organizational innovation interplay from a public hospital in Greece into a socio-technical analytical framework providing a multilevel set of action points for the eHealth roadmap with worldwide relevance. PMID:25991259

  19. A socio-technical analytical framework on the EHR-organizational innovation interplay: Insights from a public hospital in Greece.

    PubMed

    Emmanouilidou, Maria

    2015-01-01

    The healthcare sector globally is confronted with increasing internal and external pressures that urge for a radical reform of health systems' status quo. The role of technological innovations such as Electronic Health Records (EHR) is recognized as instrumental in this transition process as it is expected to accelerate organizational innovations. This is why the widespread uptake of EHR systems is a top priority in the global healthcare agenda. The successful co-deployment though of EHR systems and organizational innovations within the context of secondary healthcare institutions is a complex and multifaceted issue. Existing research in the field has made little progress thus emphasizing the need for further research contribution that will incorporate a holistic perspective. This paper presents insights about the EHR-organizational innovation interplay from a public hospital in Greece into a socio-technical analytical framework providing a multilevel set of action points for the eHealth roadmap with worldwide relevance.

  20. Restructuring an EHR system and the Medical Markup Language (MML) standard to improve interoperability by archetype technology.

    PubMed

    Kobayashi, Shinji; Kume, Naoto; Yoshihara, Hiroyuki

    2015-01-01

    In 2001, we developed an EHR system for regional healthcare information inter-exchange and to provide individual patient data to patients. This system was adopted in three regions in Japan. We also developed a Medical Markup Language (MML) standard for inter- and intra-hospital communications. The system was built on a legacy platform, however, and had not been appropriately maintained or updated to meet clinical requirements. To improve future maintenance costs, we reconstructed the EHR system using archetype technology on the Ruby on Rails platform, and generated MML equivalent forms from archetypes. The system was deployed as a cloud-based system for preliminary use as a regional EHR. The system now has the capability to catch up with new requirements, maintaining semantic interoperability with archetype technology. It is also more flexible than the legacy EHR system. PMID:26262183

  1. Restructuring an EHR system and the Medical Markup Language (MML) standard to improve interoperability by archetype technology.

    PubMed

    Kobayashi, Shinji; Kume, Naoto; Yoshihara, Hiroyuki

    2015-01-01

    In 2001, we developed an EHR system for regional healthcare information inter-exchange and to provide individual patient data to patients. This system was adopted in three regions in Japan. We also developed a Medical Markup Language (MML) standard for inter- and intra-hospital communications. The system was built on a legacy platform, however, and had not been appropriately maintained or updated to meet clinical requirements. To improve future maintenance costs, we reconstructed the EHR system using archetype technology on the Ruby on Rails platform, and generated MML equivalent forms from archetypes. The system was deployed as a cloud-based system for preliminary use as a regional EHR. The system now has the capability to catch up with new requirements, maintaining semantic interoperability with archetype technology. It is also more flexible than the legacy EHR system.

  2. From EGEE Operations Portal towards EGI Operations Portal

    NASA Astrophysics Data System (ADS)

    Cordier, Hélène; L'Orphelin, Cyril; Reynaud, Sylvain; Lequeux, Olivier; Loikkanen, Sinikka; Veyre, Pierre

    Grid operators in EGEE have been using a dedicated dashboard as their central operational tool, stable and scalable for the last 5 years despite continuous upgrade from specifications by users, monitoring tools or data providers. In EGEE-III, recent regionalisation of operations led the Operations Portal developers to conceive a standalone instance of this tool. We will see how the dashboard reorganization paved the way for the re-engineering of the portal itself. The outcome is an easily deployable package customized with relevant information sources and specific decentralized operational requirements. This package is composed of a generic and scalable data access mechanism, Lavoisier; a renowned php framework for configuration flexibility, Symfony and a MySQL database. VO life cycle and operational information, EGEE broadcast and Downtime notifications are next for the major reorganization until all other key features of the Operations Portal are migrated to the framework. Features specifications will be sketched at the same time to adapt to EGI requirements and to upgrade. Future work on feature regionalisation, on new advanced features or strategy planning will be tracked in EGI- Inspire through the Operations Tools Advisory Group, OTAG, where all users, customers and third parties of the Operations Portal are represented from January 2010.

  3. Portal Monitor Future Development Work: Hardware Improvements

    SciTech Connect

    Browne, Michael C.

    2012-07-03

    LANL portal monitor was a modification of a previously installed (permanent) unattended monitoring system (UMS). Modifications to the UMS to make the portal were sometimes based on mistaken assumptions about exercise-specific installation and access. Philosophical approach to real-time portal differs in some areas from UMS.

  4. Building a robust, scalable and standards-driven infrastructure for secondary use of EHR data: The SHARPn project

    PubMed Central

    Rea, Susan; Pathak, Jyotishman; Savova, Guergana; Oniki, Thomas A.; Westberg, Les; Beebe, Calvin E.; Tao, Cui; Parker, Craig G.; Haug, Peter J.; Huff, Stanley M.; Chute, Christopher G.

    2016-01-01

    The Strategic Health IT Advanced Research Projects (SHARP) Program, established by the Office of the National Coordinator for Health Information Technology in 2010 supports research findings that remove barriers for increased adoption of health IT. The improvements envisioned by the SHARP Area 4 Consortium (SHARPn) will enable the use of the electronic health record (EHR) for secondary purposes, such as care process and outcomes improvement, biomedical research and epidemiologic monitoring of the nation’s health. One of the primary informatics problem areas in this endeavor is the standardization of disparate health data from the nation’s many health care organizations and providers. The SHARPn team is developing open source services and components to support the ubiquitous exchange, sharing and reuse or ‘liquidity’ of operational clinical data stored in electronic health records. One year into the design and development of the SHARPn framework, we demonstrated end to end data flow and a prototype SHARPn platform, using thousands of patient electronic records sourced from two large healthcare organizations: Mayo Clinic and Intermountain Healthcare. The platform was deployed to (1) receive source EHR data in several formats, (2) generate structured data from EHR narrative text, and (3) normalize the EHR data using common detailed clinical models and Consolidated Health Informatics standard terminologies, which were (4) accessed by a phenotyping service using normalized data specifications. The architecture of this prototype SHARPn platform is presented. The EHR data throughput demonstration showed success in normalizing native EHR data, both structured and narrative, from two independent organizations and EHR systems. Based on the demonstration, observed challenges for standardization of EHR data for interoperable secondary use are discussed. PMID:22326800

  5. Primary care practitioners’ views on test result management in EHR-enabled health systems: a national survey

    PubMed Central

    Singh, Hardeep; Spitzmueller, Christiane; Petersen, Nancy J; Sawhney, Mona K; Smith, Michael W; Murphy, Daniel R; Espadas, Donna; Laxmisan, Archana; Sittig, Dean F

    2013-01-01

    Context Failure to notify patients of test results is common even when electronic health records (EHRs) are used to report results to practitioners. We sought to understand the broad range of social and technical factors that affect test result management in an integrated EHR-based health system. Methods Between June and November 2010, we conducted a cross-sectional, web-based survey of all primary care practitioners (PCPs) within the Department of Veterans Affairs nationwide. Survey development was guided by a socio-technical model describing multiple inter-related dimensions of EHR use. Findings Of 5001 PCPs invited, 2590 (51.8%) responded. 55.5% believed that the EHRs did not have convenient features for notifying patients of test results. Over a third (37.9%) reported having staff support needed for notifying patients of test results. Many relied on the patient's next visit to notify them for normal (46.1%) and abnormal results (20.1%). Only 45.7% reported receiving adequate training on using the EHR notification system and 35.1% reported having an assigned contact for technical assistance with the EHR; most received help from colleagues (60.4%). A majority (85.6%) stayed after hours or came in on weekends to address notifications; less than a third reported receiving protected time (30.1%). PCPs strongly endorsed several new features to improve test result management, including better tracking and visualization of result notifications. Conclusions Despite an advanced EHR, both social and technical challenges exist in ensuring notification of test results to practitioners and patients. Current EHR technology requires significant improvement in order to avoid similar challenges elsewhere. PMID:23268489

  6. A Data Quality Ontology for the Secondary Use of EHR Data

    PubMed Central

    Johnson, Steven G.; Speedie, Stuart; Simon, Gyorgy; Kumar, Vipin; Westra, Bonnie L.

    2015-01-01

    The secondary use of EHR data for research is expected to improve health outcomes for patients, but the benefits will only be realized if the data in the EHR is of sufficient quality to support these uses. A data quality (DQ) ontology was developed to rigorously define concepts and enable automated computation of data quality measures. The healthcare data quality literature was mined for the important terms used to describe data quality concepts and harmonized into an ontology. Four high-level data quality dimensions (“correctness”, “consistency”, “completeness” and “currency”) categorize 19 lower level measures. The ontology serves as an unambiguous vocabulary, which defines concepts more precisely than natural language; it provides a mechanism to automatically compute data quality measures; and is reusable across domains and use cases. A detailed example is presented to demonstrate its utility. The DQ ontology can make data validation more common and reproducible. PMID:26958293

  7. An Implementation of Clinical Data Repository with openEHR Approach: From Data Modeling to Architecture.

    PubMed

    Min, Lingtong; Liu, Juanjian; Lu, Xudong; Duan, Huilong; Qiao, Qingzhi

    2016-01-01

    Since electronic healthcare records are widely implemented in the hospitals, the explosion of the clinical data brings great opportunities to secondary use. Clinical data repository (CDR) plays an important role in clinical data using, including healthcare service, research and management. With evolving of clinical knowledge, it is a challenge for CDR to meet more and more requirements with adaptability and flexibility. In order to overcome this challenge, this paper proposed a solution that implemented a CDR with openEHR approach from data model to implementation. This study modelled archetypes according actual CDR requirements and implemented a CDR system in a tertiary hospital. Furthermore, this study developed data applications to facilitate healthcare service and research based on the CDR. The results of CDR system and data application demonstrate that openEHR approach could meet the continually evolving need of systems. PMID:27440296

  8. Standardized EHR interoperability - preliminary results of a German pilot project using the archetype methodology.

    PubMed

    Veseli, Hasan; Kopanitsa, Georgy; Demski, Hans

    2012-01-01

    The mobility of doctors and patients asks for multilingualism of electronic health record (EHR) systems: Doctors might face language problems using foreign medical information systems; people working abroad ask for continuous care which requires the treating physician to consult and understand the patient's health record. To address these linguistic and interoperability issues a solution is being developed that is based on widely acclaimed standards. Medical concepts that are derived from ASTM CCR define an interface model (based on ISO 13606). A server manages the data exchange between heterogeneous systems based on the interface model. It provides web services (automatic) and web forms (manual) and performs a transformation from the legacy scheme to the common structure. Furthermore, the server provides rich visualization capabilities (e.g. language-switch, custom charts etc.) which are useful for those EHR systems that don't provide these features.

  9. A cloud-based approach for interoperable electronic health records (EHRs).

    PubMed

    Bahga, Arshdeep; Madisetti, Vijay K

    2013-09-01

    We present a cloud-based approach for the design of interoperable electronic health record (EHR) systems. Cloud computing environments provide several benefits to all the stakeholders in the healthcare ecosystem (patients, providers, payers, etc.). Lack of data interoperability standards and solutions has been a major obstacle in the exchange of healthcare data between different stakeholders. We propose an EHR system - cloud health information systems technology architecture (CHISTAR) that achieves semantic interoperability through the use of a generic design methodology which uses a reference model that defines a general purpose set of data structures and an archetype model that defines the clinical data attributes. CHISTAR application components are designed using the cloud component model approach that comprises of loosely coupled components that communicate asynchronously. In this paper, we describe the high-level design of CHISTAR and the approaches for semantic interoperability, data integration, and security. PMID:25055368

  10. A cloud-based approach for interoperable electronic health records (EHRs).

    PubMed

    Bahga, Arshdeep; Madisetti, Vijay K

    2013-09-01

    We present a cloud-based approach for the design of interoperable electronic health record (EHR) systems. Cloud computing environments provide several benefits to all the stakeholders in the healthcare ecosystem (patients, providers, payers, etc.). Lack of data interoperability standards and solutions has been a major obstacle in the exchange of healthcare data between different stakeholders. We propose an EHR system - cloud health information systems technology architecture (CHISTAR) that achieves semantic interoperability through the use of a generic design methodology which uses a reference model that defines a general purpose set of data structures and an archetype model that defines the clinical data attributes. CHISTAR application components are designed using the cloud component model approach that comprises of loosely coupled components that communicate asynchronously. In this paper, we describe the high-level design of CHISTAR and the approaches for semantic interoperability, data integration, and security.

  11. Non-invasive lightweight integration engine for building EHR from autonomous distributed systems.

    PubMed

    Angulo, Carlos; Crespo, Pere; Maldonado, José A; Moner, David; Pérez, Daniel; Abad, Irene; Mandingorra, Jesús; Robles, Montserrat

    2007-12-01

    In this paper we describe Pangea-LE, a message-oriented lightweight data integration engine that allows homogeneous and concurrent access to clinical information from disperse and heterogeneous data sources. The engine extracts the information and passes it to the requesting client applications in a flexible XML format. The XML response message can be formatted on demand by appropriate Extensible Stylesheet Language (XSL) transformations in order to meet the needs of client applications. We also present a real deployment in a hospital where Pangea-LE collects and generates an XML view of all the available patient clinical information. The information is presented to healthcare professionals in an Electronic Health Record (EHR) viewer Web application with patient search and EHR browsing capabilities. Implantation in a real setting has been a success due to the non-invasive nature of Pangea-LE which respects the existing information systems.

  12. Non-invasive light-weight integration engine for building EHR from autonomous distributed systems.

    PubMed

    Crespo Molina, Pere; Angulo Fernández, Carlos; Maldonado Segura, José A; Moner Cano, David; Robles Viejo, Montserrat

    2006-01-01

    Pangea-LE is a message oriented light-weight integration engine, allowing concurrent access to clinical information from disperse and heterogeneous data sources. The engine extracts the information and serves it to the requester client applications in a flexible XML format. This XML response message can be formatted on demand by the appropriate XSL (Extensible Stylesheet Language) transformation in order to fit client application needs. In this article we present a real use case sample where Pangea-LE collects and generates "on the fly" a structured view of all the patient clinical information available in a healthcare organisation. This information is presented to healthcare professionals in an EHR (Electronic Health Record) viewer Web application with patient search and EHR browsing capabilities. Implantation in a real environment has been a notable success due to the non-invasive method which extremely respects the existing information systems.

  13. Specialty Task Force: A Strategic Component to Electronic Health Record (EHR) Optimization.

    PubMed

    Romero, Mary Rachel; Staub, Allison

    2016-01-01

    Post-implementation stage comes after an electronic health record (EHR) deployment. Analyst and end users deal with the reality that some of the concepts and designs initially planned and created may not be complementary to the workflow; creating anxiety, dissatisfaction, and failure with early adoption of system. Problems encountered during deployment are numerous and can vary from simple to complex. Redundant ticket submission creates backlog for Information Technology personnel resulting in delays in resolving concerns with EHR system. The process of optimization allows for evaluation of system and reassessment of users' needs. A solid and well executed optimization infrastructure can help minimize unexpected end-user disruptions and help tailor the system to meet regulatory agency goals and practice standards. A well device plan to resolve problems during post implementation is necessary for cost containment and to streamline communication efforts. Creating a specialty specific collaborative task force is efficacious and expedites resolution of users' concerns through a more structured process. PMID:27332478

  14. Observing health professionals' workflow patterns for diabetes care - First steps towards an ontology for EHR services.

    PubMed

    Schweitzer, M; Lasierra, N; Hoerbst, A

    2015-01-01

    Increasing the flexibility from a user-perspective and enabling a workflow based interaction, facilitates an easy user-friendly utilization of EHRs for healthcare professionals' daily work. To offer such versatile EHR-functionality, our approach is based on the execution of clinical workflows by means of a composition of semantic web-services. The backbone of such architecture is an ontology which enables to represent clinical workflows and facilitates the selection of suitable services. In this paper we present the methods and results after running observations of diabetes routine consultations which were conducted in order to identify those workflows and the relation among the included tasks. Mentioned workflows were first modeled by BPMN and then generalized. As a following step in our study, interviews will be conducted with clinical personnel to validate modeled workflows.

  15. How are clinicians involved in EHR planning? A process analysis case study of a region in Denmark.

    PubMed

    Høstgaard, Anna Marie; Bertelsen, Pernille; Nøhr, Christian

    2010-01-01

    Experience shows that to achieve a successful implementation of EHR clinicians must obtain joint ownership of the decisions made during the EHR-process. The EHR planning process in the Region of North Jutland, Denmark was studied with the aim of answering the question; "Why are not all Danish physicians overjoyed by the introduction of EHR? A case study was carried out from Oct. 2003 till April 2006 using process analysis. The EHR project management's strategy meant that there was no workload reduction. This was seen as one of the main barriers for the physicians to achieve real influence. History shows that clinician's on the one hand and administrators on the other have different perceptions of the purpose of the patient record and that they both have struggled to influence this definition. To date, the administrators have won the battle. This was the major reason for the approach chosen for the EHR planning process in North Jutland, Denmark. It explains the conditions made available for the physicians, which led to their role being reduced to clinical consultants--rather than real participants.

  16. Despite substantial progress In EHR adoption, health information exchange and patient engagement remain low in office settings.

    PubMed

    Furukawa, Michael F; King, Jennifer; Patel, Vaishali; Hsiao, Chun-Ju; Adler-Milstein, Julia; Jha, Ashish K

    2014-09-01

    The United States is making substantial investments to accelerate the adoption and use of interoperable electronic health record (EHR) systems. Using data from the 2009-13 Electronic Health Records Survey, we found that EHR adoption continues to grow: In 2013, 78 percent of office-based physicians had adopted some type of EHR, and 48 percent had the capabilities required for a basic EHR system. However, we also found persistent gaps in EHR adoption, with physicians in solo practices and non-primary care specialties lagging behind others. Physicians' electronic health information exchange with other providers was limited, with only 14 percent sharing data with providers outside their organization. Finally, we found that 30 percent of physicians routinely used capabilities for secure messaging with patients, and 24 percent routinely provided patients with the ability to view online, download, or transmit their health record. These findings suggest that although EHR adoption continues to grow, policies to support health information exchange and patient engagement will require ongoing attention. PMID:25104827

  17. Validation of the openEHR archetype library by using OWL reasoning.

    PubMed

    Menárguez-Tortosa, Marcos; Fernández-Breis, Jesualdo Tomás

    2011-01-01

    Electronic Health Record architectures based on the dual model architecture use archetypes for representing clinical knowledge. Therefore, ensuring their correctness and consistency is a fundamental research goal. In this work, we explore how an approach based on OWL technologies can be used for such purpose. This method has been applied to the openEHR archetype repository, which is the largest available one nowadays. The results of this validation are also reported in this study.

  18. Incorporating temporal EHR data in predictive models for risk stratification of renal function deterioration.

    PubMed

    Singh, Anima; Nadkarni, Girish; Gottesman, Omri; Ellis, Stephen B; Bottinger, Erwin P; Guttag, John V

    2015-02-01

    Predictive models built using temporal data in electronic health records (EHRs) can potentially play a major role in improving management of chronic diseases. However, these data present a multitude of technical challenges, including irregular sampling of data and varying length of available patient history. In this paper, we describe and evaluate three different approaches that use machine learning to build predictive models using temporal EHR data of a patient. The first approach is a commonly used non-temporal approach that aggregates values of the predictors in the patient's medical history. The other two approaches exploit the temporal dynamics of the data. The two temporal approaches vary in how they model temporal information and handle missing data. Using data from the EHR of Mount Sinai Medical Center, we learned and evaluated the models in the context of predicting loss of estimated glomerular filtration rate (eGFR), the most common assessment of kidney function. Our results show that incorporating temporal information in patient's medical history can lead to better prediction of loss of kidney function. They also demonstrate that exactly how this information is incorporated is important. In particular, our results demonstrate that the relative importance of different predictors varies over time, and that using multi-task learning to account for this is an appropriate way to robustly capture the temporal dynamics in EHR data. Using a case study, we also demonstrate how the multi-task learning based model can yield predictive models with better performance for identifying patients at high risk of short-term loss of kidney function. PMID:25460205

  19. Incorporating temporal EHR data in predictive models for risk stratification of renal function deterioration

    PubMed Central

    Singh, Anima; Nadkarni, Girish; Gottesman, Omri; Ellis, Stephen B.; Bottinger, Erwin P.; Guttag, John V.

    2015-01-01

    Predictive models built using temporal data in electronic health records (EHRs) can potentially play a major role in improving management of chronic diseases. However, these data present a multitude of technical challenges, including irregular sampling of data and varying length of available patient history. In this paper, we describe and evaluate three different approaches that use machine learning to build predictive models using temporal EHR data of a patient. The first approach is a commonly used non-temporal approach that aggregates values of the predictors in the patient’s medical history. The other two approaches exploit the temporal dynamics of the data. The two temporal approaches vary in how they model temporal information and handle missing data. Using data from the EHR of Mount Sinai Medical Center, we learned and evaluated the models in the context of predicting loss of estimated glomerular filtration rate (eGFR), the most common assessment of kidney function. Our results show that incorporating temporal information in patient’s medical history can lead to better prediction of loss of kidney function. They also demonstrate that exactly how this information is incorporated is important. In particular, our results demonstrate that the relative importance of different predictors varies over time, and that using multi-task learning to account for this is an appropriate way to robustly capture the temporal dynamics in EHR data. Using a case study, we also demonstrate how the multi-task learning based model can yield predictive models with better performance for identifying patients at high risk of short-term loss of kidney function. PMID:25460205

  20. Costs of health IT: beginning to understand the financial impact of a dental school EHR.

    PubMed

    Spallek, Heiko; Johnson, Lynn; Kerr, Joseph; Rankin, David

    2014-11-01

    Health Information Technology (Health IT) constitutes an integral component of the operations of most academic dental institutions nowadays. However, the expenses associated with the acquisition and the ongoing maintenance of these complex systems have often been buried among costs for other electronic infrastructure systems, distributed across various cost centers including unmeasured central campus support, covered centrally and therefore difficult to quantify, and spread over years, denying school administrators a clear understanding of the resources that have been dedicated to Health IT. The aim of this study was to understand the financial impact of Health IT at four similar U.S. dental schools: two schools using a purchased Electronic Health Record (EHR), and two schools that developed their own EHR. For these schools, the costs of creating ($2.5 million) and sustaining ($174,000) custom EHR software were significantly higher than acquiring ($500,000) and sustaining ($121,000) purchased software. These results are based on historical data and should not be regarded as a gold standard for what a complete Health IT suite should cost. The presented data are intended to inform school administrators about the myriad of costs associated with Health IT and give them a point of reference when comparing costs or making estimates for implementation projects.

  1. Too Much or Too Little? How Much Control Should Patients Have Over EHR Data?

    PubMed

    Bhuyan, Soumitra Sudip; Bailey-DeLeeuw, Sandra; Wyant, David K; Chang, Cyril F

    2016-07-01

    Electronic health records (EHRs) have been promoted as a mechanism to overcome the fragmented healthcare system in the United States. The challenge that is being discussed is the rights of the patient to control the access to their EHRs' data and the needs of healthcare professionals to know health data to make the best treatment decisions for their patients. The Federal Trade Commission has asked those who store consumer information to comply with the Fair Information Practice Principles. In the EHR context, these principles give the rights to the patient to control who can see their health data and what components of the data are restricted from view. Control is not limited to patients, as it also includes parents of adolescent children. We suggest that the ongoing policy discussion include consideration of the precise questions patients will be asked when a need for data sharing arises. Further, patients should understand the relative risks that they face, and the degree to which their decisions will (or will not) significantly reduce the risk of a data breach. As various approaches are considered, it is important to address the relative resource requirements and the associated costs of each option. PMID:27272134

  2. Medicare and Medicaid programs; modifications to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program for 2014 and other changes to EHR Incentive Program; and health information technology: revision to the certified EHR technology definition and EHR certification changes related to standards. Final rule.

    PubMed

    2014-09-01

    This final rule changes the meaningful use stage timeline and the definition of certified electronic health record technology (CEHRT) to allow options in the use of CEHRT for the EHR reporting period in 2014. It also sets the requirements for reporting on meaningful use objectives and measures as well as clinical quality measure (CQM) reporting in 2014 for providers who use one of the CEHRT options finalized in this rule for their EHR reporting period in 2014. In addition, it finalizes revisions to the Medicare and Medicaid EHR Incentive Programs to adopt an alternate measure for the Stage 2 meaningful use objective for hospitals to provide structured electronic laboratory results to ambulatory providers; to correct the regulation text for the measures associated with the objective for hospitals to provide patients the ability to view online, download, and transmit information about a hospital admission; and to set a case number threshold exemption for CQM reporting applicable for eligible hospitals and critical access hospitals (CAHs) beginning with FY 2013. Finally, this rule finalizes the provisionally adopted replacement of the Data Element Catalog (DEC) and the Quality Reporting Document Architecture (QRDA) Category III standards with updated versions of these standards.

  3. Optimization of an EHR Mobile Application Using the UFuRT Conceptual Framework

    PubMed Central

    Amith, Muhammad; Loubser, Paul G.; Chapman, John; Zoker, Kaafoe C.; Rabelo Ferreira, Fred E. R.

    2012-01-01

    Drchrono is an Electronic Healthcare Record (EHR) application designed specifically for the iPad. Described as portable, efficient and accessible anywhere, drchrono has several features that might be attractive to health care providers. However, EHRs have to conform to certain Federal Healthcare Information Technology Guidelines, which are evaluated in a series of 12 test procedures, defined by the Office of the National Coordinator for Health Information Technology (ONC). In this study, we evaluated Test Procedure for §170.302 (c) Maintain up-to-date problem list, in drchrono. The methodology for our evaluation was contained within Zhang’s unified framework for usability, using UFuRT, i.e. user, functional, representation and task analyses. Based upon the analysis, using Adobe Flex, we then designed a prototype that corrected or improved on perceived weaknesses in the functionality served by the test procedure. We applied the test procedure taxonomy to a prototypic modification of drchrono, and then repeated the UFuRT usability analysis. We also used a 14-item heuristic evaluation by each member of our informatics team. Our findings support a conclusion that UFuRT is a valuable tool to evaluate EHR usability and that an “up-to-date problem” list may be customized, according to healthcare provider preference. PMID:23304290

  4. Too Much or Too Little? How Much Control Should Patients Have Over EHR Data?

    PubMed

    Bhuyan, Soumitra Sudip; Bailey-DeLeeuw, Sandra; Wyant, David K; Chang, Cyril F

    2016-07-01

    Electronic health records (EHRs) have been promoted as a mechanism to overcome the fragmented healthcare system in the United States. The challenge that is being discussed is the rights of the patient to control the access to their EHRs' data and the needs of healthcare professionals to know health data to make the best treatment decisions for their patients. The Federal Trade Commission has asked those who store consumer information to comply with the Fair Information Practice Principles. In the EHR context, these principles give the rights to the patient to control who can see their health data and what components of the data are restricted from view. Control is not limited to patients, as it also includes parents of adolescent children. We suggest that the ongoing policy discussion include consideration of the precise questions patients will be asked when a need for data sharing arises. Further, patients should understand the relative risks that they face, and the degree to which their decisions will (or will not) significantly reduce the risk of a data breach. As various approaches are considered, it is important to address the relative resource requirements and the associated costs of each option.

  5. Impacts of EHR Certification and Meaningful Use Implementation on an Integrated Delivery Network.

    PubMed

    Bowes, Watson A

    2014-01-01

    Three years ago Intermountain Healthcare made the decision to participate in the Medicare and Medicaid Electronic Heath Record (EHR) Incentive Program which required that hospitals and providers use a certified EHR in a meaningful way. At that time, the barriers to enhance our home grown system, and change clinician workflows were numerous and large. This paper describes the time and effort required to enhance our legacy systems in order to pass certification, including filling 47 gaps in (EHR) functionality. We also describe the processes and resources that resulted in successful changes to many clinical workflows required by clinicians to meet meaningful use requirements. In 2011 we set meaningful use targets of 75% of employed physicians and 75% of our hospitals to meet Stage 1 of meaningful use by 2013. By the end of 2013, 87% of 696 employed eligible professionals and 100% of 22 Intermountain hospitals had successfully attested for Stage 1. This paper describes documented and perceived costs to Intermountain including time, effort, resources, postponement of other projects, as well as documented and perceived benefits of attainment of meaningful use.

  6. Architectural approach for semantic EHR systems development based on Detailed Clinical Models.

    PubMed

    Bernal, Juan G; Lopez, Diego M; Blobel, Bernd

    2012-01-01

    The integrative approach to health information in general and the development of pHealth systems in particular, require an integrated approach of formally modeled system architectures. Detailed Clinical Models (DCM) is one of the most promising modeling efforts for clinical concept representation in EHR system architectures. Although the feasibility of DCM modeling methodology has been demonstrated through examples, there is no formal, generic and automatic modeling transformation technique to ensure a semantic lossless transformation of clinical concepts expressed in DCM to either clinical concept representations based on ISO 13606/openEHR Archetypes or HL7 Templates. The objective of this paper is to propose a generic model transformation method and tooling for transforming DCM Clinical Concepts into ISO/EN 13606/openEHR Archetypes or HL7 Template models. The automation of the transformation process is supported by Model Driven-Development (MDD) transformation mechanisms and tools. The availability of processes, techniques and tooling for automatic DCM transformation would enable the development of intelligent, adaptive information systems as demanded for pHealth solutions. PMID:22942049

  7. The new IAGOS Database Portal

    NASA Astrophysics Data System (ADS)

    Boulanger, Damien; Gautron, Benoit; Thouret, Valérie; Fontaine, Alain

    2016-04-01

    IAGOS (In-service Aircraft for a Global Observing System) is a European Research Infrastructure which aims at the provision of long-term, regular and spatially resolved in situ observations of the atmospheric composition. IAGOS observation systems are deployed on a fleet of commercial aircraft. The IAGOS database is an essential part of the global atmospheric monitoring network. It contains IAGOS-core data and IAGOS-CARIBIC (Civil Aircraft for the Regular Investigation of the Atmosphere Based on an Instrument Container) data. The IAGOS Database Portal (http://www.iagos.fr, damien.boulanger@obs-mip.fr) is part of the French atmospheric chemistry data center AERIS (http://www.aeris-data.fr). The new IAGOS Database Portal has been released in December 2015. The main improvement is the interoperability implementation with international portals or other databases in order to improve IAGOS data discovery. In the frame of the IGAS project (IAGOS for the Copernicus Atmospheric Service), a data network has been setup. It is composed of three data centers: the IAGOS database in Toulouse; the HALO research aircraft database at DLR (https://halo-db.pa.op.dlr.de); and the CAMS data center in Jülich (http://join.iek.fz-juelich.de). The CAMS (Copernicus Atmospheric Monitoring Service) project is a prominent user of the IGAS data network. The new portal provides improved and new services such as the download in NetCDF or NASA Ames formats, plotting tools (maps, time series, vertical profiles, etc.) and user management. Added value products are available on the portal: back trajectories, origin of air masses, co-location with satellite data, etc. The link with the CAMS data center, through JOIN (Jülich OWS Interface), allows to combine model outputs with IAGOS data for inter-comparison. Finally IAGOS metadata has been standardized (ISO 19115) and now provides complete information about data traceability and quality.

  8. Developing Interoperable Air Quality Community Portals

    NASA Astrophysics Data System (ADS)

    Falke, S. R.; Husar, R. B.; Yang, C. P.; Robinson, E. M.; Fialkowski, W. E.

    2009-04-01

    Web portals are intended to provide consolidated discovery, filtering and aggregation of content from multiple, distributed web sources targeted at particular user communities. This paper presents a standards-based information architectural approach to developing portals aimed at air quality community collaboration in data access and analysis. An important characteristic of the approach is to advance beyond the present stand-alone design of most portals to achieve interoperability with other portals and information sources. We show how using metadata standards, web services, RSS feeds and other Web 2.0 technologies, such as Yahoo! Pipes and del.icio.us, helps increase interoperability among portals. The approach is illustrated within the context of the GEOSS Architecture Implementation Pilot where an air quality community portal is being developed to provide a user interface between the portals and clearinghouse of the GEOSS Common Infrastructure and the air quality community catalog of metadata and data services.

  9. Using a Patient Portal to Transmit Patient Reported Health Information into the Electronic Record: Workflow Implications and User Experience

    PubMed Central

    Sorondo, Barbara; Allen, Amy; Bayleran, Janet; Doore, Stacy; Fathima, Samreen; Sabbagh, Iyad; Newcomb, Lori

    2016-01-01

    Introduction: This project implemented an integrated patient self-reported screening tool in a patient portal and assessed clinical workflow and user experience in primary care practices. Methods: An electronic health risk assessment based on the CMS Annual Wellness Visit (AWV) was developed to integrate self-reported health information into the patient’s electronic health record (EHR). Patients enrolled in care coordination tested the implementation. The evaluation plan included quantitative and qualitative measures of patient adoption, provider adoption, workflow impact, financial impact, and technology impact. Findings: Seventy-two patients completed the sample AWV, and 80% of the questionnaires had clinical findings that required provider follow-up. Patients expressed satisfaction with the portal, as it enabled them to view their health record and enter information. Implementation did not reduce office staff time. Providers and office staff agreed that an electronic system for adding information to their record would increase patient satisfaction, but they expressed concern with the need to promptly review the information and the time involved to accomplish this prior to an office visit. Discussion: Despite satisfaction among patients, portal adoption is still low, due to technological limitations and to the lack of adaptability to primary care practice workflow. Notwithstanding those barriers, the use of the portal for completion of repetitive tasks, such as screening tools, should be encouraged. Conclusions: Patients can effectively use portals to complete the patient reported section of the CMS AWV. However, if the information is not completed during the same day of the office visit, the time required to address health findings outside of a regular office visit is uncompensated, and diminished the enthusiasm for this process among primary care practice staff.

  10. Using a Patient Portal to Transmit Patient Reported Health Information into the Electronic Record: Workflow Implications and User Experience

    PubMed Central

    Sorondo, Barbara; Allen, Amy; Bayleran, Janet; Doore, Stacy; Fathima, Samreen; Sabbagh, Iyad; Newcomb, Lori

    2016-01-01

    Introduction: This project implemented an integrated patient self-reported screening tool in a patient portal and assessed clinical workflow and user experience in primary care practices. Methods: An electronic health risk assessment based on the CMS Annual Wellness Visit (AWV) was developed to integrate self-reported health information into the patient’s electronic health record (EHR). Patients enrolled in care coordination tested the implementation. The evaluation plan included quantitative and qualitative measures of patient adoption, provider adoption, workflow impact, financial impact, and technology impact. Findings: Seventy-two patients completed the sample AWV, and 80% of the questionnaires had clinical findings that required provider follow-up. Patients expressed satisfaction with the portal, as it enabled them to view their health record and enter information. Implementation did not reduce office staff time. Providers and office staff agreed that an electronic system for adding information to their record would increase patient satisfaction, but they expressed concern with the need to promptly review the information and the time involved to accomplish this prior to an office visit. Discussion: Despite satisfaction among patients, portal adoption is still low, due to technological limitations and to the lack of adaptability to primary care practice workflow. Notwithstanding those barriers, the use of the portal for completion of repetitive tasks, such as screening tools, should be encouraged. Conclusions: Patients can effectively use portals to complete the patient reported section of the CMS AWV. However, if the information is not completed during the same day of the office visit, the time required to address health findings outside of a regular office visit is uncompensated, and diminished the enthusiasm for this process among primary care practice staff. PMID:27683669

  11. Extrahepatic Portal Vein Obstruction and Portal Vein Thrombosis in Special Situations: Need for a New Classification

    PubMed Central

    Wani, Zeeshan A.; Bhat, Riyaz A.; Bhadoria, Ajeet S.; Maiwall, Rakhi

    2015-01-01

    Extrahepatic portal vein obstruction is a vascular disorder of liver, which results in obstruction and cavernomatous transformation of portal vein with or without the involvement of intrahepatic portal vein, splenic vein, or superior mesenteric vein. Portal vein obstruction due to chronic liver disease, neoplasm, or postsurgery is a separate entity and is not the same as extrahepatic portal vein obstruction. Patients with extrahepatic portal vein obstruction are generally young and belong mostly to Asian countries. It is therefore very important to define portal vein thrombosis as acute or chronic from management point of view. Portal vein thrombosis in certain situations such as liver transplant and postsurgical/liver transplant period is an evolving area and needs extensive research. There is a need for a new classification, which includes all areas of the entity. In the current review, the most recent literature of extrahepatic portal vein obstruction is reviewed and summarized. PMID:26021771

  12. Extrahepatic portal vein obstruction and portal vein thrombosis in special situations: Need for a new classification.

    PubMed

    Wani, Zeeshan A; Bhat, Riyaz A; Bhadoria, Ajeet S; Maiwall, Rakhi

    2015-01-01

    Extrahepatic portal vein obstruction is a vascular disorder of liver, which results in obstruction and cavernomatous transformation of portal vein with or without the involvement of intrahepatic portal vein, splenic vein, or superior mesenteric vein. Portal vein obstruction due to chronic liver disease, neoplasm, or postsurgery is a separate entity and is not the same as extrahepatic portal vein obstruction. Patients with extrahepatic portal vein obstruction are generally young and belong mostly to Asian countries. It is therefore very important to define portal vein thrombosis as acute or chronic from management point of view. Portal vein thrombosis in certain situations such as liver transplant and postsurgical/liver transplant period is an evolving area and needs extensive research. There is a need for a new classification, which includes all areas of the entity. In the current review, the most recent literature of extrahepatic portal vein obstruction is reviewed and summarized.

  13. 1. West portal of the mudshed abutting the west portal ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. West portal of the mudshed abutting the west portal of Tunnel 5, view to the northwest, 135mm lens. The flat-roofed reinforced concrete mudsheds, rocksheds, and snowsheds are a common feature of the Natron Cutoff over the summit of the Cascades. With the railroad located on a sidehill bench cut into the precipitous slopes, the sheds protect the track from rock and mud slides, as well as from avalanches. With a solid wall on the uphill side and a series of columns on the downhill side, they form a gallery-like effect from within. This mudshed was built concurrent with the tunnel, in 1927. Though none of the mudsheds on the line are scheduled to be modified, this shed was documented as an integral element of Tunnel 5. - Southern Pacific Railroad Natron Cutoff, Tunnel 5, Milepost 545.2, McCredie Springs, Lane County, OR

  14. The ADRICOSM STAR GeoPortal

    NASA Astrophysics Data System (ADS)

    Giorgetti, Alessandra; Cesarini, Claudia; Gambetta, Marco; Reseghetti, Franco; Vinci, Matteo

    2010-05-01

    From Stockholm (1972) to Rio de Janeiro (1992) and to Johannesburg (2002), environmental protection objectives are related to the principles of sustainable development. This includes the following important components: participation, information, communication, training (capacity building) and education. Better information ensure more participation from individuals, and allows citizens to take part in many different actions that can influence the policy process. Participation to political decisions need access to reliable and quality controlled information. The ADRICOSM Portal was developed in order to manage data diversity, provide access to any kind of product, provide metadata completeness and accuracy. The product, as defined in ADRICOSM, is anything that can be offered to a client and that might satisfy a want or need. This implied the implementation of services that was taking into consideration the diversity of the objects to be provided to users: observations, model outputs, maps, etc. The implementation of the portal was based on two metadata levels: 1. Directory level - consisting of broad descriptions of the contents of data sets; used to locate data sets of potential interest and 2. Data level - consisting of the actual data objects. The portal was developed as a simplified front end for the partners data management systems, giving emphasis on federated access points focused on thematic aspects. This was based on the idea that specialized customer-related access points can be better carried out by delegated teams of experts who know the needs of different customers, define the user software which is most suited to them. The data management systems provide facilities for two data tracks, one in real-time (or near-realtime) and one in delayed mode. Both tracks are based on the same data sources and transmission systems, but the data follow different routes and are processed differently depending on user requirements. The real-time data and model products

  15. The anxious wait: assessing the impact of patient accessible EHRs for breast cancer patients

    PubMed Central

    2010-01-01

    Background Personal health records (PHRs) provide patients with access to personal health information (PHI) and targeted education. The use of PHRs has the potential to improve a wide range of outcomes, including empowering patients to be more active participants in their care. There are a number of widespread barriers to adoption, including privacy and security considerations. In addition, there are clinical concerns that patients could become anxious or distressed when accessing complex medical information. This study assesses the implementation of a PHR, and its impact on anxiety levels and perceptions of self-efficacy in a sample of breast cancer patients. Methods A quasi-experimental pre-test/post-test design was used to collect data from participants to evaluate the use of the PHR. Study participants completed background and pre-assessment questionnaires and were then registered into the portal. By entering an activation key, participants were then able to review their lab results and diagnostic imaging reports. After six weeks, participants completed post-assessment questionnaires and usability heuristics. All data were collected using an online survey tool. Data were cleaned and analyzed using SAS v9.1. Results A total of 311 breast cancer patients completed demographic and pre-assessment questionnaires, 250 registered to use the online intervention, and 125 participants completed all required study elements. Matching the pre- and post-anxiety scores demonstrated a decrease in mean anxiety scores (-2.2, p = 0.03); the chemotherapy sub-group had a statistically insignificant mean increase (1.8, p = .14). There was no mean change in self-efficacy scores. Conclusions Participants generally found the portal easy to use; however, the perceived value of improved participation was not detected in the self-efficacy scores. Having access to personal health information did not increase anxiety levels. While these results suggest that the use of this PHR may be of

  16. Vertical flow chemical detection portal

    DOEpatents

    Linker, K.L.; Hannum, D.W.; Conrad, F.J.

    1999-06-22

    A portal apparatus is described for screening objects or persons for the presence of trace amounts of chemical substances such as illicit drugs or explosives. The apparatus has a test space, in which a person may stand, defined by two generally upright sides spanned by a horizontal transom. One or more fans in the transom generate a downward air flow (uni-directional) within the test space. The air flows downwardly from a high pressure upper zone, past the object or person to be screened. Air moving past the object dislodges from the surface thereof both volatile and nonvolatile particles of the target substance. The particles are entrained into the air flow which continues flowing downward to a lower zone of reduced pressure, where the particle-bearing air stream is directed out of the test space and toward preconcentrator and detection components. The sides of the portal are specially configured to partially contain and maintain the air flow. 3 figs.

  17. Vertical flow chemical detection portal

    DOEpatents

    Linker, Kevin L.; Hannum, David W.; Conrad, Frank James

    1999-01-01

    A portal apparatus for screening objects or persons for the presence of trace amounts of chemical substances such as illicit drugs or explosives. The apparatus has a test space, in which a person may stand, defined by two generally upright sides spanned by a horizontal transom. One or more fans in the transom generate a downward air flow (uni-directional) within the test space. The air flows downwardly from a high pressure upper zone, past the object or person to be screened. Air moving past the object dislodges from the surface thereof both volatile and nonvolatile particles of the target substance. The particles are entrained into the air flow which continues flowing downward to a lower zone of reduced pressure, where the particle-bearing air stream is directed out of the test space and toward preconcentrator and detection components. The sides of the portal are specially configured to partially contain and maintain the air flow.

  18. Z-portal dark matter

    SciTech Connect

    Arcadi, Giorgio; Mambrini, Yann; Richard, Francois

    2015-03-11

    We propose to generalize the extensions of the Standard Model where the Z boson serves as a mediator between the Standard Model sector and the dark sector χ. We show that, like in the Higgs portal case, the combined constraints from the recent direct searches restrict severely the nature of the coupling of the dark matter to the Z boson and set a limit m{sub χ}≳200 GeV (except in a very narrow region around the Z-pole region). Using complementarity between spin dependent, spin independent and FERMI limits, we predict the nature of this coupling, more specifically the axial/vectorial ratio that respects a thermal dark matter coupled through a Z-portal while not being excluded by the current observations. We also show that the next generation of experiments of the type LZ or XENON1T will test Z-portal scenario for dark matter mass up to 2 TeV. The condition of a thermal dark matter naturally predicts the spin-dependent scattering cross section on the neutron to be σ{sub χn}{sup SD}≃10{sup −40} cm{sup 2}, which then becomes a clear prediction of the model and a signature testable in the near future experiments.

  19. Uzbekistan Radiation Portal Monnitoring System

    SciTech Connect

    Richardson, J; Knapp, R; Loshak, A; Yuldashev, B; Petrenko, V

    2005-06-10

    The work proposed in this presentation builds on the foundation set by the DTRA funded demonstration project begun in 2000 and completed in December of 2003. This previous work consisted of two phases whose overall objective was to install portal radiation monitors at four select ports-of-entry in Uzbekistan (Tashkent International Airport, Gisht-Kuprik (Kazakhstan border), Alat (Turkmenistan border), and Termez (Afghanistan border)) in order to demonstrate their effectiveness in preventing the illicit trafficking of nuclear materials. The objectives also included developing and demonstrating capabilities in the design, installation, operation, training, and maintenance of a radiation portal monitoring system. The system and demonstration project has proved successful in many ways. An effective working relationship among the Uzbekistan Customs Services, Uzbekistan Border Guards, and Uzbekistan Institute of Nuclear Physics has been developed. There has been unprecedented openness with the sharing of portal monitor data with Lawrence Livermore National Laboratory. The system has proved to be effective, with detection of illicit trafficking, and, at Alat, an arrest of three persons illegally transporting radioactive materials into Turkmenistan. The demonstration project has made Uzbekistan a model nonproliferation state in Central Asia and, with an expanded program, places them in a position to seal a likely transit route for illicit nuclear materials. These results will be described. In addition, this work is currently being expanded to include additional ports-of-entry in Uzbekistan. The process for deciding on which additional ports-of-entry to equip will also be described.

  20. The Higgs portal above threshold

    DOE PAGES

    Craig, Nathaniel; Lou, Hou Keong; McCullough, Matthew; Thalapillil, Arun

    2016-02-18

    The discovery of the Higgs boson opens the door to new physics interacting via the Higgs Portal, including motivated scenarios relating to baryogenesis, dark matter, and electroweak naturalness. In this study, we systematically explore the collider signatures of singlet scalars produced via the Higgs Portal at the 14TeV LHC and a prospective 100TeV hadron collider. We focus on the challenging regime where the scalars are too heavy to be produced in the decays of an on-shell Higgs boson, and instead are produced primarily via an o ff-shell Higgs. Assuming these scalars escape the detector, promising channels include missing energy inmore » association with vector boson fusion, monojets, and top pairs. In addition, we forecast the sensitivity of searches in these channels at √s = 14 & 100 TeV and compare collider reach to the motivated parameter space of singlet-assisted electroweak baryogenesis, Higgs Portal dark matter, and neutral naturalness.« less

  1. More than half of US hospitals have at least a basic EHR, but stage 2 criteria remain challenging for most.

    PubMed

    Adler-Milstein, Julia; DesRoches, Catherine M; Furukawa, Michael F; Worzala, Chantal; Charles, Dustin; Kralovec, Peter; Stalley, Samantha; Jha, Ashish K

    2014-09-01

    The national effort to promote the adoption and meaningful use of electronic health records (EHRs) is well under way. However, 2014 marks an important transition: For many hospitals, penalties will be assessed in fiscal year 2015 for failing to meet federal meaningful-use criteria by the end of fiscal year 2014. We used recent data from the American Hospital Association Annual Survey of Hospitals--IT Supplement to assess progress and challenges. EHR adoption among US hospitals continues to rise steeply: 59 percent now have at least a basic EHR. Small and rural hospitals continue to lag behind their better resourced counterparts. Most hospitals are able to meet many of the stage 2 meaningful-use criteria, but only 5.8 percent of hospitals are able to meet them all. Several criteria, including sharing care summaries with other providers and providing patients with online access to their data, will require attention from EHR vendors to ensure that the necessary functions are available and additional effort from many hospitals to make certain that these functionalities are used. Policy makers may want to consider new targeted strategies to ensure that all hospitals move toward meaningful use of EHRs. PMID:25104826

  2. OpenEHR-based representation of guideline compliance data through the example of stroke clinical practice guidelines.

    PubMed

    Anani, Nadim; Chen, Rong; Prazeres Moreira, Tiago; Koch, Sabine

    2012-01-01

    In light of the lack of integration between electronic health records and decision support, this research explores how semantic electronic health record technology, particularly openEHR, can be used to represent clinical practice guidelines (CPGs). We used the tool Visual Understanding Environment (VUE) to build a graphical representation of the European ischaemic stroke clinical management guidelines. We used openEHR archetypes to conceptually support this process and also to represent clinical concepts in stroke treatment compliance criteria. Our results show that, as an intermediate step in authoring computer-interpretable guidelines, an openEHR-based representation of CPGs and their compliance criteria supports the process of identifying the relevant knowledge and data elements in the care process to be modelled. It further eases the separation of the CPGs into data and logic components and is useful as a communication means for guideline verification by clinicians. Additionally, we retrieved existing and authored new openEHR archetypes for the acute stroke clinical management process. We conclude that openEHR-based guideline and compliance data representations may be a promising first step in building future decision support applications that are well connected to the electronic health record, can be useful in locating discrepancies between different sets of guidelines within the same care context and provide a helpful tool for driving the archetype authoring and review process. PMID:22874238

  3. Reflections of pressure waves at tunnel portals

    NASA Astrophysics Data System (ADS)

    Brown, J. M. B.; Vardy, A. E.

    1994-05-01

    Reflections of plane waves from the open ends (portals) of axisymmetric pipes and plane two-dimensional (2-D) channels are investigated analytically, numerically, and experimentally. An analytical approach developed by Rudinger for pressure decay at an axisymmetric, flanged portal is extended to longer times, and equivalent analyses are developed for reflections from unflanged portals - both axisymmetric and plane 2-D. Predictions for the latter case are compared with numerical results from a computer program based on a 2-D method of bicharacteristics. The theoretical results are compared with measurements from a low pressure shock tube, which was used to investigate alternative end configurations including scarfed portals with and without flange plates. These confirm that the rate of pressure decay is much slower in the plane 2-D case and that flange plates further reduce the rate of decay, albeit slightly. Scarfed portals are shown to cause more uniform decay rates than 90 deg portals.

  4. Noncirrhotic portal fibrosis after Wilms' tumor therapy

    SciTech Connect

    Barnard, J.A.; Marshall, G.S.; Neblett, W.W.; Gray, G.; Ghishan, F.K.

    1986-04-01

    A 9-yr-old girl developed massive hemorrhage from esophageal varices 2 yr after combined modality therapy for Wilms' tumor. Evaluation showed a patent extrahepatic portal venous system and an elevated splenic pulp pressure. In contrast to previous reports of hepatopathy after irradiation injury, histologic sections of the liver did not demonstrate occlusion of the central veins, but rather a diffuse obliteration of intrahepatic portal venous radicles. This pattern of noncirrhotic portal fibrosis has not been described following antitumor therapy.

  5. Preduodenal portal vein: its surgical significance.

    PubMed

    Makey, D A; Bowen, J C

    1978-11-01

    Preduodenal portal vein is a rare anatomical variant which may be one of many anomalies in the neonate with duodenal "atresia." Preduodenal portal vein also may be an occasional finding in an adult undergoing biliary, gastric, or pancreatic surgery. Awareness and recognition of the anomaly are essential for the avoidance of injury during such operations. We report here a symptomless patient whose preduodenal portal vein was discovered at cholecystectomy.

  6. Web-based Service Portal in Healthcare

    NASA Astrophysics Data System (ADS)

    Silhavy, Petr; Silhavy, Radek; Prokopova, Zdenka

    Information delivery is one the most important task in healthcare. The growing sector of electronic healthcare has an important impact on the information delivery. There are two basic approaches towards information delivering. The first is web portal and second is touch-screen terminal. The aim of this paper is to investigate the web-based service portal. The most important advantage of web-based portal in the field of healthcare is an independent access for patients. This paper deals with the conditions and frameworks for healthcare portals

  7. Portal hypertension: state of the art.

    PubMed

    Gatta, A; Sacerdoti, D; Bolognesi, M; Merkel, C

    1999-05-01

    In the last decade, the knowledge of the pathogenesis of portal hypertension has increased dramatically. Indeed, apart from the well-known pathogenetic importance of structural factors, the role of vasoactive factors, which enhance the increase in intrahepatic resistance, has been highlighted. The two pathogenetic factors of portal hypertension are: the increase in portal outflow resistance and an increase in splanchnic blood flow, which worsens and maintains the increased pressure in the portal vein. The increase in portal inflow is part of the hyperdynamic circulatory syndrome, which is a haemodynamic characteristic of cirrhotic patients. In portal hypertensive patients, almost all the known vasoactive systems/substances are activated or increased and the most recent studies have stressed the importance of the endothelial factors, such as endothelins, nitric oxide and prostaglandins. Knowledge of the haemodynamic mechanisms allows a pathogenetic approach to the treatment of portal hypertension, particularly as far as medical therapy is concerned. The main categories of drugs used are: the vasoconstrictors (i.e., vasopressin, glypressin, somatostatin, non-selective beta-blockers), which act by decreasing portal inflow, and the vasodilators (i.e., nitroderivatives), which act mainly by decreasing intrahepatic portal resistance. Moreover, technological developments have introduced new tools for diagnosis, such as echo-colour-Doppler, and therapy, like variceal banding and transjugular intrahepatic porto-systemic shunt.

  8. Evaluation of a clinical simulation-based assessment method for EHR-platforms.

    PubMed

    Jensen, Sanne; Rasmussen, Stine Loft; Lyng, Karen Marie

    2014-01-01

    In a procurement process assessment of issues like human factors and interaction between technology and end-users can be challenging. In a large public procurement of an Electronic health record-platform (EHR-platform) in Denmark a clinical simulation-based method for assessing and comparing human factor issues was developed and evaluated. This paper describes the evaluation of the method, its advantages and disadvantages. Our findings showed that clinical simulation is beneficial for assessing user satisfaction, usefulness and patient safety, all though it is resource demanding. The method made it possible to assess qualitative topics during the procurement and it provides an excellent ground for user involvement.

  9. Evaluation of a clinical simulation-based assessment method for EHR-platforms.

    PubMed

    Jensen, Sanne; Rasmussen, Stine Loft; Lyng, Karen Marie

    2014-01-01

    In a procurement process assessment of issues like human factors and interaction between technology and end-users can be challenging. In a large public procurement of an Electronic health record-platform (EHR-platform) in Denmark a clinical simulation-based method for assessing and comparing human factor issues was developed and evaluated. This paper describes the evaluation of the method, its advantages and disadvantages. Our findings showed that clinical simulation is beneficial for assessing user satisfaction, usefulness and patient safety, all though it is resource demanding. The method made it possible to assess qualitative topics during the procurement and it provides an excellent ground for user involvement. PMID:25160323

  10. At the crossroads: NRTRC white paper examines trends driving the convergence of telehealth, EHRs and HIE.

    PubMed

    Thielst, Christina Beach

    2010-01-01

    From the American Recovery and Reinvestment Act (ARRA) and the newly passed healthcare reform legislation to emerging reimbursement models and shifting consumer health trends, a confluence of events are driving radical change in the nation's healthcare system and bringing about the convergence of telehealth, electronic health records (EHRs) and health information exchange (HIE). That is the focus of "The Crossroads of Telehealth, Electronic Health Records & Health Information Exchange: Planning for Rural Communities," a new white paper from the Northwest Regional Telehealth Resource Center (NRTRC). "Accelerating adoption and utilization of telehealth technologies, telemedicine in particular, will be critical to a successful stakeholder response to the disruptive changes that are underway in healthcare," said NRTRC Executive Director Christina B. Thielst, FACHE. "By leveraging telehealth networks and their existing infrastructures, Regional Extension Centers, HIEs and other data-sharing initiatives will be better-positioned to fulfill their commitments to the healthcare delivery system of the future--a system in which even the most rural and remote populations have timely access to care and their health records." The white paper explores emerging trends and recent disruptors impacting the healthcare delivery system and examines the opportunities they present for the advancement of telecommunications-based health solutions and the broadband infrastructure available through telehealth networks. It also takes an in-depth look at the various uses of telehealth and the most common delivery models of telemedicine, as well as the role of the telehealth network and Telehealth Resource Centers (TRCs) in expanding the reach of these vital initiatives. Finally, the white paper highlights the evolution of the REACH Montana Telehealth Network from facilitating teleradiology at three remote sites into a consortium of healthcare providers at 18 sites linked by high

  11. A grid-based implementation of XDS-I as a part of a metropolitan EHR in Shanghai

    NASA Astrophysics Data System (ADS)

    Zhang, Jianguo; Zhang, Chenghao; Sun, Jianyong, Sr.; Yang, Yuanyuan; Jin, Jin; Yu, Fenghai; He, Zhenyu; Zheng, Xichuang; Qin, Huanrong; Feng, Jie; Zhang, Guozheng

    2007-03-01

    A number of hospitals in Shanghai are piloting the development of an EHR solution based on a grid concept with a service-oriented architecture (SOA). The first phase of the project targets the Diagnostic Imaging domain and allows seamless sharing of images and reports across the multiple hospitals. The EHR solution is fully aligned with the IHE XDS-I integration profile and consists of the components of the XDS-I Registry, Repository, Source and Consumer actors. By using SOA, the solution uses ebXML over secured http for all transactions with in the grid. However, communication with the PACS and RIS is DICOM and HL7 v3.x. The solution was installed in three hospitals and one date center in Shanghai and tested for performance of data publication, user query and image retrieval. The results are extremely positive and demonstrate that the EHR solution based on SOA with grid concept can scale effectively to server a regional implementation.

  12. Modelling of Operative Report Documents for Data Integration into an openEHR-Based Enterprise Data Warehouse.

    PubMed

    Haarbrandt, Birger; Wilschko, Andreas; Marschollek, Michael

    2016-01-01

    In order to integrate operative report documents from two operating room management systems into a data warehouse, we investigated the application of the two-level modelling approach of openEHR to create a shared data model. Based on the systems' analyses, a template consisting of 13 archetypes has been developed. Of these 13 archetypes, 3 have been obtained from the international archetype repository of the openEHR foundation. The remaining 10 archetypes have been newly created. The template was evaluated by an application system expert and through conducting a first test mapping of real-world data from one of the systems. The evaluation showed that by using the two-level modelling approach of openEHR, we succeeded to represent an integrated and shared information model for operative report documents. More research is needed to learn about the limitations of this approach in other data integration scenarios. PMID:27577414

  13. Searching for document contents in an IHE-XDS EHR architecture via archetype-based indexing of document types.

    PubMed

    Rinner, Christoph; Kohler, Michael; Saboor, Samrend; Huebner-Bloder, Gudrun; Ammenwerth, Elske; Duftschmid, Georg

    2013-01-01

    The shared EHR (electronic health record) system architecture IHE XDS is widely adopted internationally. It ensures a high level of data privacy via distributed storage of EHR documents. Its standard search capabilities, however, are limited; it only allows a retrieval of complete documents by querying a restricted set of document metadata. Existing approaches that aim to extend XDS queries to document contents typically employ a central index of document contents. Hereby they undermine XDS' basic characteristic of distributed data storage. To avoid data privacy concerns, we propose querying EHR contents in XDS by indexing document types based on Archetypes instead. We successfully tested our approach within the ISO/EN 13606 standard. PMID:23920866

  14. The Archetype-enabled EHR system ZK-ARCHE - integrating the ISO/EN 13606 standard and IHE XDS profile.

    PubMed

    Kohler, Michael; Rinner, Christoph; Hübner-Bloder, Gudrun; Saboor, Samrend; Ammenwerth, Elske; Duftschmid, Georg

    2011-01-01

    The EHR system ZK-ARCHE automatically generates forms from ISO/EN 13606 archetypes. For this purpose the archetypes are augmented with components of the reference model to achieve so-called "comprehensive archetypes". Data collected via the forms are stored in a list which associates each value with the path of the corresponding comprehensive archetype node coded as W3C XPath. From this list archetype-conformant EHR extracts can be created. The system is embedded with the IHE XDS profile to allow direct data exchange in an environment of distributed data storage.

  15. Role of OpenEHR as an open source solution for the regional modelling of patient data in obstetrics.

    PubMed

    Pahl, Christina; Zare, Mojtaba; Nilashi, Mehrbakhsh; de Faria Borges, Marco Aurélio; Weingaertner, Daniel; Detschew, Vesselin; Supriyanto, Eko; Ibrahim, Othman

    2015-06-01

    This work investigates, whether openEHR with its reference model, archetypes and templates is suitable for the digital representation of demographic as well as clinical data. Moreover, it elaborates openEHR as a tool for modelling Hospital Information Systems on a regional level based on a national logical infrastructure. OpenEHR is a dual model approach developed for the modelling of Hospital Information Systems enabling semantic interoperability. A holistic solution to this represents the use of dual model based Electronic Healthcare Record systems. Modelling data in the field of obstetrics is a challenge, since different regions demand locally specific information for the process of treatment. Smaller health units in developing countries like Brazil or Malaysia, which until recently handled automatable processes like the storage of sensitive patient data in paper form, start organizational reconstruction processes. This archetype proof-of-concept investigation has tried out some elements of the openEHR methodology in cooperation with a health unit in Colombo, Brazil. Two legal forms provided by the Brazilian Ministry of Health have been analyzed and classified into demographic and clinical data. LinkEHR-Ed editor was used to read, edit and create archetypes. Results show that 33 clinical and demographic concepts, which are necessary to cover data demanded by the Unified National Health System, were identified. Out of the concepts 61% were reused and 39% modified to cover domain requirements. The detailed process of reuse, modification and creation of archetypes is shown. We conclude that, although a major part of demographic and clinical patient data were already represented by existing archetypes, a significant part required major modifications. In this study openEHR proved to be a highly suitable tool in the modelling of complex health data. In combination with LinkEHR-Ed software it offers user-friendly and highly applicable tools, although the complexity

  16. Role of OpenEHR as an open source solution for the regional modelling of patient data in obstetrics.

    PubMed

    Pahl, Christina; Zare, Mojtaba; Nilashi, Mehrbakhsh; de Faria Borges, Marco Aurélio; Weingaertner, Daniel; Detschew, Vesselin; Supriyanto, Eko; Ibrahim, Othman

    2015-06-01

    This work investigates, whether openEHR with its reference model, archetypes and templates is suitable for the digital representation of demographic as well as clinical data. Moreover, it elaborates openEHR as a tool for modelling Hospital Information Systems on a regional level based on a national logical infrastructure. OpenEHR is a dual model approach developed for the modelling of Hospital Information Systems enabling semantic interoperability. A holistic solution to this represents the use of dual model based Electronic Healthcare Record systems. Modelling data in the field of obstetrics is a challenge, since different regions demand locally specific information for the process of treatment. Smaller health units in developing countries like Brazil or Malaysia, which until recently handled automatable processes like the storage of sensitive patient data in paper form, start organizational reconstruction processes. This archetype proof-of-concept investigation has tried out some elements of the openEHR methodology in cooperation with a health unit in Colombo, Brazil. Two legal forms provided by the Brazilian Ministry of Health have been analyzed and classified into demographic and clinical data. LinkEHR-Ed editor was used to read, edit and create archetypes. Results show that 33 clinical and demographic concepts, which are necessary to cover data demanded by the Unified National Health System, were identified. Out of the concepts 61% were reused and 39% modified to cover domain requirements. The detailed process of reuse, modification and creation of archetypes is shown. We conclude that, although a major part of demographic and clinical patient data were already represented by existing archetypes, a significant part required major modifications. In this study openEHR proved to be a highly suitable tool in the modelling of complex health data. In combination with LinkEHR-Ed software it offers user-friendly and highly applicable tools, although the complexity

  17. Issue of data acquisition and processing using short range photogrammetry and terrestrial laser scanning for educational portals and virtual museums based on Wawel cathedral. (Polish Title: Problematyka pozyskiwania i przetwarzania danych fotogrametrycznych i z naziemnego skaningu laserowego na potrzeby tworzenia portali edukacyjnych i wirtualnych muzeów na przykładzie Katedry Wawelskiej)

    NASA Astrophysics Data System (ADS)

    Mitka, B.; Szelest, P.

    2013-12-01

    This paper presents the issues related to the acquisition and processing of terrestrial photogrammetry and laser scanning for building educational portals and virtual museums. Discusses the specific requirements of measurement technology and data processing for all kinds of objects, ranging from architecture through sculpture and architectural detail on the fabric and individual museum exhibits. Educational portals and virtual museums require a modern, high-quality visuals (3D models, virtual tours, animations, etc.) supplemented by descriptive content or audio commentary. Source for obtaining such materials are mostly terrestrial laser scanning and photogrammetry as technologies that provide complete information about the presented geometric objects. However, the performance requirements of web services impose severe restrictions on the presented content. It is necessary to use optimalization geometry process to streamline the way of its presentation. Equally important problem concerns the selection of appropriate technology and process measurement data processing presented for each type of objects. Only skillful selection of measuring equipment and data processing tools effectively ensure the achievement of a satisfactory end result. Both terrestrial laser scanning technology and digital close range photogrammetry has its strengths which should be used but also the limitations that must be taken into account in this kind of work. The key is choosing the right scanner for both the measured object and terrain such as pixel size in the performance of his photos.

  18. ESO's User Portal: lessons learned

    NASA Astrophysics Data System (ADS)

    Chavan, A. M.; Tacconi-Garman, L. E.; Peron, M.; Sogni, F.; Dorigo, D.; Nass, P.; Fourniol, N.; Sforna, D.; Haggouchi, K.; Dolensky, M.

    2008-07-01

    ESO introduced a User Portal for its scientific services in November 2007. Registered users have a central entry point for the Observatory's offerings, the extent of which depends on the users' roles - see [1]. The project faced and overcame a number of challenging hurdles between inception and deployment, and ESO learned a number of useful lessons along the way. The most significant challenges were not only technical in nature; organization and coordination issues took a significant toll as well. We also indicate the project's roadmap for the future.

  19. Developing a data element repository to support EHR-driven phenotype algorithm authoring and execution.

    PubMed

    Jiang, Guoqian; Kiefer, Richard C; Rasmussen, Luke V; Solbrig, Harold R; Mo, Huan; Pacheco, Jennifer A; Xu, Jie; Montague, Enid; Thompson, William K; Denny, Joshua C; Chute, Christopher G; Pathak, Jyotishman

    2016-08-01

    The Quality Data Model (QDM) is an information model developed by the National Quality Forum for representing electronic health record (EHR)-based electronic clinical quality measures (eCQMs). In conjunction with the HL7 Health Quality Measures Format (HQMF), QDM contains core elements that make it a promising model for representing EHR-driven phenotype algorithms for clinical research. However, the current QDM specification is available only as descriptive documents suitable for human readability and interpretation, but not for machine consumption. The objective of the present study is to develop and evaluate a data element repository (DER) for providing machine-readable QDM data element service APIs to support phenotype algorithm authoring and execution. We used the ISO/IEC 11179 metadata standard to capture the structure for each data element, and leverage Semantic Web technologies to facilitate semantic representation of these metadata. We observed there are a number of underspecified areas in the QDM, including the lack of model constraints and pre-defined value sets. We propose a harmonization with the models developed in HL7 Fast Healthcare Interoperability Resources (FHIR) and Clinical Information Modeling Initiatives (CIMI) to enhance the QDM specification and enable the extensibility and better coverage of the DER. We also compared the DER with the existing QDM implementation utilized within the Measure Authoring Tool (MAT) to demonstrate the scalability and extensibility of our DER-based approach. PMID:27392645

  20. Analysis of cloud-based solutions on EHRs systems in different scenarios.

    PubMed

    Fernández-Cardeñosa, Gonzalo; de la Torre-Díez, Isabel; López-Coronado, Miguel; Rodrigues, Joel J P C

    2012-12-01

    Nowadays with the growing of the wireless connections people can access all the resources hosted in the Cloud almost everywhere. In this context, organisms can take advantage of this fact, in terms of e-Health, deploying Cloud-based solutions on e-Health services. In this paper two Cloud-based solutions for different scenarios of Electronic Health Records (EHRs) management system are proposed. We have researched articles published between the years 2005 and 2011 about the implementation of e-Health services based on the Cloud in Medline. In order to analyze the best scenario for the deployment of Cloud Computing two solutions for a large Hospital and a network of Primary Care Health centers have been studied. Economic estimation of the cost of the implementation for both scenarios has been done via the Amazon calculator tool. As a result of this analysis two solutions are suggested depending on the scenario: To deploy a Cloud solution for a large Hospital a typical Cloud solution in which are hired just the needed services has been assumed. On the other hand to work with several Primary Care Centers it's suggested the implementation of a network, which interconnects these centers with just one Cloud environment. Finally it's considered the fact of deploying a hybrid solution: in which EHRs with images will be hosted in the Hospital or Primary Care Centers and the rest of them will be migrated to the Cloud. PMID:22492177

  1. Analysis of cloud-based solutions on EHRs systems in different scenarios.

    PubMed

    Fernández-Cardeñosa, Gonzalo; de la Torre-Díez, Isabel; López-Coronado, Miguel; Rodrigues, Joel J P C

    2012-12-01

    Nowadays with the growing of the wireless connections people can access all the resources hosted in the Cloud almost everywhere. In this context, organisms can take advantage of this fact, in terms of e-Health, deploying Cloud-based solutions on e-Health services. In this paper two Cloud-based solutions for different scenarios of Electronic Health Records (EHRs) management system are proposed. We have researched articles published between the years 2005 and 2011 about the implementation of e-Health services based on the Cloud in Medline. In order to analyze the best scenario for the deployment of Cloud Computing two solutions for a large Hospital and a network of Primary Care Health centers have been studied. Economic estimation of the cost of the implementation for both scenarios has been done via the Amazon calculator tool. As a result of this analysis two solutions are suggested depending on the scenario: To deploy a Cloud solution for a large Hospital a typical Cloud solution in which are hired just the needed services has been assumed. On the other hand to work with several Primary Care Centers it's suggested the implementation of a network, which interconnects these centers with just one Cloud environment. Finally it's considered the fact of deploying a hybrid solution: in which EHRs with images will be hosted in the Hospital or Primary Care Centers and the rest of them will be migrated to the Cloud.

  2. Developing a National-Level Concept Dictionary for EHR Implementations in Kenya.

    PubMed

    Keny, Aggrey; Wanyee, Steven; Kwaro, Daniel; Mulwa, Edwin; Were, Martin C

    2015-01-01

    The increasing adoption of Electronic Health Records (EHR) by developing countries comes with the need to develop common terminology standards to assure semantic interoperability. In Kenya, where the Ministry of Health has rolled out an EHR at 646 sites, several challenges have emerged including variable dictionaries across implementations, inability to easily share data across systems, lack of expertise in dictionary management, lack of central coordination and custody of a terminology service, inadequately defined policies and processes, insufficient infrastructure, among others. A Concept Working Group was constituted to address these challenges. The country settled on a common Kenya data dictionary, initially derived as a subset of the Columbia International eHealth Laboratory (CIEL)/Millennium Villages Project (MVP) dictionary. The initial dictionary scope largely focuses on clinical needs. Processes and policies around dictionary management are being guided by the framework developed by Bakhshi-Raiez et al. Technical and infrastructure-based approaches are also underway to streamline workflow for dictionary management and distribution across implementations. Kenya's approach on comprehensive common dictionary can serve as a model for other countries in similar settings.

  3. Comparison of response times of a mobile-web EHRs system using PHP and JSP languages.

    PubMed

    De la Torre-Díez, Isabel; Antón-Rodríguez, Míriam; Díaz-Pernas, Francisco Javier; Perozo-Rondón, Freddy José

    2012-12-01

    Performance evaluation is highly important in the Electronic Health Records (EHRs) system implementation. Response time's measurement can be considered as one manner to make that evaluation. In the e-health field, after the creation of EHRs available through different platforms such as Web and/or mobile, a performance evaluation is necessary. The operation of the system in the right way is essential. In this paper, a comparison of the response times for the MEHRmobile system is presented. The first version uses PHP language with a MySQL database and the second one employs JSP with an eXist database. Both versions have got the same functionalities. In addition to the technological aspects, a significant difference is the way the information is stored. The main goal of this paper is choosing the version which offers better response times. We have created a new benchmark to calculate the response times. Better results have been obtained for the PHP version. Nowadays, this version is being used for specialists from Fundación Intras, Spain.

  4. Provider documentation of patient education: a lean investigation*

    PubMed Central

    Shipman, Jean P.; Lake, Erica W.; Van Der Volgen, Jessica; Doman, Darrin

    2016-01-01

    Purpose The study evaluates how providers give patient education materials and identifies improvements to comply with Meaningful Use (MU) requirements. Methods Thirty-eight patient-provider interactions in two health care outpatient clinics were observed. Results Providers do not uniformly know MU patient education requirements. Providers have individual preferences and find gaps in what is available. Accessing and documenting patient education varies among providers. Embedded electronic health record (EHR) materials, while available, have technical access barriers. Conclusions Providers' EHR skills and knowledge levels contribute to non-standardized patient education delivery. PMID:27076805

  5. Portal hypertensive polyps, a new entity?

    PubMed

    Martín Domínguez, Verónica; Díaz Méndez, Ariel; Santander, Cecilio; García-Buey, Luisa

    2016-05-01

    We present a case of a 62 year old woman with history of liver cirrhosis secondary to autoimmune hepatitis, with portal hypertension and coagulopathy. Gastroscopy findings were a polypoid and polylobed lesions in the gastric antrum. These were removed and the pathological study described hyperplastic polyps with edema, vascular congestion and hyperplasia of smooth muscle, corresponding to "portal hypertensive polyps" (PHP). PMID:27188590

  6. Factors Affecting Faculty Web Portal Usability

    ERIC Educational Resources Information Center

    Bringula, Rex P.; Basa, Roselle S.

    2011-01-01

    The study investigated the factors that might significantly affect web portal usability. Results of the study were intended to serve as inputs for faculty web portal development of the University of the East-Manila. Descriptive statistics utilized questionnaire data from 82 faculty members. The data showed that most of the respondents were…

  7. Pancreatic pseudocyst rupture into the portal vein.

    PubMed

    Dawson, Brian C; Kasa, David; Mazer, Mark A

    2009-07-01

    A patient with a pancreatic pseudocyst rupture into the portal vein with a resultant noninfectious systemic inflammatory response syndrome and subsequent portal vein thrombosis diagnosed by computed tomography and ultrasonography is reported. A review of the existing English literature on this rare complication is also provided. PMID:19561436

  8. Idiopathic noncirrhotic portal hypertension: current perspectives.

    PubMed

    Riggio, Oliviero; Gioia, Stefania; Pentassuglio, Ilaria; Nicoletti, Valeria; Valente, Michele; d'Amati, Giulia

    2016-01-01

    The term idiopathic noncirrhotic portal hypertension (INCPH) has been recently proposed to replace terms, such as hepatoportal sclerosis, idiopathic portal hypertension, incomplete septal cirrhosis, and nodular regenerative hyperplasia, used to describe patients with a hepatic presinusoidal cause of portal hypertension of unknown etiology, characterized by features of portal hypertension (esophageal varices, nonmalignant ascites, porto-venous collaterals), splenomegaly, patent portal, and hepatic veins and no clinical and histological signs of cirrhosis. Physicians should learn to look for this condition in a number of clinical settings, including cryptogenic cirrhosis, a disease known to be associated with INCPH, drug administration, and even chronic alterations in liver function tests. Once INCPH is clinically suspected, liver histology becomes mandatory for the correct diagnosis. However, pathologists should be familiar with the histological features of INCPH, especially in cases in which histology is not only requested to exclude liver cirrhosis. PMID:27555800

  9. Idiopathic noncirrhotic portal hypertension: current perspectives

    PubMed Central

    Riggio, Oliviero; Gioia, Stefania; Pentassuglio, Ilaria; Nicoletti, Valeria; Valente, Michele; d’Amati, Giulia

    2016-01-01

    The term idiopathic noncirrhotic portal hypertension (INCPH) has been recently proposed to replace terms, such as hepatoportal sclerosis, idiopathic portal hypertension, incomplete septal cirrhosis, and nodular regenerative hyperplasia, used to describe patients with a hepatic presinusoidal cause of portal hypertension of unknown etiology, characterized by features of portal hypertension (esophageal varices, nonmalignant ascites, porto-venous collaterals), splenomegaly, patent portal, and hepatic veins and no clinical and histological signs of cirrhosis. Physicians should learn to look for this condition in a number of clinical settings, including cryptogenic cirrhosis, a disease known to be associated with INCPH, drug administration, and even chronic alterations in liver function tests. Once INCPH is clinically suspected, liver histology becomes mandatory for the correct diagnosis. However, pathologists should be familiar with the histological features of INCPH, especially in cases in which histology is not only requested to exclude liver cirrhosis. PMID:27555800

  10. Therapeutic Challenges for Symptomatic Portal Cavernoma Cholangiopathy.

    PubMed

    Cavași, Adriana; Mercea, Voicu; Anton, Ofelia; Puia, Ion Cosmin

    2016-09-01

    Although transjugular intrahepatic portosystemic shunts are most frequently used for the management of portal hypertension, the surgical approach is preferred for symptomatic portal cavernoma cholangiopathy. We present the case of a 25-year old female patient with a portal cavernoma secondary to catheterization of the umbilical vein at birth. She had had two episodes of esophageal variceal bleeding, successfully treated by endoscopic banding. and an episode of acute cholangitis secondary to portal cavernoma cholangiopathy. Endoscopic sphincterotomy and biliary stenting were performed, and were followed by repeated episodes of biliary stent occlusion. The last biliary drainage procedure triggered a massive hemobilia. Since endoscopic therapy was ineffective, a surgical mesocaval shunt with graft interposition and splenectomy was performed with favorable outcome. In selected cases, the mesocaval shunting plays an essential role in the treatment of portal cavernoma cholangiopathy even in the era of interventional radiology. PMID:27689206

  11. Straddle carrier radiation portal monitoring

    NASA Astrophysics Data System (ADS)

    Andersen, Eric S.; Samuel, Todd J.; Mullen, O. Dennis

    2005-05-01

    U.S. Customs and Border Protection (CBP) is the primary enforcement agency protecting the nation"s ports of entry. CBP is enhancing its capability to interdict the illicit import of nuclear and radiological materials and devices that may be used by terrorists. Pacific Northwest National Laboratory (PNNL) is providing scientific and technical support to CBP in their goal to enable rapid deployment of nuclear and radiation detection systems at U. S. ports of entry to monitor 100% of the incoming international traffic and cargo while not adversely impacting the operations or throughput of the ports. The U.S. ports of entry include the following vectors: land border crossings, seaports, airports, rail crossings, and mail and express consignment courier facilities. U.S. Customs and Border Protection (CBP) determined that a screening solution was needed for Seaport cargo containers being transported by Straddle Carriers (straddle carriers). A stationary Radiation Portal Monitor (RPM) for Straddle Carriers (SCRPM) is needed so that cargo containers can be scanned while in transit under a Straddle Carrier. The Straddle Carrier Portal operational impacts were minimized by conducting a time-motion study at the Port, and adaptation of a Remotely Operated RPM (RO-RPM) booth concept that uses logical lighting schemes for traffic control, cameras, Optical Character Recognition, and wireless technology.

  12. Araport: the Arabidopsis Information Portal

    PubMed Central

    Krishnakumar, Vivek; Hanlon, Matthew R.; Contrino, Sergio; Ferlanti, Erik S.; Karamycheva, Svetlana; Kim, Maria; Rosen, Benjamin D.; Cheng, Chia-Yi; Moreira, Walter; Mock, Stephen A.; Stubbs, Joseph; Sullivan, Julie M.; Krampis, Konstantinos; Miller, Jason R.; Micklem, Gos; Vaughn, Matthew; Town, Christopher D.

    2015-01-01

    The Arabidopsis Information Portal (https://www.araport.org) is a new online resource for plant biology research. It houses the Arabidopsis thaliana genome sequence and associated annotation. It was conceived as a framework that allows the research community to develop and release ‘modules’ that integrate, analyze and visualize Arabidopsis data that may reside at remote sites. The current implementation provides an indexed database of core genomic information. These data are made available through feature-rich web applications that provide search, data mining, and genome browser functionality, and also by bulk download and web services. Araport uses software from the InterMine and JBrowse projects to expose curated data from TAIR, GO, BAR, EBI, UniProt, PubMed and EPIC CoGe. The site also hosts ‘science apps,’ developed as prototypes for community modules that use dynamic web pages to present data obtained on-demand from third-party servers via RESTful web services. Designed for sustainability, the Arabidopsis Information Portal strategy exploits existing scientific computing infrastructure, adopts a practical mixture of data integration technologies and encourages collaborative enhancement of the resource by its user community. PMID:25414324

  13. Isocurvature constraints on portal couplings

    NASA Astrophysics Data System (ADS)

    Kainulainen, Kimmo; Nurmi, Sami; Tenkanen, Tommi; Tuominen, Kimmo; Vaskonen, Ville

    2016-06-01

    We consider portal models which are ultraweakly coupled with the Standard Model, and confront them with observational constraints on dark matter abundance and isocurvature perturbations. We assume the hidden sector to contain a real singlet scalar s and a sterile neutrino ψ coupled to s via a pseudoscalar Yukawa term. During inflation, a primordial condensate consisting of the singlet scalar s is generated, and its contribution to the isocurvature perturbations is imprinted onto the dark matter abundance. We compute the total dark matter abundance including the contributions from condensate decay and nonthermal production from the Standard Model sector. We then use the Planck limit on isocurvature perturbations to derive a novel constraint connecting dark matter mass and the singlet self coupling with the scale of inflation: mDM/GeV lesssim 0.2λs3/8 (H*/1011 GeV)‑3/2. This constraint is relevant in most portal models ultraweakly coupled with the Standard Model and containing light singlet scalar fields.

  14. Straddle Carrier Radiation Portal Monitoring

    SciTech Connect

    Andersen, Eric S.; Samuel, Todd J.; Mullen, O Dennis

    2005-08-01

    U.S. Customs and Border Protection (CBP) is the primary enforcement agency protecting the nation’s ports of entry. CBP is enhancing its capability to interdict the illicit import of nuclear and radiological materials and devices that may be used by terrorists. Pacific Northwest National Laboratory (PNNL) is providing scientific and technical support to CBP in their goal to enable rapid deployment of nuclear and radiation detection systems at U. S. ports of entry to monitor 100% of the incoming international traffic and cargo while not adversely impacting the operations or throughput of the ports. The U.S. ports of entry include the following vectors: land border crossings, seaports, airports, rail crossings, and mail and express consignment courier facilities. U.S. Customs and Border Protection (CBP) determined that a screening solution was needed for Seaport cargo containers being transported by Straddle Carriers (straddle carriers). A stationary Radiation Portal Monitor (RPM) for Straddle Carriers (SCRPM) is needed so that cargo containers can be scanned while in transit under a Straddle Carrier. The Straddle Carrier Portal operational impacts were minimized by conducting a time-motion study at the Port, and adaptation of a Remotely Operated RPM (RO-RPM) booth concept that uses logical lighting schemes for traffic control, cameras, Optical Character Recognition, and wireless technology.

  15. Regional Ocean Data Portal: Transforming Information to Knowledge

    NASA Astrophysics Data System (ADS)

    Howard, M. K.; Gayanilo, F. C.; Jochens, A. E.

    2009-12-01

    producers, recreational boaters, etc.) workshops were held to elicit user needs and requirements for observing system products for each group. The GCOOS-RA’s Products and Services Committee and Education and Outreach Council have gone through similar activities aimed at determining what products various users groups want. We have been sensitive to the private sector when deciding which products to produce. While science users want numbers, users of all types mainly want maps. We have tried to develop flexible capabilities within the portal that helps users to create their own fused products, ad hoc, for a variety of output devices, from desktop screens to the smart phones. We will discuss how our data management system has evolved within the backdrop of rapidly changing technologies and diverse community requirements.

  16. Astronomia.pl Portal as a Partner for Projects Aimed at Students or Public

    NASA Astrophysics Data System (ADS)

    Czart, K.; Pomierny, J.

    2006-08-01

    There are quite many educational astronomical projects. To reach their target audience they need a proper way of communication, including suitable media. The role of Internet media continually increases and one of the elements of communication should be astronomical portal visited by teachers and students. Astronomia.pl portal participate or support (more or less formally) different projects and actions undertaken to educate or communicate astronomy. Several examples of such projects are Become a Young Copernicus, Kids on the Moon, Faulkes Telescope, Hands On Universe or events like Globe at Night and Catch a Star. The portal also organizes its own actions, like quizes for students. An address of our main website is www.astronomia.pl, English version: www.astronomia.pl/english.

  17. Rapid EHR development and implementation using web and cloud-based architecture in a large home health and hospice organization.

    PubMed

    Weaver, Charlotte A; Teenier, Pamela

    2014-01-01

    Health care organizations have long been limited to a small number of major vendors in their selection of an electronic health record (EHR) system in the national and international marketplace. These major EHR vendors have in common base systems that are decades old, are built in antiquated programming languages, use outdated server architecture, and are based on inflexible data models [1,2]. The option to upgrade their technology to keep pace with the power of new web-based architecture, programming tools and cloud servers is not easily undertaken due to large client bases, development costs and risk [3]. This paper presents the decade-long efforts of a large national provider of home health and hospice care to select an EHR product, failing that to build their own and failing that initiative to go back into the market in 2012. The decade time delay had allowed new technologies and more nimble vendors to enter the market. Partnering with a new start-up company doing web and cloud based architecture for the home health and hospice market, made it possible to build, test and implement an operational and point of care system in 264 home health locations across 40 states and three time zones in the United States. This option of "starting over" with the new web and cloud technologies may be posing a next generation of new EHR vendors that retells the Blackberry replacement by iPhone story in healthcare.

  18. Rapid EHR development and implementation using web and cloud-based architecture in a large home health and hospice organization.

    PubMed

    Weaver, Charlotte A; Teenier, Pamela

    2014-01-01

    Health care organizations have long been limited to a small number of major vendors in their selection of an electronic health record (EHR) system in the national and international marketplace. These major EHR vendors have in common base systems that are decades old, are built in antiquated programming languages, use outdated server architecture, and are based on inflexible data models [1,2]. The option to upgrade their technology to keep pace with the power of new web-based architecture, programming tools and cloud servers is not easily undertaken due to large client bases, development costs and risk [3]. This paper presents the decade-long efforts of a large national provider of home health and hospice care to select an EHR product, failing that to build their own and failing that initiative to go back into the market in 2012. The decade time delay had allowed new technologies and more nimble vendors to enter the market. Partnering with a new start-up company doing web and cloud based architecture for the home health and hospice market, made it possible to build, test and implement an operational and point of care system in 264 home health locations across 40 states and three time zones in the United States. This option of "starting over" with the new web and cloud technologies may be posing a next generation of new EHR vendors that retells the Blackberry replacement by iPhone story in healthcare. PMID:24943570

  19. Improving validated depression screen among adolescent population in primary care practice using electronic health records (EHR).

    PubMed Central

    Sudhanthar, Sathyanarayan; Thakur, Kripa; Sigal, Yakov; Turner, Jane

    2015-01-01

    Adolescent depression, has been identified as one of the important risk factors for adolescent safety. The American Academy of Pediatrics (AAP) recommends screening the adolescent population for depression with a validated screening tool at least once a year. Given the time constraints in primary care, many physicians tend to rely more on clinical questioning to screen depression.This has the potential to miss many adolescents who may have mild to moderate depression which may prove detrimental to their emotional and physical health. Quality measures had consistently indicated that the validated adolescent depression screening rate in our two pediatric clinics was 10-15% in the past two years starting from 2012. There was a need to increase our screening rate for adolescent depression with a validated questionnaire. The stakeholders identified were physicians, nurses and the health information team (HIT). The Patient Health Questionnaire-2 (PHQ-2) is a standardized tool and serves as a good first step rapid screening of the population. A decision was made to implement the use of PHQ-2 to all the adolescents aged 11-21. A clinic flow protocol was developed. As the patient checks in, there will be a computer pop-up reminding nurses to administer the PHQ-2. The PHQ-2 self-scores in the Electronic Health Record (EHR) and if the score is three or more the nurses would automatically administer the PHQ-9 which is also embedded and self-scored in the EHR. After 12 months of implementing this project with four PDSA cycles, the adolescent depression-screening rate improved from 10-15% from the previous two years to 65% (six month period) and 82% at the end of the 12 month period. The rate of referral to mental health services had also increased in the same time period compared to the previous years. In conclusion, screening for adolescent depression with a brief validated tool in a busy primary care office is possible with the help of the EHR. PMID:26734415

  20. Dealing with the Archetypes Development Process for a Regional EHR System

    PubMed Central

    Santos, M.R.; Bax, M.P.; Kalra, D.

    2012-01-01

    Objectives This paper aims to present the archetype modelling process used for the Health Department of Minas Gerais State, Brazil (SES/MG), to support building its regional EHR system, and the lessons learned during this process. Methods This study was undertaken within the Minas Gerais project. The EHR system architecture was built assuming the reference model from the ISO 13606 norm. The whole archetype development process took about ten months, coordinated by a clinical team co-ordinated by three health professionals and one systems analyst from the SES/MG. They were supported by around 30 health professionals from the internal SES/MG areas, and 5 systems analysts from the PRODEMGE. Based on a bottom-up approach, the project team used technical interviews and brainstorming sessions to conduct the modelling process. Results The main steps of the archetype modelling process were identified and described, and 20 archetypes were created. Lessons learned: –The set of principles established during the selection of PCS elements helped the clinical team to keep the focus in their objectives;–The initial focus on the archetype structural organization aspects was important;–The data elements identified were subjected to a rigorous analysis aimed at determining the most suitable clinical domain;–Levelling the concepts to accommodate them within the hierarchical levels in the reference model was definitely no easy task, and the use of a mind mapping tool facilitated the modelling process;–Part of the difficulty experienced by the clinical team was related to a view focused on the original forms previously used;–The use of worksheets facilitated the modelling process by health professionals;–It was important to have a health professional that knew about the domain tables and health classifications from the Brazilian Federal Government as member in the clinical team. Conclusion The archetypes (referencing terminology, domain tables and term lists) provided a

  1. The impact of electronic health record (EHR) interoperability on immunization information system (IIS) data quality

    PubMed Central

    Woinarowicz, Mary; Howell, Molly

    2016-01-01

    Objectives: To evaluate the impact of electronic health record (EHR) interoperability on the quality of immunization data in the North Dakota Immunization Information System (NDIIS). Methods: NDIIS doses administered data was evaluated for completeness of the patient and dose-level core data elements for records that belong to interoperable and non-interoperable providers. Data was compared at three months prior to electronic health record (EHR) interoperability enhancement to data at three, six, nine and twelve months post-enhancement following the interoperability go live date. Doses administered per month and by age group, timeliness of vaccine entry and the number of duplicate clients added to the NDIIS was also compared, in addition to, immunization rates for children 19 – 35 months of age and adolescents 11 – 18 years of age. Results: Doses administered by both interoperable and non-interoperable providers remained fairly consistent from pre-enhancement through twelve months post-enhancement. Comparing immunization rates for infants and adolescents, interoperable providers had higher rates both pre- and post-enhancement than non-interoperable providers for all vaccines and vaccine series assessed. The overall percentage of doses entered into the NDIIS within one month of administration varied slightly between interoperable and non-interoperable providers; however, there were significant changes between the percentage of doses entered within one day and within one week with the percentage entered within one day increasing and within one week decreasing with interoperability. The number of duplicate client records created by interoperable providers increased from 94 duplicates pre-enhancement to 10,552 at twelve months post-enhancement, while the duplicates from non-interoperable providers only increased from 300 to 637 over the same period. Of the 40 core data elements in the NDIIS, there was some difference in completeness between the interoperable versus

  2. The impact of electronic health record (EHR) interoperability on immunization information system (IIS) data quality.

    PubMed

    Woinarowicz, Mary; Howell, Molly

    2016-01-01

    Objectives: To evaluate the impact of electronic health record (EHR) interoperability on the quality of immunization data in the North Dakota Immunization Information System (NDIIS). Methods: NDIIS doses administered data was evaluated for completeness of the patient and dose-level core data elements for records that belong to interoperable and non-interoperable providers. Data was compared at three months prior to electronic health record (EHR) interoperability enhancement to data at three, six, nine and twelve months post-enhancement following the interoperability go live date. Doses administered per month and by age group, timeliness of vaccine entry and the number of duplicate clients added to the NDIIS was also compared, in addition to, immunization rates for children 19 - 35 months of age and adolescents 11 - 18 years of age. Results: Doses administered by both interoperable and non-interoperable providers remained fairly consistent from pre-enhancement through twelve months post-enhancement. Comparing immunization rates for infants and adolescents, interoperable providers had higher rates both pre- and post-enhancement than non-interoperable providers for all vaccines and vaccine series assessed. The overall percentage of doses entered into the NDIIS within one month of administration varied slightly between interoperable and non-interoperable providers; however, there were significant changes between the percentage of doses entered within one day and within one week with the percentage entered within one day increasing and within one week decreasing with interoperability. The number of duplicate client records created by interoperable providers increased from 94 duplicates pre-enhancement to 10,552 at twelve months post-enhancement, while the duplicates from non-interoperable providers only increased from 300 to 637 over the same period. Of the 40 core data elements in the NDIIS, there was some difference in completeness between the interoperable versus non

  3. Portal vein aneurysm: What to know.

    PubMed

    Laurenzi, Andrea; Ettorre, Giuseppe Maria; Lionetti, Raffaella; Meniconi, Roberto Luca; Colasanti, Marco; Vennarecci, Giovanni

    2015-11-01

    Portal vein aneurysm is an unusual vascular dilatation of the portal vein, which was first described by Barzilai and Kleckner in 1956 and since then less than 200 cases have been reported. The aim of this article is to provide an overview of the international literature to better clarify various aspects of this rare nosological entity and provide clear evidence-based summary, when available, of the clinical and surgical management. A systematic literature search of the Pubmed database was performed for all articles related to portal vein aneurysm. All articles published from 1956 to 2014 were examined for a total of 96 reports, including 190 patients. Portal vein aneurysm is defined as a portal vein diameter exceeding 1.9 cm in cirrhotic patients and 1.5 cm in normal livers. It can be congenital or acquired and portal hypertension represents the main cause of the acquired version. Surgical indication is considered in case of rupture, thrombosis or symptomatic aneurysms. Aneurysmectomy and aneurysmorrhaphy are considered in patients with normal liver, while shunt procedures or liver transplantation are the treatment of choice in case of portal hypertension. Being such a rare vascular entity its management should be reserved to high-volume tertiary hepato-biliary centres. PMID:26188840

  4. BSD Portals for LINUX 2.0

    NASA Technical Reports Server (NTRS)

    McNab, A. David; woo, Alex (Technical Monitor)

    1999-01-01

    Portals, an experimental feature of 4.4BSD, extend the file system name space by exporting certain open () requests to a user-space daemon. A portal daemon is mounted into the file name space as if it were a standard file system. When the kernel resolves a pathname and encounters a portal mount point, the remainder of the path is passed to the portal daemon. Depending on the portal "pathname" and the daemon's configuration, some type of open (2) is performed. The resulting file descriptor is passed back to the kernel which eventually returns it to the user, to whom it appears that a "normal" open has occurred. A proxy portalfs file system is responsible for kernel interaction with the daemon. The overall effect is that the portal daemon performs an open (2) on behalf of the kernel, possibly hiding substantial complexity from the calling process. One particularly useful application is implementing a connection service that allows simple scripts to open network sockets. This paper describes the implementation of portals for LINUX 2.0.

  5. Prototype Neutron Portal Monitor Detector

    NASA Astrophysics Data System (ADS)

    Schier, W.

    2014-05-01

    A very large drum-shaped neutron detector which could replace the 3He neutron portal monitor detector is under development. Detection is based on the 6Li(n,3H)4He reaction. 6Li metal is evaporated onto aluminum plates then covered with 22-cm x 27-cm ZnS(Ag) scintillation sheets and sealed about the edges. The equivalent of 40 detector plates will be arrayed in the 80-cm diameter drum housing and viewed by a single 20-cm diameter hemispherical photomultiplier tube without the use of light guides. Presently 25 detector plates are installed. Light collection tests are performed with a bare 210Po alpha source on a ZnS(Ag) disk. Neutron detection studies include neutrons from a 2-curie PuBe source and from a 0.255-gram 240Pu source.

  6. The Astrostatistics and Astroinformatics Portal

    NASA Astrophysics Data System (ADS)

    Feigelson, Eric; Hilbe, J. M.

    2014-01-01

    The Astrostatistics and Astroinformatics Portal (ASAIP, http://asaip.psu.edu) is a Web resource started in 2012 to foster research into advanced methodologies for astronomical research, and to promulgate such methods into the broader astronomy community. It provides searchable abstracts to Recent Papers in the field, several discussion Forums, various resources for researchers, brief Articles by experts, lists of Meetings, and access to various Web resources such as on-line courses, books and blogs. The material can be electronically searched. The site will be used for public outreach by organizations associated with the AAS, IAU, ISI (International Statistical Institute), and LSST. ASAIP has nearly 700 members who can contribute material, and its resources are readable by the general Web public. This presentation gives examples of recent ASAIP entries and encourages AAS members to use its resources.

  7. Freeze-in through portals

    SciTech Connect

    Blennow, Mattias; Fernandez-Martínez, Enrique; Zaldívar, Bryan E-mail: enrique.fernandez-martinez@uam.es

    2014-01-01

    The popular freeze-out paradigm for Dark Matter (DM) production, relies on DM-baryon couplings of the order of the weak interactions. However, different search strategies for DM have failed to provide a conclusive evidence of such (non-gravitational) interactions, while greatly reducing the parameter space of many representative models. This motivates the study of alternative mechanisms for DM genesis. In the freeze-in framework, the DM is slowly populated from the thermal bath while never reaching equilibrium. In this work, we analyse in detail the possibility of producing a frozen-in DM via a mediator particle which acts as a portal. We give analytical estimates of different freeze-in regimes and support them with full numerical analyses, taking into account the proper distribution functions of bath particles. Finally, we constrain the parameter space of generic models by requiring agreement with DM relic abundance observations.

  8. Morphological observation of Epithemia ocellata (Ehr.) Kütz. (Bacillariophyceae) from China

    NASA Astrophysics Data System (ADS)

    Fan, Yawen; Hu, Zhengyu

    2007-10-01

    The species of Epithemia ocellata (Ehr.) Kütz. from Northeastern China were observed by scanning electron microscopy (SEM). The studies on silica valve formation in different stages were made. At the early stage, a Y-shaped raphe sternum was found. Areolae were made from virgae and vimines. In immature valves, the canal formation before the raphe fissure is visible. The raphe system, virgae and vimines (areolae) might be the early siliceous elements of the valve during morphogenesis. The formations of virgae and vimines are similar to that of Gephyria media W. Arnott. Rows of silica papillae formed gradually on the face of the valve. After the areolae were covered with silica and form rows of papillae, the outer valve surface could become mature. Details of the internal costae were observed in mature valves.

  9. Use of clinical simulation for assessment in EHR-procurement: design of method.

    PubMed

    Jensen, Sanne; Rasmussen, Stine L; Lyng, Karen M

    2013-01-01

    In Denmark, two large regions cooperate in a public intervention process of acquiring a new eHealth-platform to support the daily clinical work of approximately 40,000 users in 14 hospitals. It is essential that the new platform, besides fulfilling comprehensive detailed specifications, supports the daily work practice consisting of numerous mixed tasks executed by many different clinical actors in various settings. Within health informatics it has proven beneficial to use human factors approaches in the design process to secure systems that are responsive to the actual field of application. While design methods are widely described, there are very limited descriptions of how to assess and compare different EHR-platforms and their support in work processes upon its procurement. This paper describes the method we have developed to undertake this task. It is discussed how the method differs and how it has been adjusted from existing assessment methods. Finally, future considerations are discussed.

  10. A Process for the Representation of openEHR ADL Archetypes in OWL Ontologies.

    PubMed

    Porn, Alex Mateus; Peres, Leticia Mara; Didonet Del Fabro, Marcos

    2015-01-01

    ADL is a formal language to express archetypes, independent of standards or domain. However, its specification is not precise enough in relation to the specialization and semantic of archetypes, presenting difficulties in implementation and a few available tools. Archetypes may be implemented using other languages such as XML or OWL, increasing integration with Semantic Web tools. Exchanging and transforming data can be better implemented with semantics oriented models, for example using OWL which is a language to define and instantiate Web ontologies defined by W3C. OWL permits defining significant, detailed, precise and consistent distinctions among classes, properties and relations by the user, ensuring the consistency of knowledge than using ADL techniques. This paper presents a process of an openEHR ADL archetypes representation in OWL ontologies. This process consists of ADL archetypes conversion in OWL ontologies and validation of OWL resultant ontologies using the mutation test. PMID:26262167

  11. A Process for the Representation of openEHR ADL Archetypes in OWL Ontologies.

    PubMed

    Porn, Alex Mateus; Peres, Leticia Mara; Didonet Del Fabro, Marcos

    2015-01-01

    ADL is a formal language to express archetypes, independent of standards or domain. However, its specification is not precise enough in relation to the specialization and semantic of archetypes, presenting difficulties in implementation and a few available tools. Archetypes may be implemented using other languages such as XML or OWL, increasing integration with Semantic Web tools. Exchanging and transforming data can be better implemented with semantics oriented models, for example using OWL which is a language to define and instantiate Web ontologies defined by W3C. OWL permits defining significant, detailed, precise and consistent distinctions among classes, properties and relations by the user, ensuring the consistency of knowledge than using ADL techniques. This paper presents a process of an openEHR ADL archetypes representation in OWL ontologies. This process consists of ADL archetypes conversion in OWL ontologies and validation of OWL resultant ontologies using the mutation test.

  12. Learning to Predict Post-Hospitalization VTE Risk from EHR Data

    PubMed Central

    Kawaler, Emily; Cobian, Alexander; Peissig, Peggy; Cross, Deanna; Yale, Steve; Craven, Mark

    2012-01-01

    We consider the task of predicting which patients are most at risk for post-hospitalization venothromboembolism (VTE) using information automatically elicited from an EHR. Given a set of cases and controls, we use machine-learning methods to induce models for making these predictions. Our empirical evaluation of this approach offers a number of interesting and important conclusions. We identify several risk factors for VTE that were not previously recognized. We show that machine-learning methods are able to induce models that identify high-risk patients with accuracy that exceeds previously developed scoring models for VTE. Additionally, we show that, even without having prior knowledge about relevant risk factors, we are able to learn accurate models for this task. PMID:23304314

  13. Automatic acquisition of synonyms from French UMLS for enhanced search of EHRs.

    PubMed

    Grabar, Natalia; Varoutas, Paul-Christophe; Rizand, Philippe; Livartowski, Alain; Hamon, Thierry

    2008-01-01

    Currently, the use of Natural Language Processing (NLP) approaches in order to improve search and exploration of electronic health records (EHRs) within healthcare information systems is not a common practice. One reason for this is the lack of suitable lexical resources: various types of such resources need to be collected or acquired. In this work, we propose a novel method for the acquisition of synonymous resources. This method is language-independent and relies on existence of structured terminologies. It enables to decipher hidden synonymous relations between simple words and terms on the basis of their syntactic analysis and exploitation of their compositionality. Applied to series of synonym terms from the French subset of the UMLS, the method shows 99% precision. The overlap between thus inferred terms and the existing sparse resources of synonyms is very low. PMID:18487831

  14. Zolmitriptan: A Novel Portal Hypotensive Agent Which Synergizes with Propranolol in Lowering Portal Pressure

    PubMed Central

    Reboredo, Mercedes; Chang, Haisul C. Y.; Barbero, Roberto; Rodríguez-Ortigosa, Carlos M.; Pérez-Vizcaíno, Francisco; Morán, Asunción; García, Mónica; Banales, Jesús M.; Carreño, Norberto; Alegre, Félix; Herrero, Ignacio; Quiroga, Jorge

    2013-01-01

    Objective Only a limited proportion of patients needing pharmacological control of portal hypertension are hemodynamic responders to propranolol. Here we analyzed the effects of zolmitriptan on portal pressure and its potential interaction with propranolol. Methods Zolmitriptan, propranolol or both were tested in two rat models of portal hypertension: common bile duct ligation (CBDL) and CCl4-induced cirrhosis. In these animals we measured different hemodynamic parameters including portal venous pressure, arterial renal flow, portal blood flow and cardiac output. We also studied the changes in superior mesenteric artery perfusion pressure and in arterial wall cAMP levels induced by zolmitriptan, propranolol or both. Moreover, we determined the effect of splanchnic sympathectomy on the response of PVP to zolmitriptan. Results In both models of portal hypertension zolmitriptan induced a dose-dependent transient descent of portal pressure accompanied by reduction of portal flow with only slight decrease in renal flow. In cirrhotic rats, splanchnic sympathectomy intensified and prolonged zolmitriptan-induced portal pressure descent. Also, propranolol caused more intense and durable portal pressure fall when combined with zolmitriptan. Mesenteric artery perfusion pressure peaked for about 1 min upon zolmitriptan administration but showed no change with propranolol. However propranolol enhanced and prolonged the elevation in mesenteric artery perfusion pressure induced by zolmitriptan. In vitro studies showed that propranolol prevented the inhibitory effects of β2-agonists on zolmitriptan-induced vasoconstriction and the combination of propranolol and zolmitriptan significantly reduced the elevation of cAMP caused by β2-agonists. Conclusion Zolmitriptan reduces portal hypertension and non-selective beta-blockers can improve this effect. Combination therapy deserves consideration for patients with portal hypertension failing to respond to non-selective beta

  15. Advances in health informatics education: educating students at the intersection of health care and information technology.

    PubMed

    Kushniruk, Andre; Borycki, Elizabeth; Armstrong, Brian; Kuo, Mu-Hsing

    2012-01-01

    The paper describes the authors' work in the area of health informatics (HI) education involving emerging health information technologies. A range of information technologies promise to modernize health care. Foremost among these are electronic health records (EHRs), which are expected to significantly improve and streamline health care practice. Major national and international efforts are currently underway to increase EHR adoption. However, there have been numerous issues affecting the widespread use of such information technology, ranging from a complex array of technical problems to social issues. This paper describes work in the integration of information technologies directly into the education and training of HI students at both the undergraduate and graduate level. This has included work in (a) the development of Web-based computer tools and platforms to allow students to have hands-on access to the latest technologies and (b) development of interdisciplinary educational models that can be used to guide integrating information technologies into HI education. The paper describes approaches that allow for remote hands-on access by HI students to a range of EHRs and related technology. To date, this work has been applied in HI education in a variety of ways. Several approaches for integration of this essential technology into HI education and training are discussed, along with future directions for the integration of EHR technology into improving and informing the education of future health and HI professionals.

  16. [Idiopathic non-cirrhotic portal hypertension: An update].

    PubMed

    Bissonnette, Julien; Rautou, Pierre-Emmanuel; Valla, Dominique-Charles

    2015-10-01

    Idiopathic non-cirrhotic portal hypertension is an under-estimated cause of portal hypertension. The diagnosis requires the exclusion of cirrhosis, common causes of chronic liver disease and venous obstruction of the portal and hepatic veins. It has been associated with various extra-hepatic conditions that are most frequently immunologic, prothrombotic, hematologic and toxic. The most frequent clinical complications are variceal hemorrhage and portal vein thrombosis. Complications of portal hypertension should be managed as in patients with cirrhosis. PMID:26362514

  17. Development and Evaluation of Intelligent Agent-Based Teaching Assistant in e-Learning Portals

    ERIC Educational Resources Information Center

    Rouhani, Saeed; Mirhosseini, Seyed Vahid

    2015-01-01

    Today, several educational portals established by organizations to enhance web E-learning. Intelligence agent's usage is necessary to improve the system's quality and cover limitations such as face-to-face relation. In this research, after finding two main approaches in this field that are fundamental use of intelligent agents in systems design…

  18. The Effect of E-Portal System on Corporate Image of Universities

    ERIC Educational Resources Information Center

    Tunji, Oyedepo; Nelson, Okorie

    2011-01-01

    Internet connectivity in tertiary institutions in Africa has been summarized in three characteristics-- too little, too expensive and poorly managed (African Tertiary Institutions Connectivity Survey (ATICS), 2006 report). The Internet portal system offers educational organizations the ability to track students needs and promote their programs and…

  19. The Fukushima Daiichi Accident Study Information Portal

    SciTech Connect

    Shawn St. Germain; Curtis Smith; David Schwieder; Cherie Phelan

    2012-11-01

    This paper presents a description of The Fukushima Daiichi Accident Study Information Portal. The Information Portal was created by the Idaho National Laboratory as part of joint NRC and DOE project to assess the severe accident modeling capability of the MELCOR analysis code. The Fukushima Daiichi Accident Study Information Portal was created to collect, store, retrieve and validate information and data for use in reconstructing the Fukushima Daiichi accident. In addition to supporting the MELCOR simulations, the Portal will be the main DOE repository for all data, studies and reports related to the accident at the Fukushima Daiichi nuclear power station. The data is stored in a secured (password protected and encrypted) repository that is searchable and accessible to researchers at diverse locations.

  20. Single Portal Knee Arthroscopy: 2015 Technique Update

    PubMed Central

    Cooper, Daniel E.

    2016-01-01

    A technique of single portal knee arthroscopy was reported in 2013. Using a parallel working cannula assembled to the arthroscope cannula, the instruments are passed into the joint in line with the arthroscope. The original technique video in Arthroscopy Techniques shows the use of a 25 mm tube assembly with a parallel portal through which biters and proximally bent cutter instruments are used to perform procedures in the knee. This 2015 technical update shows the current preferred and most versatile method of single portal knee arthroscopy using a parallel locking and rotating hub for passage of biters and double-bend cutters. The video shows adequate completion of a partial meniscectomy using only 1 portal. PMID:27073772

  1. Single Portal Knee Arthroscopy: 2015 Technique Update.

    PubMed

    Cooper, Daniel E

    2016-02-01

    A technique of single portal knee arthroscopy was reported in 2013. Using a parallel working cannula assembled to the arthroscope cannula, the instruments are passed into the joint in line with the arthroscope. The original technique video in Arthroscopy Techniques shows the use of a 25 mm tube assembly with a parallel portal through which biters and proximally bent cutter instruments are used to perform procedures in the knee. This 2015 technical update shows the current preferred and most versatile method of single portal knee arthroscopy using a parallel locking and rotating hub for passage of biters and double-bend cutters. The video shows adequate completion of a partial meniscectomy using only 1 portal.

  2. 23. INCLINED END POST / VERTICAL / DIAGONAL / PORTAL ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    23. INCLINED END POST / VERTICAL / DIAGONAL / PORTAL BRACING DETAIL. VIEW TO SOUTHEAST. - Abraham Lincoln Memorial Bridge, Spanning Missouri River on Highway 30 between Nebraska & Iowa, Blair, Washington County, NE

  3. Idiopathic Noncirrhotic Portal Hypertension: An Appraisal

    PubMed Central

    Lee, Hwajeong; Rehman, Aseeb Ur; Fiel, M. Isabel

    2016-01-01

    Idiopathic noncirrhotic portal hypertension is a poorly defined clinical condition of unknown etiology. Patients present with signs and symptoms of portal hypertension without evidence of cirrhosis. The disease course appears to be indolent and benign with an overall better outcome than cirrhosis, as long as the complications of portal hypertension are properly managed. This condition has been recognized in different parts of the world in diverse ethnic groups with variable risk factors, resulting in numerous terminologies and lack of standardized diagnostic criteria. Therefore, although the diagnosis of idiopathic noncirrhotic portal hypertension requires clinical exclusion of other conditions that can cause portal hypertension and histopathologic confirmation, this entity is under-recognized clinically as well as pathologically. Recent studies have demonstrated that variable histopathologic entities with different terms likely represent a histologic spectrum of a single entity of which obliterative portal venopathy might be an underlying pathogenesis. This perception calls for standardization of the nomenclature and formulation of widely accepted diagnostic criteria, which will facilitate easier recognition of this disorder and will highlight awareness of this entity. PMID:26563701

  4. Interest in the Use of Computerized Patient Portals: Role of the Provider–Patient Relationship

    PubMed Central

    Hess, Rachel; Bryce, Cindy L.; McTigue, Kathleen; Olshansky, Ellen; Fitzgerald, Katharine; Fischer, Gary S.

    2007-01-01

    Background Bioinformatics experts are developing interactive patient portals to help those living with diabetes and other chronic diseases to better manage their conditions. However, little is known about what influences patients’ desires to use this technology. Objective To discern the impact of the provider–patient relationship on interest in using a web-based patient portal. Design Qualitative analysis of focus groups. Participants Ten focus groups involving 39 patients (range 2–7) recruited from four primary care practices. Approach A qualitative approach was used, which involved reading transcribed texts until a consensus was reached on data interpretation. An intercoder reliability kappa score (0.89) was determined by comparing the provider–patient relationship talk selected by the two coders. A conceptual framework was developed, which involved the development and refinement of a codebook and the application of it to the transcripts. Results Interest in the portal was linked to dissatisfaction with the provider–patient relationship, including dissatisfaction with provider communication/responsiveness, the inability to obtain medical information, and logistical problems with the office. Disinterest in the portal was linked to satisfaction with the provider–patient relationship, including provider communication/responsiveness, difficulty in using the portal, and fear of losing relationships and e-mail contact with the provider. No patient identified encrypted e-mail communication through the portal as an advantage. Conclusions Promoting the use of computerized portals requires patient-based adaptations. These should include ease of use, direct provider e-mail, and reassurances that access and interpersonal relationships will not be lost. Education is needed about privacy concerns regarding traditional e-mail communication. PMID:18095039

  5. Infusing informatics into interprofessional education: the iTEAM (Interprofessional Technology Enhanced Advanced practice Model) project.

    PubMed

    Skiba, Diane J; Barton, Amy J; Knapfel, Sarah; Moore, Gina; Trinkley, Katy

    2014-01-01

    The iTEAM goal is to prepare advanced practice nurses, physicians and pharmacists with the interprofessional (IP) core competencies (informatics, patient centric, quality-focused, evidence based care) to provide technology enhanced collaborative care by: offering technology enhanced learning opportunities through a required informatics course, advanced practice courses (team based experiences with both standardized and virtual patients) and team based clinical experiences including e-health experiences. The innovative features of iTEAM project will be achieved through use of social media strategies, a web accessible Electronic Health Records (EHRs) system, a Virtual Clinic/Hospital in Second Life, various e-health applications including traditional telehealth tools and consumer oriented tools such as patient portals, social media consumer groups and mobile health (m-health) applications for health and wellness functions. It builds upon the schools' rich history of IP education and includes clinical partners, such as the VA and other clinical sites focused on care for underserved patient populations. PMID:24943525

  6. Becoming a Learning Organization: New Directions in Science Education Research at the National Science Foundation

    NASA Astrophysics Data System (ADS)

    Ramaley, Judith A.; Olds, Barbara M.; Earle, Janice

    2005-06-01

    The Education and Human Resources (EHR) Directorate at the National Science Foundation has been examining its role in supporting the development of new approaches to science, technology, engineering and mathematics (STEM) education. This article explores what it means to be scientifically literate, what it takes to become a learning organization, how the EHR Directorate is working towards becoming such an organization through rigorous self-study, and how EHR can best manage its large portfolio of awards that support investigations in STEM education to enhance their collective value to researchers, policymakers and educators. Several elements of the self-study process are described, and the implications for the Directorate as well as for the field of researchers in science education are explored.

  7. Photonic dark matter portal revisited

    NASA Astrophysics Data System (ADS)

    Alavi, S. A.; Kazemian, F. S.

    2016-05-01

    In our previous paper, we studied a model of dark matter (DM) in which the hidden sector interacts with standard model particles via a hidden photonic portal (HP). We investigated the effects of this new interaction on the hydrogen atom and obtained an upper bound for the coupling of the model as f ≤ 10-12. In this work, we study the effects of HP on two interesting exotic atoms namely muonium and positronium. We obtain a tighter upper limit on the coupling as f ≤ 10-13. We also calculate the change (shift) in the Aharonov-Bohm phase due to HP and find that the phase shift is negligibly small (for DM particles mass in the GeV range). Recently a 3.5 keV X-ray line signal observed in the spectrum of 73 galaxy clusters, reported by the XXM-Newton X-ray observatory. Since in HP model the DM particles can decay directly into photons, so we finally calculate the value of the coupling constant f using the condition ΔEDM = 3.5 keV.

  8. The ENSEMBLES Statistical Downscaling Portal

    NASA Astrophysics Data System (ADS)

    Cofino, Antonio S.; San-Martín, Daniel; Gutiérrez, Jose M.

    2010-05-01

    The demand for high-resolution seasonal and ACC predictions is continuously increasing due to the multiple end-user applications in a variety of sectors (hydrology, agronomy, energy, etc.) which require regional meteorological inputs. To fill the gap between the coarse-resolution grids used by global weather models and the regional needs of applications, a number of statistical downscaling techniques have been proposed. Statistical downscaling is a complex multi-disciplinary problem which requires a cascade of different scientific tools to access and process different sources of data, from GCM outputs to local observations and to run complex statistical algorithms. Thus, an end-to-end approach is needed in order to link the outputs of the ensemble prediction systems to a range of impact applications. To accomplish this task in an interactive and user-friendly form, a Web portal has been developed within the European ENSEMBLES project, integrating the necessary tools and providing the appropriate technology for distributed data access and computing. In this form, users can obtain their downscaled data testing and validating different statistical methods (from the categories weather typing, regression or weather generators) in a transparent form, not worrying about the details of the downscaling techniques and the data formats and access.

  9. 29 CFR 785.24 - Principles noted in Portal-to-Portal Bulletin.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 3 2013-07-01 2013-07-01 false Principles noted in Portal-to-Portal Bulletin. 785.24 Section 785.24 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR STATEMENTS OF GENERAL POLICY OR INTERPRETATION NOT DIRECTLY RELATED TO REGULATIONS HOURS WORKED Application of Principles Preparatory and...

  10. Electronic health record training in undergraduate medical education: bridging theory to practice with curricula for empowering patient- and relationship-centered care in the computerized setting.

    PubMed

    Wald, Hedy S; George, Paul; Reis, Shmuel P; Taylor, Julie Scott

    2014-03-01

    While electronic health record (EHR) use is becoming state-of-the-art, deliberate teaching of health care information technology (HCIT) competencies is not keeping pace with burgeoning use. Medical students require training to become skilled users of HCIT, but formal pedagogy within undergraduate medical education (UME) is sparse. How can medical educators best meet the needs of learners while integrating EHRs into medical education and practice? How can they help learners preserve and foster effective communication skills within the computerized setting? In general, how can UME curricula be devised for skilled use of EHRs to enhance rather than hinder provision of effective, humanistic health care?Within this Perspective, the authors build on recent publications that "set the stage" for next steps: EHR curricula innovation and implementation as concrete embodiments of theoretical underpinnings. They elaborate on previous calls for maximizing benefits and minimizing risks of EHR use with sufficient focus on physician-patient communication skills and for developing core competencies within medical education. The authors describe bridging theory into practice with systematic longitudinal curriculum development for EHR training in UME at their institution, informed by Kern and colleagues' curriculum development framework, narrative medicine, and reflective practice. They consider this innovation within a broader perspective-the overarching goal of empowering undergraduate medical students' patient- and relationship-centered skills while effectively demonstrating HCIT-related skills.

  11. Interfaces between electronic medical record (EMR/EHR) technology and people in American medicine: insight. imagination, and relationships in clinical practice.

    PubMed

    Stein, Howard F

    2012-08-01

    This paper explores the contexts and relationships in which EMR/EHR technology is used in healthcare settings. It approaches the EMR/EHR as an issue in clinical ethics. The author recognizes the immense contribution that healthcare informatics makes to coordinating and integrating medical care at the level of individual physician, nurse, and institutions. At the same time the author raises a cautionary note about some unrecognized dimensions of the use and experience of the EMR/EHR. The author argues that the EMR/EHR can consciously and unconsciously become an instrument of assembly line-like physician "productivity" and "production reports" that depersonalize patient and physician alike. Construed this way, the EMR/EHR can narrow the clinician's imagination, relationships, clinical decision-making, and documentation into oversimplified, and potentially distorting, clinical narratives and categories such as fit into CPT, ICD-9, DRG, DSM-IV and other codes, EBM protocols, and clinical algorithms. By contrast, the author uses a vignette and one of his own clinical poems to illustrate the rich weave of relationship and meaning that are foreground rather than background in clinical assessment, decision-making, treatment, outcome, and satisfaction. The author concludes with a call to imaginatively use the EMR/EHR as an instrument of physician-patient communication, and to include in it and make available vital narrative data (evidence) about patient, family, culture, occupation, socioeconomic status, physician, disease, and their relationships.

  12. Developing EHR-driven heart failure risk prediction models using CPXR(Log) with the probabilistic loss function.

    PubMed

    Taslimitehrani, Vahid; Dong, Guozhu; Pereira, Naveen L; Panahiazar, Maryam; Pathak, Jyotishman

    2016-04-01

    Computerized survival prediction in healthcare identifying the risk of disease mortality, helps healthcare providers to effectively manage their patients by providing appropriate treatment options. In this study, we propose to apply a classification algorithm, Contrast Pattern Aided Logistic Regression (CPXR(Log)) with the probabilistic loss function, to develop and validate prognostic risk models to predict 1, 2, and 5year survival in heart failure (HF) using data from electronic health records (EHRs) at Mayo Clinic. The CPXR(Log) constructs a pattern aided logistic regression model defined by several patterns and corresponding local logistic regression models. One of the models generated by CPXR(Log) achieved an AUC and accuracy of 0.94 and 0.91, respectively, and significantly outperformed prognostic models reported in prior studies. Data extracted from EHRs allowed incorporation of patient co-morbidities into our models which helped improve the performance of the CPXR(Log) models (15.9% AUC improvement), although did not improve the accuracy of the models built by other classifiers. We also propose a probabilistic loss function to determine the large error and small error instances. The new loss function used in the algorithm outperforms other functions used in the previous studies by 1% improvement in the AUC. This study revealed that using EHR data to build prediction models can be very challenging using existing classification methods due to the high dimensionality and complexity of EHR data. The risk models developed by CPXR(Log) also reveal that HF is a highly heterogeneous disease, i.e., different subgroups of HF patients require different types of considerations with their diagnosis and treatment. Our risk models provided two valuable insights for application of predictive modeling techniques in biomedicine: Logistic risk models often make systematic prediction errors, and it is prudent to use subgroup based prediction models such as those given by CPXR

  13. The Feasibility of using Electronic Health Records (EHRs) to describe demographic and clinical indicators of Migrant and Seasonal Farmworkers

    PubMed Central

    Socias, Christina; Liang, Yuanyuan; Delclos, George; Graves, Julie; Hendrikson, Ed; Cooper, Sharon

    2016-01-01

    Few extensive, national clinical databases exist on the health of migrant and seasonal farmworkers (MSFWs). Electronic health records (EHRs) are increasingly utilized by Federally Qualified Health Centers (FQHCs) and have the potential to improve clinical care and complement current surveillance and epidemiologic studies of underserved working populations, such as MSFWs. The aim of this feasibility study was to describe the demographics and baseline clinical indicators of patients at an FQHC by MSFW status. We described 2012 patient demographics, social history, medical indicators, and diagnoses by MSFW status from the de-identified EHR database of a large, multi-site Colorado Migrant Health Center (MHC). Included in the study were 41,817 patients from 2012: 553(1.3%) MSFWs; 20,665(49.4%) non-MSFWs; and 20,599 (49.3%) who had no information in the MSFW field. MSFWs were more often male, married, employed, Hispanic, and Spanish-speaking compared to non-MSFWs. The most frequent diagnoses for all patients were hypertension, overweight/obesity, lipid disorder, type 2 diabetes, or a back disorder. Although there were significant missing values, this feasibility study was able to analyze medical data in a timely manner and show that Meaningful Use requirements can improve the usability of EHR data for epidemiologic research of MSFWs and other patients at FQHCs. The results of this study were consistent with current literature available for MSFWs. By reaching this vulnerable working population, EHRs may be a key data source for occupational injury and illness surveillance and research. PMID:26479964

  14. Are Meaningful Use Stage 2 certified EHRs ready for interoperability? Findings from the SMART C-CDA Collaborative

    PubMed Central

    D'Amore, John D; Mandel, Joshua C; Kreda, David A; Swain, Ashley; Koromia, George A; Sundareswaran, Sumesh; Alschuler, Liora; Dolin, Robert H; Mandl, Kenneth D; Kohane, Isaac S; Ramoni, Rachel B

    2014-01-01

    Background and objective Upgrades to electronic health record (EHR) systems scheduled to be introduced in the USA in 2014 will advance document interoperability between care providers. Specifically, the second stage of the federal incentive program for EHR adoption, known as Meaningful Use, requires use of the Consolidated Clinical Document Architecture (C-CDA) for document exchange. In an effort to examine and improve C-CDA based exchange, the SMART (Substitutable Medical Applications and Reusable Technology) C-CDA Collaborative brought together a group of certified EHR and other health information technology vendors. Materials and methods We examined the machine-readable content of collected samples for semantic correctness and consistency. This included parsing with the open-source BlueButton.js tool, testing with a validator used in EHR certification, scoring with an automated open-source tool, and manual inspection. We also conducted group and individual review sessions with participating vendors to understand their interpretation of C-CDA specifications and requirements. Results We contacted 107 health information technology organizations and collected 91 C-CDA sample documents from 21 distinct technologies. Manual and automated document inspection led to 615 observations of errors and data expression variation across represented technologies. Based upon our analysis and vendor discussions, we identified 11 specific areas that represent relevant barriers to the interoperability of C-CDA documents. Conclusions We identified errors and permissible heterogeneity in C-CDA documents that will limit semantic interoperability. Our findings also point to several practical opportunities to improve C-CDA document quality and exchange in the coming years. PMID:24970839

  15. EHR systems in the Spanish Public Health National System: the lack of interoperability between primary and specialty care.

    PubMed

    de la Torre-Díez, Isabel; González, Sandra; López-Coronado, Miguel

    2013-02-01

    One of the problems of the Spanish Public Health National System is the lack of interoperability in the implemented Electronic Health Records (EHRs) systems in primary and specialty care. There is a deficiency in the electronic health systems that store the data of primary care patients, so one of the basic problems that prevent that every hospital and health center working on the same method is that deficiency. In this paper we research on this problem and to give expression to a series of solutions to it. Bibliographic material in this work has been obtained mainly from MEDLINE source. Additionally, due to the lack of information and privacy about the different EHRs systems, we have resorted to making direct contact with the organizations that have implemented those systems and technological providers. Two solutions have been propounded given several aspects for a feasibility study. The first solution is based upon in the execution of backups in different EHRs databases, which implies a huge economical and infrastructure development. The second of these solutions so that due to the creation of protocols by means of Cloud Computing Technologies. It is crucial the need to reach a homogeneity concerning to the storage of patients clinical data. On the results achieved we can emphasize that maybe the main problems are not the economical handicaps or the large technological development needed, but, as for Health each Region manages its own competences, each one governs with independent policies and decisions. PMID:23321962

  16. Evaluation of a Framework to Implement Electronic Health Record Systems Based on the openEHR Standard

    NASA Astrophysics Data System (ADS)

    Orellana, Diego A.; Salas, Alberto A.; Solarz, Pablo F.; Medina Ruiz, Luis; Rotger, Viviana I.

    2016-04-01

    The production of clinical information about each patient is constantly increasing, and it is noteworthy that the information is created in different formats and at diverse points of care, resulting in fragmented, incomplete, inaccurate and isolated, health information. The use of health information technology has been promoted as having a decisive impact to improve the efficiency, cost-effectiveness, quality and safety of medical care delivery. However in developing countries the utilization of health information technology is insufficient and lacking of standards among other situations. In the present work we evaluate the framework EHRGen, based on the openEHR standard, as mean to reach generation and availability of patient centered information. The framework has been evaluated through the provided tools for final users, that is, without intervention of computer experts. It makes easier to adopt the openEHR ideas and provides an open source basis with a set of services, although some limitations in its current state conspire against interoperability and usability. However, despite the described limitations respect to usability and semantic interoperability, EHRGen is, at least regionally, a considerable step toward EHR adoption and interoperability, so that it should be supported from academic and administrative institutions.

  17. The MISTRALS programme data portal

    NASA Astrophysics Data System (ADS)

    Brissebrat, Guillaume; Albert-Aguilar, Alexandre; Belmahfoud, Nizar; Cloché, Sophie; Darras, Sabine; Descloitres, Jacques; Ferré, Hélène; Fleury, Laurence; Focsa, Loredana; Henriot, Nicolas; Labatut, Laurent; Petit de la Villéon, Loïc; Ramage, Karim; Schmechtig, Catherine; Vermeulen, Anne

    2016-04-01

    different file formats and data processing tools. The MISTRALS data portal - http://mistrals.sedoo.fr/ - has been designed and developed as a unified tool for sharing scientific data in spite of many sources of heterogeneity, and for fostering collaboration between research communities. The metadata (data description) are standardized and comply with international standards (ISO 19115-19139; INSPIRE European Directive; Global Change Master Directory Thesaurus). A search tool allows to browse the catalog by keyword or multicriteria selection (area, period, physical property...) and to access data. Data sets managed by different data centres (ICARE, IPSL, SEDOO, CORIOLIS) are available through interoperability protocols (OPeNDAP, xml requests...) or archive synchronisation. Every in situ data set is available in the native format, but the most commonly used data sets have been homogenized (property names, units, quality flags...) and inserted in a relational database, in order to enable accurate data selection, and download of different data sets in a shared format. At present the MISTRALS data portal enables to access about 600 datasets. It counts more than 675 registered users and about 100 data requests every month. The number of available datasets is increasing daily, due to the provision of campaign datasets by several projects. Every scientist is invited to browse the catalog, complete the online registration form and use MISTRALS data. Feel free to contact mistrals-contact@sedoo.fr for any question.

  18. The MISTRALS programme data portal

    NASA Astrophysics Data System (ADS)

    Fleury, Laurence; Brissebrat, Guillaume; Belmahfoud, Nizar; Boichard, Jean-Luc; Brosolo, Laetitia; Cloché, Sophie; Descloitres, Jacques; Ferré, Hélène; Focsa, Loredana; Henriot, Nicolas; Labatut, Laurent; Mière, Arnaud; Petit de la Villéon, Loïc; Ramage, Karim; Schmechtig, Catherine; Vermeulen, Anne; André, François

    2015-04-01

    different file formats and data processing tools. The MISTRALS data portal - http://mistrals.sedoo.fr/ - has been designed and developed as a unified tool for sharing scientific data in spite of many sources of heterogeneity, and for fostering collaboration between research communities. The metadata (data description) are standardized and comply with international standards (ISO 19115-19139; INSPIRE European Directive; Global Change Master Directory Thesaurus). A search tool allows to browse the catalog by keyword or multicriteria selection (area, period, physical property...) and to access data. Data sets managed by different data centres (ICARE, IPSL, SEDOO, CORIOLIS) are available through interoperability protocols (OPeNDAP, xml requests...) or archive synchronisation. Every in situ data set is available in the native format, but the most commonly used data sets have been homogenized (property names, units, quality flags...) and inserted in a relational database, in order to enable accurate data selection, and download of different data sets in a shared format. At present the MISTRALS data portal enables to access about 550 datasets. It counts more than 600 registered users and about 100 data requests every month. The number of available datasets is increasing daily, due to the provision of campaign datasets (2012, 2013, 2014) by several projects. Every scientist is invited to browse the catalog, complete the online registration form and use MISTRALS data. Feel free to contact mistrals-contact@sedoo.fr for any question.

  19. The MISTRALS programme data portal

    NASA Astrophysics Data System (ADS)

    Fleury, Laurence; Brissebrat, Guillaume; Belmahfoud, Nizar; Boichard, Jean-Luc; Brosolo, Laetitia; Cloché, Sophie; Descloitres, Jacques; Ferré, Hélène; Focsa, Loredana; Labatut, Laurent; Mastrorillo, Laurence; Mière, Arnaud; Petit de la Villéon, Loïc; Ramage, Karim; Schmechtig, Catherine

    2014-05-01

    different file formats and data processing tools. The MISTRALS data portal - http://mistrals.sedoo.fr/ - has been designed and developed as a unified tool to share scientific data in spite of many sources of heterogeneity, and to foster collaboration between research communities. The metadata (data description) are standardized and comply with international standards (ISO 19115-19139; INSPIRE European Directive; Global Change Master Directory Thesaurus). A search tool allows to browse the catalogue by keyword or by multicriteria selection (location, period, physical property...) and to access data. Data sets managed by different data centres (ICARE, IPSL, SEDOO, CORIOLIS) are available through interoperability protocols (OPeNDAP, xml requests...) or archive synchronisation. At present the MISTRALS data portal allows to access more than 400 datasets and counts more than 500 registered users. The number of available datasets is increasing daily, due to the provision of campaign datasets (2012, 2013) by several projects. Every in situ data set is available in the native format, but the favorite data sets have been homogenized (property names, units, quality flags...) and inserted in a relational database, in order to enable more accurate data selection, and download of different datasets in a shared format. Every scientist is invited to make use of the different MISTRALS tools and data. Do not hesitate to browse the catalogue and fill the online registration form. Feel free to contact mistrals-contact@sedoo.fr for any question.

  20. Using the NASA Giovanni DICCE Portal to Investigate Land-Ocean Linkages with Satellite and Model Data

    NASA Technical Reports Server (NTRS)

    Acker, James G.; Zalles, Daniel; Krumhansl, Ruth

    2012-01-01

    Data-enhanced Investigations for Climate Change Education (DICCE), a NASA climate change education project, employs the NASA Giovanni data system to enable teachers to create climate-related classroom projects using selected satellite and assimilated model data. The easy-to-use DICCE Giovanni portal (DICCE-G) provides data parameters relevant to oceanic, terrestrial, and atmospheric processes. Participants will explore land-ocean linkages using the available data in the DICCE-G portal, in particular focusing on temperature, ocean biology, and precipitation variability related to El Ni?o and La Ni?a events. The demonstration includes the enhanced information for educators developed for the DICCE-G portal. The prototype DICCE Learning Environment (DICCE-LE) for classroom project development will also be demonstrated.

  1. Portal of medical data models: information infrastructure for medical research and healthcare

    PubMed Central

    Dugas, Martin; Neuhaus, Philipp; Meidt, Alexandra; Doods, Justin; Storck, Michael; Bruland, Philipp; Varghese, Julian

    2016-01-01

    with semantic annotation and better information exchange between information systems, in particular Electronic Data Capture (EDC) and Electronic Health Records (EHR) systems. Contents of the MDM portal need to be further expanded to reach broad coverage of all relevant medical domains. Database URL: https://medical-data-models.org PMID:26868052

  2. The GB/3D Type Fossils Online Web Portal

    NASA Astrophysics Data System (ADS)

    McCormick, T.; Howe, M. P.

    2013-12-01

    Fossils are the remains of once-living organisms that existed and played out their lives in 3-dimensional environments. The information content provided by a 3d representation of a fossil is much greater than that provided by a traditional photograph, and can grab the attention and imagination of the younger and older general public alike. The British Geological Survey has been leading a consortium of UK natural history museums including the Oxford University Museum of Natural History, the Sedgwick Museum Cambridge, the National Museum of Wales Cardiff, and a number of smaller regional British museums to construct a web portal giving access to metadata, high resolution images and interactive 3d models of type fossils from the UK. The web portal at www.3d-fossils.ac.uk was officially launched in August 2013. It can be used to discover metadata describing the provenance, taxonomy, and stratigraphy of the specimens. Zoom-able high resolution digital photographs are available, including for many specimens ';anaglyph' stereo images that can be viewed in 3d using red-cyan stereo spectacles. For many of the specimens interactive 3d models were generated by scanning with portable ';NextEngine 3D HD' 3d scanners. These models can be downloaded in zipped .OBJ and .PLY format from the web portal, or may be viewed and manipulated directly in certain web browsers. The images and scans may be freely downloaded subject to a Creative Commons Attribution ShareAlike Non-Commercial license. There is a simple application programming interface (API) allowing metadata to be downloaded, with links to the images and models, in a standardised format for use in data mash-ups and third party applications. The web portal also hosts ';open educational resources' explaining the process of fossilization and the importance of type specimens in taxonomy, as well as providing introductions to the most important fossil groups. We have experimented with using a 3d printer to create replicas of the

  3. Pancreatic Adenocarcinoma Complicated by Sinistral Portal Hypertension

    PubMed Central

    Kaley, Kristin; Lamb, Lynne

    2016-01-01

    Pancreatic cancer is known for vague symptoms that lead to a delay in diagnosis, and hence most cases are found at an advanced stage. Many complications can happen secondary to pancreatic cancer including diabetes, malabsorption, and deep venous thrombosis. Sinistral (segmental or left-sided) portal hypertension (SPH) refers to portal hypertension confined to the left-sided segment of the portal venous system namely the splenic side, and the most common etiology is splenic vein thrombosis (SVT). We present here a case of a 66-year-old male with advanced pancreatic cancer who died due to bleeding secondary to SVT. We advise physicians caring for these patients to be aware of this complication, which may also be the manifestation of an undiagnosed pancreatic cancer. PMID:27555987

  4. The hospital library and the enterprise portal.

    PubMed

    Bandy, Margaret; Fosmire, Brenda

    2004-01-01

    At Exempla Healthcare, the medical librarians and the e-Business staff are creating an enterprise information portal where medical reference is targeted, easily accessible, and supported by the medical librarians. A team approach has been essential. The e-Business department has worked for nine months coordinating technical challenges required to support personalization, targeted communications, and a single access point for clinical patient data. Exempla medical librarians have been involved in the definition and design of information access needs from the very beginning. The Clinicians Portal was the first developed, with other customizations to follow. Many challenges remain, but by definition, a portal is designed to be flexible and adapt to the changing needs of the enterprise it supports.

  5. Best Practices for Building Web Data Portals

    NASA Astrophysics Data System (ADS)

    Anderson, R. A.; Drew, L.

    2013-12-01

    With a data archive of more than 1.5 petabytes and a key role as the NASA Distributed Active Archive Center (DAAC) for synthetic aperture radar (SAR) data, the Alaska Satellite Facility (ASF) has an imperative to develop effective Web data portals. As part of continuous enhancement and expansion of its website, ASF recently created two data portals for distribution of SAR data: one for the archiving and distribution of NASA's MEaSUREs Wetlands project and one for newly digitally processed data from NASA's 1978 Seasat satellite. These case studies informed ASF's development of the following set of best practices for developing Web data portals. 1) Maintain well-organized, quality data. This is fundamental. If data are poorly organized or contain errors, credibility is lost and the data will not be used. 2) Match data to likely data uses. 3) Identify audiences in as much detail as possible. ASF DAAC's Seasat and Wetlands portals target three groups of users: a) scientists already familiar with ASF DAAC's SAR archive and our data download tool, Vertex; b) scientists not familiar with SAR or ASF, but who can use the data for their research of oceans, sea ice, volcanoes, land deformation and other Earth sciences; c) audiences wishing to learn more about SAR and its use in Earth sciences. 4) Identify the heaviest data uses and the terms scientists search for online when trying to find data for those uses. 5) Create search engine optimized (SEO) Web content that corresponds to those searches. Because search engines do not yet search raw data, so Web data portals must include content that ties the data to its likely uses. 6) Create Web designs that best serves data users (user centered design), not for how the organization views itself or its data. Usability testing was conducted for the ASF DAAC Wetlands portal to improve the user experience. 7) Use SEO tips and techniques. The ASF DAAC Seasat portal used numerous SEO techniques, including social media, blogging

  6. Spontaneous Resolution of Portal Vein Thrombosis

    PubMed Central

    Banumukala, Vishnu; Babu, Adarsh

    2008-01-01

    A 56-year-old male was admitted with symptoms of belching, abdominal pain and weight loss of 2 weeks duration. Examination revealed hepatosplenomegaly which was confirmed by computed tomography (CT). CT images also revealed filling defects in the portal vein and intrahepatic branches consistent with thrombosis and hepatosplenic infarcts. Alkaline phosphatase was elevated at 688 units, all other investigations, including full blood count, coagulation screen and tumour markers, were normal. Magnetic resonance cholangiopancreatography did not reveal any mass in the porta hepatis. Upper gastrointestinal endoscopy and colonoscopy were normal. Liver biopsy was normal and did not reveal any evidence of lymphoma. The raised alkaline phosphatase settled to reference range over a period of 3 weeks. Thrombophilia screen was negative. Contrast CT of the abdomen performed after 4 weeks displayed revascularisation of the previously thrombosed portal vein and intrahepatic branches. The patient has remained asymptomatic since and we note spontaneous recanalisation of the previously occluded portal vein. PMID:21490872

  7. Spontaneous resolution of portal vein thrombosis.

    PubMed

    Banumukala, Vishnu; Babu, Adarsh

    2008-01-01

    A 56-year-old male was admitted with symptoms of belching, abdominal pain and weight loss of 2 weeks duration. Examination revealed hepatosplenomegaly which was confirmed by computed tomography (CT). CT images also revealed filling defects in the portal vein and intrahepatic branches consistent with thrombosis and hepatosplenic infarcts. Alkaline phosphatase was elevated at 688 units, all other investigations, including full blood count, coagulation screen and tumour markers, were normal. Magnetic resonance cholangiopancreatography did not reveal any mass in the porta hepatis. Upper gastrointestinal endoscopy and colonoscopy were normal. Liver biopsy was normal and did not reveal any evidence of lymphoma. The raised alkaline phosphatase settled to reference range over a period of 3 weeks. Thrombophilia screen was negative. Contrast CT of the abdomen performed after 4 weeks displayed revascularisation of the previously thrombosed portal vein and intrahepatic branches. The patient has remained asymptomatic since and we note spontaneous recanalisation of the previously occluded portal vein. PMID:21490872

  8. Current management of sinusoidal portal hypertension.

    PubMed

    Ravindra, Kadiyala V; Eng, Mary; Marvin, Michael

    2008-01-01

    Portal hypertension resulting from cirrhosis was one of the biggest challenges faced by general surgeons up until the past two decades. The management of portal hypertensive variceal hemorrhage has undergone dramatic changes during this period. Endoscopic variceal ligation and transjugular intrahepatic portosystemic shunts are currently used with great success. The degree of liver dysfunction remains the most important determinant of outcome in these patients. Patients with cirrhosis who have good liver function and recurrent variceal bleed remain candidates for shunt surgery. However, the need for surgical intervention has become a rarity. The success of liver transplantation has ensured that portal hypertension is cured permanently and one does not often see the critically ill and decompensated patient with cirrhosis on the surgical service. A review of the current treatment options in this very ill patient population is the primary focus of this article.

  9. 340. Caltrans, Photographer October 14, 1935 "TUNNEL WEST PORTAL"; ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    340. Caltrans, Photographer October 14, 1935 "TUNNEL - WEST PORTAL"; VIEW OF TUNNEL - WEST PORTAL' UNDER CONSTRUCTION SHOWING EXCAVATION OF TUNNEL AFTER POUR. 5-1669 - San Francisco Oakland Bay Bridge, Spanning San Francisco Bay, San Francisco, San Francisco County, CA

  10. Patient portals - An online tool for your health

    MedlinePlus

    If your health care provider offers a patient portal, you will need a computer and internet connection to use it. Follow the instructions to register for an account. Once you are in your patient portal, you can ...

  11. 13. Detail, connection point of end post, top chord, portal ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    13. Detail, connection point of end post, top chord, portal strut, and tension members at upstream side of west portal, view to northwest. - Dry Creek Bridge, Spanning Dry Creek at Cook Road, Ione, Amador County, CA

  12. 43. VIEW OF THE RAMP ABOVE LOWER PORTAL AND RAMP, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    43. VIEW OF THE RAMP ABOVE LOWER PORTAL AND RAMP, LOOKING NORTHWEST. THE RAMP WAS USED TO GUIDE RUN-OFF FROM THUNDERSTORMS AWAY FROM THE PORTAL. - Independent Coal & Coke Company, Kenilworth, Carbon County, UT

  13. Application of the smart portal in transportation

    NASA Astrophysics Data System (ADS)

    Kercel, Stephen W.; Baylor, Vivian M.; Dress, William B.; Hickerson, Tim W.; Jatko, W. Bruce; Labaj, Leo E.; Muhs, Jeffrey D.; Pack, Richard M.

    1997-02-01

    Under a program sponsored by the Department of Energy, the Oak Ridge complex is developing a `Portal-of-the-Future', or `smart portal.' This is a security portal for vehicular traffic which is intended to quickly detect explosives, hidden passengers, etc. It uses several technologies, including microwaves, weigh-in-motion, digital image processing, and electroacoustic wavelet-based heartbeat detection. A novel component of particular interest is the Enclosed Space Detection System (ESDS), which detects the presence of persons hiding in a vehicle. The system operates by detecting the presence of a human ballistocardiographic signature. Each time the heart beats, it generates a small but measurable shock wave that propagates through the body. The wave, whose graph is called a ballistocardiogram, is the mechanical analog of the electrocardiograms, which is routinely used for medical diagnosis. The wave is, in turn, coupled to any surface or object with which the body is in contact. If the body is located in an enclosed space, this will result in a measurable deflection of the surface of the enclosure. Independent testing has shown ESDS to be highly reliable. The technologies used in the smart portal operate in real time and allow vehicles to be checked through the portal in much less time than would be required for human inspection. Although not originally developed for commercial transportation, the smart portal has the potential to solve several transportation problems. It could relieve congestion at international highway border crossings by reducing the time required to inspect each vehicle while increasing the level of security. It can reduce highway congestion at the entrance of secure facilities such as prisons. Also, it could provide security at intermodal transfer points, such as airport parking lots and car ferry terminals.

  14. The CeDRES data portal

    NASA Astrophysics Data System (ADS)

    Albert-Aguilar, Alexandre; Delmotte, Pauline; André, François; Brissebrat, Guillaume; Canonici, Jean-Christophe; Piguet, Bruno

    2016-04-01

    SAFIRE is the French facility dedicated to airborne measurement for environmental research. The SAFIRE steering committee decided that access to its archives should be improved. If certain data, including recent campaigns, are available online, access to them is difficult for users because these data are dispersed in as many data portals as campaigns. Most of projects are not able to keep medium to long term online access to their database. Therefore, many airborne data, particularly the oldest, are not available online, stored on media whose sustainability is not guaranteed. SAFIRE also decided to identify old data stored in Meudon (France) on paper and hard media and to rescue with the help of an archivist. At the same time, the development of a centralized digital archive - containing data collected with the Fokker - 27 " ARAT " and Merlin IV aircraft - associated to a web portal was given to SEDOO. The first part of the project consisted in modelling the database. The second part, still in progess, was the development of the CeDRES (Centre de Données aéRoportées & SAFIRE) portal (http://cedres.sedoo.fr) which is responsive and bilingual (French and English) ; and metadata standardization (iso 19115). The main objectives of this project are data preservation and open data access. A first test version of CeDRES portal will be release in mid-February 2016. And operational version is planned for summer 2016. In the future, CeDRES portal will be able to receive and to distribute metadata and data of aircraft currently in service (FALCON-20, ATR-42 and PiperAztec-23). The interoperability implementation and data homogenization are planned in the medium term. The CeDRES portal is part of the French atmospheric chemistry data center AERIS (http://www.aeris-data.fr). Every scientist is invited to browse the catalog and use CEDRES data. Feel free to contact cedres-contact@sedoo.fr for any question.

  15. Application of the smart portal in transportation

    SciTech Connect

    Kercel, S.W.; Baylor, V.M.; Dress, W.B.; Hickerson, T.W.; Jatko, W.B.; Labaj, L.E.; Muhs, J.D.; Pack, R.M.

    1996-12-31

    Under a program sponsored by the Department of Energy, the Oak Ridge complex is developed a ``Portal-of-the-Future``, or ``smart portal``. This is a security portal for vehicular traffic which is intended to quickly detect explosives, hidden passengers, etc. It uses several technologies, including microwaves, weigh-in-motion, digital image processing, and electroacoustic wavelet-based heartbeat detection. A novel component of particular interest is the Enclosed Space Detection System (ESDS), which detects the presence of persons hiding in a vehicle. The system operates by detecting the presence of a human ballistocardiographic signature. Each time the heart beats, it generates a small but measurable shock wave that propagates through the body. The wave, whose graph is called a ballistocardiogram, is the mechanical analog of the electrocardiogram, which is routinely used for medical diagnosis. The wave is, in turn, coupled to any surface or object with which the body is in contact. If the body is located in an enclosed space, this will result in a measurable deflection of the surface of the enclosure. Independent testing has shown ESDS to be highly reliable. The technologies used in the smart portal operate in real time and allow vehicles to be checked through the portal in much less time than would be required for human inspection. Although not originally developed for commercial transportation, the smart portal has the potential to solve several transportation problems. It could relieve congestion at international highway border crossings by reducing the time required to inspect each vehicle while increasing the level of security. It can reduce highway congestion at the entrance of secure facilities such as prisons. Also, it could provide security at intermodal transfer points, such as airport parking lots and car ferry terminals.

  16. Aeromonas hydrophila bacteraemia and portal pyaemia.

    PubMed

    Tulsidas, H; Ong, Y Y; Chan, K C

    2008-04-01

    The Aeromonas species uncommonly cause disease in humans. We report portal pyaemia secondary to Aeromonas hydrophila bacteraemia occurring in a 71-year-old Chinese man with no history of hepatobiliary disease or malignancy. He presented with fever, rigors and abdominal bloating for four days and was subsequently found to have Aeromonas hydrophila bacteraemia, portal vein thrombosis and a psoas abscess. He was treated with ciprofloxacin and had a good recovery. Aeromonas hydrophila infection is an uncommon cause of intestinal and extraintestinal infection in man, but must be suspected in immunocompromised hosts and in those exposed to brackish or salt water. PMID:18418529

  17. Framework Development Supporting the Safety Portal

    SciTech Connect

    Prescott, Steven Ralph; Kvarfordt, Kellie Jean; Vang, Leng; Smith, Curtis Lee

    2015-07-01

    In a collaborating scientific research arena it is important to have an environment where analysts have access to a shared repository of information, documents, and software tools, and be able to accurately maintain and track historical changes in models. The new Safety Portal cloud-based environment will be accessible remotely from anywhere regardless of computing platforms given that the platform has available Internet access and proper browser capabilities. Information stored at this environment would be restricted based on user assigned credentials. This report discusses current development of a cloud-based web portal for PRA tools.

  18. Portal increases throughput with SCADA, distributed control

    SciTech Connect

    Bell, D.E.

    1983-06-01

    Portal Pipelines has added a distributed control system run by SCADA (supervisory control and data acquisition) in its Minot, North Dakota control center. The system keeps abreast of crude movements and quantities of oil being delivered. It was installed in specified stages from 5TI programmable controller, to a PM550 controller (in conjunction with FSK modems), to a full SCADA system. Expansion of the pipeline network in 1980 made integration to SCADA necessary. The Minot control center, CRT terminal, and alarm system are described. Backup consists of redundant computers. Portal's daily movement of 100,000 bbl of crude oil would not be possible without SCADA.

  19. Portal Hypertension Secondary to Spontaneous Arterio-Portal Venous Fistulas: Transcatheter Arterial Embolization with n-Butyl Cyanoacrylate and Microcoils

    SciTech Connect

    Yamagami, Takuji; Nakamura, Toshiyuki; Nishimura, Tsunehiko

    2000-09-15

    We report a 73-year-old man with recurrent variceal bleeding due to portal hypertension caused by multiple intrahepatic arterio-portal venous fistulas, which were successfully occluded by embolization with n-butyl cyanoacrylate and micro-coils.

  20. The Monash Portal: More Than Just a Virtual Gateway.

    ERIC Educational Resources Information Center

    Kennedy, David; Webster, Len; Benson, Robyn; James, Di; Bailey, Nathan

    The My Monash Portal (Portal) at Monash University (Australia) provides a virtual gateway to support student-centered flexible learning by coordinating several of the university's key resources to meet the needs of students and staff. The Portal is intended to help deliver innovative learning programs, foster opportunities to undertake research,…

  1. User Needs of Digital Service Web Portals: A Case Study

    ERIC Educational Resources Information Center

    Heo, Misook; Song, Jung-Sook; Seol, Moon-Won

    2013-01-01

    The authors examined the needs of digital information service web portal users. More specifically, the needs of Korean cultural portal users were examined as a case study. The conceptual framework of a web-based portal is that it is a complex, web-based service application with characteristics of information systems and service agents. In…

  2. Colorectal variceal bleeding in patients with extrahepatic portal vein thrombosis and idiopathic portal hypertension.

    PubMed

    Orozco, H; Takahashi, T; Mercado, M A; Prado-Orozco, E; Ferral, H; Hernandez-Ortiz, J; Esquivel, E

    1992-03-01

    We report three patients with colonic variceal bleeding secondary to portal hypertension, 0.5% of all cases with hemorrhagic portal hypertension studied by us in the last 16 years. One patient had idiopathic portal hypertension, and the others had extrahepatic portal vein thrombosis. Colonic varices were documented in all three cases by angiogram; large arteriovenous fistulas in the territory of the superior mesenteric artery and between the inferior mesenteric artery and hemorrhoidal veins were demonstrated in one patient. Two patients underwent colonoscopy; colonic varices were seen in only one. Two patients also had bled from esophagogastric varices. One patient underwent descending colon and sigmoid resection after failure to control bleeding with ligation of arterial supply; one patient underwent the Sugiura procedure, plus transanal ligation of hemorrhoids and rectal varices. At 3 months, 2 years, and 4 years of follow-up, the patients were in good general condition without any evidence of rebleeding.

  3. Nitroglycerine effects on portal vein mechanics and oxidative stress in portal hypertension

    PubMed Central

    Vujanac, Andreja; Jakovljevic, Vladimir; Djordjevic, Dusica; Zivkovic, Vladimir; Stojkovic, Mirjana; Celikovic, Dragan; Andjelkovic, Nebojsa; Skevin, Aleksandra Jurisic; Djuric, Dragan

    2012-01-01

    AIM: Тo examine the effects of nitroglycerine on portal vein haemodynamics and oxidative stress in patients with portal hypertension. METHODS: Thirty healthy controls and 39 patients with clinically verified portal hypertension and increased vascular resistance participated in the study. Liver diameters, portal diameters and portal flow velocities were recorded using color flow imaging/pulsed Doppler detection. Cross-section area, portal flow and index of vascular resistance were calculated. In collected blood samples, superoxide anion radical (O2-), hydrogen peroxide (H2O2), index of lipid peroxidation (measured as TBARS) and nitric oxide (NO) as a marker of endothelial response (measured as nitrite-NO2-) were determined. Time-dependent analysis was performed at basal state and in 10th and 15th min after nitroglycerine (sublingual 0.5 mg) administration. RESULTS: Oxidative stress parameters changed significantly during the study. H2O2 decreased at the end of study, probably via O2- mediated disassembling in Haber Weiss and Fenton reaction; O2- increased significantly probably due to increased diameter and tension and decreased shear rate level. Consequently O2- and H2O2 degradation products, like hydroxyl radical, initiated lipid peroxidation. Increased blood flow was to some extent lower in patients than in controls due to double paradoxes, flow velocity decreased, shear rate decreased significantly indicating non Newtonian characteristics of portal blood flow. CONCLUSION: This pilot study could be a starting point for further investigation and possible implementation of some antioxidants in the treatment of portal hypertension. PMID:22294839

  4. Measuring Problem Solving Skills in "Portal 2"

    ERIC Educational Resources Information Center

    Shute, Valerie J.; Wang, Lubin

    2013-01-01

    This paper examines possible improvement to problem solving skills as a function of playing the video game "Portal 2." Stealth assessment is used in the game to evaluate students' problem solving abilities--specifically basic and flexible rule application. The stealth assessment measures will be validated against commonly accepted…

  5. Regulations.gov Federal Regulatory Portal

    ERIC Educational Resources Information Center

    Ashlin, John; Davis, Richard; Dalecky, Selene; Grasso, Richard; LaPlant, Lisa; Morales, Oscar; Nelson, Jennifer; White, Michael; Whitt, Sharon A.

    2004-01-01

    The Regulations.gov Online Rulemaking Project is 1 of the 24 e-Government Initiatives on the President's Management Agenda (PMA), which was announced by the White House in 2001. The Regulations.gov Web site is the central electronic rulemaking portal for the federal government. Through a single Web site, citizens can search, view, and comment on…

  6. A neutron portal monitor for vehicles

    SciTech Connect

    Coop, K.L.; Fehlau, P.E.; Atwater, H.F.

    1987-07-01

    The authors have designed and built a portal vehicle monitoring system for detecting neutron-emitting special nuclear material (SNM) such as plutonium. Monte Carlo calculations were used to optimize the design of the 15-cm-deep x 122-cm-high x 244-cm-long detector chambers, which utilize /sup 3/He proportional counters inside a hollow polyethylene box. Results for a variety of parametric studies, including polyethylene thickness and detector number, are described. The experimental measurements are in good agreement with the computer calculations. The monitor's decision logic uses the Sequential Probability Ratio Test (SPRT) on Poisson distributed counting data, which is superior to other statistical tests in many applications. We performed computer simulations of the SPRT logic to determine expected false-positive decision rates. A controller unit of our design that uses this SPRT was built commercially. The cost of the complete monitoring system is similar to that of vehicle portal monitors that detect gamma rays. This new neutron monitor can serve as an addition to standard gamma-ray vehicle portals or as a stand-alone portal monitor in particular safeguards monitoring situations. The monitor is being tested at Los Alamos and is scheduled for in-plant evaluation at another DOE facility in 1987.

  7. A neutron portal monitor for vehicles

    SciTech Connect

    Coop, K.L.; Fehlau, P.E.; Atwater, H.F.

    1987-07-12

    We have designed and built a portal vehicle monitoring systems for detecting neutron-emitting special nuclear material (SNM) such as plutonium. Monte Carlo calculations were used to optimize the design of the 15-cm-deep x 122-cm-high x 244-cm-long detector chambers, which utilize /sup 3/He proportional counters inside a hollow polyethylene box. Results for a variety of parametric studies, including polyethylene thickness and detector number, are described. Our experimental measurements are in good agreement with the computer calculations. The monitor's decision logic uses the Sequential Probability Ratio Test (SPRT) on Poisson distributed counting data, which is superior to other statistical tests in many applications. We performed computer simulations of the SPRT logic to determine expected false-positive decision rates. A controller unit of our design that uses this SPRT was built commercially. The cost of the complete monitoring system is similar to that of vehicle portal monitors that detect gamma rays. This new neutron monitor can serve as an addition to standard gamma-ray vehicle portals or as a stand-alone portal monitor in particular safeguards monitoring situations. The monitor is being tested at Los Alamos and is scheduled for in-plant evaluation of another DOE facility in 1987. 7 refs.

  8. Cross-Cultural Dimensions of Internet Portals.

    ERIC Educational Resources Information Center

    Zahir, Sajjad; Dobing, Brian; Hunter, M. Gordon

    2002-01-01

    Discussion of cultural influences on new technologies focuses on an analysis of full-service national Web portals from different countries that investigated whether the adoption of new technologies resulted in cultural convergence or divergence. Results showed differences in appearance and features offered that can be attributed to cultural…

  9. Liver surgery in cirrhosis and portal hypertension

    PubMed Central

    Hackl, Christina; Schlitt, Hans J; Renner, Philipp; Lang, Sven A

    2016-01-01

    The prevalence of hepatic cirrhosis in Europe and the United States, currently 250 patients per 100000 inhabitants, is steadily increasing. Thus, we observe a significant increase in patients with cirrhosis and portal hypertension needing liver resections for primary or metastatic lesions. However, extended liver resections in patients with underlying hepatic cirrhosis and portal hypertension still represent a medical challenge in regard to perioperative morbidity, surgical management and postoperative outcome. The Barcelona Clinic Liver Cancer classification recommends to restrict curative liver resections for hepatocellular carcinoma in cirrhotic patients to early tumor stages in patients with Child A cirrhosis not showing portal hypertension. However, during the last two decades, relevant improvements in preoperative diagnostic, perioperative hepatologic and intensive care management as well as in surgical techniques during hepatic resections have rendered even extended liver resections in higher-degree cirrhotic patients with portal hypertension possible. However, there are few standard indications for hepatic resections in cirrhotic patients and risk stratifications have to be performed in an interdisciplinary setting for each individual patient. We here review the indications, the preoperative risk-stratifications, the morbidity and the mortality of extended resections for primary and metastatic lesions in cirrhotic livers. Furthermore, we provide a review of literature on perioperative management in cirrhotic patients needing extrahepatic abdominal surgery and an overview of surgical options in the treatment of hepatic cirrhosis. PMID:26973411

  10. Children as Designers of Web Portals.

    ERIC Educational Resources Information Center

    Large, Andrew; Beheshti, Jamshid; Nesset, Valerie; Bowler, Leanne

    2003-01-01

    Describes the process undertaken by a design team comprising both elementary school students and researchers to design a Web portal intended for use by children. The approach adopted by the team was based upon several design theories related to usability studies: contextual inquiry, participatory design, and cooperative inquiry. Presents…

  11. Portal hypertension in acute liver failure.

    PubMed Central

    Navasa, M; Garcia-Pagán, J C; Bosch, J; Riera, J R; Bañares, R; Mas, A; Bruguera, M; Rodés, J

    1992-01-01

    Twenty five patients with acute liver failure were measured for hepatic venous pressure gradient as an index of portal pressure during the course of a transjugular liver biopsy. Hepatic venous pressure gradient ranged from 4 to 24.5 mm Hg with a mean of 12.8 (5.3) mm Hg (normal values less than 5 mm Hg). All patients but one had increased portal pressure gradient. Portal hypertension correlated with the degree of architectural distortion of the liver, as suggested by a direct correlation between hepatic venous pressure gradient and the area of reticulin collapse, evaluated by means of a morphometric analysis on Sirius red stained liver slides (r = 0.43, p less than 0.05). Hepatic venous pressure gradient was significantly higher in patients with ascites (15.1 (5) mm Hg, n = 15) or renal failure (14.4 (5.3) mm Hg, n = 16) than in those without (9.3 (3.4) mm Hg and 10.1 (4) mm Hg, respectively; p less than 0.05). Portal hypertension was associated with systemic vasodilation and a hyperkinetic circulatory state, with decreased arterial pressure, and peripheral resistance and increased cardiac output. PMID:1644339

  12. Airport testing an explosives detection portal

    SciTech Connect

    Rhykerd, C.; Linker, K.; Hannum, D.; Bouchier, F.; Parmeter, J.

    1998-08-01

    At the direction of the US Congress, following the Pan Am 103 and TWA 800 crashes, the Federal Aviation Administration funded development of non-invasive techniques to screen airline passengers for explosives. Such an explosives detection portal, developed at Sandia National Laboratories, was field tested at the Albuquerque International airport in September 1997. During the 2-week field trial, 2,400 passengers were screened and 500 surveyed. Throughput, reliability, maintenance and sensitivity were studied. Follow-up testing at Sandia and at Idaho National Engineering and Environmental Laboratory was conducted. A passenger stands in the portal for five seconds while overhead fans blow air over his body. Any explosive vapors or dislodged particles are collected in vents at the feet. Explosives are removed from the air in a preconcentrator and subsequently directed into an ion mobility spectrometer for detection. Throughput measured 300 passengers per hour. The non-invasive portal can detect subfingerprint levels of explosives residue on clothing. A survey of 500 passengers showed a 97% approval rating, with 99% stating that such portals, if effective, should be installed in airports to improve security. Results of the airport test, as well as operational issues, are discussed.

  13. Collaboration Portals for NASA's Airborne Field Campaigns

    NASA Technical Reports Server (NTRS)

    Conover, Helen; Kulkami, Ajinkya; Garrett, Michele; Goodman, Michael; Peterson, Walter Arthur; Drewry, Marilyn; Hardin, Danny M.; He, Matt

    2011-01-01

    The University of Alabama in Huntsville (UAH), in collaboration with the Global Hydrology Resource Center, a NASA Earth Science Data Center, has provided information management for a number of NASA Airborne Field campaigns, both hurricane science investigations and satellite instrument validation. Effective field campaign management requires communication and coordination tools, including utilities for personnel to upload and share flight plans, weather forecasts, a variety of mission reports, preliminary science data, and personal photos. Beginning with the Genesis and Rapid Intensification Processes (GRIP) hurricane field campaign in 2010, we have provided these capabilities via a Drupal-based collaboration portal. This portal was reused and modified for the Midlatitude Continental Convective Clouds Experiment (MC3E), part of the Global Precipitation Measurement mission ground validation program. An end goal of these development efforts is the creation of a Drupal profile for field campaign management. This presentation will discuss experiences with Drupal in developing and using these collaboration portals. Topics will include Drupal modules used, advantages and disadvantages of working with Drupal in this context, and how the science teams used the portals in comparison with other communication and collaboration tools.

  14. Collaboration Portals for NASA's Airborne Field Campaigns

    NASA Astrophysics Data System (ADS)

    Conover, H.; Kulkarni, A.; Garrett, M.; Goodman, M.; Petersen, W. A.; Drewry, M.; Hardin, D. M.; He, M.

    2011-12-01

    The University of Alabama in Huntsville (UAH), in collaboration with the Global Hydrology Resource Center, a NASA Earth Science Data Center, has provided information management for a number of NASA Airborne Field campaigns, both hurricane science investigations and satellite instrument validation. Effective field campaign management requires communication and coordination tools, including utilities for personnel to upload and share flight plans, weather forecasts, a variety of mission reports, preliminary science data, and personal photos. Beginning with the Genesis and Rapid Intensification Processes (GRIP) hurricane field campaign in 2010, we have provided these capabilities via a Drupal-based collaboration portal. This portal was reused and modified for the Midlatitude Continental Convective Clouds Experiment (MC3E), part of the Global Precipitation Measurement mission ground validation program. An end goal of these development efforts is the creation of a Drupal profile for field campaign management. This presentation will discuss experiences with Drupal in developing and using these collaboration portals. Topics will include Drupal modules used, advantages and disadvantages of working with Drupal in this context, and how the science teams used the portals in comparison with other communication and collaboration tools.

  15. ExPASy: SIB bioinformatics resource portal.

    PubMed

    Artimo, Panu; Jonnalagedda, Manohar; Arnold, Konstantin; Baratin, Delphine; Csardi, Gabor; de Castro, Edouard; Duvaud, Séverine; Flegel, Volker; Fortier, Arnaud; Gasteiger, Elisabeth; Grosdidier, Aurélien; Hernandez, Céline; Ioannidis, Vassilios; Kuznetsov, Dmitry; Liechti, Robin; Moretti, Sébastien; Mostaguir, Khaled; Redaschi, Nicole; Rossier, Grégoire; Xenarios, Ioannis; Stockinger, Heinz

    2012-07-01

    ExPASy (http://www.expasy.org) has worldwide reputation as one of the main bioinformatics resources for proteomics. It has now evolved, becoming an extensible and integrative portal accessing many scientific resources, databases and software tools in different areas of life sciences. Scientists can henceforth access seamlessly a wide range of resources in many different domains, such as proteomics, genomics, phylogeny/evolution, systems biology, population genetics, transcriptomics, etc. The individual resources (databases, web-based and downloadable software tools) are hosted in a 'decentralized' way by different groups of the SIB Swiss Institute of Bioinformatics and partner institutions. Specifically, a single web portal provides a common entry point to a wide range of resources developed and operated by different SIB groups and external institutions. The portal features a search function across 'selected' resources. Additionally, the availability and usage of resources are monitored. The portal is aimed for both expert users and people who are not familiar with a specific domain in life sciences. The new web interface provides, in particular, visual guidance for newcomers to ExPASy.

  16. Evaluation of a flowchart-based EHR query system: a case study of RetroGuide.

    PubMed

    Huser, Vojtech; Narus, Scott P; Rocha, Roberto A

    2010-02-01

    Provision of query systems which are intuitive for non-experts has been recognized as an important informatics challenge. We developed a prototype of a flowchart-based analytical framework called RetroGuide that enables non-experts to formulate query tasks using a step-based, patient-centered paradigm inspired by workflow technology. We present results of the evaluation of RetroGuide in comparison to Structured Query Language (SQL) in laboratory settings using a mixed method design. We asked 18 human subjects with limited database experience to solve query tasks in RetroGuide and SQL, and quantitatively compared their test scores. A follow-up questionnaire was designed to compare both technologies qualitatively and investigate RetroGuide technology acceptance. The quantitative comparison of test scores showed that the study subjects achieved significantly higher scores using the RetroGuide technology. Qualitative study results indicated that 94% of subjects preferred RetroGuide to SQL because RetroGuide was easier to learn, it better supported temporal tasks, and it seemed to be a more logical modeling paradigm. Additional qualitative evaluation results, based on a technology acceptance model, suggested that a fully developed RetroGuide-like technology would be well accepted by users. Our study is an example of a structure validation study of a prototype query system, results of which provided significant guidance in further development of a novel query paradigm for EHR data. We discuss the strengths and weakness of our study design and results, and their implication for future evaluations of query systems in general.

  17. Pathophysiology of Portal Hypertension and Its Clinical Links

    PubMed Central

    Seo, Yeon Seok; Shah, Vijay H

    2011-01-01

    Portal hypertension is a major cause of morbidity and mortality in patients with liver cirrhosis. Intrahepatic vascular resistance due to architectural distortion and intrahepatic vasoconstriction, increased portal blood flow due to splanchnic vasodilatation, and development of collateral circulation have been considered as major factors for the development of portal hypertension. Recently, sinusoidal remodeling and angiogenesis have been focused as potential etiologic factors and various researchers have tried to improve portal hypertension by modulating these new targets. This article reviews potential new treatments in the context of portal hypertension pathophysiology concepts. PMID:25755320

  18. Portal hypertension as portrayed by marked hepatosplenomegaly: case report

    SciTech Connect

    Greene, R.A.

    1987-12-01

    The liver is vulnerable to as host of disease processes, including portal hypertension. This is a severe hepatic condition in which the liver is subject to numerous imbalances: increased hepatic blood flow, increased portal vein pressure due to extrahepatic portal vein obstruction, and/or increases in hepatic blood flow resistance. Although many diseases states may be responsible for the development of portal hypertension, it is most commonly associated with moderately severe or advanced cirrhosis. Advanced, untreated portal hypertension may cause additional complications such as hepatosplenomegaly, gastrointestinal bleeding, and ascites.

  19. Astronomia.pl: Portal activity in 2006-2007

    NASA Astrophysics Data System (ADS)

    Czart, K.; Pomierny, J.

    2008-06-01

    We present the latest activity of Astronomia.pl - the Polish Astronomy Portal, the most popular internet portal about astronomy in Poland. Astronomia.pl is a wide-ranging portal, covering news, a database of articles, books, lectures, an astronomical calendar, a newsletter, a virtual library of diploma theses, a discussion forum, chat, galleries, a catalogue of websites and other services. The portal also owns several additional services like an on-line lexicon with biographies of astronomers, a website about Polish planetariums and a server for websites created by astronomy amateurs. There is also small part of the portal in English.

  20. Synteny Portal: a web-based application portal for synteny block analysis.

    PubMed

    Lee, Jongin; Hong, Woon-Young; Cho, Minah; Sim, Mikang; Lee, Daehwan; Ko, Younhee; Kim, Jaebum

    2016-07-01

    Recent advances in next-generation sequencing technologies and genome assembly algorithms have enabled the accumulation of a huge volume of genome sequences from various species. This has provided new opportunities for large-scale comparative genomics studies. Identifying and utilizing synteny blocks, which are genomic regions conserved among multiple species, is key to understanding genomic architecture and the evolutionary history of genomes. However, the construction and visualization of such synteny blocks from multiple species are very challenging, especially for biologists with a lack of computational skills. Here, we present Synteny Portal, a versatile web-based application portal for constructing, visualizing and browsing synteny blocks. With Synteny Portal, users can easily (i) construct synteny blocks among multiple species by using prebuilt alignments in the UCSC genome browser database, (ii) visualize and download syntenic relationships as high-quality images, (iii) browse synteny blocks with genetic information and (iv) download the details of synteny blocks to be used as input for downstream synteny-based analyses, all in an intuitive and easy-to-use web-based interface. We believe that Synteny Portal will serve as a highly valuable tool that will enable biologists to easily perform comparative genomics studies by compensating limitations of existing tools. Synteny Portal is freely available at http://bioinfo.konkuk.ac.kr/synteny_portal.

  1. Transjugular Intrahepatic Portosystemic Shunt for the Treatment of Portal Hypertension in Noncirrhotic Patients with Portal Cavernoma

    PubMed Central

    Luo, Xuefeng; Zhou, Biao; Yao, Denghua; Ma, Huaiyuan; Jiang, Mingshan; Zhang, Hailong; Li, Xiao

    2014-01-01

    Background. The purpose of this study was to evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) placement in the management of portal hypertension in noncirrhotic patients with portal cavernoma. Methods. We conducted a single institution retrospective analysis of 15 noncirrhotic patients with portal cavernoma treated with TIPS placement. 15 patients (4 women and 11 men) were evaluated via the technical success of TIPS placement, procedural complications, and follow-up shunt patency. Results. TIPS placement was technically successful in 11 out of 15 patients (73.3%). Procedure-related complications were limited to a single instance of hepatic encephalopathy in one patient. In patients with successful shunt placement, the portal pressure gradient decreased from 25.8 ± 5.7 to 9.5 ± 4.2 mmHg (P < 0.001). TIPS dysfunction occurred in two patients during a median follow-up time of 45.2 months. Revision was not performed in one patient due to inadequate inflow. The other patient died of massive gastrointestinal bleeding in a local hospital. The remaining nine patients maintained functioning shunts through their last evaluation. Conclusions. TIPS is a safe and effective therapeutic treatment for noncirrhotic patients with symptomatic portal hypertension secondary to portal cavernoma. PMID:24868203

  2. Anatomy of the Portal Vein Bifurcation: Implication for Transjugular Intrahepatic Portal Systemic Shunts

    SciTech Connect

    Kwok, Philip Chong-hei Ng, Wai Fu; Lam, Christine Suk-yee; Tsui, Polly Po; Faruqi, Asma

    2003-06-15

    Purpose: The relationship of the portalvein bifurcation to the liver capsule in Asians, which is an important landmark for transjugular intrahepatic portosystemic shunt, has not previously been described. Methods: The anatomy of the portal vein bifurcation was studied in 70 adult Chinese cadavers; it was characterized as intrahepatic or extrahepatic. The length of the exposed portion of the right and left portal veins was measured when the bifurcation was extrahepatic. Results: The portal vein bifurcation was intrahepatic in 37 cadavers (53%) and extrahepatic in 33 cadavers (47%). The mean length of the right and left extrahepatic portal veins was 0.96 cm and 0.85 cm respectively.Both were less than or equal to 2 cm in 94% of the cadavers with extrahepatic bifurcation. There was no correlation between the presence of cirrhosis and the location of the portal vein bifurcation(p 1.0). There was no statistically significant difference in liver mass in cadavers with either extrahepatic or intrahepatic bifurcation (p =0.40). Conclusions: These findings suggest that fortransjugular intrahepatic portosystemic shunt placement, a portal vein puncture 2 cm from the bifurcation will be safe in most cases.

  3. Portal hypertension associated with primary hypoplasia of the hepatic portal vein in dogs.

    PubMed

    Van den Ingh, T S; Rothuizen, J; Meyer, H P

    1995-10-21

    Portal hypertension caused by primary hypoplasia of the portal vein was diagnosed in 42 dogs. The portal hypertension was manifested by the presence of multiple portosystemic collateral vessels. The main clinical signs were retarded growth or weight loss, apathy, intermittent diarrhoea and vomiting, anorexia, abdominal distension and polydipsia. Major findings at physical examination were ascites in 23 dogs and neurological signs in 16 dogs. The dogs had increased activities of liver enzymes in plasma and increased fasting levels of total bile acids and ammonia; in many of the dogs the packed red cell volume, total serum protein and albumin were low. Gross inspection of the portal vein revealed a patent but underdeveloped extrahepatic vein in 13 of the dogs. Microscopic examination of the liver revealed hypoplasia of the intrahepatic portal veins in all the dogs, and this was associated with minor arteriolar proliferation and absence of fibrosis in 12 of them, with moderate to marked arteriolar proliferation often combined with ductular proliferation in 13, and with marked portal fibrosis (formerly described as hepatoportal fibrosis) with a varying number of arteriolar and bile ductular structures in 17 of the dogs. The disease affected mainly young dogs, and was most likely to have been of congenital origin. PMID:8560700

  4. Synteny Portal: a web-based application portal for synteny block analysis

    PubMed Central

    Lee, Jongin; Hong, Woon-young; Cho, Minah; Sim, Mikang; Lee, Daehwan; Ko, Younhee; Kim, Jaebum

    2016-01-01

    Recent advances in next-generation sequencing technologies and genome assembly algorithms have enabled the accumulation of a huge volume of genome sequences from various species. This has provided new opportunities for large-scale comparative genomics studies. Identifying and utilizing synteny blocks, which are genomic regions conserved among multiple species, is key to understanding genomic architecture and the evolutionary history of genomes. However, the construction and visualization of such synteny blocks from multiple species are very challenging, especially for biologists with a lack of computational skills. Here, we present Synteny Portal, a versatile web-based application portal for constructing, visualizing and browsing synteny blocks. With Synteny Portal, users can easily (i) construct synteny blocks among multiple species by using prebuilt alignments in the UCSC genome browser database, (ii) visualize and download syntenic relationships as high-quality images, (iii) browse synteny blocks with genetic information and (iv) download the details of synteny blocks to be used as input for downstream synteny-based analyses, all in an intuitive and easy-to-use web-based interface. We believe that Synteny Portal will serve as a highly valuable tool that will enable biologists to easily perform comparative genomics studies by compensating limitations of existing tools. Synteny Portal is freely available at http://bioinfo.konkuk.ac.kr/synteny_portal. PMID:27154270

  5. Factors influencing nursing students' acceptance of electronic health records for nursing education (EHRNE) software program.

    PubMed

    Kowitlawakul, Yanika; Chan, Sally Wai Chi; Pulcini, Joyce; Wang, Wenru

    2015-01-01

    The Institute of Medicine (IOM) and the Health Information Technology Act (2009) in America had recommended that electronic health records (EHRs) should be fully adopted by 2014. This has urged educational institutions to prepare healthcare professionals to be competent in using electronic health records (EHRs) while they are in schools. To equip nursing students with competency in using EHRs, an electronic health record for nursing education (EHRNE) has been developed and integrated it into nursing curricula. The purposes of the study were to investigate the factors influencing nursing students' acceptance of the EHRs in nursing education using the extended Technology Acceptance Model with self-efficacy as a conceptual framework. The study is a descriptive study design using self-reported questionnaires with 212 student participants. The IBM SPSS and AMOS 22.0 were used to analyze the data. The results showed that attitude toward using the EHRNE was the most influential factor on students' acceptance. The preliminary findings suggested that to enhance the students' acceptance of the EHRNE, cultivation of a positive attitude toward using this EHR as well as increasing the perceived usefulness is very important. Also, the study's framework could be used in guiding learning health informatics and be applied to nursing students.

  6. Successful Portal Vein Stent Placement in a Child with Cavernomatous Replacement of the Portal Vein After Partial Liver Transplantation: The Importance of a Recognizable Portal Vein Remnant.

    PubMed

    Miraglia, Roberto; Maruzzelli, Luigi; Caruso, Settimo; Ricotta, Calogero; Riva, Silvia; Burgio, Gaetano; Spada, Marco; Luca, Angelo

    2015-12-01

    Late portal vein thrombosis with cavernomatous replacement has been reported in 4.5% of pediatric patients who have undergone partial liver transplantation. In such cases, minimally invasive radiological treatments have a high failure rate. We report a successful case of percutaneous recanalization of the portal vein remnant, and subsequent stent placement, in a pediatric patient who underwent left lateral split liver transplantation with cavernomatous replacement of the portal vein. PMID:25809240

  7. Percutaneous Transumbilical Portal Vein Embolization in a Patient with a Ruptured Hepatocellular Carcinoma Supplied by the Portal Vein

    SciTech Connect

    Kim, Soo Chin; Kim, Hyo-Cheol Chung, Jin Wook; Jae, Hwan Jun; Park, Jae Hyung

    2011-02-15

    We describe a case of a ruptured hepatocellular carcinoma supplied by the portal vein that was successfully treated with portal vein embolization via a percutaneous transumbilical approach. A contrast material-enhanced computed tomographic (CT) scan showed the presence of a large hypervascular tumor on portal venous phase as well as right hepatic vein thrombosis and hemoperitoneum that prevented portal vein embolization by the use of the percutaneous and transjugular transhepatic approach. The use of percutaneous transumbilical portal vein embolization can be an alternative option in this situation.

  8. Design and Testing of an EHR-Integrated, Busulfan Pharmacokinetic Decision Support Tool for the Point-of-Care Clinician

    PubMed Central

    Abdel-Rahman, Susan M.; Breitkreutz, Matthew L.; Bi, Charlie; Matzuka, Brett J.; Dalal, Jignesh; Casey, K. Leigh; Garg, Uttam; Winkle, Sara; Leeder, J. Steven; Breedlove, JeanAnn; Rivera, Brian

    2016-01-01

    Background: Busulfan demonstrates a narrow therapeutic index for which clinicians routinely employ therapeutic drug monitoring (TDM). However, operationalizing TDM can be fraught with inefficiency. We developed and tested software encoding a clinical decision support tool (DST) that is embedded into our electronic health record (EHR) and designed to streamline the TDM process for our oncology partners. Methods: Our development strategy was modeled based on the features associated with successful DSTs. An initial Requirements Analysis was performed to characterize tasks, information flow, user needs, and system requirements to enable push/pull from the EHR. Back-end development was coded based on the algorithm used when manually performing busulfan TDM. The code was independently validated in MATLAB using 10,000 simulated patient profiles. A 296-item heuristic checklist was used to guide design of the front-end user interface. Content experts and end-users (n = 28) were recruited to participate in traditional usability testing under an IRB approved protocol. Results: Decision support software was developed to systematically walk the point-of-care clinician through the TDM process. The system is accessed through the EHR which transparently imports all of the requisite patient data. Data are visually inspected and then curve fit using a model-dependent approach. Quantitative goodness-of-fit are converted to single tachometer where “green” alerts the user that the model is strong, “yellow” signals caution and “red” indicates that there may be a problem with the fitting. Override features are embedded to permit application of a model-independent approach where appropriate. Simulations are performed to target a desired exposure or dose as entered by the clinician and the DST pushes the user approved recommendation back into the EHR. Usability testers were highly satisfied with our DST and quickly became proficient with the software. Conclusions: With early

  9. Becoming a Learning Organization: New Directions in Science Education Research at the National Science Foundation

    ERIC Educational Resources Information Center

    Ramaley, Judith A.; Olds, Barbara M.; Earle, Janice

    2005-01-01

    The Education and Human Resources (EHR) Directorate at the National Science Foundation has been examining its role in supporting the development of new approaches to science, technology, engineering and mathematics (STEM) education. This article explores what it means to be scientifically literate, what it takes to become a learning organization,…

  10. 2015 Edition Health Information Technology (Health IT) Certification Criteria, 2015 Edition Base Electronic Health Record (EHR) Definition, and ONC Health IT Certification Program Modifications. Final rule.

    PubMed

    2015-10-16

    This final rule finalizes a new edition of certification criteria (the 2015 Edition health IT certification criteria or "2015 Edition'') and a new 2015 Edition Base Electronic Health Record (EHR) definition, while also modifying the ONC Health IT Certification Program to make it open and accessible to more types of health IT and health IT that supports various care and practice settings. The 2015 Edition establishes the capabilities and specifies the related standards and implementation specifications that Certified Electronic Health Record Technology (CEHRT) would need to include to, at a minimum, support the achievement of meaningful use by eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) under the Medicare and Medicaid EHR Incentive Programs (EHR Incentive Programs) when such edition is required for use under these programs.

  11. Phase contrast portal imaging using synchrotron radiation

    SciTech Connect

    Umetani, K.; Kondoh, T.

    2014-07-15

    Microbeam radiation therapy is an experimental form of radiation treatment with great potential to improve the treatment of many types of cancer. We applied a synchrotron radiation phase contrast technique to portal imaging to improve targeting accuracy for microbeam radiation therapy in experiments using small animals. An X-ray imaging detector was installed 6.0 m downstream from an object to produce a high-contrast edge enhancement effect in propagation-based phase contrast imaging. Images of a mouse head sample were obtained using therapeutic white synchrotron radiation with a mean beam energy of 130 keV. Compared to conventional portal images, remarkably clear images of bones surrounding the cerebrum were acquired in an air environment for positioning brain lesions with respect to the skull structure without confusion with overlapping surface structures.

  12. Phase contrast portal imaging using synchrotron radiation

    NASA Astrophysics Data System (ADS)

    Umetani, K.; Kondoh, T.

    2014-07-01

    Microbeam radiation therapy is an experimental form of radiation treatment with great potential to improve the treatment of many types of cancer. We applied a synchrotron radiation phase contrast technique to portal imaging to improve targeting accuracy for microbeam radiation therapy in experiments using small animals. An X-ray imaging detector was installed 6.0 m downstream from an object to produce a high-contrast edge enhancement effect in propagation-based phase contrast imaging. Images of a mouse head sample were obtained using therapeutic white synchrotron radiation with a mean beam energy of 130 keV. Compared to conventional portal images, remarkably clear images of bones surrounding the cerebrum were acquired in an air environment for positioning brain lesions with respect to the skull structure without confusion with overlapping surface structures.

  13. Duodenal polyposis secondary to portal hypertensive duodenopathy

    PubMed Central

    Gurung, Ananta; Jaffe, Philip E; Zhang, Xuchen

    2015-01-01

    Portal hypertensive duodenopathy (PHD) is a recognized, but uncommon finding of portal hypertension in cirrhotic patients. Lesions associated with PHD include erythema, erosions, ulcers, telangiectasia, exaggerated villous pattern and duodenal varices. However, duodenal polyposis as a manifestation of PHD is rare. We report a case of a 52-year-old man who underwent esophagogastroduodenoscopy and was found with multiple small duodenal polyps ranging in size from 1-8 mm. Biopsy of the representative polyps revealed polypoid fragments of duodenal mucosa with villiform hyperplasia lined by reactive duodenal/gastric foveolar epithelium and underlying lamina propria showed proliferating ectatic and congested capillaries. The features were diagnostic of polyps arising in the setting of PHD. PMID:26634042

  14. Sunshot Initiative High Penetration Solar Portal

    DOE Data Explorer

    The DOE SunShot Initiative is a collaborative national initiative to make solar energy cost-competitive with other forms of energy by the end of the decade. Reducing the installed cost of solar energy systems by about 75% will drive widespread large-scale adoption of this renewable energy and restore U.S. leadership in the global clean energy race. The High Penetration Solar Portal was created as a resource to aggregate the most relevant and timely information related to high penetration solar scenarios and integrating solar into the grid. The site is designed so that utilities, grant awardees, regulators, researchers, and other solar professionals can easily share data, case studies, lessons learned, and demonstration project findings. [from https://solarhighpen.energy.gov/about_the_high_penetration_solar_portal

  15. Portal Vein Embolization: What Do We Know?

    SciTech Connect

    Denys, Alban; Prior, John; Bize, Pierre; Duran, Rafael; Baere, Thierry De; Halkic, Nermin; Demartines, Nicolas

    2012-10-15

    Portal vein embolization (PVE) has been developed to increase the size of the future remnant liver (FRL) left in place after major hepatectomy, thus reducing the risk of postoperative liver insufficiency. PVE consist in embolizing preoperatively portal branches of the segments that will be resected. Indication is based on preoperative measurements of the FRL by computed tomography and its ratio with either the theoretical liver volume or by direct measurement of the functional liver volume. After PVE, the volume and function of the FRL increases in 3 to 6 weeks, permitting extensive resections in patients otherwise contraindicated for liver resection. The PVE technique is variable from one center to another; however n-butyl-cyano-acrylate provides an interesting compromise between hypertrophy rate and procedure risk.

  16. The Benefits of a Formative Evaluation for Developing a Highly Innovative Software: The Case of the handoverEHR.

    PubMed

    Przysucha, Mareike; Flemming, Daniel; Hübner, Ursula

    2016-01-01

    Innovations are typically characterised by their relative newness for the user. In order for new eHealth applications to be accepted as innovations more criteria were proposed including "use" and "usability". The handoverEHR is a new approach that allows the user to translate the essentials of a clinical case into a graphical representation, the so-called cognitive map of the patient. This study aimed at testing the software usability. A convenience sample of 23 experienced nurses from different healthcare organisations across the country rated the usability of the handoverEHR after performing typical handover tasks. All usability scales of the IsoMetricsL questionnaire showed positive values (4 "I agree") with the exception of "error tolerance" (3 "neutral statement"). A significant improvement was found in self-descriptiveness as compared to an initial usability testing prior to this study. Different subgroups of users tended to rate the usability of the system differently. This study demonstrated the benefits of formative evaluations in terms of improving the usability of an entirely new approach. It thus helps to transform a novel piece of software towards becoming a real innovation. Our findings also hint at the importance of user characteristics that could affect the usability ratings. PMID:27577458

  17. On flattening filter-free portal dosimetry.

    PubMed

    Pardo, Eduardo; Castro Novais, Juan; Molina López, María Yolanda; Ruiz Maqueda, Sheila

    2016-07-08

    Varian introduced (in 2010) the option of removing the flattening filter (FF) in their C-Arm linacs for intensity-modulated treatments. This mode, called flattening filter-free (FFF), offers the advantage of a greater dose rate. Varian's "Portal Dosimetry" is an electronic portal imager device (EPID)-based tool for IMRT verification. This tool lacks the capability of verifying flattening filter-free (FFF) modes due to saturation and lack of an image prediction algorithm. (Note: the latest versions of this software and EPID correct these issues.) The objective of the present study is to research the feasibility of said verifications (with the older versions of the software and EPID). By placing the EPID at a greater distance, the images can be acquired without saturation, yielding a linearity similar to the flattened mode. For the image prediction, a method was optimized based on the clinically used algorithm (analytical anisotropic algorithm (AAA)) over a homogeneous phantom. The depth inside the phantom and its electronic density were tailored. An application was developed to allow the conversion of a dose plane (in DICOM format) to Varian's custom format for Portal Dosimetry. The proposed method was used for the verification of test and clinical fields for the three qualities used in our institution for IMRT: 6X, 6FFF and 10FFF. The method developed yielded a positive verification (more than 95% of the points pass a 2%/2 mm gamma) for both the clinical and test fields. This method was also capable of "predicting" static and wedged fields. A workflow for the verification of FFF fields was developed. This method relies on the clinical algorithm used for dose calculation and is able to verify the FFF modes, as well as being useful for machine quality assurance. The procedure described does not require new hardware. This method could be used as a verification of Varian's Portal Dose Image Prediction.

  18. [HEPATIC HYDATIC CYST ASSOCIATED WITH PORTAL HYPERTENSION

    PubMed

    Bustíos, S Carla; Uribe, M Rosario; Vargas, C Gloria; Myurí, B Corina

    1999-01-01

    We report the case of a 26-year-old woman from Cerro of Pasco - Per , with hydatid cyst in the liver associated with portal hypertension. We know that the echinococcosis in the liver is usually asymptomatic, although can produce clinical features that depend of the size and localization in the liver. The clinical, radiological and endoscopic findings are presented, due to the uncommon presentation and the few cases reported in the literature about this asociation

  19. On flattening filter-free portal dosimetry.

    PubMed

    Pardo, Eduardo; Castro Novais, Juan; Molina López, María Yolanda; Ruiz Maqueda, Sheila

    2016-01-01

    Varian introduced (in 2010) the option of removing the flattening filter (FF) in their C-Arm linacs for intensity-modulated treatments. This mode, called flattening filter-free (FFF), offers the advantage of a greater dose rate. Varian's "Portal Dosimetry" is an electronic portal imager device (EPID)-based tool for IMRT verification. This tool lacks the capability of verifying flattening filter-free (FFF) modes due to saturation and lack of an image prediction algorithm. (Note: the latest versions of this software and EPID correct these issues.) The objective of the present study is to research the feasibility of said verifications (with the older versions of the software and EPID). By placing the EPID at a greater distance, the images can be acquired without saturation, yielding a linearity similar to the flattened mode. For the image prediction, a method was optimized based on the clinically used algorithm (analytical anisotropic algorithm (AAA)) over a homogeneous phantom. The depth inside the phantom and its electronic density were tailored. An application was developed to allow the conversion of a dose plane (in DICOM format) to Varian's custom format for Portal Dosimetry. The proposed method was used for the verification of test and clinical fields for the three qualities used in our institution for IMRT: 6X, 6FFF and 10FFF. The method developed yielded a positive verification (more than 95% of the points pass a 2%/2 mm gamma) for both the clinical and test fields. This method was also capable of "predicting" static and wedged fields. A workflow for the verification of FFF fields was developed. This method relies on the clinical algorithm used for dose calculation and is able to verify the FFF modes, as well as being useful for machine quality assurance. The procedure described does not require new hardware. This method could be used as a verification of Varian's Portal Dose Image Prediction. PMID:27455487

  20. Interventional Radiologic Treatment for Idiopathic Portal Hypertension

    SciTech Connect

    Hirota, Shozo; Ichikawa, Satoshi; Matsumoto, Shinichi; Motohara, Tomofumi; Fukuda, Tetsuya; Yoshikawa, Takeshi

    1999-07-15

    Purpose: To evaluate the usefulness of interventional radiological treatment for idiopathic portal hypertension. Methods: Between 1995 and 1998, we performed an interventional radiological treatment in five patients with idiopathic portal hypertension, four of whom had refused surgery and one of whom had undergone surgery. Three patients with gastroesophageal varices (GEV) were treated by partial splenic embolization (PSE), one patient with esophageal varices (EV) and massive ascites by transjugular intrahepatic portosytemic shunt (TIPS) and PSE, and one patient with GEV by percutaneous transhepatic obliteration (PTO). Midterm results were analyzed in terms of the effect on esophageal and/or gastric varices. Results: In one woman with severe GEV who underwent three sessions of PSE, there was endoscopic confirmation that the GEV had disappeared. In one man his EV shrunk markedly after two sessions of PSE. In two patients slight reduction of the EV was obtained with one application of PSE combined with endoscopic variceal ligation therapy. PTO for GV in one patient resulted in good control of the varices. All patients have survived for 16-42 months since the first interventional treatment, and varices are well controlled. Conclusion: Interventional radiological treatment is effective for patients with idiopathic portal hypertension, whether or not they have undergone surgery.

  1. Capsule Endoscopy for Portal Hypertensive Enteropathy.

    PubMed

    Jeon, Seong Ran; Kim, Jin-Oh

    2016-01-01

    Portal hypertensive enteropathy (PHE) is a mucosal abnormality of the small bowel that is observed in patients with portal hypertension (PH) and can lead to gastrointestinal bleeding and anemia. The pathogenesis is still not completely understood. The introduction of new endoscopic methods, including capsule endoscopy (CE) or balloon-assisted enteroscopy, has increased the detection of these abnormalities. CE can also serve as a road map for deciding subsequent interventions and evaluating the treatment effect. The prevalence of PHE is reportedly 40-70% in patients with PH. Endoscopic findings can be roughly divided into vascular and nonvascular lesions such as inflammatory-like lesions. Traditionally, PHE-associated factors include large esophageal varices, portal hypertensive gastropathy or colopathy, Child-Turcotte-Pugh class B or C, a history of variceal treatment, and acute gastrointestinal bleeding. More recently, on using scoring systems, a high computed tomography or transient elastography score was reportedly PHE-related factors. However, the prevalence of PHE and its related associated factors remain controversial. The management of PHE has not yet been standardized. It should be individualized according to each patient's situation, the availability of therapy, and each institutional expertise. PMID:26819613

  2. Preduodenal portal vein in the adult.

    PubMed

    Papaziogas, T; Papaziogas, B; Paraskevas, G; Lazaridis, C; Patsas, A

    2000-09-01

    We present three cases of preduodenal portal vein in adult people, which were diagnosed in our department. All of them were identified during elective operation for cholelithiasis, caused some technical difficulties to the performance of the operation, but led to no major intraoperative or postoperative complications. None of them had any preoperative symptoms, which could be related to this anomaly. The preduodenal portal vein is a rare congenital anomaly, which is usually discovered in infants or children due to the obstruction of the duodenum. In adults, it is often asymptomatic, and is usually discovered as an accidental finding during laparotomy for other reason. The postcontrast CT can set the diagnosis, when this anomaly is suspected. Despite its rarity, this anomaly is of great surgical importance, because it can predispose to intraoperative complications including hemorrhage from the abnormal vein, or damage to the biliary tract or the distented duodenum. The anterior position of the portal vein results from the persistence of the ventral anastomosis between the two vitelline veins and the distal portion of the right vitelline vein, with subsequent atrophy of the cranial part of the left vitelline and dorsal anastomotic vein.

  3. The DIRAC Web Portal 2.0

    NASA Astrophysics Data System (ADS)

    Mathe, Z.; Casajus Ramo, A.; Lazovsky, N.; Stagni, F.

    2015-12-01

    For many years the DIRAC interware (Distributed Infrastructure with Remote Agent Control) has had a web interface, allowing the users to monitor DIRAC activities and also interact with the system. Since then many new web technologies have emerged, therefore a redesign and a new implementation of the DIRAC Web portal were necessary, taking into account the lessons learnt using the old portal. These new technologies allowed to build a more compact, robust and responsive web interface that enables users to have better control over the whole system while keeping a simple interface. The web framework provides a large set of “applications”, each of which can be used for interacting with various parts of the system. Communities can also create their own set of personalised web applications, and can easily extend already existing ones with a minimal effort. Each user can configure and personalise the view for each application and save it using the DIRAC User Profile service as RESTful state provider, instead of using cookies. The owner of a view can share it with other users or within a user community. Compatibility between different browsers is assured, as well as with mobile versions. In this paper, we present the new DIRAC Web framework as well as the LHCb extension of the DIRAC Web portal.

  4. ENCODE data at the ENCODE portal.

    PubMed

    Sloan, Cricket A; Chan, Esther T; Davidson, Jean M; Malladi, Venkat S; Strattan, J Seth; Hitz, Benjamin C; Gabdank, Idan; Narayanan, Aditi K; Ho, Marcus; Lee, Brian T; Rowe, Laurence D; Dreszer, Timothy R; Roe, Greg; Podduturi, Nikhil R; Tanaka, Forrest; Hong, Eurie L; Cherry, J Michael

    2016-01-01

    The Encyclopedia of DNA Elements (ENCODE) Project is in its third phase of creating a comprehensive catalog of functional elements in the human genome. This phase of the project includes an expansion of assays that measure diverse RNA populations, identify proteins that interact with RNA and DNA, probe regions of DNA hypersensitivity, and measure levels of DNA methylation in a wide range of cell and tissue types to identify putative regulatory elements. To date, results for almost 5000 experiments have been released for use by the scientific community. These data are available for searching, visualization and download at the new ENCODE Portal (www.encodeproject.org). The revamped ENCODE Portal provides new ways to browse and search the ENCODE data based on the metadata that describe the assays as well as summaries of the assays that focus on data provenance. In addition, it is a flexible platform that allows integration of genomic data from multiple projects. The portal experience was designed to improve access to ENCODE data by relying on metadata that allow reusability and reproducibility of the experiments.

  5. The portal immunosuppressive storm: relevance to islet transplantation?

    PubMed

    Shapiro, A M James; Gallant, Heather L; Hao, Er Geng; Lakey, Jonathan R T; McCready, Tara; Rajotte, Ray V; Yatscoff, Randall W; Kneteman, Norman M

    2005-02-01

    Outcomes in clinical islet transplantation improved substantially with the introduction of combined sirolimus and tacrolimus immunosuppression. However, multiple islet preparations are often required to achieve insulin independence, suggesting that islet engraftment may not be optimal when these agents are absorbed via the portal vein. The current study was designed to assess the differential concentrations of immunosuppressive drugs within the portal and systemic circulations of a large animal model, to assess the local concentrations of drugs to which islets are exposed early after implantation. Chronic catheters were placed in the portal vein and carotid artery of 6 mongrel dogs, and immunosuppressants were administered orally. Blood samples were drawn simultaneously from portal and systemic catheters, and drug concentrations were analyzed. Peak immunosuppressant levels as well as area under the curve were dramatically elevated in portal blood relative to systemic levels for all drugs tested. This "portal storm" of immunosuppression may be relevant to intrahepatic islet transplantation. PMID:15665744

  6. Disastrous Portal Vein Embolization Turned into a Successful Intervention

    SciTech Connect

    Dobrocky, Tomas; Kettenbach, Joachim; Lopez-Benitez, Ruben Kara, Levent

    2015-10-15

    Portal vein embolization (PVE) may be performed before hemihepatectomy to increase the volume of future liver remnant (FLR) and to reduce the risk of postoperative liver insufficiency. We report the case of a 71-year-old patient with hilar cholangiocarcinoma undergoing PVE with access from the right portal vein using a mixture of n-butyl-2-cyanoacrylate and ethiodized oil. During the procedure, nontarget embolization of the left portal vein occurred. An aspiration maneuver of the polymerized plug failed; however, the embolus obstructing portal venous flow in the FLR was successfully relocated into the right portal vein while carefully bypassing the plug with a balloon catheter, inflating the balloon, and pulling the plug into the main right portal vein.

  7. Development of a trace explosives detection portal for personnel screening

    SciTech Connect

    Parmeter, J.E.; Linker, K.L.; Rhykerd, C.L. Jr.; Bouchier, F.A.; Hannum, D.W.

    1998-08-01

    The authors discuss the development, design, and operation of a walk-through trace detection portal designed to screen personnel for explosives. Developed at Sandia National Laboratories (SNL) with primary funding from the Federal Aviation Administration (FAA) and additional support from the Department of Energy office of Safeguards and Security, this portal is intended primarily for use in airport terminals and in other localities where a very high throughput of pedestrian traffic is combined with stringent security requirements. The portal is capable of detecting both vapor and particulate contamination, with the collection of explosive material being based upon the entrainment of that material in air flows over the body of the person being screened. This portal is capable of detecting most types of common high explosives of interest to the FAA. The authors discuss the results of field testing of the portal in the Albuquerque International Airport in September, 1997 and more recent steps towards commercialization of the portal.

  8. EMODnet Physical Parameters (EMODNet PP) Portal

    NASA Astrophysics Data System (ADS)

    Novellino, A.; Schaap, D.; Manzella, G. M. R.; Pouliquen, S.; Gorringe, P.

    2012-04-01

    In December 2007 the European Parliament and Council adopted a common text for the Marine Strategy Framework Directive which aims to achieve environmentally healthy marine waters by 2020. This Directive includes an initiative for an overarching European Marine Observation and Data Network (EMODNet). During the one-year consultation phase that followed the release of the EU Green Paper on a Future Maritime Policy for the European Union, stakeholders gave an overwhelming positive response. Facilitating access to high quality marine data will resolve difficulties and stimulate an expansion of value-added public and commercial services, lay the foundations for sound governance and reduce uncertainties on human impact on the planet as well as of forecasts relating to the future state of the marine environment. Better and linked marine data will have an immediate impact on the planning of environmental policy and mitigation measures, and will also facilitate impact assessments and scientific work. The overall objectives of the EMODnet Physical Parameters (EMODNet PP) preparatory action is to provide access to archived and near real-time data on physical conditions in Europe's seas and oceans by means of a dedicated Pilot Portal and to determine how well the data meet the needs of users from industry, public authorities and scientists. The latter implicates that it is also an objective to identify data gaps and arguments why these gaps should be filled in future monitoring. This project will contribute towards the definition of an operational European Marine Observation and Data Network (EMODnet). This is done done by: 1. providing through a portal: a. access to marine data from measurement stations and ferryboxes. Both near real-time and archived data of time series are to be made available. b. metadata for these data sets using EMODnet/INSPIRE standards. c. metadata maps and overviews for whole sea-basins showing the availability of data and monitoring intensity of that

  9. A Climate Information Portal for Copernicus: a central portal for European climate services?

    NASA Astrophysics Data System (ADS)

    Juckes, Martin; Swart, Rob; Thysse, Peter; Som de Cerff, Wim; Groot, Annemarie; Bennett, Victoria; Costa, Luis; Lückenkötter, Johannes; Callaghan, Sarah

    2015-04-01

    The FP7 project "Climate Information Portal for Copernicus" (CLIPC) is developing a demonstration portal for the Copernicus Climate Change Service (C3S). This project is one of a suite of FP7 research activities which are administratively independent of Copernicus, focussed on creating the technical and scientific building blocks needed for the service. It is to be expected that at EGU 2015 there will be many presentations describing portals delivering new and innovative ranges of services. It would be unwise to seek to replace all this creative activity with a single portal -- instead CLIPC is designing a portal to make distributed resources more accessible through flexible discovery systems. CLIPC needs to deliver more than a directory of resources: resources need to be presented in common protocols so that users can access multiple datasets. More information about the project objectives is available at www.clipc.eu. The gulf between the climate science communities and the end user communities is a central challenge being addressed in the project. It is important to understand that there is significant diversity and multiple communication barriers within these two sets of communities as well as between them. The CLIPC services must presentation will provide a review of progress towards this ambitious goal, through a discussion of user requirements activities, an overview of the proposed architecture, work on assessing and adjusting model biasses, and a discussion of the climate impact indicators which will be provided through the portal. When looking at the usability of data for the various users, CLIPC will implement a set of services functioning as a "knowledge base" supplying information to users about the data, including definitions of terminology used, quality of datasets, versioning, and user annotations.

  10. ACTRIS Data Centre: An atmospheric data portal

    NASA Astrophysics Data System (ADS)

    Myhre, C. Lund; Fahre Vik, A.; Logna, R.; Torseth, K.; Linné, H.; O'Connor, E.

    2012-04-01

    ACTRIS (Aerosols, Clouds, and Trace gases Research InfraStructure Network) is a European Project aiming at integrating European ground-based stations equipped with advanced instrumentation for studying aerosols, clouds, and short-lived gas-phase species. The ACTRIS activities result in improved atmospheric measurements data made at more than 60 European sites, from numerous instruments and includes variables measured by ground based in situ and remote sensing technologies. Core variables are in situ aerosol optical, physical and chemical properties, short-lived trace gases (volatile organic carbon and nitrogen oxides), aerosol scattering and extinction profiles, and cloud properties. The ACTRIS data centre (ACTRIS DC) is giving free and open access to all data resulting from the activities of the infrastructure network, complemented with data from other relevant networks and data bases. The overall goal is to facilitate scientists and other user groups access to atmospheric observational data, and to provide mature products for analysis and interpretation of atmospheric composition change. The ACTRIS DC aims at substantially increasing the number of high-quality data by providing long-term observational data relevant to climate and air quality research produced with standardized or comparable procedures throughout the network. The backbone of the ACTRIS DC is the three core data bases: - EARLINET Data Base hosting aerosol lidar data from more than 30 European sites - EBAS hosting ground based atmospheric in situ data from more than 1000 sites globally - Cloudnet hosting remote sensing cloud data and products from 5 European sites Furthermore, a joint portal is developed combining information from various data sources to gain new information not presently available from standalone databases or networks. The data centre will provide tools and services to facilitate the use of measurements for broad user communities. Higher level and integrated products will be

  11. COP 21 TD: towards a situational awareness knowledge portal

    NASA Astrophysics Data System (ADS)

    Gouin, Denis; Gauvin, Marlene; Woodliffe, Elizabeth

    2003-07-01

    Portals have become an effective means of enabling organizations to access, share and manage information and knowledge of pertinence to the organizations. Several military organizations are rapidly adopting the portal approach for information exchange and situational awareness in their command & control systems. The Canadian Common Operational Picture 21st Century Technology Demonstration (COP 21 TD) project is implementing a Situation Awareness Knowledge Portal to support the Joint Staff at the Strategic level. This portal will provide commanders and staff with an integrated access to heterogeneous sources of information, personalization capabilities in terms of information content and tools, collaboration services with other users and efficient presentation techniques to provide situation awareness.

  12. View of the Warrington Avenue Bridge portal, inbound from Pittsburgh ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View of the Warrington Avenue Bridge portal, inbound from Pittsburgh - Pittsburgh & Castle Shannon Railroad, Warrington Avenue Bridge, Overbrook Trolley Line, Crossing Warrington Avenue, Pittsburgh, Allegheny County, PA

  13. View of the Warrington Avenue Bridge portal, outbound from Pittsburgh ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View of the Warrington Avenue Bridge portal, outbound from Pittsburgh - Pittsburgh & Castle Shannon Railroad, Warrington Avenue Bridge, Overbrook Trolley Line, Crossing Warrington Avenue, Pittsburgh, Allegheny County, PA

  14. Understanding Productivity and Technostress for Oncology Nurses Using an Electronic Health Record (EHR) to Increase Safety, Quality, and Effectiveness of Care for Patients with Cancer

    ERIC Educational Resources Information Center

    Evans, Elizabeth M. Wertz

    2013-01-01

    Health information technology has become more prevalent in hospitals, physician offices, clinics, and other areas of medical treatment, especially since the federal government passed legislation to offer incentive payments for the meaningful use of electronic health records (EHRs). Previous research demonstrated a decrease in medical errors as…

  15. The Impact of an eHealth Portal on Health Care Professionals’ Interaction with Patients: Qualitative Study

    PubMed Central

    Faxvaag, Arild; Svanæs, Dag

    2015-01-01

    writings and revelations thereby capturing patient challenges and acting and implementing measures. Interacting with patients through the portal can prevent dropouts and deterioration of patients’ health. However, professionals report on organizational challenges and personal constraints related to communicating with patients in writing online. Further development of guidelines and education of health care professionals about how to handle, prioritize, communicate, and facilitate patients online is required in addition to increased attention to the organizational infrastructures and incentives for enabling such solutions in health care. PMID:26601678

  16. Instructions for Uploading Data to the Assay Portal - Instructions for Uploading Data to the Assay Portal

    Cancer.gov

    This document provides instructions for configuring and uploading data files to the CPTAC Assay Portal. It is divided into sections, with an overview checklist provided at the end. If help is needed at any stage of the process, please use the support page: https://assays.cancer.gov/support/

  17. Novel Rat Model of Repetitive Portal Venous Embolization Mimicking Human Non-Cirrhotic Idiopathic Portal Hypertension

    PubMed Central

    Klein, Sabine; Hinüber, Christian; Hittatiya, Kanishka; Schierwagen, Robert; Uschner, Frank Erhard; Strassburg, Christian P.; Fischer, Hans-Peter; Spengler, Ulrich; Trebicka, Jonel

    2016-01-01

    Background Non-cirrhotic idiopathic portal hypertension (NCIPH) is characterized by splenomegaly, anemia and portal hypertension, while liver function is preserved. However, no animal models have been established yet. This study assessed a rat model of NCIPH and characterized the hemodynamics, and compared it to human NCIPH. Methods Portal pressure (PP) was measured invasively and coloured microspheres were injected in the ileocecal vein in rats. This procedure was performed weekly for 3 weeks (weekly embolization). Rats without and with single embolization served as controls. After four weeks (one week after last embolization), hemodynamics were investigated, hepatic fibrosis and accumulation of myofibroblasts were analysed. General characteristics, laboratory analyses and liver histology were collected in patients with NCIPH. Results Weekly embolization induced a hyperdynamic circulation, with increased PP. The mesenteric flow and hepatic hydroxyproline content was significantly higher in weekly embolized compared to single embolized rats (mesenteric flow +54.1%, hydroxyproline +41.7%). Mesenteric blood flow and shunt volumes increased, whereas splanchnic vascular resistance was decreased in the weekly embolization group. Fibrotic markers αSMA and Desmin were upregulated in weekly embolized rats. Discussion This study establishes a model using repetitive embolization via portal veins, comparable with human NCIPH and may serve to test new therapies. PMID:27589391

  18. 29 CFR 785.24 - Principles noted in Portal-to-Portal Bulletin.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Section 785.24 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR... regarded as work and as compensable under the Fair Labor Standards Act, remain so under the Portal Act... of Principles Preparatory and Concluding Activities § 785.24 Principles noted in...

  19. Open source portal to distributed image repositories

    NASA Astrophysics Data System (ADS)

    Tao, Wenchao; Ratib, Osman M.; Kho, Hwa; Hsu, Yung-Chao; Wang, Cun; Lee, Cason; McCoy, J. M.

    2004-04-01

    In large institution PACS, patient data may often reside in multiple separate systems. While most systems tend to be DICOM compliant, none of them offer the flexibility of seamless integration of multiple DICOM sources through a single access point. We developed a generic portal system with a web-based interactive front-end as well as an application programming interface (API) that allows both web users and client applications to query and retrieve image data from multiple DICOM sources. A set of software tools was developed to allow accessing several DICOM archives through a single point of access. An interactive web-based front-end allows user to search image data seamlessly from the different archives and display the results or route the image data to another DICOM compliant destination. An XML-based API allows other software programs to easily benefit from this portal to query and retrieve image data as well. Various techniques are employed to minimize the performance overhead inherent in the DICOM. The system is integrated with a hospital-wide HIPAA-compliant authentication and auditing service that provides centralized management of access to patient medical records. The system is provided under open source free licensing and developed using open-source components (Apache Tomcat for web server, MySQL for database, OJB for object/relational data mapping etc.). The portal paradigm offers a convenient and effective solution for accessing multiple image data sources in a given healthcare enterprise and can easily be extended to multi-institution through appropriate security and encryption mechanisms.

  20. [FEATURES LIVER TRANSPLANTATION IN PORTAL VEIN THROMBOSIS].

    PubMed

    Abbasov, P A

    2015-07-01

    In 2012 - 2013 years in 265 patients for liver transplantation was performed, including in 224 (84.5%)--from a living donor, in 41 (15.5%)--from the dead body. Using a Foley catheter to stop bleeding, and the imposition of vascular sutures during endovenectomy in portal vein thrombosis (PVT) and its possible damage under all conditions. In particular, PVT IV degree (Grade IV) in order to restore blood flow in the graft using the left gastric and renal vein is an alternative, if they are cryopreserved vein may be suitably used.

  1. The NOAO NVO Portal: Overall Design & Implementation

    NASA Astrophysics Data System (ADS)

    Fuentes, E.; Miller, C. J.; Gasson, D.

    2007-10-01

    We present an overview and design of the NOAO National Virtual Observatory (NVO) Portal. This is a web application providing one-stop discovery, analysis, and access to VO-compliant imaging data and services. It strictly follows the Model-View-Controller (MVC) design pattern and relies heavily on Asynchronous Javascript And XML (AJAX) in the browser. Because of the heavy use of AJAX, the relatively simple database schemas, and, most importantly, the rapid development/iteration schedule, Ruby-on-Rails (RoR) was chosen as the implementation language and PostgreSQL as the database engine.

  2. Visualization of CDA laboratory reports and long term trends as a possible EHR application for patients and physicians.

    PubMed

    Obenaus, Manuel; Burgsteiner, Harald

    2014-01-01

    To increase the patient's acceptance of electronic health records and understanding for their laboratory findings a web application was developed which presents all parameters and possible deviations of standard values in a clear way and visualizes the time based trend of all recorded parameters graphically. Documents corresponding to the Clinical document architecture (CDA) R2 laboratory reports standard and a rapid prototyping framework called Groovy on Grails were used. This work shows, that it is possible to create a useful, standards based tool for patients and physicians with comparatively few resources - an application that could be in similar form a part of an electronic Health Record (EHR) system like the Austrian electronic Health Record (ELGA).

  3. A Proposed Framework to Enrich Norwegian EHR System with Health-trusted Information for Patients and Professionals.

    PubMed

    Konstantinidis, Stathis Th; Kummervold, Per Egil; Luque, Luis Fernandez; Vognild, Lars Kristian

    2015-01-01

    In the era of social media, semantic web and big data, a huge amount of health-related information, knowledge and resources exist on the Web. Patients and healthcare professionals should spend enormous effort and time in order to find health-trusted information, while the appropriate technologies to interlink and retrieve this type of information already exist. In this paper we propose a framework to enrich DIPS, the most deployed Norwegian EHR System, with health-trusted information for patients and state-of-the-art resources for healthcare professionals. The framework based upon the new architecture of DIPS, namely DIPS Arena, and upon the interlinking with the semantic web, social media and open linked data cloud information, knowledge and resources through well-established medical thesauri like SNOMED CT and MeSH. PMID:26152978

  4. Palliative Portal Vein Stent Placement in Malignant and Symptomatic Extrinsic Portal Vein Stenosis or Occlusion

    SciTech Connect

    Novellas, Sebastien; Denys, Alban Bize, Pierre; Brunner, Philippe; Motamedi, Jean Paul; Gugenheim, Jean; Caroli, Francois-Xavier; Chevallier, Patrick

    2009-05-15

    This article evaluates the results of portal vein (PV) stent placement in patients with malignant extrinsic lesions stenosing or obstructing the PV and causing symptomatic PV hypertension (PVHT). Fourteen patients with bile duct cancer (n = 7), pancreatic adenocarcinoma (n = 4), or another cancer (n = 3) underwent percutaneous transhepatic portal venous stent placement because of gastroesophageal or jejunal varices (n = 9), ascites (n = 7), and/or thrombocytopenia (n = 2). Concurrent tumoral obstruction of the main bile duct was treated via the transhepatic route in the same session in four patients. Changes in portal venous pressure, complications, stent patency, and survival were evaluated. Mean {+-} standard deviation (SD) gradient of portal venous pressure decreased significantly immediately after stent placement from 11.2 mmHg {+-} 4.6 to 1.1 mmHg {+-} 1.0 (P < 0.00001). Three patients had minor complications, and one developed a liver abscess. During a mean {+-} SD follow-up of 134.4 {+-} 123.3 days, portal stents remained patent in 11 patients (78.6%); stent occlusion occurred in 3 patients, 2 of whom had undergone previous major hepatectomy. After stent placement, PVHT symptoms were relieved in four (57.1%) of seven patients who died (mean survival, 97 {+-} 71.2 days), and relieved in six (85.7%) of seven patients still alive at the end of follow-up (mean follow-up, 171.7 {+-} 153.5 days). Stent placement in the PV is feasible and relatively safe. It helped to relieve PVHT symptoms in a single session.

  5. Trans-4 Portal as a New Portal for Accessing the Lunate in Wrist Arthroscopy: a Cadaveric Study

    PubMed Central

    Shahryar-Kamrani, Reza; Saremi, Hossein; Oryadi-Zanjani, Leila; Nabian, Mohammad Hossein; Amoozadeh, Azita; Moradi, Amir Hossein

    2016-01-01

    Background Evolving wrist arthroscopy requires creating new portals, and creating portals reciprocally leads to increased indications for arthroscopic wrist procedures. To facilitate access to the lunate bone and fossa for new arthroscopic procedures, a new portal was used. This is a cadaveric study of this portal. Objectives In this cadaveric study, we evaluated a portal in wrist arthroscopy for procedures involving the lunate bone and lunate fossa. Materials and Methods Seventeen wrists from 10 fresh cadavers were included in this study. After diagnostic arthroscopy, a portal (Trans-4) was made through the fourth extensor compartment, exactly along the lunate’s long axis under direct visualization from the 3-4 portal. Strand retractors were used to protect the extensor tendons and posterior capsule. Lunate bone core decompression and osteoscopy were done through the portal. At the end of the procedure, the position of the decompression hole in the lunate and any possible injury to the extensor tendons, distal radius cartilage, lunate cartilage, and perilunate ligaments were investigated. Results Lunate bone decompression was performed successfully in all cases using the trans-4 portal. In 15 wrists, the lunate hole was located in the middle third. In the other two wrists, it was located slightly radial in one case and slightly on the ulnar side in the other case. There was no cortical penetration during decompression, and no extensor tendon, superficial nerve branches, or peri-lunate ligament injuries were observed. Conclusions The trans-4 portal could be a safe working portal in wrist arthroscopy that enables access to the lunate bone and lunate fossa.

  6. 6. East portal of Tunnel 18, oblique view to northwest, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    6. East portal of Tunnel 18, oblique view to northwest, 135mm lens. This view shows to advantage the stepped ashlar granite wingwalls and fitted rubble slab slope protection flanking the portal, features typical of the Southern Pacific Common Standard tunnels. - Central Pacific Transcontinental Railroad, Tunnel No. 18, Milepost 120.5, Newcastle, Placer County, CA

  7. 2. West portal of Tunnel 18, oblique view to northnortheast, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    2. West portal of Tunnel 18, oblique view to north-northeast, 135mm lens. Note the use of concrete face and wingwalls, with dressed stone voussoirs, wingwall coping, parapet with stone belt course and coping, and coursed stone masonry slope protection flanking the portal. - Southern Pacific Railroad Natron Cutoff, Tunnel No. 18, Milepost 410, Dorris, Siskiyou County, CA

  8. 6. East portal of Tunnel 17, oblique view to westsouthwest, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    6. East portal of Tunnel 17, oblique view to west-southwest, 90mm lens. This view shows to advantage the stepped concrete wingwalls and fitted stone masonry coping protection flanking the portal, features typical of the Southern Pacific Common Standard tunnels of this period. - Southern Pacific Railroad Natron Cutoff, Tunnel No. 17, Milepost 408, Dorris, Siskiyou County, CA

  9. [Aspects of pathogenetc pharmacotherapy for portal hypertension in liver cirrhosis].

    PubMed

    Garbuzenko, D V

    2016-01-01

    The review of literature considers the principles of medical treatment for portal hypertension in liver cirrhosis, which are based on the current views of its development mechanisms. It describes both current pharmacotherapy methods for portal hypertension and drugs, the efficacy of which is being investigated. PMID:27135108

  10. Measuring Campus Portal Effectiveness and the Contributing Factors

    ERIC Educational Resources Information Center

    Masrek, Mohamad Noorman bin

    2007-01-01

    Purpose: The purpose of the paper is to evaluate the effectiveness or success of universities' portal implementation from the perspective of students as users. Adopting the model developed by Delone and McLean, portal effectiveness is defined as being composed of information quality, systems quality and service quality. In addition, the paper also…

  11. North portal and deck view, from north, showing inclined endposts, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    North portal and deck view, from north, showing inclined endposts, Pratt through trusses, north portal strut, overhead bracing, pipe rails and posts, and concrete deck with bituminous wearing surface - Castle Garden Bridge, Township Route 343 over Bennetts Branch of Sinnemahoning Creek, Driftwood, Cameron County, PA

  12. South portal and deck view from south, showing inclined endposts, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    South portal and deck view from south, showing inclined endposts, Pratt through trusses, south portal strut, overhead bracing, pipe rails and posts, and concrete deck with bituminous wearing surface - Castle Garden Bridge, Township Route 343 over Bennetts Branch of Sinnemahoning Creek, Driftwood, Cameron County, PA

  13. Continued Use of a Chinese Online Portal: An Empirical Study

    ERIC Educational Resources Information Center

    Shih, Hung-Pin

    2008-01-01

    The evolution of the internet has made online portals a popular means of surfing the internet. In internet commerce, understanding the post-adoption behaviour of users of online portals can help enterprises to attract new users and retain existing customers. For predicting continued use intentions, this empirical study focused on applying and…

  14. 8. FIGUEROA STREET TUNNEL NO. 2, SOUTH PORTAL SEEN FROM ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    8. FIGUEROA STREET TUNNEL NO. 2, SOUTH PORTAL SEEN FROM ABOVE NORTH PORTAL OF TUNNEL NO. 3. LOOKING 12°N. - Figueroa Street Tunnels, Mileposts 24.90, 25.14, 25.28, & 25.37 on Arroyo Seco Parkway, Los Angeles, Los Angeles County, CA

  15. 3. East portal of Tunnel 39, view to west with ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. East portal of Tunnel 39, view to west with east portal of Tunnel 38 (HAER CA-211) visible in distance, 135mm lens with electronic flash fill. - Central Pacific Transcontinental Railroad, Tunnel No. 39, Milepost 180.95, Cisco, Placer County, CA

  16. Westfacing portals within Open Cut No. 2 (South Bergen Tunnel ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    West-facing portals within Open Cut No. 2 (South Bergen Tunnel on right, North Bergen Tunnel see HAER No. NJ-136) on left), from within the opposite portal of the South Bergen Tunnel, looking east - Delaware, Lackawanna & Western Railroad, South Bergen Tunnel, Jersey City, Hudson County, NJ

  17. 1. West portal of Tunnel 35, contextual view to eastnortheast ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. West portal of Tunnel 35, contextual view to east-northeast with west portal of Tunnel 36 (HAER CA-209) visible in distance at left, 135mm lens. - Central Pacific Transcontinental Railroad, Tunnel No. 35, Milepost 176.62, Yuba Pass, Nevada County, CA

  18. 1. West portal of Tunnel 39, contextual view to east, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. West portal of Tunnel 39, contextual view to east, 135mm lens. West portal of Tunnel 4 (HAER CA-214) on the original Central Pacific Transcontinental line is visible at left. - Central Pacific Transcontinental Railroad, Tunnel No. 39, Milepost 180.95, Cisco, Placer County, CA

  19. 1. West portal of Tunnel 27 in distance, contextual view ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. West portal of Tunnel 27 in distance, contextual view to northeast looking past Tunnel 26 (HAER CA-202) from atop east portal of Tunnel 25 (HAER CA-201), 380mm lens. - Central Pacific Transcontinental Railroad, Tunnel No. 27, Milepost 133.9, Applegate, Placer County, CA

  20. 1. West portal of Tunnel 38, contextual view to east, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. West portal of Tunnel 38, contextual view to east, 135mm lens. West portal of Tunnel 3 (HAER CA-212) on original Central Pacific Transcontinental line visible in distance at left. - Central Pacific Transcontinental Railroad, Tunnel No. 38, Milepost 180.58, Cisco, Placer County, CA

  1. An Analysis of Knowledge Management Mechanisms in Healthcare Portals

    ERIC Educational Resources Information Center

    Lee, Chei Sian; Goh, Dion Hoe-Lian; Chua, Alton Y. K.

    2010-01-01

    Healthcare portals are becoming increasingly popular with Internet users since they play an important role in supporting interaction between individuals and healthcare organizations with a Web presence. Additionally, many of these organizations make use of knowledge management mechanisms on their healthcare portals to manage the abundance of…

  2. Inflammation: a way to understanding the evolution of portal hypertension

    PubMed Central

    Aller, María-Angeles; Arias, Jorge-Luis; Cruz, Arturo; Arias, Jaime

    2007-01-01

    Background Portal hypertension is a clinical syndrome that manifests as ascites, portosystemic encephalopathy and variceal hemorrhage, and these alterations often lead to death. Hypothesis Splanchnic and/or systemic responses to portal hypertension could have pathophysiological mechanisms similar to those involved in the post-traumatic inflammatory response. The splanchnic and systemic impairments produced throughout the evolution of experimental prehepatic portal hypertension could be considered to have an inflammatory origin. In portal vein ligated rats, portal hypertensive enteropathy, hepatic steatosis and portal hypertensive encephalopathy show phenotypes during their development that can be considered inflammatory, such as: ischemia-reperfusion (vasodilatory response), infiltration by inflammatory cells (mast cells) and bacteria (intestinal translocation of endotoxins and bacteria) and lastly, angiogenesis. Similar inflammatory phenotypes, worsened by chronic liver disease (with anti-oxidant and anti-enzymatic ability reduction) characterize the evolution of portal hypertension and its complications (hepatorenal syndrome, ascites and esophageal variceal hemorrhage) in humans. Conclusion Low-grade inflammation, related to prehepatic portal hypertension, switches to high-grade inflammation with the development of severe and life-threatening complications when associated with chronic liver disease. PMID:17999758

  3. 8. East portal of 1898 swing span of Bridge Number ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    8. East portal of 1898 swing span of Bridge Number 210.52, view to east, 210mm lens. Note the difference in the latticed portal strut as compared to that of the 1929 approach span in the previous photo. - Southern Pacific Railroad Shasta Route, Bridge No. 210.52, Milepost 210.52, Tehama, Tehama County, CA

  4. A Community of Practice: Web Portals and Faculty Development.

    ERIC Educational Resources Information Center

    Carlson, Patricia A.

    2002-01-01

    Describes a Web portal constructed by Rose-Hulman Institute of Technology dedicated to improving middle school science, mathematics, and technology instruction. The portal emulates emerging corporate practices of knowledge management and process reinvention through information technology, and offers middle school teachers across Indiana a…

  5. Connections: A Comprehensive Student Portal. Concept Paper and Proposal.

    ERIC Educational Resources Information Center

    Harr, Gary Lynn

    A student Web portal is a personalized, student-centric view of College Web resources. The "Artemis" system at Florida Community College at Jacksonville (FCCJ), represents movement toward realization of the efficiencies and student service possibilities of a Web portal. This proposal recommends a radical expansion of Artemis functions, one that…

  6. Bleeding Ectopic Varices as the First Manifestation of Portal Hypertension

    PubMed Central

    Sharma, Brij; Raina, Sujeet; Sharma, Rajesh

    2014-01-01

    Ectopic varices are defined as dilated portosystemic collateral veins in locations other than the gastroesophageal region. We present a case of recurrent upper gastrointestinal bleeding as the first manifestation of portal hypertension. We diagnosed ectopic duodenal varices without gastroesophageal varices on upper GI endoscopy and extrahepatic portal venous obstruction (EHPVO) on CT angiography and managed this case. PMID:25374725

  7. Stent Recanalization of Chronic Portal Vein Occlusion in a Child

    SciTech Connect

    Cwikiel, Wojciech; Solvig, Jan; Schroder, Henrik

    2000-07-15

    An 8-year-old boy with a 21/2 year history of portal hypertension and repeated bleedings from esophageal varices, was referred for treatment. The 3.5-cm-long occlusion of the portal vein was passed and the channel created was stabilized with a balloon-expandable stent; a portosystemic stent-shunt was also created. The portosystemic shunt closed spontaneously within 1 month, while the recanalized segment of the portal vein remained open. The pressure gradient between the intrahepatic and extrahepatic portal vein branches dropped from 17 mmHg to 0 mmHg. The pressure in the portal vein dropped from 30 mmHg to 17 mmHg and the bleedings stopped. The next dilation of the stent was performed 12 months later due to an increased pressure gradient; the gastroesophageal varices disappeared completely. Further dilation of the stent was planned after 2, 4, and 6 years.

  8. Portal Hypertension as Immune Mediate Disease

    PubMed Central

    Manti, Sara; Marseglia, Lucia; D'Angelo, Gabriella; Filippelli, Martina; Cuppari, Caterina; Gitto, Eloisa; Romano, Claudio; Arrigo, Teresa; Salpietro, Carmelo

    2014-01-01

    Context: Portal Hypertension (PH) is a progressive complication due to chronic liver disease. In addition to pathophysiologic changes in the micro-circulation, in PH are established fibrous tissue (periportal fibrous septal) and regenerative hyperplastic nodules (from micro- to macro-nodules) promoting hepatic architectural distortion. Evidence Acquisition: A literature search of electronic databases was undertaken for the major studies published from 1981 to today. The databases searched were: PubMed, EMBASE, Orphanet, Midline and Cochrane Library. We used the keywords: "portal hypertension, children, immune system, endocrine system, liver fibrosis". Results: It is believed that PH results from three “phenotype”: ischemia-reperfusion, involving nervous system (NS); edema and oxidative damage, involving immune system; inflammation and angiogenesis, involving endocrine system. However, its exact cause still underdiagnosed and unknown. Conclusions: PH is a dynamic and potentially reversible process. Researchers have tried to demonstrate mechanisms underlying PH and its related-complications. This review focuses on the current knowledge regarding the pathogenesis, and immune, endocrine-metabolic factors of disease. The strong positive association between immune system and development of PH could be efficient to identify non-invasive markers of disease, to modify prognosis of PH, and to development and application of specific and individual anti-inflammatory therapy. PMID:24976841

  9. Amyloidosis: an unusual cause of portal hypertension.

    PubMed

    Takayasu, Vilma; Laborda, Lorena Silva; Bernardelli, Raquel; Pinesi, Henrique Trombini; Silva, Marilia Polo Minguete E; Chiavelli, Viviane; Simões, Angélica Braz; Felipe-Silva, Aloisio

    2016-01-01

    Amyloidosis comprises a group of diseases that occurs in five to nine cases per million patients per year worldwide irrespective of its classification. Although the hepatic involvement in primary amyloidosis is frequent, the clinical manifestations of liver amyloidosis are mild or even absent. The authors report the case of an aged man who complained of diffuse abdominal pain and marked weight loss and presented clinical signs of hepatopathy. Clinical workup revealed portal hypertension with ascites, hemorrhoids, and esophageal varices. The laboratory tests showed the cholestatic pattern of liver enzymes, hyperbilirubinemia, renal insufficiency and massive proteinuria accompanied by the presence of serum pike of monoclonal lambda light chain protein. The outcome was unfavorable, and the patient died. The autopsy findings revealed the diagnosis of amyloidosis predominantly involving the liver and kidneys. The bone marrow examination demonstrated the deposition of amyloid material associated with clonal plasma cells infiltration. The authors call attention to portal hypertension as a rare manifestation of primary amyloidosis. Meanwhile, this diagnosis should be taken into account whenever the hepatopathy is accompanied by laboratory abnormalities consistent with hepatic space-occupying lesions concomitantly with other organs involvement. In the case reported herein, kidney involvement was also present with renal failure, massive proteinuria with monoclonal serum gammopathy, what reinforced the diagnostic possibility of primary amyloidosis. PMID:27547738

  10. Amyloidosis: an unusual cause of portal hypertension

    PubMed Central

    Laborda, Lorena Silva; Bernardelli, Raquel; Pinesi, Henrique Trombini; Silva, Marilia Polo Minguete e; Chiavelli, Viviane; Simões, Angélica Braz; Felipe-Silva, Aloisio

    2016-01-01

    Amyloidosis comprises a group of diseases that occurs in five to nine cases per million patients per year worldwide irrespective of its classification. Although the hepatic involvement in primary amyloidosis is frequent, the clinical manifestations of liver amyloidosis are mild or even absent. The authors report the case of an aged man who complained of diffuse abdominal pain and marked weight loss and presented clinical signs of hepatopathy. Clinical workup revealed portal hypertension with ascites, hemorrhoids, and esophageal varices. The laboratory tests showed the cholestatic pattern of liver enzymes, hyperbilirubinemia, renal insufficiency and massive proteinuria accompanied by the presence of serum pike of monoclonal lambda light chain protein. The outcome was unfavorable, and the patient died. The autopsy findings revealed the diagnosis of amyloidosis predominantly involving the liver and kidneys. The bone marrow examination demonstrated the deposition of amyloid material associated with clonal plasma cells infiltration. The authors call attention to portal hypertension as a rare manifestation of primary amyloidosis. Meanwhile, this diagnosis should be taken into account whenever the hepatopathy is accompanied by laboratory abnormalities consistent with hepatic space-occupying lesions concomitantly with other organs involvement. In the case reported herein, kidney involvement was also present with renal failure, massive proteinuria with monoclonal serum gammopathy, what reinforced the diagnostic possibility of primary amyloidosis. PMID:27547738

  11. Management of rectal varices in portal hypertension

    PubMed Central

    Al Khalloufi, Kawtar; Laiyemo, Adeyinka O

    2015-01-01

    Rectal varices are portosystemic collaterals that form as a complication of portal hypertension, their prevalence has been reported as high as 94% in patients with extrahepatic portal vein obstruction. The diagnosis is typically based on lower endoscopy (colonoscopy or sigmoidoscopy). However, endoscopic ultrasonography has been shown to be superior to endoscopy in diagnosing rectal varices. Color Doppler ultrasonography is a better method because it allows the calculation of the velocity of blood flow in the varices and can be used to predict the bleeding risk in the varices. Although rare, bleeding from rectal varices can be life threatening. The management of patients with rectal variceal bleeding is not well established. It is important to ensure hemodynamic stability with blood transfusion and to correct any coagulopathy prior to treating the bleeding varices. Endoscopic injection sclerotherapy has been reported to be more effective in the management of active bleeding from rectal varices with less rebleeding rate as compared to endoscopic band ligation. Transjugular intrahepatic portsystemic shunt alone or in combination with embolization is another method used successfully in control of bleeding. Balloon-occluded retrograde transvenous obliteration is an emerging procedure for management of gastric varices that has also been successfully used to treat bleeding rectal varices. Surgical procedures including suture ligation and porto-caval shunts are considered when other methods have failed. PMID:26730278

  12. The Anatomy of a Grid portal

    NASA Astrophysics Data System (ADS)

    Licari, Daniele; Calzolari, Federico

    2011-12-01

    In this paper we introduce a new way to deal with Grid portals referring to our implementation. L-GRID is a light portal to access the EGEE/EGI Grid infrastructure via Web, allowing users to submit their jobs from a common Web browser in a few minutes, without any knowledge about the Grid infrastructure. It provides the control over the complete lifecycle of a Grid Job, from its submission and status monitoring, to the output retrieval. The system, implemented as client-server architecture, is based on the Globus Grid middleware. The client side application is based on a java applet; the server relies on a Globus User Interface. There is no need of user registration on the server side, and the user needs only his own X.509 personal certificate. The system is user-friendly, secure (it uses SSL protocol, mechanism for dynamic delegation and identity creation in public key infrastructures), highly customizable, open source, and easy to install. The X.509 personal certificate does not get out from the local machine. It allows to reduce the time spent for the job submission, granting at the same time a higher efficiency and a better security level in proxy delegation and management.

  13. The SmartGeo Portal: A retrospective

    NASA Astrophysics Data System (ADS)

    Heilmann, Zeno; Satta, Guido; Bonomi, Ernesto

    2016-04-01

    The SmartGeo portal was created in a follow-up project that evolved from the geophysical data imaging services of a Grid computing portal for Geoscience, called GRIDA3. The scope of the project was to support commercial geotechnical service providers as well as academic researchers working in near-surface geoscience. Starting from the existing services, the SmartGeo portal was set up on new hardware, using the latest version of the grid portal environment EnginFrame. After a first working version was established, the services were reviewed, updated and accompanied by new services according to the feedback we received from our partners. One partner for instance experienced large difficulties in a project that aimed at delineating the aquifer for finding water pollutant substances in an industrial area of Basel. The seismic imaging service inherited from the previous portal was employing a data-driven algorithm optimized to provide, directly during data acquisition, nearly in real-time a first image of the subsurface structure. Different to this, our user needed for his data from a geologically very complex and noisy urban environment the maximum lateral resolution and noise reduction possible. For this purpose we added two cutting edge data imaging algorithms able to deliver such high precision results by simultaneously optimizing, for every single image point, all parameters of the mathematical model---a procedure which increased the computational effort by one or two magnitudes, respectively. Thus, parallel computing on grid infrastructure served for maximizing the image resolution instead for generating real-time results. This proved also very useful for the data of an academic partner, recorded for imaging the structure of a shallow sedimentary basin, where we could obtain strongly improved seismic velocity information using these new algorithms. A general user request was to implement interactive data visualization tools. To fulfill this demand we took

  14. 29 CFR 790.5 - Effect of Portal-to-Portal Act on determination of hours worked.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... GENERAL STATEMENT AS TO THE EFFECT OF THE PORTAL-TO-PORTAL ACT OF 1947 ON THE FAIR LABOR STANDARDS ACT OF... wage and overtime compensation provisions of the Fair Labor Standards Act to activities of employees on... activity would be time worked within the meaning of the Fair......

  15. 29 CFR 790.5 - Effect of Portal-to-Portal Act on determination of hours worked.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... GENERAL STATEMENT AS TO THE EFFECT OF THE PORTAL-TO-PORTAL ACT OF 1947 ON THE FAIR LABOR STANDARDS ACT OF... wage and overtime compensation provisions of the Fair Labor Standards Act to activities of employees on... activity would be time worked within the meaning of the Fair......

  16. 29 CFR 790.5 - Effect of Portal-to-Portal Act on determination of hours worked.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... GENERAL STATEMENT AS TO THE EFFECT OF THE PORTAL-TO-PORTAL ACT OF 1947 ON THE FAIR LABOR STANDARDS ACT OF... wage and overtime compensation provisions of the Fair Labor Standards Act to activities of employees on... activity would be time worked within the meaning of the Fair......

  17. 29 CFR 790.5 - Effect of Portal-to-Portal Act on determination of hours worked.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... GENERAL STATEMENT AS TO THE EFFECT OF THE PORTAL-TO-PORTAL ACT OF 1947 ON THE FAIR LABOR STANDARDS ACT OF... wage and overtime compensation provisions of the Fair Labor Standards Act to activities of employees on... activity would be time worked within the meaning of the Fair......

  18. 29 CFR 790.5 - Effect of Portal-to-Portal Act on determination of hours worked.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... GENERAL STATEMENT AS TO THE EFFECT OF THE PORTAL-TO-PORTAL ACT OF 1947 ON THE FAIR LABOR STANDARDS ACT OF... wage and overtime compensation provisions of the Fair Labor Standards Act to activities of employees on... activity would be time worked within the meaning of the Fair......

  19. User-Friendly Handbook for Project Dissemination: Science, Mathematics, Engineering, and Technology Education.

    ERIC Educational Resources Information Center

    Ely, Donald P.; Huberman, A. Michael

    This document was developed to provide principal investigators and project evaluators working with the National Science Foundation's Directorate for Education and Human Resource Development (EHR) with a basic understanding of dissemination. It is aimed at people who want to learn more about both developing and implementing a dissemination plan. It…

  20. Nurse Educators' Consensus Opinion on Using an Academic Electronic Health Record: A Delphi Study

    ERIC Educational Resources Information Center

    Hanson, Darlene S.

    2013-01-01

    The purpose of this study was to determine the opinions of nurse educators in the state of North Dakota (ND) who were using the academic Electronic Health Record (EHR) known as SimChart. In this dissertation research study, factors that either hindered or facilitated the introduction of SimChart in nursing programs in ND were examined.…