Electronic reminders improve procedure documentation compliance and professional fee reimbursement.

PubMed

Kheterpal, Sachin; Gupta, Ruchika; Blum, James M; Tremper, Kevin K; O'Reilly, Michael; Kazanjian, Paul E

2007-03-01

Medicolegal, clinical, and reimbursement needs warrant complete and accurate documentation. We sought to identify and improve our compliance rate for the documentation of arterial catheterization in the perioperative setting. We first reviewed 12 mo of electronic anesthesia records to establish a baseline compliance rate for arterial catheter documentation. Residents and Certified Registered Nurse Anesthetists were randomly assigned to a control group and experimental group. When surgical incision and anesthesia end were documented in the electronic record keeper, a reminder routine checked for an invasive arterial blood pressure tracing. If a case used an arterial catheter, but no procedure note was observed, the resident or Certified Registered Nurse Anesthetist assigned to the case was sent an automated alphanumeric pager and e-mail reminder. Providers in the control group received no pager or e-mail message. After 2 mo, all staff received the reminders. A baseline compliance rate of 80% was observed (1963 of 2459 catheters documented). During the 2-mo study period, providers in the control group documented 152 of 202 (75%) arterial catheters, and the experimental group documented 177 of 201 (88%) arterial lines (P < 0.001). After all staff began receiving reminders, 309 of 314 arterial lines were documented in a subsequent 2 mo period (98%). Extrapolating this compliance rate to 12 mo of expected arterial catheter placement would result in an annual incremental $40,500 of professional fee reimbursement. The complexity of the tertiary care process results in documentation deficiencies. Inexpensive automated reminders can drastically improve compliance without the need for complicated negative or positive feedback.

U.S. Central Command Headquarters’ Use of the Government Purchase Card

DTIC Science & Technology

2011-01-25

required the coordinator to document training sessions. During our review, the squadron was developing a new electronic system to support the...approving officials and cardholders. 2. Establish a plan to ensure that the new electronic Government Purchase Card Tracking system is completed...tickets,” invoices, shipping/packing documents or receiving reports, or electronic purchase confirmations are acceptable) for each purchase and other

A Guidance Document for Kentucky's Oil and Gas Operations

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

None, None

1998-11-10

This technical report is a summary of the progress made for "A Guidance Document for Kentucky's Oil and Gas Operators". During this quarter, the document received continued review and editing in an elec-tronic format to satisfy the United States Department of Energy (DOE). Comments received from oil and gas operators reviewing this document prompted contact to be made with the United States Environmental Protection Agency (USEPA) to develop an addendum section to provide better explanation of USEPA requirements for Class II injection wells in Kentucky.

75 FR 32860 - Regulatory Guidance Concerning the Preparation of Drivers' Record of Duty Status To Document...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-10

... motor carrier of a scanned image of the original record; the driver would retain the original while the carrier maintains the electronic scanned electronic image along with any supporting documents. [[Page... plans to implement a new approach for receiving and processing RODS. Its drivers would complete their...

40 CFR 233.39 - Electronic reporting.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 25 2014-07-01 2014-07-01 false Electronic reporting. 233.39 Section... PROGRAM REGULATIONS Program Operation § 233.39 Electronic reporting. States that choose to receive electronic documents must satisfy the requirements of 40 CFR Part 3—(Electronic reporting) in their state...

40 CFR 233.39 - Electronic reporting.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Electronic reporting. 233.39 Section... PROGRAM REGULATIONS Program Operation § 233.39 Electronic reporting. States that choose to receive electronic documents must satisfy the requirements of 40 CFR Part 3—(Electronic reporting) in their state...

40 CFR 233.39 - Electronic reporting.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Electronic reporting. 233.39 Section... PROGRAM REGULATIONS Program Operation § 233.39 Electronic reporting. States that choose to receive electronic documents must satisfy the requirements of 40 CFR Part 3—(Electronic reporting) in their state...

40 CFR 233.39 - Electronic reporting.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Electronic reporting. 233.39 Section... PROGRAM REGULATIONS Program Operation § 233.39 Electronic reporting. States that choose to receive electronic documents must satisfy the requirements of 40 CFR Part 3—(Electronic reporting) in their state...

40 CFR 233.39 - Electronic reporting.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 26 2013-07-01 2013-07-01 false Electronic reporting. 233.39 Section... PROGRAM REGULATIONS Program Operation § 233.39 Electronic reporting. States that choose to receive electronic documents must satisfy the requirements of 40 CFR Part 3—(Electronic reporting) in their state...

48 CFR 1446.670 - Inspection, receiving and acceptance reports.

Code of Federal Regulations, 2014 CFR

2014-10-01

... each commercial shipping document or packing list, whether by manual or electronic means, for supplies... INTERIOR CONTRACT MANAGEMENT QUALITY ASSURANCE Material Inspection and Receiving Reports 1446.670...

48 CFR 1446.670 - Inspection, receiving and acceptance reports.

Code of Federal Regulations, 2012 CFR

2012-10-01

... each commercial shipping document or packing list, whether by manual or electronic means, for supplies... INTERIOR CONTRACT MANAGEMENT QUALITY ASSURANCE Material Inspection and Receiving Reports 1446.670...

48 CFR 1446.670 - Inspection, receiving and acceptance reports.

Code of Federal Regulations, 2010 CFR

2010-10-01

... each commercial shipping document or packing list, whether by manual or electronic means, for supplies... INTERIOR CONTRACT MANAGEMENT QUALITY ASSURANCE Material Inspection and Receiving Reports 1446.670...

48 CFR 1446.670 - Inspection, receiving and acceptance reports.

Code of Federal Regulations, 2013 CFR

2013-10-01

... each commercial shipping document or packing list, whether by manual or electronic means, for supplies... INTERIOR CONTRACT MANAGEMENT QUALITY ASSURANCE Material Inspection and Receiving Reports 1446.670...

48 CFR 1446.670 - Inspection, receiving and acceptance reports.

Code of Federal Regulations, 2011 CFR

2011-10-01

... each commercial shipping document or packing list, whether by manual or electronic means, for supplies... INTERIOR CONTRACT MANAGEMENT QUALITY ASSURANCE Material Inspection and Receiving Reports 1446.670...

40 CFR 51.286 - Electronic reporting.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 2 2011-07-01 2011-07-01 false Electronic reporting. 51.286 Section 51... Requirements § 51.286 Electronic reporting. States that wish to receive electronic documents must revise the State Implementation Plan to satisfy the requirements of 40 CFR Part 3—(Electronic reporting). [70 FR...

40 CFR 51.286 - Electronic reporting.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 2 2012-07-01 2012-07-01 false Electronic reporting. 51.286 Section 51... Requirements § 51.286 Electronic reporting. States that wish to receive electronic documents must revise the State Implementation Plan to satisfy the requirements of 40 CFR Part 3—(Electronic reporting). [70 FR...

40 CFR 51.286 - Electronic reporting.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 2 2010-07-01 2010-07-01 false Electronic reporting. 51.286 Section 51... Requirements § 51.286 Electronic reporting. States that wish to receive electronic documents must revise the State Implementation Plan to satisfy the requirements of 40 CFR Part 3—(Electronic reporting). [70 FR...

40 CFR 51.286 - Electronic reporting.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 2 2013-07-01 2013-07-01 false Electronic reporting. 51.286 Section 51... Requirements § 51.286 Electronic reporting. States that wish to receive electronic documents must revise the State Implementation Plan to satisfy the requirements of 40 CFR Part 3—(Electronic reporting). [70 FR...

40 CFR 51.286 - Electronic reporting.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 2 2014-07-01 2014-07-01 false Electronic reporting. 51.286 Section 51... Requirements § 51.286 Electronic reporting. States that wish to receive electronic documents must revise the State Implementation Plan to satisfy the requirements of 40 CFR Part 3—(Electronic reporting). [70 FR...

10 CFR 13.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... identity when filing documents and serving participants electronically through the E-Filing system, and... transmitted electronically from the E-Filing system to the submitter confirming receipt of electronic filing... presentation of the docket and a link to its files. E-Filing System means an electronic system that receives...

Lesson 3: Attorney General (AG) Certification

EPA Pesticide Factsheets

The AG Certification is a letter confirming legal authority to implement the electronic reporting covered by the application and enforce the affected programs using the electronic documents received under those programs.

Document management: one paving stone in the path to EHR.

PubMed

Cottrell, Carlton M

2005-05-01

Reducing the use of paper records through a document management strategy is an essential first step in implementing the electronic health record. Efficient document management can help to decrease claim denials as well as days in accounts receivable-to name only a few benefits.

Implementation of the Nutrition Care Process and International Dietetics and Nutrition Terminology in a single-center hemodialysis unit: comparing paper vs electronic records.

PubMed

Rossi, Megan; Campbell, Katrina Louise; Ferguson, Maree

2014-01-01

There is little doubt surrounding the benefits of the Nutrition Care Process and International Dietetics and Nutrition Terminology (IDNT) to dietetics practice; however, evidence to support the most efficient method of incorporating these into practice is lacking. The main objective of our study was to compare the efficiency and effectiveness of an electronic and a manual paper-based system for capturing the Nutrition Care Process and IDNT in a single in-center hemodialysis unit. A cohort of 56 adult patients receiving maintenance hemodialysis were followed for 12 months. During the first 6 months, patients received the usual standard care, with documentation via a manual paper-based system. During the following 6-month period (Months 7 to 12), nutrition care was documented by an electronic system. Workload efficiency, number of IDNT codes used related to nutrition-related diagnoses, interventions, monitoring and evaluation using IDNT, nutritional status using the scored Patient-Generated Subjective Global Assessment Tool of Quality of Life were the main outcome measures. Compared with paper-based documentation of nutrition care, our study demonstrated that an electronic system improved the efficiency of total time spent by the dietitian by 13 minutes per consultation. There were also a greater number of nutrition-related diagnoses resolved using the electronic system compared with the paper-based documentation (P<0.001). In conclusion, the implementation of an electronic system compared with a paper-based system in a population receiving hemodialysis resulted in significant improvements in the efficiency of nutrition care and effectiveness related to patient outcomes. Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

76 FR 4390 - Draft Regulatory Guide: Comment Period Extension and Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-25

....'' This Federal Register notice stated that electronic copies of DG-1229 were available in the NRC's Agencywide Documents Access and Management System (ADAMS) ( http://www.nrc.gov/reading-rm/adams.html ), under... Documents Access and Management System (ADAMS): Publicly available documents created or received at the NRC...

48 CFR 252.232-7003 - Electronic submission of payment requests and receiving reports.

Code of Federal Regulations, 2012 CFR

2012-10-01

... not acceptable electronic forms for submission of payment requests. However, scanned documents are... 48 Federal Acquisition Regulations System 3 2012-10-01 2012-10-01 false Electronic submission of... PROVISIONS AND CONTRACT CLAUSES Text of Provisions And Clauses 252.232-7003 Electronic submission of payment...

48 CFR 252.232-7003 - Electronic submission of payment requests and receiving reports.

Code of Federal Regulations, 2011 CFR

2011-10-01

... not acceptable electronic forms for submission of payment requests. However, scanned documents are... 48 Federal Acquisition Regulations System 3 2011-10-01 2011-10-01 false Electronic submission of... PROVISIONS AND CONTRACT CLAUSES Text of Provisions And Clauses 252.232-7003 Electronic submission of payment...

48 CFR 252.232-7003 - Electronic submission of payment requests and receiving reports.

Code of Federal Regulations, 2014 CFR

2014-10-01

... not acceptable electronic forms for submission of payment requests. However, scanned documents are... 48 Federal Acquisition Regulations System 3 2014-10-01 2014-10-01 false Electronic submission of... PROVISIONS AND CONTRACT CLAUSES Text of Provisions And Clauses 252.232-7003 Electronic submission of payment...

48 CFR 252.232-7003 - Electronic submission of payment requests and receiving reports.

Code of Federal Regulations, 2013 CFR

2013-10-01

... not acceptable electronic forms for submission of payment requests. However, scanned documents are... 48 Federal Acquisition Regulations System 3 2013-10-01 2013-10-01 false Electronic submission of... PROVISIONS AND CONTRACT CLAUSES Text of Provisions And Clauses 252.232-7003 Electronic submission of payment...

48 CFR 252.232-7003 - Electronic submission of payment requests and receiving reports.

Code of Federal Regulations, 2010 CFR

2010-10-01

... not acceptable electronic forms for submission of payment requests. However, scanned documents are... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Electronic submission of... PROVISIONS AND CONTRACT CLAUSES Text of Provisions And Clauses 252.232-7003 Electronic submission of payment...

5 CFR 1201.4 - General definitions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... electronic submission. (m) Electronic filing (e-filing). Filing and receiving documents in electronic form in... took the action. Appeals of Office of Personnel Management reconsideration decisions concerning... proceeding. This term applies to the Office of Personnel Management and to the Office of Special Counsel when...

Procedure for Implementing the Cross-Media Electronic Reporting Regulation (CROMERR) for EPA and Co-Regulator Systems

EPA Pesticide Factsheets

This procedure describes how to apply for and obtain approval of electronic reporting systems used to receive electronic documents in lieu of paper where the report is made pursuant to requirements or authority codified in CFR 40.

Centralized Accounting and Electronic Filing Provides Efficient Receivables Collection.

ERIC Educational Resources Information Center

School Business Affairs, 1983

1983-01-01

An electronic filing system makes financial control manageable at Bowling Green State University, Ohio. The system enables quick access to computer-stored consolidated account data and microfilm images of charges, statements, and other billing documents. (MLF)

SpecialNet. A National Computer-Based Communications Network.

ERIC Educational Resources Information Center

Morin, Alfred J.

1986-01-01

"SpecialNet," a computer-based communications network for educators at all administrative levels, has been established and is managed by National Systems Management, Inc. Users can send and receive electronic mail, share information on electronic bulletin boards, participate in electronic conferences, and send reports and other documents to each…

27 CFR 73.31 - May I submit forms electronically to TTB?

Code of Federal Regulations, 2010 CFR

2010-04-01

... requirement in this chapter, only if: (a) We have published a notice in the Federal Register and on our Web... Register and on our Web site as stated above; (c) You submit the electronic form to an electronic document receiving system that we have designated for the receipt of that specific form; and (d) The electronic form...

Determination of Receiver Susceptibility to Radio Frequency Interference from Portable Electronic Devices

NASA Technical Reports Server (NTRS)

Nguyen, Truong X.; Ely, Jay J.

2002-01-01

With the increasing pressures to allow wireless devices on aircraft, the susceptibility of aircraft receivers to interference from Portable Electronic Devices (PEDs) becomes an increasing concern. Many investigations were conducted in the past, with limited success, to quantify device emissions, path loss, and receiver interference susceptibility thresholds. This paper outlines the recent effort in determining the receiver susceptibility thresholds for ILS, VOR and GPS systems. The effort primarily consists of analysis of data available openly as reported in many RTCA and ICAO documents as well as manufacturers data on receiver sensitivity. Shortcomings with the susceptibility threshold data reported in the RTCA documents are presented, and an approach for an in-depth study is suggested. In addition, intermodulation products were observed and demonstrated in a laboratory experiment when multiple PEDs were in the proximity of each other. These intermodulation effects generate spurious frequencies that may fall within aircraft communication or navigation bands causing undesirable effects. Results from a preliminary analysis are presented that show possible harmful combinations of PEDs and the potentially affected aircraft bands.

40 CFR 3.1000 - How does a state, tribe, or local government revise or modify its authorized program to allow...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false How does a state, tribe, or local... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL CROSS-MEDIA ELECTRONIC REPORTING Electronic... state, tribe, or local government that does not have an existing electronic document receiving system...

78 FR 68981 - Electronic Retirement Processing

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-18

... in which a single key is used to sign and verify an electronic document. The single key (also known...-0299. SUPPLEMENTARY INFORMATION: On March 5, 2013, OPM published (at 78 FR 14233) proposed regulations... received no comments on the proposed regulations. Accordingly, we are now adopting the proposed regulations...

40 CFR 257.30 - Recordkeeping requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... through 257.12; and (2) Any demonstration, certification, finding, monitoring, testing, or analytical data...) The Director of an approved state program may receive electronic documents only if the state program includes the requirements of 40 CFR Part 3—(Electronic reporting). [44 FR 53460, Sept. 13, 1979, as amended...

Cross-institutional document exchange system using clinical document architecture (CDA) with virtual printing method.

PubMed

Mihara, Naoki; Ueda, Kanayo; Manabe, Shirou; Takeda, Toshihiro; Shimai, Yoshie; Horishima, Hiroyuki; Murata, Taizo; Fujii, Ayumi; Matsumura, Yasushi

2015-01-01

Recently one patient received care from several hospitals at around the same time. When the patient visited a new hospital, the new hospital's physician tried to get patient information the previous hospital. Thus, patient information is frequently exchanged between them. Many types of healthcare facilities have implemented an electronic medical record system, but in Japan, healthcare information exchange is often done by paper. In other words, after a clinical doctor prints a referral document and sends it to another hospital's physician, another hospital's doctor receives it and scans to store the EMR in his own hospital's system. It is a wasteful way to exchange healthcare information about a patient. In order to solve this problem, we have developed a cross-institutional document exchange system using clinical document architecture (CDA) with a virtual printing method.

Paper trails. Document management is no silver bullet, but it can patch holes as hospitals transition to paperless.

PubMed

Gamble, Kate Huvane

2009-10-01

Hospitals are leveraging content management to ease the transition from a paper-based to electronic environment. Document management is used to scan, index and archive medical records and financial documents. Even fully integrated health systems receive outside documents such as lab results and referrals that must be incorporated into the patient record. The data in scanned documents cannot be used for trending purposes without manual work. The market for natural language processing, a tool used to extract data elements from scanned documents, could ramp up significantly in the near future.

77 FR 35349 - Confidentiality of Information; Magnuson-Stevens Fishery Conservation and Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-13

..., by any of the following methods: Electronic Submission: Submit all electronic public comments via the... Moline Instructions: Comments must be submitted by one of the above methods to ensure that the comments are received, documented, and considered by NMFS. Comments sent by any other method, to any other...

75 FR 3963 - Requested Administrative Waiver of the Coastwise Trade Laws

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-25

... p.m., E.T., Monday through Friday, except Federal holidays. An electronic version of this document...: Intended Commercial Use of Vessel: ``Sport fishing out of Nawiliwili Harbor and the surrounding waters in... able to search the electronic form of all comments received into any of our dockets by the name of the...

78 FR 19212 - Notice of Availability of a Supplemental Draft Environmental Impact Statement for Effects of Oil...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-29

... approaches for authorizing geological and geophysical (G&G) surveys and ancillary activities under the Outer... following methods: Electronic Submission: Submit all electronic public comments via the Federal e-Rulemaking... the above methods to ensure that the comments are received, documented, and considered by NMFS...

Document Monitor

NASA Technical Reports Server (NTRS)

1988-01-01

The charters of Freedom Monitoring System will periodically assess the physical condition of the U.S. Constitution, Declaration of Independence and Bill of Rights. Although protected in helium filled glass cases, the documents are subject to damage from light vibration and humidity. The photometer is a CCD detector used as the electronic film for the camera system's scanning camera which mechanically scans the document line by line and acquires a series of images, each representing a one square inch portion of the document. Perkin-Elmer Corporation's photometer is capable of detecting changes in contrast, shape or other indicators of degradation with 5 to 10 times the sensitivity of the human eye. A Vicom image processing computer receives the data from the photometer stores it and manipulates it, allowing comparison of electronic images over time to detect changes.

Improving documentation of a beta-blocker quality measure through an anesthesia information management system and real-time notification of documentation errors.

PubMed

Nair, Bala G; Peterson, Gene N; Newman, Shu-Fang; Wu, Wei-Ying; Kolios-Morris, Vickie; Schwid, Howard A

2012-06-01

Continuation of perioperative beta-blockers for surgical patients who are receiving beta-blockers prior to arrival for surgery is an important quality measure (SCIP-Card-2). For this measure to be considered successful, name, date, and time of the perioperative beta-blocker must be documented. Alternately, if the beta-blocker is not given, the medical reason for not administering must be documented. Before the study was conducted, the institution lacked a highly reliable process to document the date and time of self-administration of beta-blockers prior to hospital admission. Because of this, compliance with the beta-blocker quality measure was poor (-65%). To improve this measure, the anesthesia care team was made responsible for documenting perioperative beta-blockade. Clear documentation guidelines were outlined, and an electronic Anesthesia Information Management System (AIMS) was configured to facilitate complete documentation of the beta-blocker quality measure. In addition, real-time electronic alerts were generated using Smart Anesthesia Messenger (SAM), an internally developed decision-support system, to notify users concerning incomplete beta-blocker documentation. Weekly compliance for perioperative beta-blocker documentation before the study was 65.8 +/- 16.6%, which served as the baseline value. When the anesthesia care team started documenting perioperative beta-blocker in AIMS, compliance was 60.5 +/- 8.6% (p = .677 as compared with baseline). Electronic alerts with SAM improved documentation compliance to 94.6 +/- 3.5% (p < .001 as compared with baseline). To achieve high compliance for the beta-blocker measure, it is essential to (1) clearly assign a medical team to perform beta-blocker documentation and (2) enhance features in the electronic medical systems to alert the user concerning incomplete documentation.

75 FR 22770 - National Electric Transmission Congestion Study

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-30

... Study is available at http://www.oe.energy.gov . DATES: Written comments may be filed electronically in.... Copies of written comments received and other relevant documents and information may be reviewed at http...

78 FR 69172 - Requested Administrative Waiver of the Coastwise Trade Laws: Vessel PURSE PRINCESS; Invitation...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-18

.... A request for such a waiver has been received by MARAD. The vessel, and a brief description of the... 10 a.m. and 5 p.m., E.T., Monday through Friday, except federal holidays. An electronic version of this document and all documents entered into this docket is available on the World Wide Web at http...

77 FR 67305 - Fisheries of the Northeastern United States; Atlantic Mackerel, Squid, and Butterfish Fisheries...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-09

...-0209, by any one of the following methods: Electronic Submission: Submit all electronic public comments...'' icon on the right of that line. Mail to NMFS, Northeast Regional Office, 55 Great Republic Dr... above methods to ensure that they are received, documented, and considered by NMFS. Comments sent by any...

42 CFR 495.370 - Appeals process for a Medicaid provider receiving electronic health record incentive payments.

Code of Federal Regulations, 2011 CFR

2011-10-01

... STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the... in § 447.253(e) of this chapter for a provider or entity to appeal the following issues related to... entity) has an opportunity to challenge the State's determination under this Part by submitting documents...

76 FR 10781 - Amendments to Adjudicatory Process Rules and Related Requirements

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-28

... documents created or received at the NRC are available electronically at the NRC's Electronic Reading Room at http://www.nrc.gov/reading-rm/adams.html . From this page, the public can gain entry into ADAMS... make faster and better-reasoned decisions. The NRC is therefore proposing to extend the time to file an...

Identifying health facilities outside the enterprise: challenges and strategies for supporting health reform and meaningful use.

PubMed

Dixon, Brian E; Colvard, Cyril; Tierney, William M

2014-06-24

Objective: To support collation of data for disability determination, we sought to accurately identify facilities where care was delivered across multiple, independent hospitals and clinics. Methods: Data from various institutions' electronic health records were merged and delivered as continuity of care documents to the United States Social Security Administration (SSA). Results: Electronic records for nearly 8000 disability claimants were exchanged with SSA. Due to the lack of standard nomenclature for identifying the facilities in which patients received the care documented in the electronic records, SSA could not match the information received with information provided by disability claimants. Facility identifiers were generated arbitrarily by health care systems and therefore could not be mapped to the existing international standards. Discussion: We propose strategies for improving facility identification in electronic health records to support improved tracking of a patient's care between providers to better serve clinical care delivery, disability determination, health reform and meaningful use. Conclusion: Accurately identifying the facilities where health care is delivered to patients is important to a number of major health reform and improvement efforts underway in many nations. A standardized nomenclature for identifying health care facilities is needed to improve tracking of care and linking of electronic health records.

40 CFR 258.29 - Recordkeeping requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Section 258.29 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES CRITERIA FOR MUNICIPAL SOLID WASTE LANDFILLS Operating Criteria § 258.29 Recordkeeping requirements. (a) The... of an approved state program may receive electronic documents only if the state program includes the...

40 CFR 258.29 - Recordkeeping requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Section 258.29 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES CRITERIA FOR MUNICIPAL SOLID WASTE LANDFILLS Operating Criteria § 258.29 Recordkeeping requirements. (a) The... of an approved state program may receive electronic documents only if the state program includes the...

40 CFR 258.29 - Recordkeeping requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Section 258.29 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES CRITERIA FOR MUNICIPAL SOLID WASTE LANDFILLS Operating Criteria § 258.29 Recordkeeping requirements. (a) The... of an approved state program may receive electronic documents only if the state program includes the...

76 FR 69274 - Draft Guidance for Industry and Food and Drug Administration Staff; 510(k) Device Modifications...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-08

... for Devices and Radiological Health (CDRH) guidance documents is available at http://www.fda.gov...'' from CDRH, you may either send an email request to [email protected] to receive an electronic copy of...

Messages discriminated from the media about illicit drugs.

PubMed

Patterson, S J

1994-01-01

The electronic media have been an instrumental tool in the most recent efforts to address the issue of illicit drug abuse in the United States. Messages about illicit drugs appear in three places in the media: advertising content, news content, and entertainment content. Many studies have documented the amount and types of messages that appear on the electronic media, but few have asked the audience how they interpret these messages. The purpose of this study is to investigate how much and what type of information college students receive from the media about drugs. Interviews were conducted with 228 students using the message discrimination protocol. The messages were then content analyzed into theme areas. Results indicate the majority of messages discriminated from advertising content were fear appeals; that the majority of messages discriminated from news content documented the enforcement efforts in the war on drugs; and that messages about drugs in entertainment content were more likely to provide clear accurate information about drugs than the other two content sources. The results are discussed in terms of the audience receiving fear and fight messages from the electronic media rather than clear, accurate information necessary to make informed decisions about drugs.

12 CFR 1235.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

..., or stored by electronic means. E-mail means a document created or received on a computer network for... conduct of the business of a regulated entity or the Office of Finance (which business, in the case of the... is stored or located, including network servers, desktop or laptop computers and handheld computers...

12 CFR 1235.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., or stored by electronic means. E-mail means a document created or received on a computer network for... conduct of the business of a regulated entity or the Office of Finance (which business, in the case of the... is stored or located, including network servers, desktop or laptop computers and handheld computers...

77 FR 52694 - Marine Mammals; File No. 17324

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-30

..., identified by NOAA-NMFS- 2012-0158, by any of the following methods: Electronic Submission: Submit all... to comment on from the resulting list and click on the ``Comment Now'' icon on the right of that line... above methods to ensure that the comments are received, documented, and considered by NMFS. Comments...

EDExpress Application Processing, 1999-2000.

ERIC Educational Resources Information Center

Department of Education, Washington, DC.

This document is a comprehensive guide to electronic data exchange (EDE) of Title IV student financial aid application data to and from the U.S. Department of Education. An overview chapter defines terms for processing financial aid applications through EDE, explains the seven-step process for sending and receiving data using EDE, and describes…

75 FR 32988 - Notice on Waiver of the Terms of the Order Limiting Scheduled Operations at LaGuardia Airport

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-10

... background documents or comments received in this proceeding, you may go to http://www.regulations.gov at any time and follow the online instructions for accessing the electronic docket. You may also go to the U.S...

Integration and test of high-speed transmitter electronics for free-space laser communications

NASA Technical Reports Server (NTRS)

Soni, Nitin J.; Lizanich, Paul J.

1994-01-01

The NASA Lewis Research Center in Cleveland, Ohio, has developed the electronics for a free-space, direct-detection laser communications system demonstration. Under the High-Speed Laser Integrated Terminal Electronics (Hi-LITE) Project, NASA Lewis has built a prototype full-duplex, dual-channel electronics transmitter and receiver operating at 325 megabit S per second (Mbps) per channel and using quaternary pulse-position modulation (QPPM). This paper describes the integration and testing of the transmitter portion for future application in free-space, direct-detection laser communications. A companion paper reviews the receiver portion of the prototype electronics. Minor modifications to the transmitter were made since the initial report on the entire system, and this paper addresses them. The digital electronics are implemented in gallium arsenide integrated circuits mounted on prototype boards. The fabrication and implementation issues related to these high-speed devices are discussed. The transmitter's test results are documented, and its functionality is verified by exercising all modes of operation. Various testing issues pertaining to high-speed circuits are addressed. A description of the transmitter electronics packaging concludes the paper.

43 CFR 4.401 - Documents.

Code of Federal Regulations, 2012 CFR

2012-10-01

... of the transfer or encumbrance in the proper land office, become entitled to receive and be given the... required to be given to a party to the proceeding. Every such notice of a transfer or encumbrance will be... party. (iii) Electronic means Transmitted to the party, unless the serving party learns that it did not...

75 FR 4334 - Administrative Waivers of the Coastwise Trade Laws: New Definition of Eligible Vessels

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-27

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78 FR 38574 - Technical Amendments to Counter-Terrorism Sanctions Regulations Implemented by OFAC

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-27

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75 FR 48997 - NUREG-1946, “Inservice Testing of Pumps and Valves, and Inservice Examination and Testing of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-12

..., and Inservice Examination and Testing of Dynamic Restraints (Snubbers) at Nuclear Power Plants, Draft... Dynamic Restraints (Snubbers) at Nuclear Power Plants, Draft Report for Comment.'' DATES: Please submit... System (ADAMS): Publicly available documents created or received at the NRC are available electronically...

Issues and approaches for electronic document approval and transmittal using digital signatures and text authentication: Prototype documentation

NASA Astrophysics Data System (ADS)

Boling, M. E.

1989-09-01

Prototypes were assembled pursuant to recommendations made in report K/DSRD-96, Issues and Approaches for Electronic Document Approval and Transmittal Using Digital Signatures and Text Authentication, and to examine and discover the possibilities for integrating available hardware and software to provide cost effective systems for digital signatures and text authentication. These prototypes show that on a LAN, a multitasking, windowed, mouse/keyboard menu-driven interface can be assembled to provide easy and quick access to bit-mapped images of documents, electronic forms and electronic mail messages with a means to sign, encrypt, deliver, receive or retrieve and authenticate text and signatures. In addition they show that some of this same software may be used in a classified environment using host to terminal transactions to accomplish these same operations. Finally, a prototype was developed demonstrating that binary files may be signed electronically and sent by point to point communication and over ARPANET to remote locations where the authenticity of the code and signature may be verified. Related studies on the subject of electronic signatures and text authentication using public key encryption were done within the Department of Energy. These studies include timing studies of public key encryption software and hardware and testing of experimental user-generated host resident software for public key encryption. This software used commercially available command-line source code. These studies are responsive to an initiative within the Office of the Secretary of Defense (OSD) for the protection of unclassified but sensitive data. It is notable that these related studies are all built around the same commercially available public key encryption products from the private sector and that the software selection was made independently by each study group.

40 CFR 3.2000 - What are the requirements authorized state, tribe, and local programs' reporting systems must meet?

Code of Federal Regulations, 2010 CFR

2010-07-01

... made before the electronic document is received, by means of: (A) Identifiers or attributes that are... 40 Protection of Environment 1 2010-07-01 2010-07-01 false What are the requirements authorized... Under EPA-Authorized State, Tribe, and Local Programs § 3.2000 What are the requirements authorized...

76 FR 61103 - Draft Guidance for Industry and Food and Drug Administration Staff; De Novo Classification...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-03

... all CDRH guidance documents is available at http://www.fda.gov/MedicalDevices/DeviceRegulationand...),'' from CDRH you may either send an e-mail request to [email protected] to receive an electronic copy of... guidance describes how FDA's Center for Devices and Radiological Health (CDRH) and Center for Biologics...

77 FR 19589 - Electronic On-Board Recorders and Hours of Service Supporting Documents

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-02

... Grand Ballroom IJK on the 2nd floor. Internet Address for Live Webcast. FMCSA will post specific... number for this notice. Note that DOT posts all comments received without change to www.regulations.gov... study of these problems with EOBRs already in use, and a comparison with carriers that do not use these...

Medical Student Documentation in the Electronic Medical Record: Patterns of Use and Barriers.

PubMed

Wittels, Kathleen; Wallenstein, Joshua; Patwari, Rahul; Patel, Sundip

2017-01-01

Electronic health records (EHR) have become ubiquitous in emergency departments. Medical students rotating on emergency medicine (EM) clerkships at these sites have constant exposure to EHRs as they learn essential skills. The Association of American Medical Colleges (AAMC), the Liaison Committee on Medical Education (LCME), and the Alliance for Clinical Education (ACE) have determined that documentation of the patient encounter in the medical record is an essential skill that all medical students must learn. However, little is known about the current practices or perceived barriers to student documentation in EHRs on EM clerkships. We performed a cross-sectional study of EM clerkship directors at United States medical schools between March and May 2016. A 13-question IRB-approved electronic survey on student documentation was sent to all EM clerkship directors. Only one response from each institution was permitted. We received survey responses from 100 institutions, yielding a response rate of 86%. Currently, 63% of EM clerkships allow medical students to document a patient encounter in the EHR. The most common reasons cited for not permitting students to document a patient encounter were hospital or medical school rule forbidding student documentation (80%), concern for medical liability (60%), and inability of student notes to support medical billing (53%). Almost 95% of respondents provided feedback on student documentation with supervising faculty being the most common group to deliver feedback (92%), followed by residents (64%). Close to two-thirds of medical students are allowed to document in the EHR on EM clerkships. While this number is robust, many organizations such as the AAMC and ACE have issued statements and guidelines that would look to increase this number even further to ensure that students are prepared for residency as well as their future careers. Almost all EM clerkships provided feedback on student documentation indicating the importance for students to learn this skill.

Incidence and management of arthralgias in breast cancer patients treated with aromatase inhibitors in an outpatient oncology clinic.

PubMed

Menas, Pamela; Merkel, Douglas; Hui, Wendy; Lawton, Jessica; Harper, Abigail; Carro, George

2012-12-01

Aromatase inhibitors (AIs) are routinely used as first-line adjuvant treatment of breast cancer in postmenopausal women with hormone receptor positive tumors. The current recommended length of treatment with an AI is 5 years. Arthralgias have been frequently cited as the primary reason for discontinuation of AI therapy. Various treatment strategies are proposed in literature, but a standardized treatment algorithm has not been established. The initial purpose of this study was to describe the incidence and management of AI-induced arthralgias in patients treated at Kellogg Cancer Center (KCC). Further evaluation led to the development and the implementation of a treatment algorithm and electronic medical record (EMR) documentation tools. The retrospective chart review included 206 adult patients with hormone receptor positive breast cancer who were receiving adjuvant therapy with an AI. A multidisciplinary treatment team consisting of pharmacists, collaborative practice nurses, and physicians met to develop a standardized treatment algorithm and corresponding EMR documentation tool. The treatment algorithm and documentation tool were developed after the study to better monitor and proactively treat patients with AI-induced arthralgias. RESULTS/ CONCLUSIONS: The overall incidence of arthralgias at KCC was 48% (n = 98/206). Of these patients, 32% were documented as having arthralgias within the first 6 months of therapy initiation. Patients who reported AI-induced arthralgias were younger than patients who did not report AI-induced arthralgias (61 vs. 65 years, p = 0.002). There was no statistical difference in the incidence of arthralgias in patients with a history of chemotherapy (including taxane therapy) compared to those who did not receive chemotherapy (p = 0.352). Of patients presenting with AI-induced arthralgias, 41% did not have physician-managed treatment documented in the EMR. A standardized treatment algorithm and electronic chart documentation tools were then developed by the multidisciplinary team.

Driver's Education for the Information Super Highway: Computer Mediated Communication on a Local Area Network.

ERIC Educational Resources Information Center

Kilgore, Beverly M.

This document describes a project whereby a researcher spent time in a fifth-grade classroom teaching students to use electronic mail. For two 40-minute periods each week over a period of 18 weeks, 28 students received instruction on mechanics such as sending and reading mail, attaching and retrieving files, and forwarding messages with their own…

Use of Electronic Documentation for Quality Improvement in Hospice

PubMed Central

Cagle, John G.; Rokoske, Franziska S.; Durham, Danielle; Schenck, Anna P.; Spence, Carol; Hanson, Laura C.

2015-01-01

Little evidence exists on the use of electronic documentation in hospice and its relationship to quality improvement practices. The purposes of this study were to: (1) estimate the prevalence of electronic documentation use in hospice; (2) identify organizational characteristics associated with use of electronic documentation; and (3) determine whether quality measurement practices differed based on documentation format (electronic vs. nonelectronic). Surveys concerning the use of electronic documentation for quality improvement practices and the monitoring of quality-related care and outcomes were collected from 653 hospices. Users of electronic documentation were able to monitor a wider range of quality-related data than users of nonelectronic documentation. Quality components such as advanced care planning, cultural needs, experience during care of the actively dying, and the number/types of care being delivered were more likely to be documented by users of electronic documentation. Use of electronic documentation may help hospices to monitor quality and compliance. PMID:22267819

Community-Based Palliative Care and Advance Care Planning Documentation: Evidence from a Multispecialty Group.

PubMed

Tai-Seale, Ming; Yang, Yan; Dillon, Ellis; Tapper, Sharon; Lai, Steve; Yu, Peter; Allore, Heather; Ritchie, Christine

2018-02-01

With the growing public demand for access to critical health data across care settings, it is essential that advance care planning (ACP) information be included in the electronic health record (EHR) so that multiple clinicians can access it and understand individuals' preferences for end-of-life care. Community-based palliative care programs often incorporate ACP services. This study examined whether a community-based palliative care program is associated with digitally extractable ACP documentation in the EHR. Observational study using propensity score-weighted generalized estimation equations to examine patterns of digitally extractable ACP documentation. Palo Alto Medical Foundation (PAMF), a multispecialty ambulatory healthcare system in northern California. Individuals aged 65 and older with serious illnesses between January 1, 2013, and December 31, 2014 (N = 3,444). Community-based palliative care program in PAMF. Digitally extractable ACP in EHR. We found that only 14% (n = 483) of individuals with serious illnesses had digitally extractable ACP in electronic health records. Of the 6% of individuals receiving palliative care, 65% had ACP, versus 11% of those not receiving palliative care. Study results showed a strong positive association between palliative care and ACP. Only a small percentage of individuals with serious illnesses had ACP documentation in the EHR. Individuals with serious illnesses infrequently used palliative care delivered by board-certified palliative care specialists. Palliative care service use was associated with higher rates of ACP after controlling for organizational and individual characteristics using a propensity score weighting method. Scalable interventions targeted at non-palliative care clinicians for universal access to ACP are needed. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

A linear photodiode array employed in a short range laser triangulation obstacle avoidance sensor. M.S. Thesis; [Martian roving vehicle sensor

NASA Technical Reports Server (NTRS)

Odenthal, J. P.

1980-01-01

An opto-electronic receiver incorporating a multi-element linear photodiode array as a component of a laser-triangulation rangefinder was developed as an obstacle avoidance sensor for a Martian roving vehicle. The detector can resolve the angle of laser return in 1.5 deg increments within a field of view of 30 deg and a range of five meters. A second receiver with a 1024 elements over 60 deg and a 3 meter range is also documented. Design criteria, circuit operation, schematics, experimental results and calibration procedures are discussed.

Using Adaptive Turnaround Documents to Electronically Acquire Structured Data in Clinical Settings

PubMed Central

Biondich, Paul G.; Anand, Vibha; Downs, Stephen M.; McDonald, Clement J.

2003-01-01

We developed adaptive turnaround documents (ATDs) to address longstanding challenges inherent in acquiring structured data at the point of care. These computer-generated paper forms both request and receive patient tailored information specifically for electronic storage. In our pilot, we evaluated the usability, accuracy, and user acceptance of an ATD designed to enrich a pediatric preventative care decision support system. The system had an overall digit recognition rate of 98.6% (95% CI: 98.3 to 98.9) and a marksense accuracy of 99.2% (95% CI: 99.1 to 99.3). More importantly, the system reliably extracted all data from 56.6% (95% CI: 53.3 to 59.9) of our pilot forms without the need for a verification step. These results translate to a minimal workflow burden to end users. This suggests that ATDs can serve as an inexpensive, workflow-sensitive means of structured data acquisition in the clinical setting. PMID:14728139

Natural Language Processing–Enabled and Conventional Data Capture Methods for Input to Electronic Health Records: A Comparative Usability Study

PubMed Central

Sheehan, Barbara; Stetson, Peter; Bhatt, Ashish R; Field, Adele I; Patel, Chirag; Maisel, James Mark

2016-01-01

Background The process of documentation in electronic health records (EHRs) is known to be time consuming, inefficient, and cumbersome. The use of dictation coupled with manual transcription has become an increasingly common practice. In recent years, natural language processing (NLP)–enabled data capture has become a viable alternative for data entry. It enables the clinician to maintain control of the process and potentially reduce the documentation burden. The question remains how this NLP-enabled workflow will impact EHR usability and whether it can meet the structured data and other EHR requirements while enhancing the user’s experience. Objective The objective of this study is evaluate the comparative effectiveness of an NLP-enabled data capture method using dictation and data extraction from transcribed documents (NLP Entry) in terms of documentation time, documentation quality, and usability versus standard EHR keyboard-and-mouse data entry. Methods This formative study investigated the results of using 4 combinations of NLP Entry and Standard Entry methods (“protocols”) of EHR data capture. We compared a novel dictation-based protocol using MediSapien NLP (NLP-NLP) for structured data capture against a standard structured data capture protocol (Standard-Standard) as well as 2 novel hybrid protocols (NLP-Standard and Standard-NLP). The 31 participants included neurologists, cardiologists, and nephrologists. Participants generated 4 consultation or admission notes using 4 documentation protocols. We recorded the time on task, documentation quality (using the Physician Documentation Quality Instrument, PDQI-9), and usability of the documentation processes. Results A total of 118 notes were documented across the 3 subject areas. The NLP-NLP protocol required a median of 5.2 minutes per cardiology note, 7.3 minutes per nephrology note, and 8.5 minutes per neurology note compared with 16.9, 20.7, and 21.2 minutes, respectively, using the Standard-Standard protocol and 13.8, 21.3, and 18.7 minutes using the Standard-NLP protocol (1 of 2 hybrid methods). Using 8 out of 9 characteristics measured by the PDQI-9 instrument, the NLP-NLP protocol received a median quality score sum of 24.5; the Standard-Standard protocol received a median sum of 29; and the Standard-NLP protocol received a median sum of 29.5. The mean total score of the usability measure was 36.7 when the participants used the NLP-NLP protocol compared with 30.3 when they used the Standard-Standard protocol. Conclusions In this study, the feasibility of an approach to EHR data capture involving the application of NLP to transcribed dictation was demonstrated. This novel dictation-based approach has the potential to reduce the time required for documentation and improve usability while maintaining documentation quality. Future research will evaluate the NLP-based EHR data capture approach in a clinical setting. It is reasonable to assert that EHRs will increasingly use NLP-enabled data entry tools such as MediSapien NLP because they hold promise for enhancing the documentation process and end-user experience. PMID:27793791

Natural Language Processing-Enabled and Conventional Data Capture Methods for Input to Electronic Health Records: A Comparative Usability Study.

PubMed

Kaufman, David R; Sheehan, Barbara; Stetson, Peter; Bhatt, Ashish R; Field, Adele I; Patel, Chirag; Maisel, James Mark

2016-10-28

The process of documentation in electronic health records (EHRs) is known to be time consuming, inefficient, and cumbersome. The use of dictation coupled with manual transcription has become an increasingly common practice. In recent years, natural language processing (NLP)-enabled data capture has become a viable alternative for data entry. It enables the clinician to maintain control of the process and potentially reduce the documentation burden. The question remains how this NLP-enabled workflow will impact EHR usability and whether it can meet the structured data and other EHR requirements while enhancing the user's experience. The objective of this study is evaluate the comparative effectiveness of an NLP-enabled data capture method using dictation and data extraction from transcribed documents (NLP Entry) in terms of documentation time, documentation quality, and usability versus standard EHR keyboard-and-mouse data entry. This formative study investigated the results of using 4 combinations of NLP Entry and Standard Entry methods ("protocols") of EHR data capture. We compared a novel dictation-based protocol using MediSapien NLP (NLP-NLP) for structured data capture against a standard structured data capture protocol (Standard-Standard) as well as 2 novel hybrid protocols (NLP-Standard and Standard-NLP). The 31 participants included neurologists, cardiologists, and nephrologists. Participants generated 4 consultation or admission notes using 4 documentation protocols. We recorded the time on task, documentation quality (using the Physician Documentation Quality Instrument, PDQI-9), and usability of the documentation processes. A total of 118 notes were documented across the 3 subject areas. The NLP-NLP protocol required a median of 5.2 minutes per cardiology note, 7.3 minutes per nephrology note, and 8.5 minutes per neurology note compared with 16.9, 20.7, and 21.2 minutes, respectively, using the Standard-Standard protocol and 13.8, 21.3, and 18.7 minutes using the Standard-NLP protocol (1 of 2 hybrid methods). Using 8 out of 9 characteristics measured by the PDQI-9 instrument, the NLP-NLP protocol received a median quality score sum of 24.5; the Standard-Standard protocol received a median sum of 29; and the Standard-NLP protocol received a median sum of 29.5. The mean total score of the usability measure was 36.7 when the participants used the NLP-NLP protocol compared with 30.3 when they used the Standard-Standard protocol. In this study, the feasibility of an approach to EHR data capture involving the application of NLP to transcribed dictation was demonstrated. This novel dictation-based approach has the potential to reduce the time required for documentation and improve usability while maintaining documentation quality. Future research will evaluate the NLP-based EHR data capture approach in a clinical setting. It is reasonable to assert that EHRs will increasingly use NLP-enabled data entry tools such as MediSapien NLP because they hold promise for enhancing the documentation process and end-user experience. ©David R. Kaufman, Barbara Sheehan, Peter Stetson, Ashish R. Bhatt, Adele I. Field, Chirag Patel, James Mark Maisel. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 28.10.2016.

Quality and correlates of medical record documentation in the ambulatory care setting

PubMed Central

Soto, Carlos M; Kleinman, Kenneth P; Simon, Steven R

2002-01-01

Background Documentation in the medical record facilitates the diagnosis and treatment of patients. Few studies have assessed the quality of outpatient medical record documentation, and to the authors' knowledge, none has conclusively determined the correlates of chart documentation. We therefore undertook the present study to measure the rates of documentation of quality of care measures in an outpatient primary care practice setting that utilizes an electronic medical record. Methods We reviewed electronic medical records from 834 patients receiving care from 167 physicians (117 internists and 50 pediatricians) at 14 sites of a multi-specialty medical group in Massachusetts. We abstracted information for five measures of medical record documentation quality: smoking history, medications, drug allergies, compliance with screening guidelines, and immunizations. From other sources we determined physicians' specialty, gender, year of medical school graduation, and self-reported time spent teaching and in patient care. Results Among internists, unadjusted rates of documentation were 96.2% for immunizations, 91.6% for medications, 88% for compliance with screening guidelines, 61.6% for drug allergies, 37.8% for smoking history. Among pediatricians, rates were 100% for immunizations, 84.8% for medications, 90.8% for compliance with screening guidelines, 50.4% for drug allergies, and 20.4% for smoking history. While certain physician and patient characteristics correlated with some measures of documentation quality, documentation varied depending on the measure. For example, female internists were more likely than male internists to document smoking history (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.27 – 2.83) but were less likely to document drug allergies (OR, 0.51; 95% CI, 0.35 – 0.75). Conclusions Medical record documentation varied depending on the measure, with room for improvement in most domains. A variety of characteristics correlated with medical record documentation, but no pattern emerged. Further study could lead to targeted interventions to improve documentation. PMID:12473161

Validation of a Novel Electronic Health Record Patient Portal Advance Care Planning Delivery System.

PubMed

Bose-Brill, Seuli; Feeney, Michelle; Prater, Laura; Miles, Laura; Corbett, Angela; Koesters, Stephen

2018-06-26

Advance care planning allows patients to articulate their future care preferences should they no longer be able to make decisions on their own. Early advance care planning in outpatient settings provides benefits such as less aggressive care and fewer hospitalizations, yet it is underutilized due to barriers such as provider time constraints and communication complexity. Novel methods, such as patient portals, provide a unique opportunity to conduct advance care planning previsit planning for outpatient care. This follow-up to our pilot study aimed to conduct pragmatic testing of a novel electronic health record-tethered framework and its effects on advance care planning delivery in a real-world primary care setting. Our intervention tested a previsit advance care planning workflow centered around a framework sent via secure electronic health record-linked patient portal in a real-world clinical setting. The primary objective of this study was to determine its impact on frequency and quality of advance care planning documentation. We conducted a pragmatic trial including 2 sister clinical sites, one site implementing the intervention and the other continuing standard care. A total of 419 patients aged between 50 and 93 years with active portal accounts received intervention (n=200) or standard care (n=219). Chart review analyzed the presence of advance care planning and its quality and was graded with previously established scoring criteria based on advance care planning best practice guidelines from multiple nations. A total of 19.5% (39/200) of patients who received previsit planning responded to the framework. We found that the intervention site had statistically significant improvement in new advance care planning documentation rates (P<.01) and quality (P<.01) among all eligible patients. Advance care planning documentation rates increased by 105% (19/39 to 39/39) and quality improved among all patients who engaged in the previsit planning framework (n=39). Among eligible patients aged between 50 and 60 years at the intervention site, advance care planning documentation rates increased by 37% (27/96 to 37/96). Advance care planning documentation rates increased 34% among high users (27/67 to 36/67). Advance care planning previsit planning using a secure electronic health record-supported patient portal framework yielded improvement in the presence of advance care planning documentation, with highest improvement in active patient portal users and patients aged between 50 and 60 years. Targeted previsit patient portal advance care planning delivery in these populations can potentially improve the quality of care in these populations. ©Seuli Bose-Brill, Michelle Feeney, Laura Prater, Laura Miles, Angela Corbett, Stephen Koesters. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.06.2018.

Architecture of a consent management suite and integration into IHE-based Regional Health Information Networks.

PubMed

Heinze, Oliver; Birkle, Markus; Köster, Lennart; Bergh, Björn

2011-10-04

The University Hospital Heidelberg is implementing a Regional Health Information Network (RHIN) in the Rhine-Neckar-Region in order to establish a shared-care environment, which is based on established Health IT standards and in particular Integrating the Healthcare Enterprise (IHE). Similar to all other Electronic Health Record (EHR) and Personal Health Record (PHR) approaches the chosen Personal Electronic Health Record (PEHR) architecture relies on the patient's consent in order to share documents and medical data with other care delivery organizations, with the additional requirement that the German legislation explicitly demands a patients' opt-in and does not allow opt-out solutions. This creates two issues: firstly the current IHE consent profile does not address this approach properly and secondly none of the employed intra- and inter-institutional information systems, like almost all systems on the market, offers consent management solutions at all. Hence, the objective of our work is to develop and introduce an extensible architecture for creating, managing and querying patient consents in an IHE-based environment. Based on the features offered by the IHE profile Basic Patient Privacy Consent (BPPC) and literature, the functionalities and components to meet the requirements of a centralized opt-in consent management solution compliant with German legislation have been analyzed. Two services have been developed and integrated into the Heidelberg PEHR. The standard-based Consent Management Suite consists of two services. The Consent Management Service is able to receive and store consent documents. It can receive queries concerning a dedicated patient consent, process it and return an answer. It represents a centralized policy enforcement point. The Consent Creator Service allows patients to create their consents electronically. Interfaces to a Master Patient Index (MPI) and a provider index allow to dynamically generate XACML-based policies which are stored in a CDA document to be transferred to the first service. Three workflows have to be considered to integrate the suite into the PEHR: recording the consent, publishing documents and viewing documents. Our approach solves the consent issue when using IHE profiles for regional health information networks. It is highly interoperable due to the use of international standards and can hence be used in any other region to leverage consent issues and substantially promote the use of IHE for regional health information networks in general.

Architecture of a consent management suite and integration into IHE-based regional health information networks

PubMed Central

2011-01-01

Background The University Hospital Heidelberg is implementing a Regional Health Information Network (RHIN) in the Rhine-Neckar-Region in order to establish a shared-care environment, which is based on established Health IT standards and in particular Integrating the Healthcare Enterprise (IHE). Similar to all other Electronic Health Record (EHR) and Personal Health Record (PHR) approaches the chosen Personal Electronic Health Record (PEHR) architecture relies on the patient's consent in order to share documents and medical data with other care delivery organizations, with the additional requirement that the German legislation explicitly demands a patients' opt-in and does not allow opt-out solutions. This creates two issues: firstly the current IHE consent profile does not address this approach properly and secondly none of the employed intra- and inter-institutional information systems, like almost all systems on the market, offers consent management solutions at all. Hence, the objective of our work is to develop and introduce an extensible architecture for creating, managing and querying patient consents in an IHE-based environment. Methods Based on the features offered by the IHE profile Basic Patient Privacy Consent (BPPC) and literature, the functionalities and components to meet the requirements of a centralized opt-in consent management solution compliant with German legislation have been analyzed. Two services have been developed and integrated into the Heidelberg PEHR. Results The standard-based Consent Management Suite consists of two services. The Consent Management Service is able to receive and store consent documents. It can receive queries concerning a dedicated patient consent, process it and return an answer. It represents a centralized policy enforcement point. The Consent Creator Service allows patients to create their consents electronically. Interfaces to a Master Patient Index (MPI) and a provider index allow to dynamically generate XACML-based policies which are stored in a CDA document to be transferred to the first service. Three workflows have to be considered to integrate the suite into the PEHR: recording the consent, publishing documents and viewing documents. Conclusions Our approach solves the consent issue when using IHE profiles for regional health information networks. It is highly interoperable due to the use of international standards and can hence be used in any other region to leverage consent issues and substantially promote the use of IHE for regional health information networks in general. PMID:21970788

Sources of information used to support quality use of medicines: findings from a national survey of nurse practitioners in Australia.

PubMed

Buckley, Thomas; Stasa, Helen; Cashin, Andrew; Stuart, Meg; Dunn, Sandra V

2015-02-01

The purpose of this study was to investigate the sources, both print and electronic formats, which Australian nurse practitioners (NPs) currently use to obtain information regarding quality use of medicines (QUM). An additional aim was to document NPs' preferences for continuing education in relation to QUM. A national electronic survey of Australian NPs was conducted in 2007 and again in 2010. Eighty percent of respondents accessed information on QUM from professional literature, which may include scholarly journal articles, reports, and independent publications. There was a decrease in the percentage of respondents who obtained information from drug industry representatives. NPs prefer to receive medicines information in an electronic form, rather than a paper-based version, and over the time period more NPs are utilizing electronic sources rather than paper. These findings provide important insights into medical information products for the developers who may be able to use these results to ensure that their products meet the needs of NP clinicians. Additionally, the finding that NPs prefer to receive their continuing information related to medicines in electronic format, but also highly value conference proceedings, may help to inform future planning of NP education needs in relation to QUM. ©2014 American Association of Nurse Practitioners.

Implementation of an Electronic Ionosonde to Monitor the Earth's Ionosphere via a Projected Column through USRP.

PubMed

Barona Mendoza, Jhon Jairo; Quiroga Ruiz, Carlos Fernando; Pinedo Jaramillo, Carlos Rafael

2017-04-25

This document illustrates the processes carried out for the construction of an ionospheric sensor or ionosonde, from a universal software radio peripheral (USRP), and its programming using GNU-Radio and MATLAB. The development involved the in-depth study of the characteristics of the ionosphere, to apply the corresponding mathematical models used in the radar-like pulse compression technique and matched filters, among others. The sensor operates by firing electromagnetic waves in a frequency sweep, which are reflected against the ionosphere and are received on its return by the receiver of the instrument, which calculates the reflection height through the signal offset. From this information and a series of calculations, the electron density of the terrestrial ionosphere could be obtained. Improving the SNR of received echoes reduces the transmission power to a maximum of 400 W. The resolution associated with the bandwidth of the signal used is approximately 5 km, but this can be improved, taking advantage of the fact that the daughterboards used in the USRP allow a higher sampling frequency than the one used in the design of this experiment.

Using Natural Language Processing to Improve Efficiency of Manual Chart Abstraction in Research: The Case of Breast Cancer Recurrence

PubMed Central

Carrell, David S.; Halgrim, Scott; Tran, Diem-Thy; Buist, Diana S. M.; Chubak, Jessica; Chapman, Wendy W.; Savova, Guergana

2014-01-01

The increasing availability of electronic health records (EHRs) creates opportunities for automated extraction of information from clinical text. We hypothesized that natural language processing (NLP) could substantially reduce the burden of manual abstraction in studies examining outcomes, like cancer recurrence, that are documented in unstructured clinical text, such as progress notes, radiology reports, and pathology reports. We developed an NLP-based system using open-source software to process electronic clinical notes from 1995 to 2012 for women with early-stage incident breast cancers to identify whether and when recurrences were diagnosed. We developed and evaluated the system using clinical notes from 1,472 patients receiving EHR-documented care in an integrated health care system in the Pacific Northwest. A separate study provided the patient-level reference standard for recurrence status and date. The NLP-based system correctly identified 92% of recurrences and estimated diagnosis dates within 30 days for 88% of these. Specificity was 96%. The NLP-based system overlooked 5 of 65 recurrences, 4 because electronic documents were unavailable. The NLP-based system identified 5 other recurrences incorrectly classified as nonrecurrent in the reference standard. If used in similar cohorts, NLP could reduce by 90% the number of EHR charts abstracted to identify confirmed breast cancer recurrence cases at a rate comparable to traditional abstraction. PMID:24488511

Investigation of The Omaha System for dentistry.

PubMed

Jurkovich, M W; Ophaug, M; Salberg, S; Monsen, K

2014-01-01

Today, dentists and hygienists have inadequate tools to identify contributing factors to dental disease, diagnosis of disease or to document outcomes in a standardized and machine readable format. Increasing demand to find the most effective care methodologies make the development of further terminologies for dentistry more urgent. Preventive care is the focus of early efforts to define best practices. We reviewed one possibility with a history of public health documentation that might assist in these early efforts at identifying best practices. This paper examines, through a survey of dentists, the Omaha System Problem Classification Scheme. The survey requested that dentists rate the usefulness of knowing about specific signs and symptoms for each of the 42 problems within the Problem list of the Omaha System. Using a weighted scoring system, 22 of the 42 problems received over 50% of the possible maximum score and 30 of the 42 problems received at least 25% of the possible points. These findings suggests that further evaluation of The Omaha System, may be useful to dentistry. At a minimum, the survey provides additional information about non-physiological problems, signs, and symptoms that may be appropriate for documentation purposes within an electronic health record (EHR) used in dentistry.

Intelligence and Electronic Warfare (IEW) Streamlining Project. Volume 3. Reference Documentation (Part 5)

DTIC Science & Technology

1992-11-18

Army. He is a graduate of Henderson State Univer- sity, Arkadelphia, Arkansas, and holds a master ofspend on financial management controls. Asset...supply system, he will receive credit receipts, and making monthly reconciliations with from the tactical unit financial management infor- activi ies at...obtain financial management rather than being added to the daily batch of requests information, and provide supply status information passed to the direct

48 CFR 204.270 - Electronic Document Access.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 3 2014-10-01 2014-10-01 false Electronic Document Access..., DEPARTMENT OF DEFENSE GENERAL ADMINISTRATIVE MATTERS Contract Distribution 204.270 Electronic Document Access. Follow the procedures at PGI 204.270 relating to obtaining an account in the Electronic Document Access...

48 CFR 204.270 - Electronic Document Access.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 3 2011-10-01 2011-10-01 false Electronic Document Access..., DEPARTMENT OF DEFENSE GENERAL ADMINISTRATIVE MATTERS Contract Distribution 204.270 Electronic Document Access. Follow the procedures at PGI 204.270 relating to obtaining an account in the Electronic Document Access...

48 CFR 204.270 - Electronic Document Access.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 3 2013-10-01 2013-10-01 false Electronic Document Access..., DEPARTMENT OF DEFENSE GENERAL ADMINISTRATIVE MATTERS Contract Distribution 204.270 Electronic Document Access. Follow the procedures at PGI 204.270 relating to obtaining an account in the Electronic Document Access...

48 CFR 204.270 - Electronic Document Access.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Electronic Document Access..., DEPARTMENT OF DEFENSE GENERAL ADMINISTRATIVE MATTERS Contract Distribution 204.270 Electronic Document Access. Follow the procedures at PGI 204.270 relating to obtaining an account in the Electronic Document Access...

48 CFR 204.270 - Electronic Document Access.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 3 2012-10-01 2012-10-01 false Electronic Document Access..., DEPARTMENT OF DEFENSE GENERAL ADMINISTRATIVE MATTERS Contract Distribution 204.270 Electronic Document Access. Follow the procedures at PGI 204.270 relating to obtaining an account in the Electronic Document Access...

The Effect of an Electronic SBAR Communication Tool on Documentation of Acute Events in the Pediatric Intensive Care Unit.

PubMed

Panesar, Rahul S; Albert, Ben; Messina, Catherine; Parker, Margaret

2016-01-01

The Situation, Background, Assessment, Recommendation (SBAR) handoff tool is designed to improve communication. The effects of integrating an electronic medical record (EMR) with a SBAR template are unclear. The research team hypothesizes that an electronic SBAR template improves documentation and communication between nurses and physicians. In all, 84 patient events were recorded from 542 admissions to the pediatric intensive care unit. Three time periods were studied: (a) paper documentation only, (b) electronic documentation, and (c) electronic documentation with an SBAR template. Documentation quality was assessed using a 4-point scoring system. The frequency of event notes increased progressively during the 3 study periods. Mean quality scores improved significantly from paper documentation to EMR free-text notes and to electronic SBAR-template notes, as did nurse and attending physician notification. The implementation of an electronic SBAR note is associated with more complete documentation and increased frequency of documentation of communication among nurses and physicians. © The Author(s) 2014.

Management of patients with cardiac implantable electronic devices (CIED) undergoing radiotherapy: A consensus document from Associazione Italiana Aritmologia e Cardiostimolazione (AIAC), Associazione Italiana Radioterapia Oncologica (AIRO), Associazione Italiana Fisica Medica (AIFM).

PubMed

Zecchin, Massimo; Severgnini, Mara; Fiorentino, Alba; Malavasi, Vincenzo Livio; Menegotti, Loris; Alongi, Filippo; Catanzariti, Domenico; Jereczek-Fossa, Barbara Alicja; Stasi, Michele; Russi, Elvio; Boriani, Giuseppe

2018-03-15

The management of patients with a cardiac implanted electronic device (CIED) receiving radiotherapy (RT) is challenging and requires a structured multidisciplinary approach. A consensus document is presented as a result of a multidisciplinary working group involving cardiac electrophysiologists, radiation oncologists and physicists in order to stratify the risk of patients with CIED requiring RT and approaching RT sessions appropriately. When high radiation doses and beam energy higher than 6MV are used, CIED malfunctions can occur during treatment. In our document, we reviewed the different types of RT and CIED behavior in the presence of ionizing radiations and electromagnetic interferences, from the cardiologist's, radiation oncologist's and medical physicist's point of view. We also reviewed in vitro and in vivo literature data and other national published guidelines on this issue so far. On the basis of literature data and consensus of experts, a detailed approach based on risk stratification and appropriate management of RT patients with CIEDs is suggested, with important implications for clinical practice. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

7 CFR 900.31 - Electronic submission of hearing documents.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 8 2013-01-01 2013-01-01 false Electronic submission of hearing documents. 900.31... and Marketing Orders § 900.31 Electronic submission of hearing documents. To the extent practicable..., USDA. All documents should reference the docket number of the proceeding. Instructions for electronic...

7 CFR 900.31 - Electronic submission of hearing documents.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Electronic submission of hearing documents. 900.31... and Marketing Orders § 900.31 Electronic submission of hearing documents. To the extent practicable..., USDA. All documents should reference the docket number of the proceeding. Instructions for electronic...

VLBI2010 Receiver Back End Comparison

NASA Technical Reports Server (NTRS)

Petrachenko, Bill

2013-01-01

VLBI2010 requires a receiver back-end to convert analog RF signals from the receiver front end into channelized digital data streams to be recorded or transmitted electronically. The back end functions are typically performed in two steps: conversion of analog RF inputs into IF bands (see Table 2), and conversion of IF bands into channelized digital data streams (see Tables 1a, 1b and 1c). The latter IF systems are now completely digital and generically referred to as digital back ends (DBEs). In Table 2 two RF conversion systems are compared, and in Tables 1a, 1b, and 1c nine DBE systems are compared. Since DBE designs are advancing rapidly, the data in these tables are only guaranteed to be current near the update date of this document.

Mental health measurement among women veterans receiving co-located, collaborative care services.

PubMed

Lilienthal, Kaitlin R; Buchholz, Laura J; King, Paul R; Vair, Christina L; Funderburk, Jennifer S; Beehler, Gregory P

2017-12-01

Routine use of measurement to identify patient concerns and track treatment progress is critical to high quality patient care. This is particularly relevant to the Primary Care Behavioral Health model, where rapid symptom assessment and effective referral management are critical to sustaining population-based care. However, research suggests that women who receive treatment in co-located collaborative care settings utilizing the PCBH model are less likely to be assessed with standard measures than men in these settings. The current study utilized regional retrospective data obtained from the Veterans Health Administration's electronic medical record system to: (1) explore rates of mental health measurement for women receiving co-located collaborative care services (N = 1008); and (2) to identify predictors of mental health measurement in women veterans in these settings. Overall, only 8% of women had documentation of standard mental health measures. Measurement was predicted by diagnosis, facility size, length of care episode and care setting. Specifically, women diagnosed with depression were less likely than those with anxiety disorders to have standard mental health measurement documented. Several suggestions are offered to increase the quality of mental health care for women through regular use of measurement in integrated care settings.

Ultrastructural liver changes in the experimental thyrotoxicosis.

PubMed

Pasyechko, Nadiya Vasylivna; Kuleshko, Iryna Ihorivna; Kulchinska, Veronika Mykolaiivna; Naumova, Liudmyla Valeriivna; Smachylo, Iryna Volodymyrivna; Bob, Anzhela Olehivna; Radetska, Liudmyla Volodymyrivna; Havryliuk, Mykhailo Yevhenovych; Sopel, Olha Mykolaiivna; Mazur, Liudmyla Petrivna

Aim of the study is to evaluate ultrastructural changes of rat liver in experimental thyrotoxicosis. For the study, 36 male rats have been utilized, weighing approximately 150-190 g, which were divided into three groups: the first, control group (12 animals) was composed of healthy rats that received intragastric sodium chloride 0.9% solution, the second group (12 animals) - animals with experimental thyrotoxicosis, which received intragastric solution of L-thyroxine at the rate of 200 μg/kg for 2 weeks, and the third group (12 animals) - rats with experimental thyrotoxicosis, which received intragastric solution of L-thyroxine at the rate of 200 μg/kg for 4 weeks. For electron-microscopic studies small pieces of liver tissue were taken at the end of the 2nd and 4th weeks of the experiment. The material was studied and documented in electron micrographs by using a TEM-125K electron microscope. In experiment in white male rats the electron-microscopic state of the liver in thyrotoxicosis has been studied. It has been established that thyrotoxicosis is accompanied by the significant changes of the hepatocytes ultrastructure, blood and bile capillaries. Experimental thyrotoxicosis causes significant damage of the liver plasma membranes and intracellular structural components of hepatocytes and endothelial cells. In experimental thyrotoxicosis, on the background of microcirculatory disorders, significant damage of plasmatic and intracellular organoid membranes of hepatocytes in the liver develops, which has an adverse effect on the functionality of the organ. The found ultrastructural changes are aggravated depending on the duration of thyrotoxicosis.

10 CFR 2.302 - Filing of documents.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Officer Powers, and General Hearing Management for NRC Adjudicatory Hearings § 2.302 Filing of documents... electronic transmission when the filer performs the last act that it must perform to transmit a document, in... electronic documents. The exempt participant is permitted to file electronic documents by physically...

10 CFR 2.302 - Filing of documents.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Officer Powers, and General Hearing Management for NRC Adjudicatory Hearings § 2.302 Filing of documents... electronic transmission when the filer performs the last act that it must perform to transmit a document, in... electronic documents. The exempt participant is permitted to file electronic documents by physically...

Electronic Documentation Support Tools and Text Duplication in the Electronic Medical Record

ERIC Educational Resources Information Center

Wrenn, Jesse

2010-01-01

In order to ease the burden of electronic note entry on physicians, electronic documentation support tools have been developed to assist in note authoring. There is little evidence of the effects of these tools on attributes of clinical documentation, including document quality. Furthermore, the resultant abundance of duplicated text and…

International Conference on Harmonisation; Electronic Transmission of Postmarket Individual Case Safety Reports for Drugs and Biologics, Excluding Vaccines; Availability of Food and Drug Administration Regional Implementation Specifications for ICH E2B(R3) Reporting to the Food and Drug Administration Adverse Event Reporting System. Notice of Availability.

PubMed

2016-06-23

The Food and Drug Administration (FDA) is announcing the availability of its FDA Adverse Event Reporting System (FAERS) Regional Implementation Specifications for the International Conference on Harmonisation (ICH) E2B(R3) Specification. FDA is making this technical specifications document available to assist interested parties in electronically submitting individual case safety reports (ICSRs) (and ICSR attachments) to the Center for Drug Evaluation and Research (CDER) and the Center for Biologics Evaluation and Research (CBER). This document, entitled "FDA Regional Implementation Specifications for ICH E2B(R3) Implementation: Postmarket Submission of Individual Case Safety Reports (ICSRs) for Drugs and Biologics, Excluding Vaccines" supplements the "E2B(R3) Electronic Transmission of Individual Case Safety Reports (ICSRs) Implementation Guide--Data Elements and Message Specification" final guidance for industry and describes FDA's technical approach for receiving ICSRs, for incorporating regionally controlled terminology, and for adding region-specific data elements when reporting to FAERS.

Health professionals' use of documents obtained through the Regional Medical Library Network.

PubMed

Lovas, I; Graham, E; Flack, V

1991-01-01

The Pacific Southwest Regional Medical Library Service (PSRMLS) studied how health professionals use documents obtained through the regional medical library (RML) network and how various factors, such as delivery time, affected that use. A random sample of libraries in Region 7 of the RML network was selected to survey health professionals who had received documents through the interlibrary loan (ILL) network. The survey provided data about the purposes for which health professionals requested documents, how the immediacy of need for the items affected their usefulness, what effect the obtained information had on the health professionals' work, and whether the illustrations represented an important part of the information content of the items. Survey results provided a positive assessment of the ILL network. Results also verified the basic value of the materials provided to health professionals through ILL and identified some areas for consideration in future network development. Users of the documents indicated that the network works efficiently and effectively to provide timely and useful information needed by health professionals. Technological developments in electronic information transmission and imaging will further enhance network operation in the future.

7 CFR 735.402 - Providers of other electronic documents.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 7 2011-01-01 2011-01-01 false Providers of other electronic documents. 735.402... Electronic Providers § 735.402 Providers of other electronic documents. (a) To establish a USWA-authorized...) Records; (6) Conflict of interest requirements; (7) USDA common electronic information requirements; (8...

7 CFR 735.402 - Providers of other electronic documents.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 7 2012-01-01 2012-01-01 false Providers of other electronic documents. 735.402... Electronic Providers § 735.402 Providers of other electronic documents. (a) To establish a USWA-authorized...) Records; (6) Conflict of interest requirements; (7) USDA common electronic information requirements; (8...

A survey of nursing documentation, terminologies and standards in European countries

PubMed Central

Thoroddsen, Asta; Ehrenberg, Anna; Sermeus, Walter; Saranto, Kaija

2012-01-01

A survey was carried out to describe the current state of art in the use of nursing documentation, terminologies, standards and education. Key informants in European countries were targeted by the Association for Common European Nursing Diagnoses, Interventions and Outcomes (ACENDIO). Replies were received from key informants in 20 European countries. Results show that the nursing process was most often used to structure nursing documentation. Many standardized nursing terminologies were used in Europe with NANDA, NIC, NOC and ICF most frequently used. In 70% of the countries minimum requirements were available for electronic health records (EHR), but nursing not addressed specifically. Standards in use for nursing terminologies and information systems were lacking. The results should be a major concern to the nursing community in Europe. As a European platform, ACENDIO can play a role in enhancing standardization activities, and should develop its role accordingly. PMID:24199130

NASA STI Program Seminar: Electronic documents

NASA Technical Reports Server (NTRS)

1994-01-01

The theme of this NASA Scientific and Technical Information Program Seminar was electronic documents. Topics covered included Electronic Documents Management at the CASI, the Impact of Electronic Publishing on User Expectations and Searching Image Record Management, Secondary Publisher Considerations for Electronic Journal Literature, and the Technical Manual Publishing On Demand System (TMPODS).

Integration of clinical research documentation in electronic health records.

PubMed

Broach, Debra

2015-04-01

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

'Correction:'Peer chart audits: A tool to meet Accreditation Council on Graduate Medical Education (ACGME) competency in practice-based learning and improvement

PubMed Central

Staton, Lisa J; Kraemer, Suzanne M; Patel, Sangnya; Talente, Gregg M; Estrada, Carlos A

2007-01-01

Background The Accreditation Council on Graduate Medical Education (ACGME) supports chart audit as a method to track competency in Practice-Based Learning and Improvement. We examined whether peer chart audits performed by internal medicine residents were associated with improved documentation of foot care in patients with diabetes mellitus. Methods A retrospective electronic chart review was performed on 347 patients with diabetes mellitus cared for by internal medicine residents in a university-based continuity clinic from May 2003 to September 2004. Residents abstracted information pertaining to documentation of foot examinations (neurological, vascular, and skin) from the charts of patients followed by their physician peers. No formal feedback or education was provided. Results Significant improvement in the documentation of foot exams was observed over the course of the study. The percentage of patients receiving neurological, vascular, and skin exams increased by 20% (from 13% to 33%) (p = 0.001), 26% (from 45% to 71%) (p < 0.001), and 18% (51%–72%) (p = 0.005), respectively. Similarly, the proportion of patients receiving a well-documented exam which includes all three components – neurological, vascular and skin foot exam – increased over time (6% to 24%, p < 0.001). Conclusion Peer chart audits performed by residents in the absence of formal feedback were associated with improved documentation of the foot exam in patients with diabetes mellitus. Although this study suggests that peer chart audits may be an effective tool to improve practice-based learning and documentation of foot care in diabetic patients, evaluating the actual performance of clinical care was beyond the scope of this study and would be better addressed by a randomized controlled trial. PMID:17662124

Peer chart audits: a tool to meet Accreditation Council on Graduate Medical Education (ACGME) competency in practice-based learning and improvement.

PubMed

Staton, Lisa J; Kraemer, Suzanne M; Patel, Sangnya; Talente, Gregg M; Estrada, Carlos A

2007-07-27

The Accreditation Council on Graduate Medical Education (ACGME) supports chart audit as a method to track competency in Practice-Based Learning and Improvement. We examined whether peer chart audits performed by internal medicine residents were associated with improved documentation of foot care in patients with diabetes mellitus. A retrospective electronic chart review was performed on 347 patients with diabetes mellitus cared for by internal medicine residents in a university-based continuity clinic from May 2003 to September 2004. Residents abstracted information pertaining to documentation of foot examinations (neurological, vascular, and skin) from the charts of patients followed by their physician peers. No formal feedback or education was provided. Significant improvement in the documentation of foot exams was observed over the course of the study. The percentage of patients receiving neurological, vascular, and skin exams increased by 20% (from 13% to 33%) (p = 0.001), 26% (from 45% to 71%) (p < 0.001), and 18% (51%-72%) (p = 0.005), respectively. Similarly, the proportion of patients receiving a well-documented exam which includes all three components - neurological, vascular and skin foot exam - increased over time (6% to 24%, p < 0.001). Peer chart audits performed by residents in the absence of formal feedback were associated with improved documentation of the foot exam in patients with diabetes mellitus. Although this study suggests that peer chart audits may be an effective tool to improve practice-based learning and documentation of foot care in diabetic patients, evaluating the actual performance of clinical care was beyond the scope of this study and would be better addressed by a randomized controlled trial.

Accuracy of outpatient service data for activity-based funding in New South Wales, Australia.

PubMed

Munyisia, Esther N; Reid, David; Yu, Ping

2017-05-01

Despite increasing research on activity-based funding (ABF), there is no empirical evidence on the accuracy of outpatient service data for payment. This study aimed to identify data entry errors affecting ABF in two drug and alcohol outpatient clinic services in Australia. An audit was carried out on healthcare workers' (doctors, nurses, psychologists, social workers, counsellors, and aboriginal health education officers) data entry errors in an outpatient electronic documentation system. Of the 6919 data entries in the electronic documentation system, 7.5% (518) had errors, 68.7% of the errors were related to a wrong primary activity, 14.5% were due to a wrong activity category, 14.5% were as a result of a wrong combination of primary activity and modality of care, 1.9% were due to inaccurate information on a client's presence during service delivery and 0.4% were related to a wrong modality of care. Data entry errors may affect the amount of funding received by a healthcare organisation, which in turn may affect the quality of treatment provided to clients due to the possibility of underfunding the organisation. To reduce errors or achieve an error-free environment, there is a need to improve the naming convention of data elements, their descriptions and alignment with the national standard classification of outpatient services. It is also important to support healthcare workers in their data entry by embedding safeguards in the electronic documentation system such as flags for inaccurate data elements.

Improving the Quality of Electronic Documentation in Critical Care Nursing

ERIC Educational Resources Information Center

Stevens, Brent

2017-01-01

Electronic nursing documentation systems can facilitate complete, accurate, timely documentation practices, but without effective policies and procedures in place, a gap in practice exists and quality of care may be impacted. This systematic review of literature examined current evidence regarding electronic nursing documentation quality. General…

Sick Note to Fit Note: one trust’s project to improve usage by hospital clinicians

PubMed Central

Moran, Amy; Mainwaring, Cathryn; Keane, Oliver; Sanctuary, Thomas; Watson, Kathryn; Lasoye, Tunji

2018-01-01

Introduction In April 2010, the government introduced a new Statement of Fitness to Work or ’Fit Note' for patients requiring time off of work or adaptations to their work due to illness. Responsibility to issue these documents has shifted from primary to secondary care. Hospital clinicians are required to issue for inpatients and for outpatients where clinical responsibility has not been taken over by the general practitioner (GP). However, awareness of this change is lacking. Misdirecting patients to their GP for the sole purpose of receiving a ’Fit Note' is an unnecessary use of appointment time and negatively impacts on patients. King’s College Hospital NHS Trust receives a number of quality alerts from primary care regarding this issue. Methods A trust-wide educational initiative was designed and implemented to increase staff awareness of Fit Notes and their correct usage in order to reduce the number of patients being misdirected to their GP to obtain one. Interventions included direct staff engagement, a trust-wide promotional campaign and creation of an electronic version of the document. Results Uptake of the electronic version of the Fit Note has steadily increased and there has been a fall in the number of quality alerts received by the trust. However, staff awareness on the whole remains low. Conclusions Patients being misdirected to their general practice for Fit Notes is an important issue and one on which the baseline level of awareness among hospital clinicians is low. Challenges during this intervention have been in penetrating a trust of this size and getting the message across to staff. However, digitising the Fit Note can help to increase its use. PMID:29333499

Critical Infrastructure References: Documented Literature Search

DTIC Science & Technology

2012-10-01

the literature search document can be a resource for DRDC and external partners. Future plans: At present, the electronic copies of the reference...Personal Information Protection and Electronic Documents Act (S.C. 2000, c. 5) Title: Personal Information Protection and Electronic Documents Act (S.C...2011 Overview: • "An Act to support and promote electronic commerce by protecting personal information that is collected, used or disclosed in

Implementation of an Electronic Ionosonde to Monitor the Earth’s Ionosphere via a Projected Column through USRP

PubMed Central

Barona Mendoza, Jhon Jairo; Quiroga Ruiz, Carlos Fernando; Pinedo Jaramillo, Carlos Rafael

2017-01-01

This document illustrates the processes carried out for the construction of an ionospheric sensor or ionosonde, from a universal software radio peripheral (USRP), and its programming using GNU-Radio and MATLAB. The development involved the in-depth study of the characteristics of the ionosphere, to apply the corresponding mathematical models used in the radar-like pulse compression technique and matched filters, among others. The sensor operates by firing electromagnetic waves in a frequency sweep, which are reflected against the ionosphere and are received on its return by the receiver of the instrument, which calculates the reflection height through the signal offset. From this information and a series of calculations, the electron density of the terrestrial ionosphere could be obtained. Improving the SNR of received echoes reduces the transmission power to a maximum of 400 W. The resolution associated with the bandwidth of the signal used is approximately 5 km, but this can be improved, taking advantage of the fact that the daughterboards used in the USRP allow a higher sampling frequency than the one used in the design of this experiment. PMID:28441329

Training for spacecraft technical analysts

NASA Technical Reports Server (NTRS)

Ayres, Thomas J.; Bryant, Larry

1989-01-01

Deep space missions such as Voyager rely upon a large team of expert analysts who monitor activity in the various engineering subsystems of the spacecraft and plan operations. Senior teammembers generally come from the spacecraft designers, and new analysts receive on-the-job training. Neither of these methods will suffice for the creation of a new team in the middle of a mission, which may be the situation during the Magellan mission. New approaches are recommended, including electronic documentation, explicit cognitive modeling, and coached practice with archived data.

Global Combat Support Basing. Robust Prepositioning Strategies for Air Force War Reserve Material

DTIC Science & Technology

2010-01-01

e.g., WRM assets at b may receive their mainte- nance from a traveling maintenance team based offsite at b’ ). Both the 5 Mark S. Daskin , Lawrence V...This document and trademark(s) contained herein are protected by law as indicated in a notice appearing later in this work. This electronic...representation of RAND intellectual property is provided for non-commercial use only. Unauthorized posting of RAND PDFs to a non-RAND Web site is

The Development of a Tactical Dual-Wavelength Nephelometer.

DTIC Science & Technology

1982-11-24

Instrument Layout 50 4.5 Optical Systems 53 4.6 Electronic Systems 56 4.6.1 Transmitter System 56 4.6.2 Receiver Systems 58 5. R&D TEST AND ACCEPTANCE PLAN 61... PLAN , 136 HSS-B-086, 10 DEC1981. APPENDIX B ARVIN CALSPAN DOCUMENTATION OF 155 EXTINCTION AND PARTICLE SIZE MEASUREMENTS FOR CHAMBER TESTS OF MAY 1982. 6...121 FP’enn Aerosol Models. 8.9 Aerosol Extinction Coefficients at Two Wavelenghts 129 and their Ratio for Four Deirmendjian Aerosol Models. 10

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

PubMed

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

2017-01-01

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

Duly noted: Lessons from a two-site intervention to assess and improve the quality of clinical documentation in the electronic health record.

PubMed

Fanucchi, Laura; Yan, Donglin; Conigliaro, Rosemarie L

2016-07-06

Communication errors are identified as a root cause contributing to a majority of sentinel events. The clinical note is a cornerstone of physician communication, yet there are few published interventions on teaching note writing in the electronic health record (EHR). This is a prospective, two-site, quality improvement project to assess and improve the quality of clinical documentation in the EHR using a validated assessment tool. Internal Medicine (IM) residents at the University of Kentucky College of Medicine (UK) and Montefiore Medical Center/Albert Einstein College of Medicine (MMC) received one of two interventions during an inpatient ward month: either a lecture, or a lecture and individual feedback on progress notes. A third group of residents in each program served as control. Notes were evaluated with the Physician Documentation Quality Instrument 9 (PDQI-9). Due to a significant difference in baseline PDQI-9 scores at MMC, the sites were not combined. Of 75 residents at the UK site, 22 were eligible, 20 (91%) enrolled, 76 notes in total were scored. Of 156 residents at MMC, 22 were eligible, 18 (82%) enrolled, 40 notes in total were scored. Note quality did not improve as measured by the PDQI-9. This educational quality improvement project did not improve the quality of clinical documentation as measured by the PDQI-9. This project underscores the difficulty in improving note quality. Further efforts should explore more effective educational tools to improve the quality of clinical documentation in the EHR.

Outcomes of Computerized Physician Order Entry in an Electronic Health Record After Implementation in an Outpatient Oncology Setting

PubMed Central

Harshberger, Cara A.; Harper, Abigail J.; Carro, George W.; Spath, Wayne E.; Hui, Wendy C.; Lawton, Jessica M.; Brockstein, Bruce E.

2011-01-01

Purpose: Computerized physician order entry (CPOE) in electronic health records (EHR) has been recognized as an important tool in optimal health care provision that can reduce errors and improve safety. The objective of this study is to describe documentation completeness and user satisfaction of medical charts before and after implementation of an outpatient oncology EHR/ CPOE system in a hospital-based outpatient cancer center within three treatment sites. Methods: This study is a retrospective chart review of 90 patients who received one of the following regimens between 1999 and 2006: FOLFOX, AC, carboplatin + paclitaxel, ABVD, cisplatin + etoposide, R-CHOP, and clinical trials. Documentation completeness scores were assigned to each chart based on the number of documented data points found out of the total data points assessed. EHR/CPOE documentation completeness was compared with completeness of paper charts orders of the same regimens. A user satisfaction survey of the paper chart and EHR/CPOE system was conducted among the physicians, nurses, and pharmacists who worked with both systems. Results: The mean percentage of identified data points successfully found in the EHR/CPOE charts was 93% versus 67% in the paper charts (P < .001). Regimen complexity did not alter the number of data points found. The survey response rate was 64%, and the results showed that satisfaction was statistically significant in favor of the EHR/CPOE system. Conclusion: Using EHR/CPOE systems improves completeness of medical record and chemotherapy order documentation and improves user satisfaction with the medical record system. EHR/CPOE requires constant vigilance and maintenance to optimize patient safety. PMID:22043187

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

PubMed

Sujansky, Walter; Wilson, Tom

2015-04-01

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

Quadriplegic areflexic ICU illness: selective thick filament loss and normal nerve histology.

PubMed

Sander, Howard W; Golden, Marianna; Danon, Moris J

2002-10-01

Areflexic quadriplegia that occurs in the intensive care unit (ICU) is commonly ascribed to critical illness polyneuropathy based upon electrophysiology or muscle light microscopy. However, electron microscopy often documents a selective thick filament loss myopathy. Eight ICU patients who developed areflexic quadriplegia underwent biopsy. Seven patients had received steroids, and 2 had also received paralytic agents. Electrodiagnostic studies revealed absent or low-amplitude motor responses in 7. Sensory responses were normal in 5 of 6 and absent in 1. Initial electromyography revealed absent (n = 3), small (n = 3), or polyphasic (n = 1) motor unit potentials, and diffuse fibrillation potentials (n = 5). In all 8, light microscopy of muscle revealed numerous atrophic-angulated fibers and corelike lesions, and electron microscopy revealed extensive thick filament loss. Morphology of sural and intramuscular nerves, and, in one autopsied case, of the obturator nerve and multiple nerve roots, was normal. Although clinical, electrodiagnostic, and light microscopic features mimicked denervating disease, muscle electron microscopy revealed thick filament loss, and nerve histology was normal. This suggests that areflexic ICU quadriplegia is a primary myopathy and not an axonal polyneuropathy. Copyright 2002 Wiley Periodicals, Inc. Muscle Nerve 26: 499-505, 2002

7 CFR 900.41 - Electronic document submission standards.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 8 2012-01-01 2012-01-01 false Electronic document submission standards. 900.41... Agreements and Marketing Orders § 900.41 Electronic document submission standards. To the extent practicable.... Instructions for electronic filing shall be provided at the amendatory formal rulemaking hearing and in each...

7 CFR 900.41 - Electronic document submission standards.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 8 2011-01-01 2011-01-01 false Electronic document submission standards. 900.41... Agreements and Marketing Orders § 900.41 Electronic document submission standards. To the extent practicable.... Instructions for electronic filing shall be provided at the amendatory formal rulemaking hearing and in each...

7 CFR 900.41 - Electronic document submission standards.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 8 2014-01-01 2014-01-01 false Electronic document submission standards. 900.41... Agreements and Marketing Orders § 900.41 Electronic document submission standards. To the extent practicable.... Instructions for electronic filing shall be provided at the amendatory formal rulemaking hearing and in each...

7 CFR 900.41 - Electronic document submission standards.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Electronic document submission standards. 900.41... Agreements and Marketing Orders § 900.41 Electronic document submission standards. To the extent practicable.... Instructions for electronic filing shall be provided at the amendatory formal rulemaking hearing and in each...

7 CFR 900.41 - Electronic document submission standards.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 8 2013-01-01 2013-01-01 false Electronic document submission standards. 900.41... Agreements and Marketing Orders § 900.41 Electronic document submission standards. To the extent practicable.... Instructions for electronic filing shall be provided at the amendatory formal rulemaking hearing and in each...

43 CFR 45.12 - Where and how must documents be filed?

Code of Federal Regulations, 2011 CFR

2011-10-01

... documents be filed? (a) Place of filing. Any documents relating to a case under this subpart must be filed... sending the document by facsimile if: (A) The document is 20 pages or less, including all attachments; (B... is received. However, any document received after 5 p.m. at the place where the filing is due is...

43 CFR 45.12 - Where and how must documents be filed?

Code of Federal Regulations, 2010 CFR

2010-10-01

... documents be filed? (a) Place of filing. Any documents relating to a case under this subpart must be filed... sending the document by facsimile if: (A) The document is 20 pages or less, including all attachments; (B... is received. However, any document received after 5 p.m. at the place where the filing is due is...

25 CFR 559.7 - May a tribe submit documents required by this part electronically?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 2 2013-04-01 2013-04-01 false May a tribe submit documents required by this part... NOTIFICATIONS AND SUBMISSIONS § 559.7 May a tribe submit documents required by this part electronically? Yes. Tribes wishing to submit documents electronically should contact the Commission for guidance on...

25 CFR 559.7 - May a tribe submit documents required by this part electronically?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 2 2014-04-01 2014-04-01 false May a tribe submit documents required by this part... NOTIFICATIONS AND SUBMISSIONS § 559.7 May a tribe submit documents required by this part electronically? Yes. Tribes wishing to submit documents electronically should contact the Commission for guidance on...

17 CFR 232.401 - XBRL-Related Document submissions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... REGULATION S-T-GENERAL RULES AND REGULATIONS FOR ELECTRONIC FILINGS Xbrl-Related Documents § 232.401 XBRL-Related Document submissions. (a) Only an electronic filer that is an investment company registered under... XBRL-Related Documents relate; or, if the electronic filer is eligible to file a Form 8-K (§ 249.308 of...

17 CFR 232.401 - XBRL-Related Document submissions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... REGULATION S-T-GENERAL RULES AND REGULATIONS FOR ELECTRONIC FILINGS Xbrl-Related Documents § 232.401 XBRL-Related Document submissions. (a) Only an electronic filer that is an investment company registered under... XBRL-Related Documents relate; or, if the electronic filer is eligible to file a Form 8-K (§ 249.308 of...

17 CFR 232.401 - XBRL-Related Document submissions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... REGULATION S-T-GENERAL RULES AND REGULATIONS FOR ELECTRONIC FILINGS Xbrl-Related Documents § 232.401 XBRL-Related Document submissions. (a) Only an electronic filer that is an investment company registered under... XBRL-Related Documents relate; or, if the electronic filer is eligible to file a Form 8-K (§ 249.308 of...

17 CFR 232.401 - XBRL-Related Document submissions.

Code of Federal Regulations, 2013 CFR

2013-04-01

... REGULATION S-T-GENERAL RULES AND REGULATIONS FOR ELECTRONIC FILINGS Xbrl-Related Documents § 232.401 XBRL-Related Document submissions. (a) Only an electronic filer that is an investment company registered under... XBRL-Related Documents relate; or, if the electronic filer is eligible to file a Form 8-K (§ 249.308 of...

17 CFR 232.401 - XBRL-Related Document submissions.

Code of Federal Regulations, 2014 CFR

2014-04-01

... REGULATION S-T-GENERAL RULES AND REGULATIONS FOR ELECTRONIC FILINGS Xbrl-Related Documents § 232.401 XBRL-Related Document submissions. (a) Only an electronic filer that is an investment company registered under... XBRL-Related Documents relate; or, if the electronic filer is eligible to file a Form 8-K (§ 249.308 of...

Combined photon-electron beams in the treatment of the supraclavicular lymph nodes in breast cancer: A novel technique that achieves adequate coverage while reducing lung dose

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

Salem, Ahmed, E-mail: ahmed.salem@doctors.org.uk; Mohamad, Issa; Dayyat, Abdulmajeed

2015-10-01

Radiation pneumonitis is a well-documented side effect of radiation therapy for breast cancer. The purpose of this study was to compare combined photon-electron, photon-only, and electron-only plans in the radiation treatment of the supraclavicular lymph nodes. In total, 13 patients requiring chest wall and supraclavicular nodal irradiation were planned retrospectively using combined photon-electron, photon-only, and electron-only supraclavicular beams. A dose of 50 Gy over 25 fractions was prescribed. Chest wall irradiation parameters were fixed for all plans. The goal of this planning effort was to cover 95% of the supraclavicular clinical target volume (CTV) with 95% of the prescribed dosemore » and to minimize the volume receiving ≥ 105% of the dose. Comparative end points were supraclavicular CTV coverage (volume covered by the 95% isodose line), hotspot volume, maximum radiation dose, contralateral breast dose, mean total lung dose, total lung volume percentage receiving at least 20 Gy (V{sub 20} {sub Gy}), heart volume percentage receiving at least 25 Gy (V{sub 25} {sub Gy}). Electron and photon energies ranged from 8 to 18 MeV and 4 to 6 MV, respectively. The ratio of photon-to-electron fractions in combined beams ranged from 5:20 to 15:10. Supraclavicular nodal coverage was highest in photon-only (mean = 96.2 ± 3.5%) followed closely by combined photon-electron (mean = 94.2 ± 2.5%) and lowest in electron-only plans (mean = 81.7 ± 14.8%, p < 0.001). The volume of tissue receiving ≥ 105% of the prescription dose was higher in the electron-only (mean = 69.7 ± 56.1 cm{sup 3}) as opposed to combined photon-electron (mean = 50.8 ± 40.9 cm{sup 3}) and photon-only beams (mean = 32.2 ± 28.1 cm{sup 3}, p = 0.114). Heart V{sub 25} {sub Gy} was not statistically different among the plans (p = 0.999). Total lung V{sub 20} {sub Gy} was lowest in electron-only (mean = 10.9 ± 2.3%) followed by combined photon-electron (mean = 13.8 ± 2.3%) and highest in photon-only plans (mean = 16.2 ± 3%, p < 0.001). As expected, photon-only plans demonstrated the highest target coverage and total lung V{sub 20} {sub Gy}. The superiority of electron-only beams, in terms of decreasing lung dose, is set back by the dosimetric hotspots associated with such plans. Combined photon-electron treatment is a feasible technique for supraclavicular nodal irradiation and results in adequate target coverage, acceptable dosimetric hotspot volume, and slightly reduced lung dose.« less

The changes in caregivers' perceptions about the quality of information and benefits of nursing documentation associated with the introduction of an electronic documentation system in a nursing home.

PubMed

Munyisia, Esther N; Yu, Ping; Hailey, David

2011-02-01

To date few studies have compared nursing home caregivers' perceptions about the quality of information and benefits of nursing documentation in paper and electronic formats. With the increased interest in the use of information technology in nursing homes, it is important to obtain information on the benefits of newer approaches to nursing documentation so as to inform investment, organisational and care service decisions in the aged care sector. This study aims to investigate caregivers' perceptions about the quality of information and benefits of nursing documentation before and after the introduction of an electronic documentation system in a nursing home. A self-administered questionnaire survey was conducted three months before, and then six, 18 and 31 months after the introduction of an electronic documentation system. Further evidence was obtained through informal discussions with caregivers. Scores for questionnaire responses showed that the benefits of the electronic documentation system were perceived by the caregivers as provision of more accurate, legible and complete information, and reduction of repetition in data entry, with consequential managerial benefits. However, caregivers' perceptions of relevance and reliability of information, and of their communication and decision-making abilities were perceived to be similar either using an electronic or a paper-based documentation system. Improvement in some perceptions about the quality of information and benefits of nursing documentation was evident in the measurement conducted six months after the introduction of the electronic system, but were not maintained 18 or 31 months later. The electronic documentation system was perceived to perform better than the paper-based system in some aspects, with subsequent benefits to management of aged care services. In other areas, perceptions of additional benefits from the electronic documentation system were not maintained. In a number of attributes, there were similar perceptions on the two types of systems. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Back to the future: An online OSCE Management Information System for nursing OSCEs.

PubMed

Meskell, Pauline; Burke, Eimear; Kropmans, Thomas J B; Byrne, Evelyn; Setyonugroho, Winny; Kennedy, Kieran M

2015-11-01

The Objective Structured Clinical Examination (OSCE) is an established tool in the repertoire of clinical assessment methods in nurse education. The use of OSCEs facilitates the assessment of psychomotor skills as well as knowledge and attitudes. Identified benefits of OSCE assessment include development of students' confidence in their clinical skills and preparation for clinical practice. However, a number of challenges exist with the traditional paper methodology, including documentation errors and inadequate student feedback. To explore electronic OSCE delivery and evaluate the benefits of using an electronic OSCE management system. To explore assessors' perceptions of and attitudes to the computer based package. This study was conducted using electronic software in the management of a four station OSCE assessment with a cohort of first year undergraduate nursing students delivered over two consecutive years (n=203) in one higher education institution in Ireland. A quantitative descriptive survey methodology was used to obtain the views of the assessors on the process and outcome of using the software. OSCE documentation was converted to electronic format. Assessors were trained in the use of the OSCE management software package and laptops were procured to facilitate electronic management of the OSCE assessment. Following the OSCE assessment, assessors were invited to evaluate the experience. Electronic software facilitated the storage and analysis of overall group and individual results thereby offering considerable time savings. Submission of electronic forms was allowed only when fully completed thus removing the potential for missing data. The feedback facility allowed the student to receive timely evaluation on their performance and to benchmark their performance against the class. Assessors' satisfaction with the software was high. Analysis of assessment results can highlight issues around internal consistency being moderate and examiners variability. Regression analysis increases fairness of result calculations. Copyright © 2015. Published by Elsevier Ltd.

Anthrax vaccination in the Millennium Cohort: validation and measures of health.

PubMed

Smith, Besa; Leard, Cynthia A; Smith, Tyler C; Reed, Robert J; Ryan, Margaret A K

2007-04-01

In 1998, the United States Department of Defense initiated the Anthrax Vaccine Immunization Program. Concerns about vaccine-related adverse health effects followed, prompting several studies. Although some studies used self-reported vaccination data, the reliability of such data has not been established. The purpose of this study was to compare self-reported anthrax vaccination to electronic vaccine records among a large military cohort and to evaluate the relationship between vaccine history and health outcome data. Between September 2005 and February 2006 self-reported anthrax vaccination was compared to electronic records for 67,018 participants enrolled in the Millennium Cohort Study between 2001 and 2003 using kappa statistics. Multivariable modeling investigated vaccination concordance as it pertains to subjective health (functional status) and objective health (hospitalization) metrics. Greater than substantial agreement (kappa=0.80) was found between self-report and electronic recording of anthrax vaccination. Of all participants with electronic documentation of anthrax vaccination, 98% self-reported being vaccinated; and of all participants with no electronic record of vaccination, 90% self-reported not receiving a vaccination. There were no differences between vaccinated and unvaccinated participants in overall measures of health. Only the subset of participants who self-reported anthrax vaccination, but had no electronic confirmation, differed from others in the cohort, with consistently lower measures of health as indicated by Medical Outcomes Study 36-Item Short Form Health Survey for Veterans (SF-36V) scores. These results indicate that military members accurately recall their anthrax vaccinations. Results also suggest that anthrax vaccination among Millennium Cohort participants is not associated with self-reported health problems or broad measures of health problems severe enough to require hospitalization. Service members who self-report vaccination with no electronic documentation of vaccination, however, report lower measures of physical and mental health and deserve further research.

Staff experiences within the implementation of computer-based nursing records in residential aged care facilities: a systematic review and synthesis of qualitative research.

PubMed

Meißner, Anne; Schnepp, Wilfried

2014-06-20

Since the introduction of electronic nursing documentation systems, its implementation in recent years has increased rapidly in Germany. The objectives of such systems are to save time, to improve information handling and to improve quality. To integrate IT in the daily working processes, the employee is the pivotal element. Therefore it is important to understand nurses' experience with IT implementation. At present the literature shows a lack of understanding exploring staff experiences within the implementation process. A systematic review and meta-ethnographic synthesis of primary studies using qualitative methods was conducted in PubMed, CINAHL, and Cochrane. It adheres to the principles of the PRISMA statement. The studies were original, peer-reviewed articles from 2000 to 2013, focusing on computer-based nursing documentation in Residential Aged Care Facilities. The use of IT requires a different form of information processing. Some experience this new form of information processing as a benefit while others do not. The latter find it more difficult to enter data and this result in poor clinical documentation. Improvement in the quality of residents' records leads to an overall improvement in the quality of care. However, if the quality of those records is poor, some residents do not receive the necessary care. Furthermore, the length of time necessary to complete the documentation is a prominent theme within that process. Those who are more efficient with the electronic documentation demonstrate improved time management. For those who are less efficient with electronic documentation the information processing is perceived as time consuming. Normally, it is possible to experience benefits when using IT, but this depends on either promoting or hindering factors, e.g. ease of use and ability to use it, equipment availability and technical functionality, as well as attitude. In summary, the findings showed that members of staff experience IT as a benefit when it simplifies their daily working routines and as a burden when it complicates their working processes. Whether IT complicates or simplifies their routines depends on influencing factors. The line between benefit and burden is semipermeable. The experiences differ according to duties and responsibilities.

Relationships between public health nurse-delivered physical activity interventions and client physical activity behavior.

PubMed

Olsen, Jeanette M; Horning, Melissa L; Thorson, Diane; Monsen, Karen A

2018-04-01

The purpose of this study was to identify physical activity interventions delivered by public health nurses (PHNs) and examine their association with physical activity behavior change among adult clients. Physical activity is a public health priority, yet little is known about nurse-delivered physical activity interventions in day-to-day practice or their outcomes. This quantitative retrospective evaluation examined de-identified electronic-health-record data. Adult clients with at least two Omaha System Physical activity Knowledge, Behavior, and Status (KBS) ratings documented by PHNs between October 2010-June 2016 (N=419) were included. Omaha System baseline and follow-up Physical activity KBS ratings, interventions, and demographics were examined. Younger clients typically receiving maternal-child/family services were more likely to receive interventions than older clients (p<0.001). A total of 2869 Physical activity interventions were documented among 197 clients. Most were from categories of Teaching, Guidance, Counseling (n=1639) or Surveillance (n=1183). Few were Case Management (n=46). Hierarchical regression modeling explained 15.4% of the variance for change in Physical activity Behavior rating with significant influence from intervention dose (p=0.03) and change in Physical activity Knowledge (p<0.001). This study identified and described physical activity interventions delivered by PHNs. Implementation of department-wide policy requiring documentation of Physical activity assessment for all clients enabled the evaluation. A higher dose of physical activity interventions and increased Physical activity knowledge were associated with increased Physical activity Behavior. More research is needed to identify factors influencing who receives interventions and how interventions are selected. Copyright © 2017 Elsevier Inc. All rights reserved.

Applying language technology to nursing documents: pros and cons with a focus on ethics.

PubMed

Suominen, Hanna; Lehtikunnas, Tuija; Back, Barbro; Karsten, Helena; Salakoski, Tapio; Salanterä, Sanna

2007-10-01

The present study discusses ethics in building and using applications based on natural language processing in electronic nursing documentation. Specifically, we first focus on the question of how patient confidentiality can be ensured in developing language technology for the nursing documentation domain. Then, we identify and theoretically analyze the ethical outcomes which arise when using natural language processing to support clinical judgement and decision-making. In total, we put forward and justify 10 claims related to ethics in applying language technology to nursing documents. A review of recent scientific articles related to ethics in electronic patient records or in the utilization of large databases was conducted. Then, the results were compared with ethical guidelines for nurses and the Finnish legislation covering health care and processing of personal data. Finally, the practical experiences of the authors in applying the methods of natural language processing to nursing documents were appended. Patient records supplemented with natural language processing capabilities may help nurses give better, more efficient and more individualized care for their patients. In addition, language technology may facilitate patients' possibility to receive truthful information about their health and improve the nature of narratives. Because of these benefits, research about the use of language technology in narratives should be encouraged. In contrast, privacy-sensitive health care documentation brings specific ethical concerns and difficulties to the natural language processing of nursing documents. Therefore, when developing natural language processing tools, patient confidentiality must be ensured. While using the tools, health care personnel should always be responsible for the clinical judgement and decision-making. One should also consider that the use of language technology in nursing narratives may threaten patients' rights by using documentation collected for other purposes. Applying language technology to nursing documents may, on the one hand, contribute to the quality of care, but, on the other hand, threaten patient confidentiality. As an overall conclusion, natural language processing of nursing documents holds the promise of great benefits if the potential risks are taken into consideration.

Methods, media, and systems for detecting attack on a digital processing device

DOEpatents

Stolfo, Salvatore J.; Li, Wei-Jen; Keromylis, Angelos D.; Androulaki, Elli

2014-07-22

Methods, media, and systems for detecting attack are provided. In some embodiments, the methods include: comparing at least part of a document to a static detection model; determining whether attacking code is included in the document based on the comparison of the document to the static detection model; executing at least part of the document; determining whether attacking code is included in the document based on the execution of the at least part of the document; and if attacking code is determined to be included in the document based on at least one of the comparison of the document to the static detection model and the execution of the at least part of the document, reporting the presence of an attack. In some embodiments, the methods include: selecting a data segment in at least one portion of an electronic document; determining whether the arbitrarily selected data segment can be altered without causing the electronic document to result in an error when processed by a corresponding program; in response to determining that the arbitrarily selected data segment can be altered, arbitrarily altering the data segment in the at least one portion of the electronic document to produce an altered electronic document; and determining whether the corresponding program produces an error state when the altered electronic document is processed by the corresponding program.

Methods, media, and systems for detecting attack on a digital processing device

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

Stolfo, Salvatore J.; Li, Wei-Jen; Keromytis, Angelos D.

Methods, media, and systems for detecting attack are provided. In some embodiments, the methods include: comparing at least part of a document to a static detection model; determining whether attacking code is included in the document based on the comparison of the document to the static detection model; executing at least part of the document; determining whether attacking code is included in the document based on the execution of the at least part of the document; and if attacking code is determined to be included in the document based on at least one of the comparison of the document tomore » the static detection model and the execution of the at least part of the document, reporting the presence of an attack. In some embodiments, the methods include: selecting a data segment in at least one portion of an electronic document; determining whether the arbitrarily selected data segment can be altered without causing the electronic document to result in an error when processed by a corresponding program; in response to determining that the arbitrarily selected data segment can be altered, arbitrarily altering the data segment in the at least one portion of the electronic document to produce an altered electronic document; and determining whether the corresponding program produces an error state when the altered electronic document is processed by the corresponding program.« less

XML and its impact on content and structure in electronic health care documents.

PubMed Central

Sokolowski, R.; Dudeck, J.

1999-01-01

Worldwide information networks have the requirement that electronic documents must be easily accessible, portable, flexible and system-independent. With the development of XML (eXtensible Markup Language), the future of electronic documents, health care informatics and the Web itself are about to change. The intent of the recently formed ASTM E31.25 subcommittee, "XML DTDs for Health Care", is to develop standard electronic document representations of paper-based health care documents and forms. A goal of the subcommittee is to work together to enhance existing levels of interoperability among the various XML/SGML standardization efforts, products and systems in health care. The ASTM E31.25 subcommittee uses common practices and software standards to develop the implementation recommendations for XML documents in health care. The implementation recommendations are being developed to standardize the many different structures of documents. These recommendations are in the form of a set of standard DTDs, or document type definitions that match the electronic document requirements in the health care industry. This paper discusses recent efforts of the ASTM E31.25 subcommittee. PMID:10566338

SGML and HTML: The Merging of Document Management and Electronic Document Publishing.

ERIC Educational Resources Information Center

Dixon, Ross

1996-01-01

Document control is an issue for organizations that use SGML/HTML. The prevalent approach is to apply the same techniques to document elements that are applied to full documents, a practice that has led to an overlap of electronic publishing and document management. Lists requirements for the management of SGML/HTML documents. (PEN)

Facing the Limitations of Electronic Document Handling.

ERIC Educational Resources Information Center

Moralee, Dennis

1985-01-01

This essay addresses problems associated with technology used in the handling of high-resolution visual images in electronic document delivery. Highlights include visual fidelity, laser-driven optical disk storage, electronics versus micrographics for document storage, videomicrographics, and system configurations and peripherals. (EJS)

76 FR 411 - Regulatory Guidance Concerning Electronic Signatures and Documents

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-04

... Concerning Electronic Signatures and Documents AGENCY: Federal Motor Carrier Safety Administration (FMCSA), DOT. ACTION: Notice of regulatory guidance. SUMMARY: FMCSA issues regulatory guidance concerning the... regulatory guidance concerning the use of electronic signatures and documents to comply with FMCSA...

4 CFR 201.3 - Publicly available documents and electronic reading room.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 4 Accounts 1 2011-01-01 2011-01-01 false Publicly available documents and electronic reading room. 201.3 Section 201.3 Accounts RECOVERY ACCOUNTABILITY AND TRANSPARENCY BOARD PUBLIC INFORMATION AND REQUESTS § 201.3 Publicly available documents and electronic reading room. (a) Many Board records are available electronically at the Board's Web sit...

4 CFR 201.3 - Publicly available documents and electronic reading room.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 4 Accounts 1 2012-01-01 2012-01-01 false Publicly available documents and electronic reading room. 201.3 Section 201.3 Accounts RECOVERY ACCOUNTABILITY AND TRANSPARENCY BOARD PUBLIC INFORMATION AND REQUESTS § 201.3 Publicly available documents and electronic reading room. (a) Many Board records are available electronically at the Board's Web sit...

4 CFR 201.3 - Publicly available documents and electronic reading room.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 4 Accounts 1 2013-01-01 2013-01-01 false Publicly available documents and electronic reading room. 201.3 Section 201.3 Accounts RECOVERY ACCOUNTABILITY AND TRANSPARENCY BOARD PUBLIC INFORMATION AND REQUESTS § 201.3 Publicly available documents and electronic reading room. (a) Many Board records are available electronically at the Board's Web sit...

4 CFR 201.3 - Publicly available documents and electronic reading room.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 4 Accounts 1 2014-01-01 2013-01-01 true Publicly available documents and electronic reading room. 201.3 Section 201.3 Accounts RECOVERY ACCOUNTABILITY AND TRANSPARENCY BOARD PUBLIC INFORMATION AND REQUESTS § 201.3 Publicly available documents and electronic reading room. (a) Many Board records are available electronically at the Board's Web site...

10 CFR 2.302 - Filing of documents.

Code of Federal Regulations, 2012 CFR

2012-01-01

... electronic documents. The exempt participant is permitted to file electronic documents by physically... 10 Energy 1 2012-01-01 2012-01-01 false Filing of documents. 2.302 Section 2.302 Energy NUCLEAR... General Applicability: Hearing Requests, Petitions To Intervene, Availability of Documents, Selection of...

10 CFR 2.302 - Filing of documents.

Code of Federal Regulations, 2011 CFR

2011-01-01

... electronic documents. The exempt participant is permitted to file electronic documents by physically... 10 Energy 1 2011-01-01 2011-01-01 false Filing of documents. 2.302 Section 2.302 Energy NUCLEAR... General Applicability: Hearing Requests, Petitions To Intervene, Availability of Documents, Selection of...

Documentation of pain care processes does not accurately reflect pain management delivered in primary care.

PubMed

Krebs, Erin E; Bair, Matthew J; Carey, Timothy S; Weinberger, Morris

2010-03-01

Researchers and quality improvement advocates sometimes use review of chart-documented pain care processes to assess the quality of pain management. Studies have found that primary care providers frequently fail to document pain assessment and management. To assess documentation of pain care processes in an academic primary care clinic and evaluate the validity of this documentation as a measure of pain care delivered. Prospective observational study. 237 adult patients at a university-affiliated internal medicine clinic who reported any pain in the last week. Immediately after a visit, we asked patients to report the pain treatment they received. Patients completed the Brief Pain Inventory (BPI) to assess pain severity at baseline and 1 month later. We extracted documentation of pain care processes from the medical record and used kappa statistics to assess agreement between documentation and patient report of pain treatment. Using multivariable linear regression, we modeled whether documented or patient-reported pain care predicted change in pain at 1 month. Participants' mean age was 53.7 years, 66% were female, and 74% had chronic pain. Physicians documented pain assessment for 83% of visits. Patients reported receiving pain treatment more often (67%) than was documented by physicians (54%). Agreement between documentation and patient report was moderate for receiving a new pain medication (k = 0.50) and slight for receiving pain management advice (k = 0.13). In multivariable models, documentation of new pain treatment was not associated with change in pain (p = 0.134). In contrast, patient-reported receipt of new pain treatment predicted pain improvement (p = 0.005). Chart documentation underestimated pain care delivered, compared with patient report. Documented pain care processes had no relationship with pain outcomes at 1 month, but patient report of receiving care predicted clinically significant improvement. Chart review measures may not accurately reflect the pain management patients receive in primary care.

Critical issues in an electronic documentation system.

PubMed

Weir, Charlene R; Nebeker, Jonathan R

2007-10-11

The Veterans Health Administration (VHA), of the U.S. Department of Veteran Affairs has instituted a medical record (EMR) that includes electronic documentation of all narrative components of the medical record. To support clinicians using the system, multiple efforts have been instituted to ease the creation of narrative reports. Although electronic documentation is easier to read and improves access to information, it also may create new and additional hazards for users. This study is the first step in a series of studies to evaluate the issues surrounding the creation and use of electronic documentation. Eighty-eight providers across multiple clinical roles were interviewed in 10 primary care sites in the VA system. Interviews were tape-recorded, transcribed and qualitatively analyzed for themes. In addition, specific questions were asked about perceived harm due to electronic documentation practices. Five themes relating to difficulties with electronic documentation were identified: 1) information overload; 2) hidden information; 3) lack of trust; 4) communication; 5) decision-making. Three providers reported that they knew of an incident where current documentation practices had caused patient harm and over 75% of respondents reported significant mis-trust of the system.

Rapid Implementation of Inpatient Electronic Physician Documentation at an Academic Hospital

PubMed Central

Hahn, J.S.; Bernstein, J.A.; McKenzie, R.B.; King, B.J.; Longhurst, C.A.

2012-01-01

Electronic physician documentation is an essential element of a complete electronic medical record (EMR). At Lucile Packard Children’s Hospital, a teaching hospital affiliated with Stanford University, we implemented an inpatient electronic documentation system for physicians over a 12-month period. Using an EMR-based free-text editor coupled with automated import of system data elements, we were able to achieve voluntary, widespread adoption of the electronic documentation process. When given the choice between electronic versus dictated report creation, the vast majority of users preferred the electronic method. In addition to increasing the legibility and accessibility of clinical notes, we also decreased the volume of dictated notes and scanning of handwritten notes, which provides the opportunity for cost savings to the institution. PMID:23620718

A systematic approach to baseline assessment of nursing documentation and enterprise-wide prioritization for electronic conversion.

PubMed

Dykes, Patricia C; Spurr, Cindy; Gallagher, Joan; Li, Qi; Ives Erickson, Jeanette

2006-01-01

An important challenge associated with making the transition from paper to electronic documentation systems is achieving consensus regarding priorities for electronic conversion across diverse groups. In our work we focus on applying a systematic approach to evaluating the baseline state of nursing documentation across a large healthcare system and establishing a unified vision for electronic conversion. A review of the current state of nursing documentation across PHS was conducted using structured tools. Data from this assessment was employed to facilitate an evidence-based approach to decision-making regarding conversion to electronic documentation at local and PHS levels. In this paper we present highlights of the assessment process and the outcomes of this multi-site collaboration.

7 CFR 735.401 - Electronic warehouse receipt and USWA electronic document providers.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 7 2013-01-01 2013-01-01 false Electronic warehouse receipt and USWA electronic... UNITED STATES WAREHOUSE ACT Electronic Providers § 735.401 Electronic warehouse receipt and USWA electronic document providers. (a) To establish a USWA-authorized system to issue and transfer EWR's and USWA...

7 CFR 735.401 - Electronic warehouse receipt and USWA electronic document providers.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 7 2014-01-01 2014-01-01 false Electronic warehouse receipt and USWA electronic... UNITED STATES WAREHOUSE ACT Electronic Providers § 735.401 Electronic warehouse receipt and USWA electronic document providers. (a) To establish a USWA-authorized system to issue and transfer EWR's and USWA...

7 CFR 735.401 - Electronic warehouse receipt and USWA electronic document providers.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 7 2010-01-01 2010-01-01 false Electronic warehouse receipt and USWA electronic... UNITED STATES WAREHOUSE ACT Electronic Providers § 735.401 Electronic warehouse receipt and USWA electronic document providers. (a) To establish a USWA-authorized system to issue and transfer EWR's and USWA...

7 CFR 735.401 - Electronic warehouse receipt and USWA electronic document providers.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 7 2012-01-01 2012-01-01 false Electronic warehouse receipt and USWA electronic... UNITED STATES WAREHOUSE ACT Electronic Providers § 735.401 Electronic warehouse receipt and USWA electronic document providers. (a) To establish a USWA-authorized system to issue and transfer EWR's and USWA...

7 CFR 735.401 - Electronic warehouse receipt and USWA electronic document providers.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 7 2011-01-01 2011-01-01 false Electronic warehouse receipt and USWA electronic... UNITED STATES WAREHOUSE ACT Electronic Providers § 735.401 Electronic warehouse receipt and USWA electronic document providers. (a) To establish a USWA-authorized system to issue and transfer EWR's and USWA...

GUI-Based Document Access via SATCOMMS: Online Electronic Document Retrieval at the European Telecommunications Satellite Organization EUTELSAT.

ERIC Educational Resources Information Center

Burton, Adrian P.

1995-01-01

Discusses accessing online electronic documents at the European Telecommunications Satellite Organization (EUTELSAT). Highlights include off-site paper document storage, the document management system, benefits, the EUTELSAT Standard IBM Access software, implementation, the development process, and future enhancements. (AEF)

Script identification from images using cluster-based templates

DOEpatents

Hochberg, J.G.; Kelly, P.M.; Thomas, T.R.

1998-12-01

A computer-implemented method identifies a script used to create a document. A set of training documents for each script to be identified is scanned into the computer to store a series of exemplary images representing each script. Pixels forming the exemplary images are electronically processed to define a set of textual symbols corresponding to the exemplary images. Each textual symbol is assigned to a cluster of textual symbols that most closely represents the textual symbol. The cluster of textual symbols is processed to form a representative electronic template for each cluster. A document having a script to be identified is scanned into the computer to form one or more document images representing the script to be identified. Pixels forming the document images are electronically processed to define a set of document textual symbols corresponding to the document images. The set of document textual symbols is compared to the electronic templates to identify the script. 17 figs.

Script identification from images using cluster-based templates

DOEpatents

Hochberg, Judith G.; Kelly, Patrick M.; Thomas, Timothy R.

1998-01-01

A computer-implemented method identifies a script used to create a document. A set of training documents for each script to be identified is scanned into the computer to store a series of exemplary images representing each script. Pixels forming the exemplary images are electronically processed to define a set of textual symbols corresponding to the exemplary images. Each textual symbol is assigned to a cluster of textual symbols that most closely represents the textual symbol. The cluster of textual symbols is processed to form a representative electronic template for each cluster. A document having a script to be identified is scanned into the computer to form one or more document images representing the script to be identified. Pixels forming the document images are electronically processed to define a set of document textual symbols corresponding to the document images. The set of document textual symbols is compared to the electronic templates to identify the script.

Lesson 5: Defining Valid Electronic Signatures

EPA Pesticide Factsheets

A valid electronic signature on an electronic document is one that is created with an electronic signature device that is uniquely entitled to a signatory, not compromised, and used by a signatory who is authorized to sign the electronic document.

Electronic Document Management Using Inverted Files System

NASA Astrophysics Data System (ADS)

Suhartono, Derwin; Setiawan, Erwin; Irwanto, Djon

2014-03-01

The amount of documents increases so fast. Those documents exist not only in a paper based but also in an electronic based. It can be seen from the data sample taken by the SpringerLink publisher in 2010, which showed an increase in the number of digital document collections from 2003 to mid of 2010. Then, how to manage them well becomes an important need. This paper describes a new method in managing documents called as inverted files system. Related with the electronic based document, the inverted files system will closely used in term of its usage to document so that it can be searched over the Internet using the Search Engine. It can improve document search mechanism and document save mechanism.

Evaluation of Measles-Mumps-Rubella Vaccination Among Newly Arrived Refugees.

PubMed

Lee, Deborah; Weinberg, Michelle; Benoit, Stephen

2017-05-01

To assess US availability and use of measles-mumps-rubella (MMR) vaccination documentation for refugees vaccinated overseas. We selected 1500 refugee records from 14 states from March 2013 through July 2015 to determine whether overseas vaccination records were available at the US postarrival health assessment and integrated into the Advisory Committee on Immunization Practices schedule. We assessed number of doses, dosing interval, and contraindications. Twelve of 14 (85.7%) states provided data on 1118 (74.5%) refugees. Overseas records for 972 (86.9%) refugees were available, most from the Centers for Disease Control and Prevention's Electronic Disease Notification system (66.9%). Most refugees (829; 85.3%) were assessed appropriately for MMR vaccination; 37 (3.8%) should have received MMR vaccine but did not; 106 (10.9%) did not need the MMR vaccine but were vaccinated. Overseas documentation was available at most clinics, and MMR vaccinations typically were given when needed. Further collaboration between refugee health clinics and state immunization information systems would improve accessibility of vaccination documentation.

Secure content objects

DOEpatents

Evans, William D [Cupertino, CA

2009-02-24

A secure content object protects electronic documents from unauthorized use. The secure content object includes an encrypted electronic document, a multi-key encryption table having at least one multi-key component, an encrypted header and a user interface device. The encrypted document is encrypted using a document encryption key associated with a multi-key encryption method. The encrypted header includes an encryption marker formed by a random number followed by a derivable variation of the same random number. The user interface device enables a user to input a user authorization. The user authorization is combined with each of the multi-key components in the multi-key encryption key table and used to try to decrypt the encrypted header. If the encryption marker is successfully decrypted, the electronic document may be decrypted. Multiple electronic documents or a document and annotations may be protected by the secure content object.

25 CFR 1000.69 - How can a Tribe/Consortium obtain comments or selection documents received or utilized after OSG...

Code of Federal Regulations, 2010 CFR

2010-04-01

...-DETERMINATION AND EDUCATION ACT Other Financial Assistance for Planning and Negotiation Grants for Non-BIA... documents received or utilized after OSG has made a decision on a planning grant application? 1000.69... selection documents received or utilized after OSG has made a decision on a planning grant application? A...

The Electronic Documentation Project in the NASA mission control center environment

NASA Technical Reports Server (NTRS)

Wang, Lui; Leigh, Albert

1994-01-01

NASA's space programs like many other technical programs of its magnitude is supported by a large volume of technical documents. These documents are not only diverse but also abundant. Management, maintenance, and retrieval of these documents is a challenging problem by itself; but, relating and cross-referencing this wealth of information when it is all on a medium of paper is an even greater challenge. The Electronic Documentation Project (EDP) is to provide an electronic system capable of developing, distributing and controlling changes for crew/ground controller procedures and related documents. There are two primary motives for the solution. The first motive is to reduce the cost of maintaining the current paper based method of operations by replacing paper documents with electronic information storage and retrieval. And, the other is to improve the efficiency and provide enhanced flexibility in document usage. Initially, the current paper based system will be faithfully reproduced in an electronic format to be used in the document viewing system. In addition, this metaphor will have hypertext extensions. Hypertext features support basic functions such as full text searches, key word searches, data retrieval, and traversal between nodes of information as well as speeding up the data access rate. They enable related but separate documents to have relationships, and allow the user to explore information naturally through non-linear link traversals. The basic operational requirements of the document viewing system are to: provide an electronic corollary to the current method of paper based document usage; supplement and ultimately replace paper-based documents; maintain focused toward control center operations such as Flight Data File, Flight Rules and Console Handbook viewing; and be available NASA wide.

As-received microstructure of a SiC/Ti-15-3 composite

NASA Technical Reports Server (NTRS)

Lerch, Bradley A.; Hull, David R.; Leonhardt, Todd A.

1988-01-01

A silicon carbide fiber reinforced titanium (Ti-15V-3Cr-3Sn-3Al) composite is metallographically examined. Several methods for examining composite materials are investigated and documented. Polishing techniques for this material are described. An interference layering method is developed to reveal the structure of the fiber, the reaction zone, and various phases within the matrix. Microprobe and transmission electron microscope (TEM) analyses are performed on the fiber/matrix interface. A detailed description of the fiber distribution as well as the microstructure of the fiber and matrix are presented.

78 FR 79708 - Notice of Receipt of Complaint; Solicitation of Comments Relating to the Public Interest

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-31

... accessed on the Commission's Electronic Document Information System (EDIS) at EDIS,\\1\\ and will be...-2000. \\1\\ Electronic Document Information System (EDIS): http://edis.usitc.gov . General information... the Commission's Electronic Document Information System (EDIS) at EDIS.\\3\\ Hearing-impaired persons...

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

PubMed

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

2016-03-01

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

Development of a Cancer Care Summary Through the Electronic Health Record.

PubMed

Carr, Laurie L; Zelarney, Pearlanne; Meadows, Sarah; Kern, Jeffrey A; Long, M Bronwyn; Kern, Elizabeth

2016-02-01

Our objective was to improve communication concerning lung cancer patients by developing and distributing a Cancer Care Summary that would provide clinically useful information about the patient's diagnosis and care to providers in diverse settings. We designed structured, electronic forms for the electronic health record (EHR), detailing tumor staging, classification, and treatment. To ensure completeness and accuracy of the information, we implemented a data quality cycle, composed of reports that are reviewed by oncology clinicians. The data from the EHR forms are extracted into a structured query language database system on a daily basis, from which the Summaries are derived. We conducted focus groups regarding the utility, format, and content of the Summary. Cancer Care Summaries are automatically generated 4 months after a patient's date of diagnosis, then every 6 months for those receiving treatment, and on an as-needed basis for urgent care or hospital admission. The product of our improvement project is the Cancer Care Summary. To date, 102 individual patient Summaries have been generated. These documents are automatically entered into the National Jewish Health (NJH) EHR, attached to correspondence to primary care providers, available to patients as electronic documents on the NJH patient portal, and faxed to emergency departments and admitting physicians on patient evaluation. We developed a sustainable tool to improve cancer care communication. The Cancer Care Summary integrates information from the EHR in a timely manner and distributes the information through multiple avenues. Copyright © 2016 by American Society of Clinical Oncology.

Using an electronic medical record to improve communication within a prenatal care network.

PubMed

Bernstein, Peter S; Farinelli, Christine; Merkatz, Irwin R

2005-03-01

In 2002, the Institute of Medicine called for the introduction of information technologies in health care settings to improve quality of care. We conducted a review of hospital charts of women who delivered before and after the implementation of an intranet-based computerized prenatal record in an inner-city practice. Our objective was to assess whether the use of this record improved communication among the outpatient office, the ultrasonography unit, and the labor floor. The charts of patients who delivered in August 2002 and August 2003 and received their prenatal care at the Comprehensive Family Care Center at Montefiore Medical Center were analyzed. Data collected included the presence of a copy of the prenatal record in the hospital chart, the date of the last documented prenatal visit, and documentation of any prenatal ultrasonograms performed. Forty-three charts in each group were available for review. The prenatal chart was absent in 16% of the charts of patients from August 2002 compared with only 2% in August 2003 charts (P < .05). Among charts with prenatal records available, the median length of time between the last documented prenatal visit and delivery was significantly longer for August 2002 patients compared with August 2003 patients (36 compared with 4 days, respectively, P < .001). All patients received prenatal ultrasonograms, but documentation of the ultrasonogram was missing from 16% of the August 2002 charts compared with none of the August 2003 charts (P = .01). The use of a paperless, hospital intranet-based prenatal chart significantly improves communication among providers.

The digital curriculum vitae.

PubMed

Galdino, Greg M; Gotway, Michael

2005-02-01

The curriculum vitae (CV) has been the traditional method for radiologists to illustrate their accomplishments in the field of medicine. Despite its presence in medicine as a standard, widely accepted means to describe one's professional career and its use for decades as an accomplice to most applications and interviews, there is relatively little written in the medical literature regarding the CV. Misrepresentation on medical students', residents', and fellows' applications has been reported. Using digital technology, CVs have the potential to be much more than printed words on paper and offers a solution to misrepresentation. Digital CVs may incorporate full-length articles, graphics, presentations, clinical images, and video. Common formats for digital CVs include CD-ROMs or DVD-ROMs containing articles (in Adobe Portable Document Format) and presentations (in Microsoft PowerPoint format) accompanying printed CVs, word processing documents with hyperlinks to articles and presentations either locally (on CD-ROMs or DVD-ROMs) or remotely (via the Internet), or hypertext markup language documents. Digital CVs afford the ability to provide more information that is readily accessible to those receiving and reviewing them. Articles, presentations, videos, images, and Internet links can be illustrated using standard file formats commonly available to all radiologists. They can be easily updated and distributed on an inexpensive media, such as a CD-ROM or DVD-ROM. With the availability of electronic articles, presentations, and information via the Internet, traditional paper CVs may soon be superseded by their electronic successors.

76 FR 1173 - Draft Guidance for Industry on Electronic Source Documentation in Clinical Investigations...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-07

...] Draft Guidance for Industry on Electronic Source Documentation in Clinical Investigations; Availability... Documentation in Clinical Investigations.'' This document provides guidance to sponsors, contract research organizations (CROs), data management centers, and clinical investigators on capturing, using, and archiving...

Comparison of provider-documented and patient-reported brief intervention for unhealthy alcohol use in VA outpatients.

PubMed

Lapham, Gwen T; Rubinsky, Anna D; Shortreed, Susan M; Hawkins, Eric J; Richards, Julie; Williams, Emily C; Berger, Douglas; Chavez, Laura J; Kivlahan, Daniel R; Bradley, Katharine A

2015-08-01

Performance measures for brief alcohol interventions (BIs) are currently based on provider documentation of BI. However, provider documentation may not be a reliable measure of whether or not patients are offered clinically meaningful BIs. In particular, BI documented with clinical decision support in an electronic medical record (EMR) could appear identical irrespective of the quality of BI provided. We hypothesized that differences in how BI was implemented across health systems could lead to differences in the proportion of documented BI recalled and reported by patients across health systems. Male outpatients with unhealthy alcohol use identified by confidential satisfaction surveys (2009-2012) were assessed for whether they reported receiving BI in the past year (patient-reported BI) and whether they had BI documented in the EMR during the same period (documented BI). We evaluated and compared the prevalence of documented BI to patient-reported BI across 21 VA networks to determine whether documented BI had a variable association with patient-reported BI across the networks. Of 9896 eligible male outpatients with unhealthy alcohol use, 59.0% (95% CI 57.4-60.5%) reported BI (50.4-64.9% across networks) and 37.4% (95% CI 36.0-38.9%) had BI documented in the EMR (28.0-44.2% across networks). Overall, 72.9% (95% CI 70.8-75.5%) of patients with documented BI also reported BI. The association between documented BI and patient-reported BI did not vary across VA networks in adjusted logistic regression models. Performance measures of BI that rely on provider documentation in EMRs appear comparable to patient report for comparing care across VA networks. Published by Elsevier Ireland Ltd.

75 FR 32984 - Policy on the Retention of Supporting Documents and the Use of Electronic Mobile Communication...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-10

...-0168] Policy on the Retention of Supporting Documents and the Use of Electronic Mobile Communication/Tracking Technology in Assessing Motor Carriers' and Commercial Motor Vehicle Drivers' Compliance With the... changes regarding the retention of supporting documents and the use of electronic mobile communication...

Correlates of human papillomavirus vaccination rates in low-income, minority adolescents: a multicenter study.

PubMed

Perkins, Rebecca B; Brogly, Susan B; Adams, William G; Freund, Karen M

2012-08-01

Low rates of human papillomavirus (HPV) vaccination in low-income, minority adolescents may exacerbate racial disparities in cervical cancer incidence. Using electronic medical record data and chart abstraction, we examined correlates of HPV vaccine series initiation and completion among 7702 low-income and minority adolescents aged 11-21 receiving primary care at one of seven medical centers between May 1, 2007, and June 30, 2009. Our population included 61% African Americans, 13% Caucasians, 15% Latinas, and 11% other races; 90% receive public insurance (e.g., Medicaid). We used logistic regression to estimate the associations between vaccine initiation and completion and age, race/ethnicity, number of contacts with the healthcare system, provider documentation, and clinical site of care. Of the 41% of adolescent girls who initiated HPV vaccination, 20% completed the series. A higher proportion of girls aged 11-<13 (46%) and 13-<18 (47%) initiated vaccination than those aged 18-21 (28%). In adjusted analyses, receipt of other recommended adolescent vaccines was associated with vaccine initiation, and increased contact with the medical system was associated with both initiation and completion of the series. Conversely, provider failure to document risky health behaviors predicted nonvaccination. Manual review of a subset of unvaccinated patients' charts revealed no documentation of vaccine discussions in 67% of cases. Fewer than half of low-income and minority adolescents receiving health maintenance services initiated HPV vaccination, and only 20% completed the series. Provider failure to discuss vaccination with their patients appears to be an important contributor to nonvaccination. Future research should focus on improving both initiation and completion of HPV vaccination in high-risk adolescents.

The Ocean Tracking Network and its contribution to ocean biological observation

NASA Astrophysics Data System (ADS)

Whoriskey, F. G.

2016-02-01

Animals move to meet their needs for food, shelter, reproduction and to avoid unfavorable environments. In aquatic systems, it is essential that we understand these movements if we are to sustainably manage populations and maintain healthy ecosystems. Thus the ability to document and monitor changes in aquatic animal movements is a biological observing system need. The Ocean Tracking Network (OTN) is a global research, technology development, and data management platform headquartered at Dalhousie University, in Halifax, Nova Scotia working to fill this need. OTN uses electronic telemetry to document the local-to-global movements and survival of aquatic animals, and to correlate them to oceanographic or limnological variables that are influencing movements. Such knowledge can assist with planning for and managing of anthropogenic impacts on present and future animal distributions, including those due to climate change. OTN works with various tracking methods including satellite and data storage tag systems, but its dominant focus is acoustic telemetry. OTN is built on global partnerships for the sharing of equipment and data, and has stimulated technological development in telemetry by bringing researchers with needs for new capabilities together with manufacturers to generate, test, and operationalize new technologies. This has included pioneering work into the use of marine autonomous vehicles (Slocum electric gliders; Liquid Robotics Wave Glider) in animal telemetry research. Similarly, OTN scientists worked with the Sea Mammal Research Unit to develop mobile acoustic receiver that have been placed on grey seals and linked via Bluetooth to a satellite transmitter/receiver. This provided receiver coverage in areas occupied by the seals during their typically extensive migrations and allowed for the examination of ecosystem linkages by documenting behavioral interactions the seals had with the physical environment, conspecifics, and other tagged species.

The last three days of life: a comparison of pain management in the young old and the oldest old hospitalised patients using the Resident Assessment Instrument for Palliative Care.

PubMed

Steindal, Simen Alexander; Bredal, Inger Schou; Ranhoff, Anette Hylen; Sørbye, Liv Wergeland; Lerdal, Anners

2015-12-01

Pain is a common symptom in older patients at the end of life. Little research has evaluated pain management among the oldest hospitalised dying patients. To compare the pain characteristics documented by healthcare workers for the young old and the oldest old hospitalised patients and the types of analgesics administered in the last three days of life. A retrospective cross-sectional comparative study. The study included 190 patients from a Norwegian general hospital: 101 young old patients (aged 65-84 years) and 89 oldest old patients (aged 85-100 years). Data were extracted from electronic patient records (EPRs) using the Resident Assessment Instrument for Palliative Care. No significant differences were found between the young old and the oldest old patients with regard to pain characteristics. Pain intensity was poorly recorded in the EPRs. Most of the patients received adequate pain control. Morphine was the most frequently administered analgesic for dying patients. Compared to the oldest old patients, a greater proportion of the young old patients received paracetamol combined with codeine (OR = 3.25, 95% CI 1.02-10.40). There appeared to be no differences in healthcare workers' documentation of pain characteristics in young old and oldest old patients, but young old patients were more likely to receive paracetamol in combination with codeine. A limitation of the study is the retrospective design and that data were collected from a single hospital. Therefore, caution should be taken for interpretation of the results. The use of systematic patient-reported assessments in combination with feasible validated tools could contribute to more comprehensive documentation of pain intensity and improved pain control. © 2014 John Wiley & Sons Ltd.

NASAwide electronic publishing system: Prototype STI electronic document distribution, stage-4 evaluation report

NASA Technical Reports Server (NTRS)

Tuey, Richard C.; Collins, Mary; Caswell, Pamela; Haynes, Bob; Nelson, Michael L.; Holm, Jeanne; Buquo, Lynn; Tingle, Annette; Cooper, Bill; Stiltner, Roy

1996-01-01

This evaluation report contains an introduction, seven chapters, and five appendices. The Introduction describes the purpose, conceptual frame work, functional description, and technical report server of the STI Electronic Document Distribution (EDD) project. Chapter 1 documents the results of the prototype STI EDD in actual operation. Chapter 2 documents each NASA center's post processing publication processes. Chapter 3 documents each center's STI software, hardware, and communications configurations. Chapter 7 documents STI EDD policy, practices, and procedures. The appendices, which arc contained in Part 2 of this document, consist of (1) STI EDD Project Plan, (2) Team members, (3) Phasing Schedules, (4) Accessing On-line Reports, and (5) Creating an HTML File and Setting Up an xTRS. In summary, Stage 4 of the NASAwide Electronic Publishing System is the final phase of its implementation through the prototyping and gradual integration of each NASA center's electronic printing systems, desktop publishing systems, and technical report servers to be able to provide to NASA's engineers, researchers, scientists, and external users the widest practicable and appropriate dissemination of information concerning its activities and the result thereof to their work stations.

The quality of paper-based versus electronic nursing care plan in Australian aged care homes: A documentation audit study.

PubMed

Wang, Ning; Yu, Ping; Hailey, David

2015-08-01

The nursing care plan plays an essential role in supporting care provision in Australian aged care. The implementation of electronic systems in aged care homes was anticipated to improve documentation quality. Standardized nursing terminologies, developed to improve communication and advance the nursing profession, are not required in aged care practice. The language used by nurses in the nursing care plan and the effect of the electronic system on documentation quality in residential aged care need to be investigated. To describe documentation practice for the nursing care plan in Australian residential aged care homes and to compare the quantity and quality of documentation in paper-based and electronic nursing care plans. A nursing documentation audit was conducted in seven residential aged care homes in Australia. One hundred and eleven paper-based and 194 electronic nursing care plans, conveniently selected, were reviewed. The quantity of documentation in a care plan was determined by the number of phrases describing a resident problem and the number of goals and interventions. The quality of documentation was measured using 16 relevant questions in an instrument developed for the study. There was a tendency to omit 'nursing problem' or 'nursing diagnosis' in the nursing process by changing these terms (used in the paper-based care plan) to 'observation' in the electronic version. The electronic nursing care plan documented more signs and symptoms of resident problems and evaluation of care than the paper-based format (48.30 vs. 47.34 out of 60, P<0.01), but had a lower total mean quality score. The electronic care plan contained fewer problem or diagnosis statements, contributing factors and resident outcomes than the paper-based system (P<0.01). Both types of nursing care plan were weak in documenting measurable and concrete resident outcomes. The overall quality of documentation content for the nursing process was no better in the electronic system than in the paper-based system. Omission of the nursing problem or diagnosis from the nursing process may reflect a range of factors behind the practice that need to be understood. Further work is also needed on qualitative aspects of the nurse care plan, nurses' attitudes towards standardized terminologies and the effect of different documentation practice on care quality and resident outcomes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

27 CFR 73.33 - Am I legally bound by a form I sign electronically?

Code of Federal Regulations, 2010 CFR

2010-04-01

... TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY (CONTINUED) PROCEDURES AND PRACTICES ELECTRONIC SIGNATURES; ELECTRONIC SUBMISSION OF FORMS Electronic Filing of Documents with TTB § 73.33 Am I legally bound... paper document submitted to satisfy the same reporting requirement. Persons using electronic signatures...

The Storied Experiences of Registered Nurses' Transition from Paper to Electronic Nursing Documentation

ERIC Educational Resources Information Center

Smith, Jeff S.

2010-01-01

This narrative inquiry was designed to bring to life the storied experiences of registered nurses who have transitioned from paper to electronic nursing documentation and to provide a foundation for others who may be preparing to implement electronic documentation and wish to consider the significance of these nurses' stories of change in their…

41 CFR 301-71.3 - May we use electronic signatures on travel documents?

Code of Federal Regulations, 2012 CFR

2012-07-01

... 41 Public Contracts and Property Management 4 2012-07-01 2012-07-01 false May we use electronic signatures on travel documents? 301-71.3 Section 301-71.3 Public Contracts and Property Management Federal... ACCOUNTABILITY REQUIREMENTS General § 301-71.3 May we use electronic signatures on travel documents? Yes, if you...

41 CFR 301-71.3 - May we use electronic signatures on travel documents?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 41 Public Contracts and Property Management 4 2011-07-01 2011-07-01 false May we use electronic signatures on travel documents? 301-71.3 Section 301-71.3 Public Contracts and Property Management Federal... ACCOUNTABILITY REQUIREMENTS General § 301-71.3 May we use electronic signatures on travel documents? Yes, if you...

41 CFR 301-71.3 - May we use electronic signatures on travel documents?

Code of Federal Regulations, 2014 CFR

2014-07-01

... 41 Public Contracts and Property Management 4 2014-07-01 2014-07-01 false May we use electronic signatures on travel documents? 301-71.3 Section 301-71.3 Public Contracts and Property Management Federal... ACCOUNTABILITY REQUIREMENTS General § 301-71.3 May we use electronic signatures on travel documents? Yes, if you...

41 CFR 301-71.3 - May we use electronic signatures on travel documents?

Code of Federal Regulations, 2013 CFR

2013-07-01

... 41 Public Contracts and Property Management 4 2013-07-01 2012-07-01 true May we use electronic signatures on travel documents? 301-71.3 Section 301-71.3 Public Contracts and Property Management Federal... ACCOUNTABILITY REQUIREMENTS General § 301-71.3 May we use electronic signatures on travel documents? Yes, if you...

41 CFR 301-71.3 - May we use electronic signatures on travel documents?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false May we use electronic signatures on travel documents? 301-71.3 Section 301-71.3 Public Contracts and Property Management Federal... ACCOUNTABILITY REQUIREMENTS General § 301-71.3 May we use electronic signatures on travel documents? Yes, if you...

7 CFR 1.670 - How must documents be filed and served under §§ 1.670 through 1.673?

Code of Federal Regulations, 2014 CFR

2014-01-01

... complete copy of the document must be served on each license party and FERC, using: (i) One of the methods..., documents must be filed using one of the methods set forth in § 1.612(b). (2) A document is considered filed on the date it is received. However, any document received after 5 p.m. at the place where the filing...

10 CFR 2.1013 - Use of the electronic docket during the proceeding.

Code of Federal Regulations, 2010 CFR

2010-01-01

... bi-tonal documents. (v) Electronic submissions must be generated in the appropriate PDF output format by using: (A) PDF—Formatted Text and Graphics for textual documents converted from native applications; (B) PDF—Searchable Image (Exact) for textual documents converted from scanned documents; and (C...

14 CFR 302.3 - Filing of documents.

Code of Federal Regulations, 2013 CFR

2013-01-01

... in Washington, DC. Documents may be filed either on paper or by electronic means using the process set at the DOT Dockets Management System (DMS) internet website. (2) Such documents will be deemed to... below the space provided for signature. Electronic filers need only submit one copy of the document...

14 CFR 302.3 - Filing of documents.

Code of Federal Regulations, 2012 CFR

2012-01-01

... in Washington, DC. Documents may be filed either on paper or by electronic means using the process set at the DOT Dockets Management System (DMS) internet website. (2) Such documents will be deemed to... below the space provided for signature. Electronic filers need only submit one copy of the document...

5 CFR 850.303 - Return of personal documents.

Code of Federal Regulations, 2014 CFR

2014-01-01

... REGULATIONS (CONTINUED) ELECTRONIC RETIREMENT PROCESSING Records § 850.303 Return of personal documents. An..., OPM may provide the individual with a copy of the document that is derived from electronic records. ... 5 Administrative Personnel 2 2014-01-01 2014-01-01 false Return of personal documents. 850.303...

14 CFR 302.3 - Filing of documents.

Code of Federal Regulations, 2014 CFR

2014-01-01

... in Washington, DC. Documents may be filed either on paper or by electronic means using the process set at the DOT Dockets Management System (DMS) internet website. (2) Such documents will be deemed to... below the space provided for signature. Electronic filers need only submit one copy of the document...

14 CFR 302.3 - Filing of documents.

Code of Federal Regulations, 2011 CFR

2011-01-01

... in Washington, DC. Documents may be filed either on paper or by electronic means using the process set at the DOT Dockets Management System (DMS) internet website. (2) Such documents will be deemed to... below the space provided for signature. Electronic filers need only submit one copy of the document...

Nurses using futuristic technology in today's healthcare setting.

PubMed

Wolf, Debra M; Kapadia, Amar; Kintzel, Jessie; Anton, Bonnie B

2009-01-01

Human computer interaction (HCI) equates nurses using voice assisted technology within a clinical setting to document patient care real time, retrieve patient information from care plans, and complete routine tasks. This is a reality currently utilized by clinicians today in acute and long term care settings. Voice assisted documentation provides hands & eyes free accurate documentation while enabling effective communication and task management. The speech technology increases the accuracy of documentation, while interfacing directly into the electronic health record (EHR). Using technology consisting of a light weight headset and small fist size wireless computer, verbal responses to easy to follow cues are converted into a database systems allowing staff to obtain individualized care status reports on demand. To further assist staff in their daily process, this innovative technology allows staff to send and receive pages as needed. This paper will discuss how leading edge and award winning technology is being integrated within the United States. Collaborative efforts between clinicians and analyst will be discussed reflecting the interactive design and build functionality. Features such as the system's voice responses and directed cues will be shared and how easily data can be documented, viewed and retrieved. Outcome data will be presented on how the technology impacted organization's quality outcomes, financial reimbursement, and employee's level of satisfaction.

17 CFR 232.105 - Limitation on use of HTML documents and hypertext links.

Code of Federal Regulations, 2014 CFR

2014-04-01

... submit the following documents in ASCII: Form N-SAR (§ 274.101 of this chapter) and Form 13F (§ 249.325... exhibits to Form N-SAR in HTML. (b) Electronic filers may not include in any HTML document hypertext links... documents within the current submission and to documents previously filed electronically and located in the...

17 CFR 232.105 - Limitation on use of HTML documents and hypertext links.

Code of Federal Regulations, 2013 CFR

2013-04-01

... submit the following documents in ASCII: Form N-SAR (§ 274.101 of this chapter) and Form 13F (§ 249.325... exhibits to Form N-SAR in HTML. (b) Electronic filers may not include in any HTML document hypertext links... documents within the current submission and to documents previously filed electronically and located in the...

17 CFR 232.105 - Limitation on use of HTML documents and hypertext links.

Code of Federal Regulations, 2011 CFR

2011-04-01

... submit the following documents in ASCII: Form N-SAR (§ 274.101 of this chapter) and Form 13F (§ 249.325... exhibits to Form N-SAR in HTML. (b) Electronic filers may not include in any HTML document hypertext links... documents within the current submission and to documents previously filed electronically and located in the...

17 CFR 232.105 - Limitation on use of HTML documents and hypertext links.

Code of Federal Regulations, 2012 CFR

2012-04-01

... submit the following documents in ASCII: Form N-SAR (§ 274.101 of this chapter) and Form 13F (§ 249.325... exhibits to Form N-SAR in HTML. (b) Electronic filers may not include in any HTML document hypertext links... documents within the current submission and to documents previously filed electronically and located in the...

Teaching residents screening, brief intervention, and referral to treatment (SBIRT) skills for alcohol use: Using chart-stimulated recall to assess curricular impact.

PubMed

Wamsley, Maria A; Steiger, Scott; Julian, Katherine A; Gleason, Nathaniel; O'Sullivan, Patricia S; Guy, Michelle; Satterfield, Jason M

2016-01-01

Screening, brief intervention, and referral to treatment (SBIRT) improves identification and intervention for patients at risk for developing an alcohol use disorder (AUD). Residency curriculum is designed to teach SBIRT skills, but resources are needed to promote skill implementation. The electronic health record (EHR) can facilitate implementation through integration of decision-support tools. The authors developed electronic tools to facilitate documentation of alcohol assessment and brief intervention and to reinforce skills from an SBIRT curriculum. This prospective cohort study assessed primary care internal medicine residents' use of SBIRT skills and EHR tools in practice using chart-stimulated recall (CSR). Postgraduate year 2 and 3 residents received a 5-hour SBIRT curriculum with skills practice and instruction on SBIRT electronic tools. Participants were then given a list of their patients seen in a 1-year period who were drinking at/above the recommended limit. Trainees selected 3 patients to review with a faculty member in a CSR. Faculty used a 24-item chart checklist to assess application of SBIRT skills and electronic tool use and met with residents to complete a CSR interview. CSR interview notes were analyzed qualitatively to understand application of SBIRT skills and EHR tool use. Eighteen of 20 residents participated in the CSR, and 5 faculty reviewed 46 patient charts. Residents documented alcohol use (84.2% of charts) and assessment of quantity/frequency of use (71.0%) but were less likely to document assessment for an AUD (34%), an appropriate plan (50.0%), or follow-up (55%). Few residents used EHR tools. Residents reported barriers in addressing alcohol use, including lack of knowledge, patient barriers, and time constraints. More intensive training in SBIRT with opportunities for practice and feedback may be necessary for residents to consistently apply SBIRT skills in practice. EHR tools need to be better integrated into the clinic workflow in order to be useful.

27 CFR 73.35 - Do I need to keep paper copies of forms I submit to TTB electronically?

Code of Federal Regulations, 2010 CFR

2010-04-01

... Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY (CONTINUED) PROCEDURES AND PRACTICES ELECTRONIC SIGNATURES; ELECTRONIC SUBMISSION OF FORMS Electronic Filing of Documents with TTB § 73... unless TTB otherwise authorizes you to maintain electronic copies of these documents through a general...

NLS Flight Simulation Laboratory (FSL) documentation

NASA Technical Reports Server (NTRS)

1995-01-01

The Flight Simulation Laboratory (FSL) Electronic Documentation System design consists of modification and utilization of the MSFC Integrated Engineering System (IES), translation of the existing FSL documentation to an electronic format, and generation of new drawings to represent the Engine Flight Simulation Laboratory design and implementation. The intent of the electronic documentation is to provide ease of access, local print/plot capabilities, as well as the ability to correct and/or modify the stored data by network users who are authorized to access this information.

Secure scalable disaster electronic medical record and tracking system.

PubMed

Demers, Gerard; Kahn, Christopher; Johansson, Per; Buono, Colleen; Chipara, Octav; Griswold, William; Chan, Theodore

2013-10-01

Electronic medical records (EMRs) are considered superior in documentation of care for medical practice. Current disaster medical response involves paper tracking systems and radio communication for mass-casualty incidents (MCIs). These systems are prone to errors, may be compromised by local conditions, and are labor intensive. Communication infrastructure may be impacted, overwhelmed by call volume, or destroyed by the disaster, making self-contained and secure EMR response a critical capability. Report As the prehospital disaster EMR allows for more robust content including protected health information (PHI), security measures must be instituted to safeguard these data. The Wireless Internet Information System for medicAl Response in Disasters (WIISARD) Research Group developed a handheld, linked, wireless EMR system utilizing current technology platforms. Smart phones connected to radio frequency identification (RFID) readers may be utilized to efficiently track casualties resulting from the incident. Medical information may be transmitted on an encrypted network to fellow prehospital team members, medical dispatch, and receiving medical centers. This system has been field tested in a number of exercises with excellent results, and future iterations will incorporate robust security measures. A secure prehospital triage EMR improves documentation quality during disaster drills.

A randomized trial of automated electronic alerts demonstrating improved reimbursable anesthesia time documentation.

PubMed

Freundlich, Robert E; Barnet, Caryn S; Mathis, Michael R; Shanks, Amy M; Tremper, Kevin K; Kheterpal, Sachin

2013-03-01

To investigate whether alerting providers to errors results in improved documentation of reimbursable anesthesia care. Prospective randomized controlled trial. Operating room (OR) of a university hospital. Anesthesia cases were evaluated to determine whether they met the definition for appropriate anesthesia start time over 4 separate, 45-day calendar cycles: the pre-study period, study period, immediate post-study period, and 3-year follow-up period. During the study period, providers were randomly assigned to either a control or an alert group. Providers in the alert cohort received an automated alphanumeric page if the anesthesia start time occurred concurrently with the patient entering the OR, or more than 30 minutes before entering the OR. Three years after the intervention period, overall compliance was analyzed to assess learned behavior. Baseline compliance was 33% ± 5%. During the intervention period, providers in the alert group showed 87% ± 6% compliance compared with 41% ± 7% compliance in the control group (P < 0.001). Long-term follow-up after cessation of the alerts showed 85% ± 4% compliance. Automated electronic reminders for time-based billing charges are effective and result in improved ongoing reimbursement. Copyright © 2013 Elsevier Inc. All rights reserved.

Final Report: MaRSPlus Sensor System Electrical Cable Management and Distributed Motor Control Computer Interface

NASA Technical Reports Server (NTRS)

Reil, Robin

2011-01-01

The success of JPL's Next Generation Imaging Spectrometer (NGIS) in Earth remote sensing has inspired a follow-on instrument project, the MaRSPlus Sensor System (MSS). One of JPL's responsibilities in the MSS project involves updating the documentation from the previous JPL airborne imagers to provide all the information necessary for an outside customer to operate the instrument independently. As part of this documentation update, I created detailed electrical cabling diagrams to provide JPL technicians with clear and concise build instructions and a database to track the status of cables from order to build to delivery. Simultaneously, a distributed motor control system is being developed for potential use on the proposed 2018 Mars rover mission. This system would significantly reduce the mass necessary for rover motor control, making more mass space available to other important spacecraft systems. The current stage of the project consists of a desktop computer talking to a single "cold box" unit containing the electronics to drive a motor. In order to test the electronics, I developed a graphical user interface (GUI) using MATLAB to allow a user to send simple commands to the cold box and display the responses received in a user-friendly format.

5 CFR 890.308 - Disenrollment.

Code of Federal Regulations, 2010 CFR

2010-01-01

... enrollment records or does not receive documentation necessary to resolve the discrepancy from the employing... documentation to resolve the discrepancy. Appropriate documentation includes, but is not limited to, a copy of... date which is the last day of the pay period in which information of the death is received. Reliable...

Electronic availability of microgravity experiments safety and integration requirements documents

NASA Technical Reports Server (NTRS)

Hogan, Jean M.

1995-01-01

This follow-on to NASA Contractor Report 195447, Microgravity Experiments Safety and Integration Requirements Document Tree, provides the details for accessing the systems that contain the official, electronic versions of the documents initially researched in NASA Contractor Report 195447. The data in this report serves as a valuable information source for the NASA Lewis Research Center Project Documentation Center (PDC), as well as for all developers of space experiments. The PDC has acquired the hardware, software, ID's, and passwords necessary to access most of these systems and is now able to provide customers with current document information as well as immediate delivery of available documents in either electronic or hard copy format.

Safety and fitness electronic records (SAFER) system : logical architecture document : working draft

DOT National Transportation Integrated Search

1997-01-31

This Logical Architecture Document includes the products developed during the functional analysis of the Safety and Fitness Electronic Records (SAFER) System. This document, along with the companion Operational Concept and Physical Architecture Docum...

26 CFR 1.6050W-2 - Electronic furnishing of information statements for payments made in settlement of payment card...

Code of Federal Regulations, 2014 CFR

2014-04-01

... statements required by section 6050W(f) electronically on a website instead of in a paper format. The letter... website, downloading the consent document, completing the consent document, and e-mailing the completed consent back to F. The consent document posted on the website uses the same electronic format that F uses...

26 CFR 1.6050W-2 - Electronic furnishing of information statements for payments made in settlement of payment card...

Code of Federal Regulations, 2012 CFR

2012-04-01

... statements required by section 6050W(f) electronically on a website instead of in a paper format. The letter... website, downloading the consent document, completing the consent document, and e-mailing the completed consent back to F. The consent document posted on the website uses the same electronic format that F uses...

26 CFR 1.6050W-2 - Electronic furnishing of information statements for payments made in settlement of payment card...

Code of Federal Regulations, 2013 CFR

2013-04-01

... statements required by section 6050W(f) electronically on a website instead of in a paper format. The letter... website, downloading the consent document, completing the consent document, and e-mailing the completed consent back to F. The consent document posted on the website uses the same electronic format that F uses...

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

PubMed

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

2018-02-01

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

Understanding Clinician Information Demands and Synthesis of Clinical Documents in Electronic Health Record Systems

ERIC Educational Resources Information Center

Farri, Oladimeji Feyisetan

2012-01-01

Large quantities of redundant clinical data are usually transferred from one clinical document to another, making the review of such documents cognitively burdensome and potentially error-prone. Inadequate designs of electronic health record (EHR) clinical document user interfaces probably contribute to the difficulties clinicians experience while…

10 CFR 2.304 - Formal requirements for documents; signatures; acceptance for filing.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., and General Hearing Management for NRC Adjudicatory Hearings § 2.304 Formal requirements for documents... section, it may be struck. (1) An electronic document must be signed using a participant's or a... paragraph (d) of this section. (i) When signing an electronic document using a digital ID certificate, the...

10 CFR 2.304 - Formal requirements for documents; signatures; acceptance for filing.

Code of Federal Regulations, 2012 CFR

2012-01-01

..., and General Hearing Management for NRC Adjudicatory Hearings § 2.304 Formal requirements for documents... section, it may be struck. (1) An electronic document must be signed using a participant's or a... paragraph (d) of this section. (i) When signing an electronic document using a digital ID certificate, the...

10 CFR 2.304 - Formal requirements for documents; signatures; acceptance for filing.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Management for NRC Adjudicatory Hearings § 2.304 Formal requirements for documents; signatures; acceptance... section, it may be struck. (1) An electronic document must be signed using a participant's or a... paragraph (d) of this section. (i) When signing an electronic document using a digital ID certificate, the...

10 CFR 2.304 - Formal requirements for documents; signatures; acceptance for filing.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Management for NRC Adjudicatory Hearings § 2.304 Formal requirements for documents; signatures; acceptance... section, it may be struck. (1) An electronic document must be signed using a participant's or a... paragraph (d) of this section. (i) When signing an electronic document using a digital ID certificate, the...

Longitudinal analysis on utilization of medical document management system in a hospital with EPR implementation.

PubMed

Kuwata, Shigeki; Yamada, Hitomi; Park, Keunsik

2011-01-01

Document management systems (DMS) have widespread in major hospitals in Japan as a platform to digitize the paper-based records being out of coverage by EPR. This study aimed to examine longitudinal trends of actual use of DMS in a hospital in which EPR had been in operation, which would be conducive to planning the further information management system in the hospital. Degrees of utilization of electronic documents and templates with DMS were analyzed based on data extracted from a university-affiliated hospital with EPR. As a result, it was found that the number of electronic documents as well as scanned documents circulating at the hospital tended to increase. The result indicated that replacement of paper-based documents with electronic documents did not occur. Therefore it was anticipated that the need for DMS would continue to increase in the hospital. The methods used this study to analyze the trend of DMS utilization would be applicable to other hospitals with with a variety of DMS implementation, such as electronic storage by scanning documents or paper preservation that is compatible with EPR.

Clinician Documentation on Receipt of Trauma-Focused Evidence-Based Psychotherapies in a VA PTSD Clinic.

PubMed

Lu, Mary W; Plagge, Jane M; Marsiglio, Mary C; Dobscha, Steven K

2016-01-01

The U.S. Department of Veterans Affairs (VA) is implementing two trauma-focused, evidence-based psychotherapies (TF-EBPs) for posttraumatic stress disorder (PTSD): cognitive processing therapy and prolonged exposure therapy (PE). Veterans with PTSD often do not receive these treatments, and little is known about the reasons veterans may not receive TF-EBPs. The aim of this qualitative study was to summarize clinician-reported reasons in medical records for nonreceipt of TF-EBPs. All veterans (N = 63) identified through PTSD screening who were newly engaged in mental health care and received individual evaluations in a PTSD specialty clinic in fiscal year 2008 were included in the sample. Content analysis of electronic medical records revealed multiple potential reasons for nonreceipt of TF-EBPs including referral to other PTSD treatments, other clinical priorities, poor engagement in care, practical barriers, negative beliefs, and receipt of care in other settings. Eight veterans (13%) initiated TF-EBPs. Further interventions to promote engagement in PTSD treatment are warranted.

78 FR 77354 - Procedural Rules To Permit Parties To File and Serve Documents Electronically

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-23

... by handwriting his or her signature. For documents filed by electronic transmission, a party may sign... transmission. A party or representative of the party shall sign a document by handwriting his signature. (2...

NASAwide electronic publishing system-prototype STI electronic document distribution: Stage-4 evaluation report. Part 2; Appendices

NASA Technical Reports Server (NTRS)

Tuey, Richard C.; Collins, Mary; Caswell, Pamela; Haynes, Bob; Nelson, Michael L.; Holm, Jeanne; Buquo, Lynn; Tingle, Annette; Cooper, Bill; Stiltner, Roy

1996-01-01

This evaluation report contains an introduction, seven chapters, and five appendices. The Introduction describes the purpose, conceptual framework, functional description, and technical report server of the Scientific and Technical Information (STI) Electronic Document Distribution (EDD) project. Chapter 1 documents the results of the prototype STI EDD in actual operation. Chapter 2 documents each NASA center's post processing publication processes. Chapter 3 documents each center's STI software, hardware. and communications configurations. Chapter 7 documents STI EDD policy, practices, and procedures. The appendices consist of (A) the STI EDD Project Plan, (B) Team members, (C) Phasing Schedules, (D) Accessing On-line Reports, and (E) Creating an HTML File and Setting Up an xTRS. In summary, Stage 4 of the NASAwide Electronic Publishing System is the final phase of its implementation through the prototyping and gradual integration of each NASA center's electronic printing systems, desk top publishing systems, and technical report servers, to be able to provide to NASA's engineers, researchers, scientists, and external users, the widest practicable and appropriate dissemination of information concerning its activities and the result thereof to their work stations.

Modified timing module for Loran-C receiver

NASA Technical Reports Server (NTRS)

Lilley, R. W.

1983-01-01

Full hardware documentation is provided for the circuit card implementing the Loran-C timing loop, and the receiver event-mark and re-track functions. This documentation is to be combined with overall receiver drawings to form the as-built record for this device. Computer software to support this module is integrated with the remainder of the receiver software, in the LORPROM program.

Electron radiography

DOEpatents

Merrill, Frank E.; Morris, Christopher

2005-05-17

A system capable of performing radiography using a beam of electrons. Diffuser means receive a beam of electrons and diffuse the electrons before they enter first matching quadrupoles where the diffused electrons are focused prior to the diffused electrons entering an object. First imaging quadrupoles receive the focused diffused electrons after the focused diffused electrons have been scattered by the object for focusing the scattered electrons. Collimator means receive the scattered electrons and remove scattered electrons that have scattered to large angles. Second imaging quadrupoles receive the collimated scattered electrons and refocus the collimated scattered electrons and map the focused collimated scattered electrons to transverse locations on an image plane representative of the electrons' positions in the object.

Quantifying the improvement in sepsis diagnosis, documentation, and coding: the marginal causal effect of year of hospitalization on sepsis diagnosis.

PubMed

Jafarzadeh, S Reza; Thomas, Benjamin S; Marschall, Jonas; Fraser, Victoria J; Gill, Jeff; Warren, David K

2016-01-01

To quantify the coinciding improvement in the clinical diagnosis of sepsis, its documentation in the electronic health records, and subsequent medical coding of sepsis for billing purposes in recent years. We examined 98,267 hospitalizations in 66,208 patients who met systemic inflammatory response syndrome criteria at a tertiary care center from 2008 to 2012. We used g-computation to estimate the causal effect of the year of hospitalization on receiving an International Classification of Diseases, Ninth Revision, Clinical Modification discharge diagnosis code for sepsis by estimating changes in the probability of getting diagnosed and coded for sepsis during the study period. When adjusted for demographics, Charlson-Deyo comorbidity index, blood culture frequency per hospitalization, and intensive care unit admission, the causal risk difference for receiving a discharge code for sepsis per 100 hospitalizations with systemic inflammatory response syndrome, had the hospitalization occurred in 2012, was estimated to be 3.9% (95% confidence interval [CI], 3.8%-4.0%), 3.4% (95% CI, 3.3%-3.5%), 2.2% (95% CI, 2.1%-2.3%), and 0.9% (95% CI, 0.8%-1.1%) from 2008 to 2011, respectively. Patients with similar characteristics and risk factors had a higher of probability of getting diagnosed, documented, and coded for sepsis in 2012 than in previous years, which contributed to an apparent increase in sepsis incidence. Copyright © 2016 Elsevier Inc. All rights reserved.

Electronic Flight Bag (EFB) 2015 Industry Survey.

DOT National Transportation Integrated Search

2015-10-01

This document provides an overview of Electronic Flight Bag (EFB) hardware and software capabilities, including portable electronic devices (PEDs) used as EFBs, as of July 2015. This document updates and replaces the Volpe Centers previous EFB ind...

47 CFR 54.409 - Consumer qualification for Lifeline.

Code of Federal Regulations, 2010 CFR

2010-10-01

... that the consumer receives benefits from at least one of the programs mentioned in this paragraph or... identifying in that document the program or programs from which that consumer receives benefits, an eligible... signature on a document certifying under penalty of perjury that: (1) The consumer receives benefits from...

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

PubMed Central

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

2010-01-01

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

Development of an interface for an ultrareliable fault-tolerant control system and an electronic servo-control unit

NASA Technical Reports Server (NTRS)

Shaver, Charles; Williamson, Michael

1986-01-01

The NASA Ames Research Center sponsors a research program for the investigation of Intelligent Flight Control Actuation systems. The use of artificial intelligence techniques in conjunction with algorithmic techniques for autonomous, decentralized fault management of flight-control actuation systems is explored under this program. The design, development, and operation of the interface for laboratory investigation of this program is documented. The interface, architecturally based on the Intel 8751 microcontroller, is an interrupt-driven system designed to receive a digital message from an ultrareliable fault-tolerant control system (UFTCS). The interface links the UFTCS to an electronic servo-control unit, which controls a set of hydraulic actuators. It was necessary to build a UFTCS emulator (also based on the Intel 8751) to provide signal sources for testing the equipment.

Using electronic clinical practice audits as needs assessment to produce effective continuing medical education programming.

PubMed

Klein, Doug; Staples, John; Pittman, Carmen; Stepanko, Cheryl

2012-01-01

The traditional needs assessment used in developing continuing medical education programs typically relies on surveying physicians and tends to only capture perceived learning needs. Instead, using tools available in electronic medical record systems to perform a clinical audit on a physician's practice highlights physician-specific practice patterns. The purpose of this study was to test the feasibility of implementing an electronic clinical audit needs assessment process for family physicians in Canada. A clinical audit of 10 preventative care interventions and 10 chronic disease interventions was performed on family physician practices in Alberta, Canada. The physicians used the results from the audit to produce personalized learning needs, which were then translated into educational programming. A total of 26 family practices and 4489 patient records were audited. Documented completion rates for interventions ranged from 13% for ensuring a patient's tetanus vaccine is current to 97% of pregnant patients receiving the recommended prenatal vitamins. Electronic medical record-based needs assessments may provide a better basis for developing continuing medical education than a more traditional survey-based needs assessment. This electronic needs assessment uses the physician's own patient outcome information to assist in determining learning objectives that reflect both perceived and unperceived needs.

Document Delivery: An Annotated Selective Bibliography.

ERIC Educational Resources Information Center

Khalil, Mounir A.; Katz, Suzanne R.

1992-01-01

Presents a selective annotated bibliography of 61 items that deal with topics related to document delivery, including networks; hypertext; interlibrary loan; computer security; electronic publishing; copyright; online catalogs; resource sharing; electronic mail; electronic libraries; optical character recognition; microcomputers; liability issues;…

Electronic Document Supply Systems.

ERIC Educational Resources Information Center

Cawkell, A. E.

1991-01-01

Describes electronic document delivery systems used by libraries and document image processing systems used for business purposes. Topics discussed include technical specifications; analogue read-only laser videodiscs; compact discs and CD-ROM; WORM; facsimile; ADONIS (Article Delivery over Network Information System); DOCDEL; and systems at the…

Seamless Management of Paper and Electronic Documents for Task Knowledge Sharing

NASA Astrophysics Data System (ADS)

Kojima, Hiroyuki; Iwata, Ken

Due to the progress of Internet technology and the increase of distributed information on networks, the present knowledge management has been based more and more on the performance of various experienced users. In addition to the increase of electronic documents, the use of paper documents has not been reduced because of their convenience. This paper describes a method of tracking paper document locations and contents using radio frequency identification (RFID) technology. This research also focuses on the expression of a task process and the seamless structuring of related electronic and paper documents as a result of task knowledge formalization using information organizing. A system is proposed here that implements information organization for both Web documents and paper documents with the task model description and RFID technology. Examples of a prototype system are also presented.

Development of a prediction model on the acceptance of electronic laboratory notebooks in academic environments.

PubMed

Kloeckner, Frederik; Farkas, Robert; Franken, Tobias; Schmitz-Rode, Thomas

2014-04-01

Documentation of research data plays a key role in the biomedical engineering innovation processes. It makes an important contribution to the protection of intellectual property, the traceability of results and fulfilling the regulatory requirement. Because of the increasing digitalization in laboratories, an electronic alternative to the commonly-used paper-bound notebooks could contribute to the production of sophisticated documentation. However, compared to in an industrial environment, the use of electronic laboratory notebooks is not widespread in academic laboratories. Little is known about the acceptance of an electronic documentation system and the underlying reasons for this. Thus, this paper aims to establish a prediction model on the potential preference and acceptance of scientists either for paper-based or electronic documentation. The underlying data for the analysis originate from an online survey of 101 scientists in industrial, academic and clinical environments. Various parameters were analyzed to identify crucial factors for the system preference using binary logistic regression. The analysis showed significant dependency between the documentation system preference and the supposed workload associated with the documentation system (p<0.006; odds ratio=58.543) and an additional personal component. Because of the dependency of system choice on specific parameters it is possible to predict the acceptance of an electronic laboratory notebook before implementation.

Electronics Teacher's Guide. Science and Technology Document Series No. 40.

ERIC Educational Resources Information Center

Lewis, John

This is the second document on the teaching of electronics to appear as part of UNESCO's science and technology education program. An introductory section describes the role that electronics plays as part of the physics curriculum. The following section outlines the content of the electronics course. The outline includes guidelines for determining…

Creating a Living Portfolio: Documenting Student Growth with Electronic Portfolios.

ERIC Educational Resources Information Center

Siegle, Del

2002-01-01

This article explains how teachers can use electronic portfolios of students' work to document learner progress. It considers different file formats for storing student work, describes steps to creating an electronic portfolio, and discusses an art and literature electronic magazine created by one school featuring work from student portfolios. (CR)

Inter-professional electronic documents and child health: a study of persisting non-electronic communication in the use of electronic documents.

PubMed

Saario, Sirpa; Hall, Christopher; Peckover, Sue

2012-12-01

Information and communication technologies are widely used in health and social care settings to replace previous means of record keeping, assessment and communication. Commentary on the strengths and weaknesses of such systems abound, thus it is useful to examine how they are used in practice. This article draws on findings from two separate studies, conducted between 2005 and 2007, which examined how child health and welfare professionals use electronic documents in Finland and England. Known respectively as Miranda and CAF, these systems are different in terms of structure and function but in their everyday use common features are identified, notably the continued use of and reliance on non-electronic means of communication. Based on interviews with professionals, three forms of non-electronic communication are described: alternative records, phone calls and letters, which facilitate the sharing of the electronic record. Finally, the electronic documents are further analysed as potential boundary objects which aim to create common understanding between sites and professionals. Copyright © 2012 Elsevier Ltd. All rights reserved.

46 CFR 67.218 - Optional filing of instruments in portable document format as attachments to electronic mail.

Code of Federal Regulations, 2010 CFR

2010-10-01

... recording under § 67.200 may be submitted in portable document format (.pdf) as an attachment to electronic... submitted for filing in .pdf format pertains to a vessel that is not a currently documented vessel, a... with the National Vessel Documentation Center or must be submitted in .pdf format with the instrument...

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

PubMed

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

2016-01-01

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

12 CFR 1209.29 - Discovery.

Code of Federal Regulations, 2014 CFR

2014-01-01

... the timely, cost-effective management of document discovery (including, if applicable, electronically... discovery plan shall specify the form of electronic productions, if any. Documents are to be produced in... proceeding under this part may obtain document discovery by serving upon any other party in the proceeding a...

12 CFR 1209.29 - Discovery.

Code of Federal Regulations, 2012 CFR

2012-01-01

... the timely, cost-effective management of document discovery (including, if applicable, electronically... discovery plan shall specify the form of electronic productions, if any. Documents are to be produced in... proceeding under this part may obtain document discovery by serving upon any other party in the proceeding a...

12 CFR 1209.29 - Discovery.

Code of Federal Regulations, 2013 CFR

2013-01-01

... the timely, cost-effective management of document discovery (including, if applicable, electronically... discovery plan shall specify the form of electronic productions, if any. Documents are to be produced in... proceeding under this part may obtain document discovery by serving upon any other party in the proceeding a...

15 CFR 971.802 - Public disclosure of documents received by NOAA.

Code of Federal Regulations, 2013 CFR

2013-01-01

... received by NOAA. 971.802 Section 971.802 Commerce and Foreign Trade Regulations Relating to Commerce and... Miscellaneous § 971.802 Public disclosure of documents received by NOAA. (a) Purpose. This section provides a... assure that NOAA has a complete and proper basis for determining the legality and appropriateness of...

15 CFR 971.802 - Public disclosure of documents received by NOAA.

Code of Federal Regulations, 2014 CFR

2014-01-01

... received by NOAA. 971.802 Section 971.802 Commerce and Foreign Trade Regulations Relating to Commerce and... Miscellaneous § 971.802 Public disclosure of documents received by NOAA. (a) Purpose. This section provides a... assure that NOAA has a complete and proper basis for determining the legality and appropriateness of...

15 CFR 971.802 - Public disclosure of documents received by NOAA.

Code of Federal Regulations, 2012 CFR

2012-01-01

... received by NOAA. 971.802 Section 971.802 Commerce and Foreign Trade Regulations Relating to Commerce and... Miscellaneous § 971.802 Public disclosure of documents received by NOAA. (a) Purpose. This section provides a... assure that NOAA has a complete and proper basis for determining the legality and appropriateness of...

15 CFR 971.802 - Public disclosure of documents received by NOAA.

Code of Federal Regulations, 2010 CFR

2010-01-01

... received by NOAA. 971.802 Section 971.802 Commerce and Foreign Trade Regulations Relating to Commerce and... Miscellaneous § 971.802 Public disclosure of documents received by NOAA. (a) Purpose. This section provides a... assure that NOAA has a complete and proper basis for determining the legality and appropriateness of...

Assessment of the Content, Design, and Dissemination of the Real Warriors Campaign

DTIC Science & Technology

2012-01-01

by law as indicated in a notice appearing later in this work. This electronic representation of RAND intellectual property is provided for non...commercial use only. Unauthorized posting of RAND electronic documents to a non-RAND website is prohibited. RAND electronic documents are protected under...copyright law. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use. For

Electron/proton spectrometer certification documentation analyses

NASA Technical Reports Server (NTRS)

Gleeson, P.

1972-01-01

A compilation of analyses generated during the development of the electron-proton spectrometer for the Skylab program is presented. The data documents the analyses required by the electron-proton spectrometer verification plan. The verification plan was generated to satisfy the ancillary hardware requirements of the Apollo Applications program. The certification of the spectrometer requires that various tests, inspections, and analyses be documented, approved, and accepted by reliability and quality control personnel of the spectrometer development program.

Design and implementation of an inpatient physician documentation system using off-the-shelf components.

PubMed

Cucina, Russell J; Bokser, Seth J; Carter, Jonathan T; McLaren, Kevin M; Blum, Michael S

2007-10-11

We report the development and implementation of an electronic inpatient physician documentation system using off-the-shelf components, rapidly and at low cost. Within 9 months of deployment, over half of physician notes were electronic, and within 20 months, paper physician notes were eliminated. Our results suggest institutions can prioritize conversion to inpatient electronic physician documentation without waiting for development of sophisticated software packages or large capital investments.

Implementation of standardized nomenclature in the electronic medical record.

PubMed

Klehr, Joan; Hafner, Jennifer; Spelz, Leah Mylrea; Steen, Sara; Weaver, Kathy

2009-01-01

To describe a customized electronic medical record documentation system which provides an electronic health record, Epic, which was implemented in December 2006 using standardized taxonomies for nursing documentation. Descriptive data is provided regarding the development, implementation, and evaluation processes for the electronic medical record system. Nurses used standardized nursing nomenclature including NANDA-I diagnoses, Nursing Interventions Classification, and Nursing Outcomes Classification in a measurable and user-friendly format using the care plan activity. Key factors in the success of the project included close collaboration among staff nurses and information technology staff, ongoing support and encouragement from the vice president/chief nursing officer, the ready availability of expert resources, and nursing ownership of the project. Use of this evidence-based documentation enhanced institutional leadership in clinical documentation.

Assessing usage patterns of electronic clinical documentation templates.

PubMed

Vawdrey, David K

2008-11-06

Many vendors of electronic medical records support structured and free-text entry of clinical documents using configurable templates. At a healthcare institution comprising two large academic medical centers, a documentation management data mart and a custom, Web-accessible business intelligence application were developed to track the availability and usage of electronic documentation templates. For each medical center, template availability and usage trends were measured from November 2007 through February 2008. By February 2008, approximately 65,000 electronic notes were authored per week on the two campuses. One site had 934 available templates, with 313 being used to author at least one note. The other site had 765 templates, of which 480 were used. The most commonly used template at both campuses was a free text note called "Miscellaneous Nursing Note," which accounted for 33.3% of total documents generated at one campus and 15.2% at the other.

A Systematic Process to Facilitate Evidence-Informed Decisionmaking Regarding Program Expansion. The RAND Toolkit, Volume 3

DTIC Science & Technology

2014-01-01

provided for non - commercial use only. Unauthorized posting of RAND electronic documents to a non -RAND website is prohibited. RAND electronic documents...documents to a non -RAND website is prohibited. RAND documents are protected under copyright law. Permission is given to duplicate this document for...the DoD-wide decisionmaking board to focus their review efforts on larger programs or those that function in multiple branches of service, as well as

Electronic Derivative Classifier/Reviewing Official

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

Harris, Joshua C; McDuffie, Gregory P; Light, Ken L

2017-02-17

The electronic Derivative Classifier, Reviewing Official (eDC/RO) is a web based document management and routing system that reduces security risks and increases workflow efficiencies. The system automates the upload, notification review request, and document status tracking of documents for classification review on a secure server. It supports a variety of document formats (i.e., pdf, doc, docx, xls, xlsx, xlsm, ppt, pptx, vsd, vsdx and txt), and allows for the dynamic placement of classification markings such as the classification level, category and caveats on the document, in addition to a document footer and digital signature.

The effect of various types of patients' reminders on the uptake of pneumococcal vaccine in adults: A randomized controlled trial.

PubMed

Ghadieh, Alexandra S; Hamadeh, Ghassan N; Mahmassani, Dina M; Lakkis, Najla A

2015-10-26

Invasive pneumococcal disease is one of the most important vaccine-preventable diseases threatening the adult community due to missed opportunities for vaccination. This study compares the effect of three different types of patient reminder system on adulthood Streptococcus pneumoniae immunization in a primary care setting. The study targeted patients aged 40 and older eligible for pneumococcal vaccine, but did not receive it yet (89.5% of 3072 patients) based on their electronic medical records in a family medicine center in Beirut. The sample population was randomized using an automated computer randomization system into six equal groups, receiving short phone calls, short text messaging system (sms-text) or e-mails each with or without patient education. Each group received three identical reminders spaced by a period of four weeks. Documentation of vaccine administration was then added to the longitudinal electronic patient record. The primary outcome was the vaccine administration rate in the clinics. Of the eligible patients due for the pneumococcal 23-polyvalent vaccine, 1380 who had mobile phone numbers and e-mails were randomized into six equal intervention groups. The various reminders increased vaccination rate to 14.9%: 16.5% of the short phone calls group, 7.2% of the sms-text group and 5.7% of the e-mail group took the vaccine. The vaccination rate was independent of the age, associated education message and the predisposing condition. Use of electronic text reminders via e-mails and mobile phones seems to be a feasible and sustainable model to increase pneumococcal vaccination rates in a primary care center. Copyright © 2015 Elsevier Ltd. All rights reserved.

Responses to the advanced notice of proposed rulemaking EPA published on June 6, 1996 regarding changes to the EPA allowance auctions and elimination of the direct sale

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

Critchfield, L.R.

1997-12-31

On June 6, 1996, EPA`s Acid Rain Program published an advance notice of proposed rulemaking (ANPRM) in the Federal Register seeking comment on: (1) whether to change the design of the annual sulfur dioxide (SO{sub 2}) allowance auctions; (2) whether to change the timing of the allowance auctions; (3) whether to change the requirement that the minimum price of offered allowances must be in whole dollars, and (4) whether EPA should propose the ability to submit allowance transfers electronically. EPA also published on that day a proposed and direct final rule on whether to eliminate the direct sale. This papermore » documents the issues addressed in the ANPRM, the comments EPA received, and EPA`s responses to those comments. EPA received comments from 14 separate commenters.« less

Exploring Vital Sign Data Quality in Electronic Health Records with Focus on Emergency Care Warning Scores.

PubMed

Skyttberg, Niclas; Chen, Rong; Blomqvist, Hans; Koch, Sabine

2017-08-30

Computerized clinical decision support and automation of warnings have been advocated to assist clinicians in detecting patients at risk of physiological instability. To provide reliable support such systems are dependent on high-quality vital sign data. Data quality depends on how, when and why the data is captured and/or documented. This study aims to describe the effects on data quality of vital signs by three different types of documentation practices in five Swedish emergency hospitals, and to assess data fitness for calculating warning and triage scores. The study also provides reference data on triage vital signs in Swedish emergency care. We extracted a dataset including vital signs, demographic and administrative data from emergency care visits (n=335027) at five Swedish emergency hospitals during 2013 using either completely paper-based, completely electronic or mixed documentation practices. Descriptive statistics were used to assess fitness for use in emergency care decision support systems aiming to calculate warning and triage scores, and data quality was described in three categories: currency, completeness and correctness. To estimate correctness, two further categories - plausibility and concordance - were used. The study showed an acceptable correctness of the registered vital signs irrespectively of the type of documentation practice. Completeness was high in sites where registrations were routinely entered into the Electronic Health Record (EHR). The currency was only acceptable in sites with a completely electronic documentation practice. Although vital signs that were recorded in completely electronic documentation practices showed plausible results regarding correctness, completeness and currency, the study concludes that vital signs documented in Swedish emergency care EHRs cannot generally be considered fit for use for calculation of triage and warning scores. Low completeness and currency were found if the documentation was not completely electronic.

Benefits of an Electronic Consultation-Liaison Note System: Better Notes Faster

ERIC Educational Resources Information Center

Sola, Christopher L.; Bostwick, J. Michael; Sampson, Shirlene

2007-01-01

Objective: The authors determined the efficiency of electronic documentation in consultation-liaison psychiatry. METHOD: An electronic note system was customized for a psychiatric consultation note. Specific attention given to common diagnoses permitted rapid documentation. Results: Residents learned the system quickly. The standardized nature of…

Association of Medical Directors of Information Systems consensus on inpatient electronic health record documentation.

PubMed

Shoolin, J; Ozeran, L; Hamann, C; Bria, W

2013-01-01

In 2013, electronic documentation of clinical care stands at a crossroads. The benefits of creating digital notes are at risk of being overwhelmed by the inclusion of easily importable detail. Providers are the primary authors of encounters with patients. We must document clearly our understanding of patients and our communication with them and our colleagues. We want to document efficiently to meet without exceeding documentation guidelines. We copy and paste documentation, because it not only simplifies the documentation process generally, but also supports meeting coding and regulatory requirements specifically. Since the primary goal of our profession is to spend as much time as possible listening to, understanding and helping patients, clinicians need information technology to make electronic documentation easier, not harder. At the same time, there should be reasonable restrictions on the use of copy and paste to limit the growing challenge of 'note bloat'. We must find the right balance between ease of use and thoughtless documentation. The guiding principles in this document may be used to launch an interdisciplinary dialogue that promotes useful and necessary documentation that best facilitates efficient information capture and effective display.

Managing the life cycle of electronic clinical documents.

PubMed

Payne, Thomas H; Graham, Gail

2006-01-01

To develop a model of the life cycle of clinical documents from inception to use in a person's medical record, including workflow requirements from clinical practice, local policy, and regulation. We propose a model for the life cycle of clinical documents as a framework for research on documentation within electronic medical record (EMR) systems. Our proposed model includes three axes: the stages of the document, the roles of those involved with the document, and the actions those involved may take on the document at each stage. The model includes the rules to describe who (in what role) can perform what actions on the document, and at what stages they can perform them. Rules are derived from needs of clinicians, and requirements of hospital bylaws and regulators. Our model encompasses current practices for paper medical records and workflow in some EMR systems. Commercial EMR systems include methods for implementing document workflow rules. Workflow rules that are part of this model mirror functionality in the Department of Veterans Affairs (VA) EMR system where the Authorization/ Subscription Utility permits document life cycle rules to be written in English-like fashion. Creating a model of the life cycle of clinical documents serves as a framework for discussion of document workflow, how rules governing workflow can be implemented in EMR systems, and future research of electronic documentation.

Space Act Agreement Maker (SAAM) With Electronic Routing System (ERouter) Developed

NASA Technical Reports Server (NTRS)

Stauber, Laurel J.

2003-01-01

Members of the Commercial Technology Office at the NASA Glenn Research Center have developed an exciting new tool that greatly reduces the lead time in creating and routing Space Act Agreements. The Space Act Agreement Maker (SAAM) is an e-government Web-based system that automates the initial drafting of Space Act Agreements by technical and program personnel. SAAM also is used for editing and will be used later for maintaining electronic copies of all Space Act Agreements. During the initial drafting, the software prompts NASA personnel proposing an agreement to answer questions regarding the agreement. On the basis of the answers, the software selects from a matrix of NASA standard clauses to produce a first draft of the agreement. The draft agreement and information submitted by the NASA personnel are electronically routed to Glenn s Commercial Technology Office for review and, where necessary, editing. The final version of the agreement, along with any supporting documentation, is then routed for electronic concurrence/approval to the necessary internal review participants using the electronic routing system (e-router). SAAM was developed cooperatively by Glenn s Commercial Technology Office and Glenn s Office of Chief Counsel. Currently, SAAM is being evaluated by the NASA Headquarters General Counsel Office for use at all NASA centers. This system allows for the effective processing of Space Act Agreements for NASA s internal and external customers. Document control is maintained by a database. With SAAM s electronic routing, review times can be reduced significantly, allowing Glenn to more rapidly establish partnerships with industry. Prior to the creation of SAAM, it took several hours to draft a Space Act Agreement. With SAAM in place, the document can be written in about 30 min. Using the e-router also saves time in determining where the agreement is in the routing process. The document can be tracked easily, and delays can be avoided. Important research with industry partners can commence quickly after preliminary discussions have been held. The development of these products is in line with the expanding e-government initiative that is part of the Presidential Management Agenda. By using this product, NASA researchers can secure greater support from industry and academia partners. The Space Act Agreement Maker has been very well received at NASA Headquarters and at some of the other NASA centers as well. We anticipate that the NASA Ames Research Center will have the system in place very soon, and that some of the other centers will use SAAM in the near future. The General Counsel s office at NASA Headquarters has encouraged the Glenn team to develop a similar system for processing patent licenses. Find out more about Glenn's Technology Transfer & Partnership Office http://technology.grc.nasa.gov/.

Promoting International Energy Security. Volume 3: Sea-Lanes to Asia

DTIC Science & Technology

2012-01-01

commercial use only. Unauthorized posting of RAND electronic documents to a non-RAND website is prohibited. RAND electronic documents are protected under...copyright law. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use . For...trademark. © Copyright 2012 RAND Corporation Permission is given to duplicate this document for personal use only, as long as it is unaltered and

Xyce Parallel Electronic Simulator : reference guide, version 2.0.

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

Hoekstra, Robert John; Waters, Lon J.; Rankin, Eric Lamont

This document is a reference guide to the Xyce Parallel Electronic Simulator, and is a companion document to the Xyce Users' Guide. The focus of this document is (to the extent possible) exhaustively list device parameters, solver options, parser options, and other usage details of Xyce. This document is not intended to be a tutorial. Users who are new to circuit simulation are better served by the Xyce Users' Guide.

Xyce™ Parallel Electronic Simulator Reference Guide Version 6.8

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

Keiter, Eric R.; Aadithya, Karthik Venkatraman; Mei, Ting

This document is a reference guide to the Xyce Parallel Electronic Simulator, and is a companion document to the Xyce Users' Guide. The focus of this document is (to the extent possible) exhaustively list device parameters, solver options, parser options, and other usage details of Xyce . This document is not intended to be a tutorial. Users who are new to circuit simulation are better served by the Xyce Users' Guide.

Fosaprepitant-induced phlebitis: a focus on patients receiving doxorubicin/cyclophosphamide therapy.

PubMed

Leal, A D; Kadakia, K C; Looker, S; Hilger, C; Sorgatz, K; Anderson, K; Jacobson, A; Grendahl, D; Seisler, D; Hobday, T; Loprinzi, Charles L

2014-05-01

The purpose of this study was to investigate the incidence of fosaprepitant-associated infusion site adverse events (ISAEs) among a cohort of breast cancer patients receiving doxorubicin/cyclophosphamide (AC) chemotherapy. A retrospective review of electronic medical record (EMR) data was performed for all patients who were initiated on AC from January 2011 to April 2012. Data collected included baseline demographics, antiemetic regimen, documentation of ISAEs, and type of intravenous (IV) access. Descriptive statistics (mean and standard deviation or percentages) were summarized overall, by type of IV access and initial antiemetic given. Among the 148 patients included in this analysis, 98 initially received fosaprepitant and 44 received aprepitant. The incidence of ISAEs associated with fosaprepitant administration was 34.7 % (n=34), while the incidence of aprepitant-associated ISAEs was 2.3 % (n=1). All ISAEs were associated with peripheral IV access. The most commonly reported ISAEs were infusion site pain (n=26), erythema (n=22), swelling (n=12), superficial thrombosis (n=8), infusion site hives (n=5), and phlebitis/thrombophlebitis (n=5). Twenty-six patients experienced more than one type of ISAE. The incidence and severity of ISAEs associated with fosaprepitant administration among a group of patients receiving AC chemotherapy are significant and appreciably higher than what has been previously reported.

Fosaprepitant-induced Phlebitis: A Focus on Patients receiving Doxorubicin/Cyclophosphamide therapy

PubMed Central

Leal, A. D.; Kadakia, K. C.; Looker, S.; Hilger, C.; Sorgatz, K.; Anderson, K.; Jacobson, A.; Grendahl, D.; Seisler, D.; Hobday, T.; Loprinzi, C. L.

2014-01-01

Purpose The purpose of this study was to investigate the incidence of fosaprepitant-associated infusion site adverse events (ISAEs) among a cohort of breast cancer patients receiving doxorubicin/cyclophosphamide (AC) chemotherapy. Methods A retrospective review of electronic medical record (EMR) data was performed for all patients who were initiated on AC from January 2011 to April 2012. Data collected included baseline demographics, antiemetic regimen, documentation of ISAEs and type of intravenous (IV) access. Descriptive statistics (mean and standard deviation or percentages) were summarized overall, by type of IV access and initial antiemetic given. Results Among the 148 patients included in this analysis, 98 initially received fosaprepitant and 44 received aprepitant. The incidence of ISAEs associated with fosaprepitant administration was 34.7% (n=34), while the incidence of aprepitant-associated ISAEs was 2.3% (n=1). All ISAEs were associated with peripheral IV access. The most commonly reported ISAEs were: infusion site pain (n=26), erythema (n=22), swelling (n=12), superficial thrombosis (n=8), infusion site hives (n=5) and phlebitis/thrombophlebitis (n=5). Twenty-six patients experienced more than one type of ISAE. Conclusions The incidence and severity of ISAEs associated with fosaprepitant administration among a group of patients receiving AC chemotherapy is significant and appreciably higher than what has been previously reported. PMID:24402411

Information retrieval system utilizing wavelet transform

DOEpatents

Brewster, Mary E.; Miller, Nancy E.

2000-01-01

A method for automatically partitioning an unstructured electronically formatted natural language document into its sub-topic structure. Specifically, the document is converted to an electronic signal and a wavelet transform is then performed on the signal. The resultant signal may then be used to graphically display and interact with the sub-topic structure of the document.

49 CFR 1104.1 - Address, identification, and electronic filing option.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 2 of 4” and so forth). (e) Persons filing pleadings and documents with the Board have the option of electronically filing (e-filing) certain types of pleadings and documents instead of filing paper copies. Details regarding the types of pleadings and documents eligible for e-filing, the procedures to be followed, and...

15 CFR 758.5 - Conformity of documents and unloading of items.

Code of Federal Regulations, 2011 CFR

2011-01-01

... and Shipper's Export Declaration (SED) or AES electronic equivalent. (2) Optional ports of unloading... ultimate destination or are included on the BIS license and SED or AES electronic equivalent. (ii... ports of unloading on the SED or AES electronic equivalent and other export control documents, so long...

Document Storage and Retrieval in the Electronic Office.

ERIC Educational Resources Information Center

Ashford, John

1985-01-01

Proposals are made for practical approaches to the design of electronic office systems to provide for the effective storage and retrieval of the documents that they generate. Problems of records management and requirements to be met by the designer of an electronic office system are highlighted. Nineteen references are cited. (EJS)

Improvement in Herpes Zoster Vaccination in Patients with Rheumatoid Arthritis: A Quality Improvement Project.

PubMed

Sheth, Heena; Moreland, Larry; Peterson, Hilary; Aggarwal, Rohit

2017-01-01

To improve herpes zoster (HZ) vaccination rates in high-risk patients with rheumatoid arthritis (RA) being treated with immunosuppressive therapy. This quality improvement project was based on the pre- and post-intervention design. The project targeted all patients with RA over the age of 60 years while being treated with immunosuppressive therapy (not with biologics) seen in 13 rheumatology outpatient clinics. The study period was from July 2012 to June 2013 for the pre-intervention and February 2014 to January 2015 for the post-intervention phase. The electronic best practice alert (BPA) for HZ vaccination was developed; it appeared on electronic medical records during registration and medication reconciliation of the eligible patient by the medical assistant. The BPA was designed to electronically identify patient eligibility and to enable the physician to order the vaccine or to document refusal or deferral reason. Education regarding vaccine guidelines, BPA, vaccination process, and feedback were crucial components of the project interventions. The vaccination rates were compared using the chi-square test. We evaluated 1823 and 1554 eligible patients with RA during the pre-intervention and post-intervention phases, respectively. The HZ vaccination rates, reported as patients vaccinated among all eligible patients, improved significantly from the pre-intervention period of 10.1% (184/1823) to 51.7% (804/1554) during the intervention phase (p < 0.0001). The documentation rates (vaccine received, vaccine ordered, patient refusal, and deferral reasons) increased from 28% (510/1823) to 72.9% (1133/1554; p < 0.0001). The HZ infection rates decreased significantly from 2% to 0.3% (p = 0.002). Electronic identification of vaccine eligibility and BPA significantly improved HZ vaccination rates. The process required minimal modification of clinic work flow and did not burden the physician's time, and has the potential for self-sustainability and generalizability.

Machine Learning Methods to Extract Documentation of Breast Cancer Symptoms From Electronic Health Records.

PubMed

Forsyth, Alexander W; Barzilay, Regina; Hughes, Kevin S; Lui, Dickson; Lorenz, Karl A; Enzinger, Andrea; Tulsky, James A; Lindvall, Charlotta

2018-06-01

Clinicians document cancer patients' symptoms in free-text format within electronic health record visit notes. Although symptoms are critically important to quality of life and often herald clinical status changes, computational methods to assess the trajectory of symptoms over time are woefully underdeveloped. To create machine learning algorithms capable of extracting patient-reported symptoms from free-text electronic health record notes. The data set included 103,564 sentences obtained from the electronic clinical notes of 2695 breast cancer patients receiving paclitaxel-containing chemotherapy at two academic cancer centers between May 1996 and May 2015. We manually annotated 10,000 sentences and trained a conditional random field model to predict words indicating an active symptom (positive label), absence of a symptom (negative label), or no symptom at all (neutral label). Sentences labeled by human coder were divided into training, validation, and test data sets. Final model performance was determined on 20% test data unused in model development or tuning. The final model achieved precision of 0.82, 0.86, and 0.99 and recall of 0.56, 0.69, and 1.00 for positive, negative, and neutral symptom labels, respectively. The most common positive symptoms were pain, fatigue, and nausea. Machine-based labeling of 103,564 sentences took two minutes. We demonstrate the potential of machine learning to gather, track, and analyze symptoms experienced by cancer patients during chemotherapy. Although our initial model requires further optimization to improve the performance, further model building may yield machine learning methods suitable to be deployed in routine clinical care, quality improvement, and research applications. Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Randomised trial comparing the recording ability of a novel, electronic emergency documentation system with the AHA paper cardiac arrest record.

PubMed

Grigg, Eliot; Palmer, Andrew; Grigg, Jeffrey; Oppenheimer, Peter; Wu, Tim; Roesler, Axel; Nair, Bala; Ross, Brian

2014-10-01

To evaluate the ability of an electronic system created at the University of Washington to accurately document prerecorded VF and pulseless electrical activity (PEA) cardiac arrest scenarios compared with the American Heart Association paper cardiac arrest record. 16 anaesthesiology residents were randomly assigned to view one of two prerecorded, simulated VF and PEA scenarios and asked to document the event with either the paper or electronic system. Each subject then repeated the process with the other video and documentation method. Five types of documentation errors were defined: (1) omission, (2) specification, (3) timing, (4) commission and (5) noise. The mean difference in errors between the paper and electronic methods was analysed using a single factor repeated measures ANOVA model. Compared with paper records, the electronic system omitted 6.3 fewer events (95% CI -10.1 to -2.5, p=0.003), which represents a 28% reduction in omission errors. Users recorded 2.9 fewer noise items (95% CI -5.3 to -0.6, p=0.003) when compared with paper, representing a 36% decrease in redundant or irrelevant information. The rate of timing (Δ=-3.2, 95% CI -9.3 to 3.0, p=0.286) and commission (Δ=-4.4, 95% CI -9.4 to 0.5, p=0.075) errors were similar between the electronic system and paper, while the rate of specification errors were about a third lower for the electronic system when compared with the paper record (Δ=-3.2, 95% CI -6.3 to -0.2, p=0.037). Compared with paper documentation, documentation with the electronic system captured 24% more critical information during a simulated medical emergency without loss in data quality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

47 CFR 1.1206 - Permit-but-disclose proceedings.

Code of Federal Regulations, 2012 CFR

2012-10-01

... document to be filed electronically contains metadata that is confidential or protected from disclosure by... metadata from the document before filing it electronically. (iii) Filing dates outside the Sunshine period...

47 CFR 1.1206 - Permit-but-disclose proceedings.

Code of Federal Regulations, 2011 CFR

2011-10-01

... technically possible. Where the document to be filed electronically contains metadata that is confidential or... filer may remove such metadata from the document before filing it electronically. (iii) Filing dates...

Smart roadside initiative : system design document.

DOT National Transportation Integrated Search

2015-09-01

This document describes the software design for the Smart Roadside Initiative (SRI) for the delivery of capabilities related to wireless roadside inspections, electronic screening/virtual weigh stations, universal electronic commercial vehicle identi...

Xyce parallel electronic simulator reference guide, Version 6.0.1.

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

Keiter, Eric R; Mei, Ting; Russo, Thomas V.

2014-01-01

This document is a reference guide to the Xyce Parallel Electronic Simulator, and is a companion document to the Xyce Users Guide [1] . The focus of this document is (to the extent possible) exhaustively list device parameters, solver options, parser options, and other usage details of Xyce. This document is not intended to be a tutorial. Users who are new to circuit simulation are better served by the Xyce Users Guide [1] .

Xyce parallel electronic simulator reference guide, version 6.0.

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

Keiter, Eric R; Mei, Ting; Russo, Thomas V.

2013-08-01

This document is a reference guide to the Xyce Parallel Electronic Simulator, and is a companion document to the Xyce Users Guide [1] . The focus of this document is (to the extent possible) exhaustively list device parameters, solver options, parser options, and other usage details of Xyce. This document is not intended to be a tutorial. Users who are new to circuit simulation are better served by the Xyce Users Guide [1] .

The implementation and evaluation of an evidence-based statewide prehospital pain management protocol developed using the national prehospital evidence-based guideline model process for emergency medical services.

PubMed

Brown, Kathleen M; Hirshon, Jon Mark; Alcorta, Richard; Weik, Tasmeen S; Lawner, Ben; Ho, Shiu; Wright, Joseph L

2014-01-01

In 2008, the National Highway Traffic Safety Administration funded the development of a model process for the development and implementation of evidence-based guidelines (EBGs) for emergency medical services (EMS). We report on the implementation and evaluation of an evidence-based prehospital pain management protocol developed using this model process. An evidence-based protocol for prehospital management of pain resulting from injuries and burns was reviewed by the Protocol Review Committee (PRC) of the Maryland Institute for Emergency Medical Services Systems (MIEMSS). The PRC recommended revisions to the Maryland protocol that reflected recommendations in the EBG: weight-based dosing and repeat dosing of morphine. A training curriculum was developed and implemented using Maryland's online Learning Management System and successfully accessed by 3,941 paramedics and 15,969 BLS providers. Field providers submitted electronic patient care reports to the MIEMSS statewide prehospital database. Inclusion criteria were injured or burned patients transported by Maryland ambulances to Maryland hospitals whose electronic patient care records included data for level of EMS provider training during a 12-month preimplementation period and a 12-month postimplementation period from September 2010 through March 2012. We compared the percentage of patients receiving pain scale assessments and morphine, as well as the dose of morphine administered and the use of naloxone as a rescue medication for opiate use, before and after the protocol change. No differences were seen in the percentage of patients who had a pain score documented or the percent of patients receiving morphine before and after the protocol change, but there was a significant increase in the total dose and dose in mg/kg administered per patient. During the postintervention phase, patients received an 18% higher total morphine dose and a 14.9% greater mg/kg dose. We demonstrated that the implementation of a revised statewide prehospital pain management protocol based on an EBG developed using the National Prehospital Evidence-based Guideline Model Process was associated with an increase in dosing of narcotic pain medication consistent with that recommended by the EBG. No differences were seen in the percentage of patients receiving opiate analgesia or in the documentation of pain scores.

47 CFR 1.1206 - Permit-but-disclose proceed-ings.

Code of Federal Regulations, 2013 CFR

2013-10-01

... technically possible. Where the document to be filed electronically contains metadata that is confidential or... filer may remove such metadata from the document before filing it electronically. (iii) Filing dates...

47 CFR 1.1206 - Permit-but-disclose proceed-ings.

Code of Federal Regulations, 2014 CFR

2014-10-01

... technically possible. Where the document to be filed electronically contains metadata that is confidential or... filer may remove such metadata from the document before filing it electronically. (iii) Filing dates...

Advance Care Planning Documentation in Electronic Health Records: Current Challenges and Recommendations for Change.

PubMed

Lamas, Daniela; Panariello, Natalie; Henrich, Natalie; Hammes, Bernard; Hanson, Laura C; Meier, Diane E; Guinn, Nancy; Corrigan, Janet; Hubber, Sean; Luetke-Stahlman, Hannah; Block, Susan

2018-04-01

To develop a set of clinically relevant recommendations to improve the state of advance care planning (ACP) documentation in the electronic health record (EHR). Advance care planning (ACP) is a key process that supports goal-concordant care. For preferences to be honored, clinicians must be able to reliably record, find, and use ACP documentation. However, there are no standards to guide ACP documentation in the electronic health record (EHR). We interviewed 21 key informants to understand the strengths and weaknesses of EHR documentation systems for ACP and identify best practices. We analyzed these interviews using a qualitative content analysis approach and subsequently developed a preliminary set of recommendations. These recommendations were vetted and refined in a second round of input from a national panel of content experts. Informants identified six themes regarding current inadequacies in documentation and accessibility of ACP information and opportunities for improvement. We offer a set of concise, clinically relevant recommendations, informed by expert opinion, to improve the state of ACP documentation in the EHR.

A Proposed Integration Environment for Enhanced User Interaction and Value-Adding of Electronic Documents: An Empirical Evaluation.

ERIC Educational Resources Information Center

Liew, Chern Li; Chennupati, K. R.; Foo, Schubert

2001-01-01

Explores the potential and impact of an innovative information environment in enhancing user activities in using electronic documents for various tasks, and to support the value-adding of these e-documents. Discusses the conceptual design and prototyping of a proposed environment, PROPIE. Presents an empirical and formative evaluation of the…

Information retrieval system utilizing wavelet transform

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

Brewster, M.E.; Miller, N.E.

A method is disclosed for automatically partitioning an unstructured electronically formatted natural language document into its sub-topic structure. Specifically, the document is converted to an electronic signal and a wavelet transform is then performed on the signal. The resultant signal may then be used to graphically display and interact with the sub-topic structure of the document.

76 FR 13121 - Electronic On-Board Recorders and Hours of Service Supporting Documents

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-10

... DEPARTMENT OF TRANSPORTATION Federal Motor Carrier Safety Administration 49 CFR Parts 385, 390, and 395 [Docket No. FMCSA-2010-0167] RIN 2126-AB20 Electronic On-Board Recorders and Hours of Service... comment period for the Electronic On-Board Recorder and Hours of Service Supporting Documents Notice of...

76 FR 61937 - Practice and Procedure: Rules of General Application, Safeguards, Antidumping and Countervailing...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-06

... System Web site at https://edis.usitc.gov . Failure to comply with the requirements of this chapter and... Electronic Document Information System (EDIS) already accepts electronic filing of certain documents, and..., regardless of whether the electronic docketing system is operational. The ITC TLA makes a similar comment...

78 FR 49280 - 30-Day Notice of Proposed Information Collection: Third-Party Documentation Facsimile Transmittal...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-13

... calling the toll-free Federal Relay Service at (800) 877-8339. This is not a toll- free number. Copies of... produces an electronic version of the document that will be matched with the electronic application....g., permitting electronic submission of responses. HUD encourages interested parties to submit...

Electronic Imaging in Admissions, Records & Financial Aid Offices.

ERIC Educational Resources Information Center

Perkins, Helen L.

Over the years, efforts have been made to work more efficiently with the ever increasing number of records and paper documents that cross workers' desks. Filing records on optical disk through electronic imaging is an alternative that many feel is the answer to successful document management. The pioneering efforts in electronic imaging in…

Advanced Electronics. Curriculum Development. Bulletin 1778.

ERIC Educational Resources Information Center

Eppler, Thomas

This document is a curriculum guide for a 180-hour course in advanced electronics for 11th and 12th grades that has four instructional units. The instructional units are orientation, discrete components, integrated circuits, and electronic systems. The document includes a course flow chart; a two-page section that describes the course, lists…

41 CFR 302-7.106 - What documentation is required to receive an advance under the commuted rate method?

Code of Federal Regulations, 2010 CFR

2010-07-01

... STORAGE OF PROPERTY 7-TRANSPORTATION AND TEMPORARY STORAGE OF HOUSEHOLD GOODS AND PROFESSIONAL BOOKS, PAPERS, AND EQUIPMENT (PBP&E) Commuted Rate § 302-7.106 What documentation is required to receive an...

Perspectives of healthcare practitioners: An exploration of interprofessional communication using electronic medical records.

PubMed

Bardach, Shoshana H; Real, Kevin; Bardach, David R

2017-05-01

Contemporary state-of-the-art healthcare facilities are incorporating technology into their building design to improve communication and patient care. However, technological innovations may also have unintended consequences. This study seeks to better understand how technology influences interprofessional communication within a hospital setting based in the United States. Nine focus groups were conducted including a range of healthcare professions. The focus groups explored practitioners' experiences working on two floors of a newly designed hospital and included questions about the ways in which technology shaped communication with other healthcare professionals. All focus groups were recorded, transcribed, and coded to identify themes. Participant responses focused on the electronic medical record, and while some benefits of the electronic medical record were discussed, participants indicated use of the electronic medical record has resulted in a reduction of in-person communication. Different charting approaches resulted in barriers to communication between specialties and reduced confidence that other practitioners had received one's notes. Limitations in technology-including limited computer availability, documentation complexity, and sluggish sign-in processes-also were identified as barriers to effective and timely communication between practitioners. Given the ways in which technology shapes interprofessional communication, future research should explore how to create standardised electronic medical record use across professions at the optimal level to support communication and patient care.

7 CFR 400.209 - Electronic transmission and receiving system.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 6 2012-01-01 2012-01-01 false Electronic transmission and receiving system. 400.209... Contract-Standards for Approval § 400.209 Electronic transmission and receiving system. Any Contractor...; (b) Maintain an electronic system which must be tested and approved by the Corporation; (c) Maintain...

7 CFR 400.209 - Electronic transmission and receiving system.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 6 2013-01-01 2013-01-01 false Electronic transmission and receiving system. 400.209... Contract-Standards for Approval § 400.209 Electronic transmission and receiving system. Any Contractor...; (b) Maintain an electronic system which must be tested and approved by the Corporation; (c) Maintain...

7 CFR 400.209 - Electronic transmission and receiving system.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 6 2011-01-01 2011-01-01 false Electronic transmission and receiving system. 400.209... Contract-Standards for Approval § 400.209 Electronic transmission and receiving system. Any Contractor...; (b) Maintain an electronic system which must be tested and approved by the Corporation; (c) Maintain...

7 CFR 400.209 - Electronic transmission and receiving system.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 6 2010-01-01 2010-01-01 false Electronic transmission and receiving system. 400.209... Contract-Standards for Approval § 400.209 Electronic transmission and receiving system. Any Contractor...; (b) Maintain an electronic system which must be tested and approved by the Corporation; (c) Maintain...

43 CFR 45.70 - How must documents be filed and served under this subpart?

Code of Federal Regulations, 2013 CFR

2013-10-01

... must be served on each license party and FERC, using: (i) One of the methods of service in § 45.13(c... one of the methods set forth in § 45.12(b). (2) A document is considered filed on the date it is received. However, any document received after 5 p.m. at the place where the filing is due is considered...

43 CFR 45.70 - How must documents be filed and served under this subpart?

Code of Federal Regulations, 2011 CFR

2011-10-01

... must be served on each license party and FERC, using: (i) One of the methods of service in § 45.13(c... one of the methods set forth in § 45.12(b). (2) A document is considered filed on the date it is received. However, any document received after 5 p.m. at the place where the filing is due is considered...

43 CFR 45.70 - How must documents be filed and served under this subpart?

Code of Federal Regulations, 2012 CFR

2012-10-01

... must be served on each license party and FERC, using: (i) One of the methods of service in § 45.13(c... one of the methods set forth in § 45.12(b). (2) A document is considered filed on the date it is received. However, any document received after 5 p.m. at the place where the filing is due is considered...

Photoelectrochemically driven self-assembly method

DOEpatents

Nielson, Gregory N.; Okandan, Murat

2017-01-17

Various technologies described herein pertain to assembling electronic devices into a microsystem. The electronic devices are disposed in a solution. Light can be applied to the electronic devices in the solution. The electronic devices can generate currents responsive to the light applied to the electronic devices in the solution, and the currents can cause electrochemical reactions that functionalize regions on surfaces of the electronic devices. Additionally or alternatively, the light applied to the electronic devices in the solution can cause the electronic devices to generate electric fields, which can orient the electronic devices and/or induce movement of the electronic devices with respect to a receiving substrate. Further, electrodes on a receiving substrate can be biased to attract and form connections with the electronic devices having the functionalized regions on the surfaces. The microsystem can include the receiving substrate and the electronic devices connected to the receiving substrate.

Xyce parallel electronic simulator reference guide, version 6.1

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

Keiter, Eric R; Mei, Ting; Russo, Thomas V.

2014-03-01

This document is a reference guide to the Xyce Parallel Electronic Simulator, and is a companion document to the Xyce Users Guide [1] . The focus of this document is (to the extent possible) exhaustively list device parameters, solver options, parser options, and other usage details of Xyce. This document is not intended to be a tutorial. Users who are new to circuit simulation are better served by the Xyce Users Guide [1] .

Voyager electronic parts radiation program. Volume 2: Test requirements and procedures

NASA Technical Reports Server (NTRS)

Stanley, A. G.; Martin, K. E.; Price, W. E.

1978-01-01

Documents are presented outlining the conditions and requirements of the test program. The Appendixes are as follows: appendix A -- Electron Simulation Radiation Test Specification for Voyager Electronic Parts and Devices, appendix B -- Electronic Piece-Part Testing Program for Voyager, appendix C -- Test Procedure for Radiation Screening of Voyager Piece Parts, appendix D -- Boeing In Situ Test Fixture, and appendix E -- Irradiate - Anneal (IRAN) Screening Documents.

Using electronic document management systems to manage highway project files.

DOT National Transportation Integrated Search

2011-12-12

"WisDOTs Bureau of Technical Services is interested in learning about the practices of other state departments of : transportation in developing and implementing an electronic document management system to manage highway : project files"

76 FR 66311 - Draft Documents To Support Submission of an Electronic Common Technical Document; Availability

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-26

.../DevelopmentApprovalProcess/FormsSubmissionRequirements/ElectronicSubmissions/ucm253101.htm , http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/default.htm , or http...

The Importance of the Medical Record: A Critical Professional Responsibility.

PubMed

Ngo, Elizabeth; Patel, Nachiket; Chandrasekaran, Krishnaswamy; Tajik, A Jamil; Paterick, Timothy E

2016-01-01

Comprehensive, detailed documentation in the medical record is critical to patient care and to a physician when allegations of negligence arise. Physicians, therefore, would be prudent to have a clear understanding of this documentation. It is important to understand who is responsible for documentation, what is important to document, when to document, and how to document. Additionally, it should be understood who owns the medical record, the significance of the transition to the electronic medical record, problems and pitfalls when using the electronic medical record, and how the Health Information Technology for Economic and Clinical Health Act affects healthcare providers and health information technology.

Using an Educational Electronic Documentation System to Help Nursing Students Accurately Identify Nursing Diagnoses

ERIC Educational Resources Information Center

Pobocik, Tamara J.

2013-01-01

The use of technology and electronic medical records in healthcare has exponentially increased. This quantitative research project used a pretest/posttest design, and reviewed how an educational electronic documentation system helped nursing students to identify the accurate related to statement of the nursing diagnosis for the patient in the case…

Examining Evidence-Based Content Related to Hospital Acquired Pressure Ulcer Prevention in Paper and Electronic Health Records

ERIC Educational Resources Information Center

Jaekel, Camilla M.

2012-01-01

Although there have been great advancements in the Electronic Health Record (EHR), there is a dearth of rigorous research that examines the relationship between the use of electronic documentation to capture nursing process components and the impact of consistent documentation on patient outcomes (Daly, Buckwalter & Maas, 2002; Gugerty, 2006;…

E-submission Format for Sub-chronic and Chronic Studies

EPA Pesticide Factsheets

The purpose of this document is to suggest the format for final reports and to provide instructions for creation of Adobe PDF electronic submission documents for electronic submission of sub-chronic and chronic studies for pesticides.

Developing an Interface to Order and Document Health Education Videos in the Electronic Health Record.

PubMed

Wojcik, Lauren

2015-01-01

Transitioning to electronic health records (EHRs) provides an opportunity for health care systems to integrate educational content available on interactive patient systems (IPS) with the medical documentation system. This column discusses how one hospital simplified providers' workflow by making it easier to order educational videos and ensure that completed education is documented within the medical record. Integrating the EHR and IPS streamlined the provision of patient education, improved documentation, and supported the organization in meeting core requirements for Meaningful Use.

A Document-Based EHR System That Controls the Disclosure of Clinical Documents Using an Access Control List File Based on the HL7 CDA Header.

PubMed

Takeda, Toshihiro; Ueda, Kanayo; Nakagawa, Akito; Manabe, Shirou; Okada, Katsuki; Mihara, Naoki; Matsumura, Yasushi

2017-01-01

Electronic health record (EHR) systems are necessary for the sharing of medical information between care delivery organizations (CDOs). We developed a document-based EHR system in which all of the PDF documents that are stored in our electronic medical record system can be disclosed to selected target CDOs. An access control list (ACL) file was designed based on the HL7 CDA header to manage the information that is disclosed.

Improving Herpes Zoster Vaccination Rates Through Use of a Clinical Pharmacist and a Personal Health Record

PubMed Central

Otsuka, Shelley H.; Tayal, Neeraj H.; Porter, Kyle; Embi, Peter J.; Beatty, Stuart J.

2014-01-01

BACKGROUND Preventative health services, including herpes zoster vaccination rates, remain low despite known benefits. A new care model to improve preventative health services is warranted. The objective of this study is to investigate whether the functions of an electronic medical record, in combination with a pharmacist as part of the care team, can improve the herpes zoster vaccination rate. METHODS This study was a 6-month, randomized controlled trial at a General Internal Medicine clinic at The Ohio State University. The 2589 patients aged 60 years and older without documented herpes zoster vaccination in the electronic medical record were stratified on the basis of activated personal health record status, an online tool used to share health information between patient and provider. Of the 674 personal health record users, 250 were randomized to receive information regarding the herpes zoster vaccination via an electronic message and 424 were randomized to standard of care. Likewise, of the 1915 nonpersonal health record users, 250 were randomized to receive the same information via the US Postal Service and 1665 were randomized to standard of care. After pharmacist chart review, eligible patients were mailed a herpes zoster vaccine prescription. Herpes zoster vaccination rates were compared by chi-square tests. RESULTS Intervention recipients had significantly higher vaccination rates than controls in both personal health record (relative risk, 2.7; P = .0007) and nonpersonal health record (relative risk, 2.9; P = .0001) patient populations. CONCLUSIONS Communication outside of face-to-face office visits, by both personal health record electronic message and information by mail, can improve preventative health intervention rates compared with standard care. PMID:23830534

Use of an electronic problem list by primary care providers and specialists.

PubMed

Wright, Adam; Feblowitz, Joshua; Maloney, Francine L; Henkin, Stanislav; Bates, David W

2012-08-01

Accurate patient problem lists are valuable tools for improving the quality of care, enabling clinical decision support, and facilitating research and quality measurement. However, problem lists are frequently inaccurate and out-of-date and use varies widely across providers. Our goal was to assess provider use of an electronic problem list and identify differences in usage between medical specialties. Chart review of a random sample of 100,000 patients who had received care in the past two years at a Boston-based academic medical center. Counts were collected of all notes and problems added for each patient from 1/1/2002 to 4/30/2010. For each entry, the recording provider and the clinic in which the entry was recorded was collected. We used the Healthcare Provider Taxonomy Code Set to categorize each clinic by specialty. We analyzed the problem list use across specialties, controlling for note volume as a proxy for visits. A total of 2,264,051 notes and 158,105 problems were recorded in the electronic medical record for this population during the study period. Primary care providers added 82.3% of all problems, despite writing only 40.4% of all notes. Of all patients, 49.1% had an assigned primary care provider (PCP) affiliated with the hospital; patients with a PCP had an average of 4.7 documented problems compared to 1.5 problems for patients without a PCP. Primary care providers were responsible for the majority of problem documentation; surgical and medical specialists and subspecialists recorded a disproportionately small number of problems on the problem list.

Electronic flight bag (EFB) : 2010 industry survey

DOT National Transportation Integrated Search

2010-09-01

This document provides an overview of Electronic Flight Bag (EFB) systems and capabilities, as of June 2010. This document updates and replaces the April 2007 EFB Industry Review (Yeh and Chandra, 2007). As with the previous industry survey, the focu...

42 CFR 482.90 - Condition of participation: Patient and living donor selection.

Code of Federal Regulations, 2011 CFR

2011-10-01

... principles of medical ethics. Transplant centers must: (1) Ensure that a prospective living donor receives a... candidate on its waiting list, the candidate's medical record must contain documentation that the candidate... selected to receive a transplant, the center must document in the patient's medical record the patient...

18 CFR 385.2010 - Service (Rule 2010).

Code of Federal Regulations, 2012 CFR

2012-04-01

.... Name (if applicable) Address Telephone No. (k) Designation of corporate officials to receive service... the Secretary of the Commission: (i) The name of the corporate official or person that is to receive... participant filing a document in a proceeding must serve a copy of the document on: (i) Each person whose name...

18 CFR 385.2010 - Service (Rule 2010).

Code of Federal Regulations, 2011 CFR

2011-04-01

.... Name (if applicable) Address Telephone No. (k) Designation of corporate officials to receive service... the Secretary of the Commission: (i) The name of the corporate official or person that is to receive... participant filing a document in a proceeding must serve a copy of the document on: (i) Each person whose name...

18 CFR 385.2010 - Service (Rule 2010).

Code of Federal Regulations, 2014 CFR

2014-04-01

.... Name (if applicable) Address Telephone No. (k) Designation of corporate officials to receive service... the Secretary of the Commission: (i) The name of the corporate official or person that is to receive... participant filing a document in a proceeding must serve a copy of the document on: (i) Each person whose name...

18 CFR 385.2010 - Service (Rule 2010).

Code of Federal Regulations, 2013 CFR

2013-04-01

.... Name (if applicable) Address Telephone No. (k) Designation of corporate officials to receive service... the Secretary of the Commission: (i) The name of the corporate official or person that is to receive... participant filing a document in a proceeding must serve a copy of the document on: (i) Each person whose name...

U-10Mo Sample Preparation and Examination using Optical and Scanning Electron Microscopy

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

Prabhakaran, Ramprashad; Joshi, Vineet V.; Rhodes, Mark A.

2016-10-01

The purpose of this document is to provide guidelines to prepare specimens of uranium alloyed with 10 weight percent molybdenum (U-10Mo) for optical metallography and scanning electron microscopy. This document also provides instructions to set up an optical microscope and a scanning electron microscope to analyze U-10Mo specimens and to obtain the required information.

U-10Mo Sample Preparation and Examination using Optical and Scanning Electron Microscopy

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

Prabhakaran, Ramprashad; Joshi, Vineet V.; Rhodes, Mark A.

2016-03-30

The purpose of this document is to provide guidelines to prepare specimens of uranium alloyed with 10 weight percent molybdenum (U-10Mo) for optical metallography and scanning electron microscopy. This document also provides instructions to set up an optical microscope and a scanning electron microscope to analyze U-10Mo specimens and to obtain the required information.

Improving Adherence to Long-term Opioid Therapy Guidelines to Reduce Opioid Misuse in Primary Care A Cluster-Randomized Clinical Trial

PubMed Central

Liebschutz, Jane M.; Xuan, Ziming; Shanahan, Christopher W.; LaRochelle, Marc; Keosaian, Julia; Beers, Donna; Guara, George; O’Connor, Kristen; Alford, Daniel P.; Parker, Victoria; Weiss, Roger D.; Samet, Jeffrey H.; Crosson, Julie; Cushman, Phoebe A.; Lasser, Karen E.

2017-01-01

IMPORTANCE Prescription opioid misuse is a national crisis. Few interventions have improved adherence to opioid-prescribing guidelines. OBJECTIVE To determine whether a multicomponent intervention, Transforming Opioid Prescribing in Primary Care (TOPCARE; http://mytopcare.org/), improves guideline adherence while decreasing opioid misuse risk. DESIGN, SETTING, AND PARTICIPANTS Cluster-randomized clinical trial among 53 primary care clinicians (PCCs) and their 985 patients receiving long-term opioid therapy for pain. The study was conducted from January 2014 to March 2016 in 4 safety-net primary care practices. INTERVENTIONS Intervention PCCs received nurse care management, an electronic registry, 1-on-1 academic detailing, and electronic decision tools for safe opioid prescribing. Control PCCs received electronic decision tools only. MAIN OUTCOMES AND MEASURES Primary outcomes included documentation of guideline-concordant care (both a patient-PCC agreement in the electronic health record and at least 1 urine drug test [UDT]) over 12 months and 2 or more early opioid refills. Secondary outcomes included opioid dose reduction (ie, 10% decrease in morphine-equivalent daily dose [MEDD] at trial end) and opioid treatment discontinuation. Adjusted outcomes controlled for differing baseline patient characteristics: substance use diagnosis, mental health diagnoses, and language. RESULTS Of the 985 participating patients, 519 were men, and 466 were women (mean [SD] patient age, 54.7 [11.5] years). Patients received a mean (SD) MEDD of 57.8 (78.5) mg. At 1 year, intervention patients were more likely than controls to receive guideline-concordant care (65.9% vs 37.8%; P < .001; adjusted odds ratio [AOR], 6.0; 95% CI, 3.6–10.2), to have a patient-PCC agreement (of the 376 without an agreement at baseline, 53.8% vs 6.0%; P < .001; AOR, 11.9; 95% CI, 4.4–32.2), and to undergo at least 1 UDT (74.6% vs 57.9%; P < .001; AOR, 3.0; 95% CI, 1.8–5.0). There was no difference in odds of early refill receipt between groups (20.7% vs 20.1%; AOR, 1.1; 95% CI, 0.7–1.8). Intervention patients were more likely than controls to have either a 10% dose reduction or opioid treatment discontinuation (AOR, 1.6; 95% CI, 1.3–2.1; P < .001). In adjusted analyses, intervention patients had a mean (SE) MEDD 6.8 (1.6) mg lower than controls (P < .001). CONCLUSIONS AND RELEVANCE A multicomponent intervention improved guideline-concordant care but did not decrease early opioid refills. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01909076 PMID:28715535

Improving Adherence to Long-term Opioid Therapy Guidelines to Reduce Opioid Misuse in Primary Care: A Cluster-Randomized Clinical Trial.

PubMed

Liebschutz, Jane M; Xuan, Ziming; Shanahan, Christopher W; LaRochelle, Marc; Keosaian, Julia; Beers, Donna; Guara, George; O'Connor, Kristen; Alford, Daniel P; Parker, Victoria; Weiss, Roger D; Samet, Jeffrey H; Crosson, Julie; Cushman, Phoebe A; Lasser, Karen E

2017-09-01

Prescription opioid misuse is a national crisis. Few interventions have improved adherence to opioid-prescribing guidelines. To determine whether a multicomponent intervention, Transforming Opioid Prescribing in Primary Care (TOPCARE; http://mytopcare.org/), improves guideline adherence while decreasing opioid misuse risk. Cluster-randomized clinical trial among 53 primary care clinicians (PCCs) and their 985 patients receiving long-term opioid therapy for pain. The study was conducted from January 2014 to March 2016 in 4 safety-net primary care practices. Intervention PCCs received nurse care management, an electronic registry, 1-on-1 academic detailing, and electronic decision tools for safe opioid prescribing. Control PCCs received electronic decision tools only. Primary outcomes included documentation of guideline-concordant care (both a patient-PCC agreement in the electronic health record and at least 1 urine drug test [UDT]) over 12 months and 2 or more early opioid refills. Secondary outcomes included opioid dose reduction (ie, 10% decrease in morphine-equivalent daily dose [MEDD] at trial end) and opioid treatment discontinuation. Adjusted outcomes controlled for differing baseline patient characteristics: substance use diagnosis, mental health diagnoses, and language. Of the 985 participating patients, 519 were men, and 466 were women (mean [SD] patient age, 54.7 [11.5] years). Patients received a mean (SD) MEDD of 57.8 (78.5) mg. At 1 year, intervention patients were more likely than controls to receive guideline-concordant care (65.9% vs 37.8%; P < .001; adjusted odds ratio [AOR], 6.0; 95% CI, 3.6-10.2), to have a patient-PCC agreement (of the 376 without an agreement at baseline, 53.8% vs 6.0%; P < .001; AOR, 11.9; 95% CI, 4.4-32.2), and to undergo at least 1 UDT (74.6% vs 57.9%; P < .001; AOR, 3.0; 95% CI, 1.8-5.0). There was no difference in odds of early refill receipt between groups (20.7% vs 20.1%; AOR, 1.1; 95% CI, 0.7-1.8). Intervention patients were more likely than controls to have either a 10% dose reduction or opioid treatment discontinuation (AOR, 1.6; 95% CI, 1.3-2.1; P < .001). In adjusted analyses, intervention patients had a mean (SE) MEDD 6.8 (1.6) mg lower than controls (P < .001). A multicomponent intervention improved guideline-concordant care but did not decrease early opioid refills. clinicaltrials.gov Identifier: NCT01909076.

Title list of documents made publicly available. Volume 17, No. 10

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

NONE

This document is a monthly publication containing descriptions of information received and generated by the US Nuclear Regulatory Commission (NRC). This information includes (1) docketed material associated with civilian nuclear power plants and other uses of radioactive materials, and (2) nondocketed material received and generated by NRC pertinent to its role as a regulatory agency. The following indexes are included: Personal Author, Corporate Source, Report Number, and Cross Reference of Enclosures to Principal Documents.

Title list of documents made publicly available, September 1--30, 1994. Volume 16, No. 9

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

Not Available

1994-11-01

This document is a monthly publication containing descriptions of information received and generated by the US Nuclear Regulatory Commission (NRC). This information includes docketed material associated with civilian nuclear power plants and other uses of radioactive materials, and nondocketed material received and generated by NRC pertinent to its role as a regulatory agency. The following indexes are included: Personal Author, Corporate Source, Report Number, and Cross Reference of Enclosures to Principal Documents.

Title list of documents made publicly available, November 1--30, 1994. Volume 16, No. 11

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

Not Available

1995-01-01

This document is a monthly publication containing descriptions of information received and generated by the US Nuclear Regulatory Commission (NRC). This information includes docketed material associated with civilian nuclear power plants and other uses of radioactive materials, and nondocketed material received and generated by NRC pertinent to its role as a regulatory agency. The following indexes are included: Personal Author, Corporate Source, Report Number, and Cross Reference of Enclosures to Principal Documents.

Emergency Medicine Resident Physicians’ Perceptions of Electronic Documentation and Workflow

PubMed Central

Neri, P.M.; Redden, L.; Poole, S.; Pozner, C.N.; Horsky, J.; Raja, A.S.; Poon, E.; Schiff, G.

2015-01-01

Summary Objective To understand emergency department (ED) physicians’ use of electronic documentation in order to identify usability and workflow considerations for the design of future ED information system (EDIS) physician documentation modules. Methods We invited emergency medicine resident physicians to participate in a mixed methods study using task analysis and qualitative interviews. Participants completed a simulated, standardized patient encounter in a medical simulation center while documenting in the test environment of a currently used EDIS. We recorded the time on task, type and sequence of tasks performed by the participants (including tasks performed in parallel). We then conducted semi-structured interviews with each participant. We analyzed these qualitative data using the constant comparative method to generate themes. Results Eight resident physicians participated. The simulation session averaged 17 minutes and participants spent 11 minutes on average on tasks that included electronic documentation. Participants performed tasks in parallel, such as history taking and electronic documentation. Five of the 8 participants performed a similar workflow sequence during the first part of the session while the remaining three used different workflows. Three themes characterize electronic documentation: (1) physicians report that location and timing of documentation varies based on patient acuity and workload, (2) physicians report a need for features that support improved efficiency; and (3) physicians like viewing available patient data but struggle with integration of the EDIS with other information sources. Conclusion We confirmed that physicians spend much of their time on documentation (65%) during an ED patient visit. Further, we found that resident physicians did not all use the same workflow and approach even when presented with an identical standardized patient scenario. Future EHR design should consider these varied workflows while trying to optimize efficiency, such as improving integration of clinical data. These findings should be tested quantitatively in a larger, representative study. PMID:25848411

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

PubMed Central

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

2011-01-01

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

[Law courts and clinical documentation].

PubMed

Jiménez Carnicero, M P; Magallón, A I; Gordillo, A

2006-01-01

Background. Until 2004, requests for clinical documentation proceeding from the Judicial Administration on Specialist Care of Pamplona were received in six different centres and were processed independently, with different procedures, and documents were even sent in duplicate, with the resulting work load. This article describes the procedure for processing requests for documentation proceeding from the Law Courts and analyses the requests received. Methods. A circuit was set up to channel the judicial requests that arrived at the Specialist Health Care Centres of Pamplona and at the Juridical Regime Service of the Health System of Navarra-Osasunbidea, and a Higher Technician in Health Documentation was contracted to centralise these requests. A proceedings protocol was established to unify criteria and speed up the process, and a database was designed to register the proceedings. Results. In the course of 2004, 210 requests for documentation by legal requirement were received. Of these, 24 were claims of patrimonial responsibility and 13 were requested by lawyers with the patient's authorisation. The most frequent jurisdictional order was penal (43.33%). Ninety-three point one five percent (93.15%) of the requests proceeded from law courts in the autonomous community of Navarra. The centre that received the greatest number of requests was the "Príncipe de Viana" Consultation Centre (33.73%).The most frequently requested documentation was a copy of reports (109) and a copy of the complete clinical record (39). On two occasions the original clinical record was required. The average time of response was 6.6 days. Conclusions. The centralisation of administration has brought greater agility to the process and homogeneity in the criteria of processing. Less time is involved in preparing and dispatching the documentation, the dispatch of duplicate documents is avoided, the work load has been reduced and the dispersal of documentation is avoided, a situation that guarantees greater privacy for the patient.

Leveraging Observations of Security Force Assistance in Afghanistan for Global Operations

DTIC Science & Technology

2013-01-01

commercial use only. Unauthorized posting of RAND electronic documents to a non-RAND website is prohibited. RAND electronic documents are protected under...copyright law. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use . For...contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of

Xyce™ Parallel Electronic Simulator Reference Guide, Version 6.5

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

Keiter, Eric R.; Aadithya, Karthik V.; Mei, Ting

2016-06-01

This document is a reference guide to the Xyce Parallel Electronic Simulator, and is a companion document to the Xyce Users’ Guide. The focus of this document is (to the extent possible) exhaustively list device parameters, solver options, parser options, and other usage details of Xyce. This document is not intended to be a tutorial. Users who are new to circuit simulation are better served by the Xyce Users’ Guide. The information herein is subject to change without notice. Copyright © 2002-2016 Sandia Corporation. All rights reserved.

Electronic document management systems: an overview.

PubMed

Kohn, Deborah

2002-08-01

For over a decade, most health care information technology (IT) professionals erroneously learned that document imaging, which is one of the many component technologies of an electronic document management system (EDMS), is the only technology of an EDMS. In addition, many health care IT professionals erroneously believed that EDMSs have either a limited role or no place in IT environments. As a result, most health care IT professionals do not understand documents and unstructured data and their value as structured data partners in most aspects of transaction and information processing systems.

16 CFR 4.2 - Requirements as to form, and filing of documents other than correspondence.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Administrative Law Judge) or twelve (12) paper copies (if before the Commission), and an electronic copy in Adobe... an electronic copy on a compact disc (CD) or digital video disc (DVD) in Adobe portable document...

16 CFR 4.2 - Requirements as to form, and filing of documents other than correspondence.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Administrative Law Judge) or twelve (12) paper copies (if before the Commission), and an electronic copy in Adobe... an electronic copy on a compact disc (CD) or digital video disc (DVD) in Adobe portable document...

47 CFR 61.17 - Applications for special permission.

Code of Federal Regulations, 2011 CFR

2011-10-01

... (CONTINUED) TARIFFS Rules for Electronic Filing § 61.17 Applications for special permission. (a) All issuing carriers that file applications for special permission, associated documents, such as transmittal letters, requests for special permission, and supporting information, shall file those documents electronically. (b...

48 CFR 2152.215-70 - Contractor records retention.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Contractor chooses to maintain paper documents in electronic format, the electronic version must be an exact replica of the paper document. (End of clause) [70 FR 41155, July 18, 2005] ... MANAGEMENT, FEDERAL EMPLOYEES GROUP LIFE INSURANCE FEDERAL ACQUISITION REGULATION CLAUSES AND FORMS...

48 CFR 2152.215-70 - Contractor records retention.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Contractor chooses to maintain paper documents in electronic format, the electronic version must be an exact replica of the paper document. (End of clause) [70 FR 41155, July 18, 2005] ... MANAGEMENT, FEDERAL EMPLOYEES GROUP LIFE INSURANCE FEDERAL ACQUISITION REGULATION CLAUSES AND FORMS...

48 CFR 2152.215-70 - Contractor records retention.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Contractor chooses to maintain paper documents in electronic format, the electronic version must be an exact replica of the paper document. (End of clause) [70 FR 41155, July 18, 2005] ... MANAGEMENT, FEDERAL EMPLOYEES GROUP LIFE INSURANCE FEDERAL ACQUISITION REGULATION CLAUSES AND FORMS...

48 CFR 2152.215-70 - Contractor records retention.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Contractor chooses to maintain paper documents in electronic format, the electronic version must be an exact replica of the paper document. (End of clause) [70 FR 41155, July 18, 2005] ... MANAGEMENT, FEDERAL EMPLOYEES GROUP LIFE INSURANCE FEDERAL ACQUISITION REGULATION CLAUSES AND FORMS...

Intratheater Airlift Functional Solution Analysis (FSA)

DTIC Science & Technology

2011-01-01

law as indicated in a notice appearing later in this work. This electronic representation of RAND intellectual property is provided for non ...commercial use only. Unauthorized posting of RAND electronic documents to a non -RAND website is prohibited. RAND electronic documents are protected under...1. REPORT DATE 2011 2. REPORT TYPE 3. DATES COVERED 00-00-2011 to 00-00-2011 4. TITLE AND SUBTITLE Intratheater Airlift Functional Solution

75 FR 48629 - Electronic Tariff Filing System (ETFS)

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-11

...In this document, the Federal Communications Commission (Commission) seeks comment on extending the electronic tariff filing requirement for incumbent local exchange carriers to all carriers that file tariffs and related documents. Additionally, the Commission seeks comment on the appropriate time frame for implementing this proposed requirement. The Commission also seeks comment on the proposal that the Chief of the Wireline Competition Bureau administer the adoption of this extended electronic filing requirement. Also, the Commission seeks comment on proposed rule changes to implement mandatory electronic tariff filing.

Title list of documents made publicly available: December 1--31, 1996. Volume 18, Number 12

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

NONE

1997-03-01

This document is a monthly publication containing descriptions of information received and generated by the US Nuclear Regulatory Commission (NRC). This information includes (1) docketed material associated with civilian nuclear power plants and other uses of radioactive materials, and (2) nondocketed material received and generated by NRC pertinent to its role as a regulatory agency. The following indexes are included: Personal Author, Corporate Source, Report Number, and Cross Reference of Enclosures to Principal Documents.

Title List of documents made publicly available, September 1--30, 1993. Volume 15, No. 9

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

Not Available

1993-11-01

This document is a monthly publication containing descriptions of information received and generated by the US Nuclear Regulatory Commission (NRC). This information includes (1) docketed material associated with civilian nuclear power plants and other uses of radioactive materials, and (2) nondocketed material received and generated by NRC pertinent to its role as a regulatory agency. The following indexes are included: Personal Author, Corporate Source, Report Number, and Cross Reference of Enclosures to Principals Documents.

Title list of documents made publicly available: November 1--30, 1997. Volume 19, Number 11

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

NONE

This document is a monthly publication containing descriptions of information received and generated by the US Nuclear Regulatory Commission (NRC). This information includes (1) docketed material associated with civilian nuclear power plants and other uses of radioactive materials and (2) nondocketed material received and generated by NRC pertinent to its role as a regulatory agency. The following indexes are included: Personal Author, Corporate source, Report Number, and Cross Reference of Enclosures to Principal Documents.

Winning performance improvement strategies--linking documentation and accounts receivable.

PubMed

Braden, J H; Swadley, D

1996-01-01

When the HIM department at The University of Texas Medical Branch set out to improve documentation and accounts receivable management, it established a plan that encompassed a broad spectrum of data management process changes. The department examined and acknowledged the deficiencies in data management processes and used performance improvement tools to achieve successful results.

Outpatients flow management and ophthalmic electronic medical records system in university hospital using Yahgee Document View.

PubMed

Matsuo, Toshihiko; Gochi, Akira; Hirakawa, Tsuyoshi; Ito, Tadashi; Kohno, Yoshihisa

2010-10-01

General electronic medical records systems remain insufficient for ophthalmology outpatient clinics from the viewpoint of dealing with many ophthalmic examinations and images in a large number of patients. Filing systems for documents and images by Yahgee Document View (Yahgee, Inc.) were introduced on the platform of general electronic medical records system (Fujitsu, Inc.). Outpatients flow management system and electronic medical records system for ophthalmology were constructed. All images from ophthalmic appliances were transported to Yahgee Image by the MaxFile gateway system (P4 Medic, Inc.). The flow of outpatients going through examinations such as visual acuity testing were monitored by the list "Ophthalmology Outpatients List" by Yahgee Workflow in addition to the list "Patients Reception List" by Fujitsu. Patients' identification number was scanned with bar code readers attached to ophthalmic appliances. Dual monitors were placed in doctors' rooms to show Fujitsu Medical Records on the left-hand monitor and ophthalmic charts of Yahgee Document on the right-hand monitor. The data of manually-inputted visual acuity, automatically-exported autorefractometry and non-contact tonometry on a new template, MaxFile ED, were again automatically transported to designated boxes on ophthalmic charts of Yahgee Document. Images such as fundus photographs, fluorescein angiograms, optical coherence tomographic and ultrasound scans were viewed by Yahgee Image, and were copy-and-pasted to assigned boxes on the ophthalmic charts. Ordering such as appointments, drug prescription, fees and diagnoses input, central laboratory tests, surgical theater and ward room reservations were placed by functions of the Fujitsu electronic medical records system. The combination of the Fujitsu electronic medical records and Yahgee Document View systems enabled the University Hospital to examine the same number of outpatients as prior to the implementation of the computerized filing system.

22 CFR 42.65 - Supporting documents.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF IMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Application for Immigrant Visas § 42.65 Supporting documents. (a) Authority to... establish the alien's eligibility to receive an immigrant visa. All such documents submitted and other...

22 CFR 42.65 - Supporting documents.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF IMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Application for Immigrant Visas § 42.65 Supporting documents. (a) Authority to... establish the alien's eligibility to receive an immigrant visa. All such documents submitted and other...

22 CFR 42.65 - Supporting documents.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF IMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Application for Immigrant Visas § 42.65 Supporting documents. (a) Authority to... establish the alien's eligibility to receive an immigrant visa. All such documents submitted and other...

22 CFR 42.65 - Supporting documents.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF IMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Application for Immigrant Visas § 42.65 Supporting documents. (a) Authority to... establish the alien's eligibility to receive an immigrant visa. All such documents submitted and other...

22 CFR 42.65 - Supporting documents.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF IMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Application for Immigrant Visas § 42.65 Supporting documents. (a) Authority to... establish the alien's eligibility to receive an immigrant visa. All such documents submitted and other...

Loan Stars: ILL Comes of Age.

ERIC Educational Resources Information Center

Jackson, Mary E.

1998-01-01

Assesses the changes in interlibrary loan (ILL) practices, and points the way to an ideal future. Discusses patron-initiated document request systems; library-mediated ordering systems; document delivery suppliers; accessing electronic resources; ILL management software; paying ILL invoices; new electronic delivery options; and results of a…

[The electronic health record: computerised provider order entry and the electronic instruction document as new functionalities].

PubMed

Derikx, Joep P M; Erdkamp, Frans L G; Hoofwijk, A G M

2013-01-01

An electronic health record (EHR) should provide 4 key functionalities: (a) documenting patient data; (b) facilitating computerised provider order entry; (c) displaying the results of diagnostic research; and (d) providing support for healthcare providers in the clinical decision-making process.- Computerised provider order entry into the EHR enables the electronic receipt and transfer of orders to ancillary departments, which can take the place of handwritten orders.- By classifying the computer provider order entries according to disorders, digital care pathways can be created. Such care pathways could result in faster and improved diagnostics.- Communicating by means of an electronic instruction document that is linked to a computerised provider order entry facilitates the provision of healthcare in a safer, more efficient and auditable manner.- The implementation of a full-scale EHR has been delayed as a result of economic, technical and legal barriers, as well as some resistance by physicians.

22 CFR 41.105 - Supporting documents and fingerprinting.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Section 41.105 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF NONIMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Application for Nonimmigrant Visa § 41.105 Supporting documents... receive a nonimmigrant visa. All documents and other evidence presented by the alien, including briefs...

22 CFR 41.105 - Supporting documents and fingerprinting.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Section 41.105 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF NONIMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Application for Nonimmigrant Visa § 41.105 Supporting documents... receive a nonimmigrant visa. All documents and other evidence presented by the alien, including briefs...

22 CFR 41.105 - Supporting documents and fingerprinting.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Section 41.105 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF NONIMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Application for Nonimmigrant Visa § 41.105 Supporting documents... receive a nonimmigrant visa. All documents and other evidence presented by the alien, including briefs...

22 CFR 41.105 - Supporting documents and fingerprinting.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Section 41.105 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF NONIMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Application for Nonimmigrant Visa § 41.105 Supporting documents... receive a nonimmigrant visa. All documents and other evidence presented by the alien, including briefs...

22 CFR 41.105 - Supporting documents and fingerprinting.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Section 41.105 Foreign Relations DEPARTMENT OF STATE VISAS VISAS: DOCUMENTATION OF NONIMMIGRANTS UNDER THE IMMIGRATION AND NATIONALITY ACT, AS AMENDED Application for Nonimmigrant Visa § 41.105 Supporting documents... receive a nonimmigrant visa. All documents and other evidence presented by the alien, including briefs...

Expanding the Use of Time/Frequency Difference of Arrival Geolocation in the Department of Defense

DTIC Science & Technology

2012-01-01

next decade. Military acquisition and research , development, test , and evaluation will likely be the hardest hit by spending cuts (Eaglen and Nguyen...Unauthorized posting of RAND electronic documents to a non-RAND website is prohibited. RAND electronic documents are protected under copyright law...Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use. For information on reprint

Improving Army Basic Research: Report of an Expert Panel on the Future of Army Laboratories

DTIC Science & Technology

2012-01-01

commercial use only. Unauthorized posting of RAND electronic documents to a non-RAND website is prohibited. RAND electronic documents are protected under...complete. Copies may not be duplicated for commercial purposes. Unauthorized posting of RAND documents to a non-RAND website is prohibited. RAND...Inspired senior scientists and technologists with vision will be essential in research as well as in the design , development, evaluation, and

Patterns of Care Among Patients Receiving Radiation Therapy for Bone Metastases at a Large Academic Institution

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

Ellsworth, Susannah G.; Alcorn, Sara R., E-mail: salcorn2@jhmi.edu; Hales, Russell K.

Purpose: This study evaluates outcomes and patterns of care among patients receiving radiation therapy (RT) for bone metastases at a high-volume academic institution. Methods and Materials: Records of all patients whose final RT course was for bone metastases from April 2007 to July 2012 were identified from electronic medical records. Chart review yielded demographic and clinical data. Rates of complicated versus uncomplicated bone metastases were not analyzed. Results: We identified 339 patients whose final RT course was for bone metastases. Of these, 52.2% were male; median age was 65 years old. The most common primary was non-small-cell lung cancer (29%). Most patientsmore » (83%) were prescribed ≤10 fractions; 8% received single-fraction RT. Most patients (52%) had a documented goals of care (GOC) discussion with their radiation oncologist; hospice referral rates were higher when patients had such discussions (66% with vs 50% without GOC discussion, P=.004). Median life expectancy after RT was 96 days. Median survival after RT was shorter based on inpatient as opposed to outpatient status at the time of consultation (35 vs 136 days, respectively, P<.001). Hospice referrals occurred for 56% of patients, with a median interval between completion of RT and hospice referral of 29 days and a median hospice stay of 22 days. Conclusions: These data document excellent adherence to American Society for Radiation Oncolology Choosing Wisely recommendation to avoid routinely using >10 fractions of palliative RT for bone metastasis. Nonetheless, single-fraction RT remains relatively uncommon. Participating in GOC discussions with a radiation oncologist is associated with higher rates of hospice referral. Inpatient status at consultation is associated with short survival.« less

Physician assessments of the value of therapeutic information delivered via e-mail

PubMed Central

Grad, Roland; Pluye, Pierre; Repchinsky, Carol; Jovaisas, Barbara; Marlow, Bernard; Marques Ricarte, Ivan L.; Galvão, Maria Cristiane Barbosa; Shulha, Michael; de Gaspé Bonar, James

2014-01-01

Abstract Problem addressed Although e-learning programs are popular and access to electronic knowledge resources has improved, raising awareness about updated therapeutic recommendations in practice continues to be a challenge. Objective of program To raise awareness about and document the use of therapeutic recommendations. Program description In 2010, family physicians evaluated e-Therapeutics (e-T) Highlights with a Web-based tool called the Information Assessment Method (IAM). The e-T Highlights consisted of information found in the primary care reference e-Therapeutics+. Each week, family physicians received an e-mail containing a link to 1 Highlight from a different chapter of e-Therapeutics+. Family physicians received continuing medical education credits for each Highlight they rated with the IAM. Of the 5346 participants, 85% of them were full-time or part-time practitioners. A total of 31 429 Highlights ratings were received in 2010 (median of 2 ratings per participant, range 1 to 49). Among participants who rated more than 2 Highlights, the median number of ratings was 7 (mean 11.9). The relevance of the information from individual Highlights varied widely; however, for 90% of the rated Highlights participants indicated total or partial relevance of the information for at least 1 patient. For 41% of rated Highlights, participants expected patient health benefits to result from implementing the recommendation, such as avoiding an unnecessary or inappropriate treatment, or a preventive intervention. Conclusion This continuing medical education program stimulated family physicians to rate therapeutic recommendations that were delivered weekly via e-mail. The process of rating e-T Highlights with the IAM raised awareness about treatment recommendations and documented self-reported use of this information in practice. PMID:24829020

Does incorporation of a clinical support template in the electronic medical record improve capture of wound care data in a cohort of veterans with diabetic foot ulcers?

PubMed

Lowe, Jeanne R; Raugi, Gregory J; Reiber, Gayle E; Whitney, Joanne D

2013-01-01

The purpose of this cohort study was to evaluate the effect of a 1-year intervention of an electronic medical record wound care template on the completeness of wound care documentation and medical coding compared to a similar time interval for the fiscal year preceding the intervention. From October 1, 2006, to September 30, 2007, a "good wound care" intervention was implemented at a rural Veterans Affairs facility to prevent amputations in veterans with diabetes and foot ulcers. The study protocol included a template with foot ulcer variables embedded in the electronic medical record to facilitate data collection, support clinical decision making, and improve ordering and medical coding. The intervention group showed significant differences in complete documentation of good wound care compared to the historic control group (χ = 15.99, P < .001), complete documentation of coding for diagnoses and procedures (χ = 30.23, P < .001), and complete documentation of both good wound care and coding for diagnoses and procedures (χ = 14.96, P < .001). An electronic wound care template improved documentation of evidence-based interventions and facilitated coding for wound complexity and procedures.

A Business Case for Electronic Commerce

DTIC Science & Technology

1990-09-01

Electronic Commerce . This report presents the results of that examination. Based upon an examination of 16 key documents, we estimate that DoD could realize direct and indirect cost savings of almost $1.2 billion over a 10-year period by replacing these manually processed documents with their electronic equivalents. To achieve those savings, DoD would need to make investments totaling approximately $80 million in new systems and procedures. (Author)

Modeling, Simulation, and Measurement of Balanced Antipodal Vivaldi (BAV) Antennas for Fully Polarimetric Forward-Looking Ground-Penetrating Radar (FLGPR) Receive Channels

DTIC Science & Technology

2017-08-01

compared against the current receiver. The focus of the design was to maximize low-frequency performance, particularly below 1.0 GHz. The current...Department of the Army position unless so designated by other authorized documents. Citation of manufacturer’s or trade names does not constitute an...documents the design , simulation, and measurement of balanced antipodal Vivaldi (BAV) antenna elements for the receive channels of a US Army Research

43 CFR 1822.13 - May I file electronically?

Code of Federal Regulations, 2011 CFR

2011-10-01

... MANAGEMENT, DEPARTMENT OF THE INTERIOR GENERAL MANAGEMENT (1000) APPLICATION PROCEDURES Filing a Document... electronic filing if an original signature is not required. If BLM requires your signature, you must file your application or document by delivery or by mailing. If you have any questions regarding which types...

43 CFR 1822.13 - May I file electronically?

Code of Federal Regulations, 2012 CFR

2012-10-01

... MANAGEMENT, DEPARTMENT OF THE INTERIOR GENERAL MANAGEMENT (1000) APPLICATION PROCEDURES Filing a Document... electronic filing if an original signature is not required. If BLM requires your signature, you must file your application or document by delivery or by mailing. If you have any questions regarding which types...

43 CFR 1822.13 - May I file electronically?

Code of Federal Regulations, 2014 CFR

2014-10-01

... MANAGEMENT, DEPARTMENT OF THE INTERIOR GENERAL MANAGEMENT (1000) APPLICATION PROCEDURES Filing a Document... electronic filing if an original signature is not required. If BLM requires your signature, you must file your application or document by delivery or by mailing. If you have any questions regarding which types...

43 CFR 1822.13 - May I file electronically?

Code of Federal Regulations, 2013 CFR

2013-10-01

... MANAGEMENT, DEPARTMENT OF THE INTERIOR GENERAL MANAGEMENT (1000) APPLICATION PROCEDURES Filing a Document... electronic filing if an original signature is not required. If BLM requires your signature, you must file your application or document by delivery or by mailing. If you have any questions regarding which types...

3 CFR - Presidential Determination on Eligibility of the Federal Republic of Somalia To Receive Defense...

Code of Federal Regulations, 2014 CFR

2014-01-01

... 3 The President 1 2014-01-01 2014-01-01 false Presidential Determination on Eligibility of the Federal Republic of Somalia To Receive Defense Articles and Defense Services Under the Foreign Assistance Act of 1961, as Amended, and the Arms Export Control Act, as Amended Presidential Documents Other Presidential Documents Presidential Determinatio...

Documentation of preventive care for pressure ulcers initiated during annual evaluations in SCI.

PubMed

Guihan, Marylou; Murphy, Deidre; Rogers, Thea J; Parachuri, Ramadevi; Sae Richardson, Michael; Lee, Kenneth K; Bates-Jensen, Barbara M

2016-05-01

Community-acquired pressure ulcers (PrUs) are a frequent cause of hospitalization of Veterans with spinal cord injury (SCI). The Veterans Health Administration (VHA) recommends that SCI annual evaluations include assessment of PrU risk factors, a thorough skin inspection and sharing of recommendations for PrU prevention strategies. We characterized consistency of preventive skin care during annual evaluations for Veterans with SCI as a first step in identifying strategies to more actively promote PrU prevention care in other healthcare encounters. Retrospective cross-sectional observational design, including review of electronic medical records for 206 Veterans with SCI admitted to 2 VA SCI centers from January-December, 2011. Proportion of applicable skin health elements documented (number of applicable elements/skin health elements documented). Our sample was primarily white (78%) male (96.1%), and mean age = 61 years. 40% of participants' were hospitalized for PrU treatment, with a mean of 294 days (median = 345 days) from annual evaluation to the index admission. On average, Veterans received an average of 75.5% (IQR 68-86%) of applicable skin health elements. Documentation of applicable skin health elements was significantly higher during inpatient vs. outpatient annual evaluations (mean elements received = 80.3% and 64.3%, respectively, P > 0.001). No significant differences were observed in documentation of skin health elements by Veterans at high vs. low PrU risk. Additional PrU preventive care in the VHA outpatient setting may increase identification and detection of PrU risk factors and early PrU damage for Veterans with SCI in the community, allowing for earlier intervention.

Color-Coded Labels Cued Nurses to Adhere to Central Line Connector Change.

PubMed

Morrison, Theresa Lynch; Laney, Christina; Foglesong, Jan; Brennaman, Laura

2016-01-01

This study examined nurses' adherence to policies regarding needleless connector changes using a novel, day-of-the-week, color-coded label compared with usual care that relied on electronic medical record (EMR) documentation. This was a prospective, comparative study. The study was performed on 4 medical-surgical units in a seasonally fluctuating, 715-bed healthcare system composed of 2 community hospitals. Convenience sample was composed of adults with central lines hospitalized for 4 or more days. At 4-day intervals, investigators observed bedside label use and EMR needleless connector change documentation. Control patients received standard care-needleless connector change with associated documentation in the EMR. Intervention patients, in addition to standard care, had a day-of-the-week, color-coded label placed on each needleless connector. To account for clustering within unit, multinomial logistic regression models using survey sampling methodology were used to conduct Wald χ tests. A multinominal odds ratio and 95% confidence interval (CI) provided an estimate of using labels that were provided on units relative to usual care documentation of needleless connector change in the EMR. In 335 central line observations, the units with labels (n = 205) had a 321% increase rate of documentation of needleless connector change in the EMR (odds ratio, 4.21; 95% CI, 1.76-10.10; P = .003) compared with the usual care control patients. For units with labels, when labels were present, placement of labels on needleless connectors increased the odds that nurses documented connector changes per policy (4.72; 95% CI, 2.02, 10.98; P = .003). Day-of-the-week, color-coded labels cued nurses to document central line needleless connector change in the EMR, which increased adherence to the needleless connector change policy. Providing day-of-the-week, color-coded needleless connector labels increased EMR documentation of timely needleless connector changes. Timely needleless connector changes may lower the incidence of central line-associated bloodstream infection.

50 CFR 221.12 - Where and how must documents be filed?

Code of Federal Regulations, 2011 CFR

2011-10-01

... Hearing Process Document Filing and Service § 221.12 Where and how must documents be filed? (a) Place of... facsimile if: (A) The document is 20 pages or less, including all attachments; (B) The sending facsimile..., any document received after 5 p.m. at the place where the filing is due is considered filed on the...

Low Adoption Rates of Electronic Medical Records Systems: A Qualitative Study

ERIC Educational Resources Information Center

Slaughter, Andre

2017-01-01

This qualitative phenomenological research study explored the challenges of physicians working with Electronic Medical Records (EMR) systems for medical documentation. Additionally, this study sought to understand why many providers sought alternate means of patient documentation. Previous research studies focused on the use of EMR systems from…

4 CFR 201.3 - Publicly available documents and electronic reading room.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 4 Accounts 1 2010-01-01 2010-01-01 false Publicly available documents and electronic reading room. 201.3 Section 201.3 Accounts RECOVERY ACCOUNTABILITY AND TRANSPARENCY BOARD PUBLIC INFORMATION AND... Board. (5) Biographical information about the Chairman and other Board members. (6) Copies of records...

Electronic Document Delivery: New Options for Libraries.

ERIC Educational Resources Information Center

Leach, Ronald G.; Tribble, Judith E.

1993-01-01

Examines commercial electronic document delivery services that are available to academic libraries. Highlights include collection development issues; criteria for selection and evaluation; remote access systems, including CARL UnCover 2, Faxon Finder and Faxon Xpress, ContentsFirst and ArticleFirst, and CitaDel; and on-site access systems,…

38 CFR 36.4333 - Maintenance of records.

Code of Federal Regulations, 2012 CFR

2012-07-01

... electronic form; i.e., an image of the original document in .jpg, .gif, .pdf, or a similar widely accepted... (CONTINUED) LOAN GUARANTY Guaranty or Insurance of Loans to Veterans With Electronic Reporting § 36.4333... factors affecting the obligor's credit worthiness, work sheets, and other documents supporting the holder...

38 CFR 36.4333 - Maintenance of records.

Code of Federal Regulations, 2011 CFR

2011-07-01

... electronic form; i.e., an image of the original document in .jpg, .gif, .pdf, or a similar widely accepted... (CONTINUED) LOAN GUARANTY Guaranty or Insurance of Loans to Veterans With Electronic Reporting § 36.4333... factors affecting the obligor's credit worthiness, work sheets, and other documents supporting the holder...

75 FR 1382 - Wireless Telecommunications Bureau Seeks Comment on Petition for Reconsideration or Clarification...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-11

... its Electronic Document Management System (EDOCS): http://hraunfoss.fcc.gov/edocs_public/SilverStream... Communications Commission. ACTION: Notice. SUMMARY: In this document, comment is sought on a December 17, 2009...'s Electronic Comment Filing System (ECFS), (2) the Federal Government's eRulemaking Portal, or (3...

38 CFR 36.4333 - Maintenance of records.

Code of Federal Regulations, 2014 CFR

2014-07-01

... electronic form; i.e., an image of the original document in .jpg, .gif, .pdf, or a similar widely accepted... (CONTINUED) LOAN GUARANTY Guaranty or Insurance of Loans to Veterans With Electronic Reporting § 36.4333... factors affecting the obligor's credit worthiness, work sheets, and other documents supporting the holder...

48 CFR 252.232-7006 - Wide Area WorkFlow Payment Instructions.

Code of Federal Regulations, 2013 CFR

2013-10-01

...— (1) Have a designated electronic business point of contact in the System for Award Management at... submission. Document submissions may be via Web entry, Electronic Data Interchange, or File Transfer Protocol... that uniquely identifies a unit, activity, or organization. Document type means the type of payment...

48 CFR 252.232-7006 - Wide Area WorkFlow Payment Instructions.

Code of Federal Regulations, 2014 CFR

2014-10-01

...— (1) Have a designated electronic business point of contact in the System for Award Management at... submission. Document submissions may be via Web entry, Electronic Data Interchange, or File Transfer Protocol... that uniquely identifies a unit, activity, or organization. Document type means the type of payment...

Alcohol-related and mental health care for patients with unhealthy alcohol use and posttraumatic stress disorder in a National Veterans Affairs cohort.

PubMed

Chen, Jessica A; Owens, Mandy D; Browne, Kendall C; Williams, Emily C

2018-02-01

Unhealthy alcohol use and posttraumatic stress disorder (PTSD) frequently co-occur. Patients with both conditions have poorer functioning and worse treatment adherence compared to those with either condition alone. Therefore, it is possible that PTSD, when co-occurring with unhealthy alcohol use, may influence receipt of evidence-based alcohol-related care and mental health care. We evaluated receipt of interventions for unhealthy alcohol use and receipt of mental health follow-up care among patients screening positive for unhealthy alcohol use with and without PTSD in a national sample from the Veterans Health Administration (VA). National clinical and administrative data from VA's electronic medical record were used to identify all patients who screened positive for unhealthy alcohol use (AUDIT-C score≥5) between 10/1/09-5/30/13. Unadjusted and adjusted Poisson regression models were fit to estimate the relative rate and prevalence of receipt of: brief interventions (advice to reduce or abstain from drinking≤14days after positive screening), specialty addictions treatment for alcohol use disorder (AUD; documented visit≤365days after positive screening), pharmacotherapy for AUD (filled prescription≤365days after positive screening), and mental health care ≤14days after positive screening for patients with and without PTSD (documented with ICD-9 CM codes). In secondary analyses, we tested effect modification by both severity of unhealthy alcohol use and age. Among 830,825 patients who screened positive for unhealthy alcohol use, 140,388 (16.9%) had documented PTSD. Of the full sample, 71.6% received brief interventions, 10.3% received specialty AUD treatment, 3.1% received pharmacotherapy for AUD, and 24.0% received mental health care. PTSD was associated with increased likelihood of receiving all types of care. Adjusted relative rates were 1.04 (95% CI 1.03-1.05) for brief interventions, 1.06 (1.05-1.08) for specialty AUD treatment, 1.35 (1.31-1.39) for AUD pharmacotherapy, and 1.82 (1.80-1.84) for mental health care. Alcohol use severity modified effects of PTSD for specialty AUD treatment, AUD pharmacotherapy, and mental health care such that effects were maintained at lower severity but attenuated among patients with severe unhealthy alcohol use. Age modified all effects with the strength of the association between PTSD and care outcomes being strongest for younger (18-29years) and older veterans (65+ years) and weaker or non-significant for middle-aged veterans (30-44 and 45-64years). In this large national sample of patients with unhealthy alcohol use, PTSD was associated with increased likelihood of receiving alcohol-related and mental health care. PTSD does not appear to be a barrier to care among VA patients with unhealthy alcohol use. Published by Elsevier Inc.

47 CFR 61.16 - Base documents.

Code of Federal Regulations, 2011 CFR

2011-10-01

... for Electronic Filing § 61.16 Base documents. (a) The Base Document is a complete tariff which incorporates all effective revisions, as of the last day of the preceding month. The Base Document should be... 47 Telecommunication 3 2011-10-01 2011-10-01 false Base documents. 61.16 Section 61.16...

47 CFR 61.16 - Base documents.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 3 2012-10-01 2012-10-01 false Base documents. 61.16 Section 61.16... for Electronic Filing § 61.16 Base documents. (a) The Base Document is a complete tariff which incorporates all effective revisions, as of the last day of the preceding month. The Base Document should be...

47 CFR 61.16 - Base documents.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 3 2013-10-01 2013-10-01 false Base documents. 61.16 Section 61.16... for Electronic Filing § 61.16 Base documents. (a) The Base Document is a complete tariff which incorporates all effective revisions, as of the last day of the preceding month. The Base Document should be...

47 CFR 61.16 - Base documents.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 3 2010-10-01 2010-10-01 false Base documents. 61.16 Section 61.16... for Electronic Filing § 61.16 Base documents. (a) The Base Document is a complete tariff which incorporates all effective revisions, as of the last day of the preceding month. The Base Document should be...

Medication order communication using fax and document-imaging technologies.

PubMed

Simonian, Armen I

2008-03-15

The implementation of fax and document-imaging technology to electronically communicate medication orders from nursing stations to the pharmacy is described. The evaluation of a commercially available pharmacy order imaging system to improve order communication and to make document retrieval more efficient led to the selection and customization of a system already licensed and used in seven affiliated hospitals. The system consisted of existing fax machines and document-imaging software that would capture images of written orders and send them from nursing stations to a central database server. Pharmacists would then retrieve the images and enter the orders in an electronic medical record system. The pharmacy representatives from all seven hospitals agreed on the configuration and functionality of the custom application. A 30-day trial of the order imaging system was successfully conducted at one of the larger institutions. The new system was then implemented at the remaining six hospitals over a period of 60 days. The transition from a paper-order system to electronic communication via a standardized pharmacy document management application tailored to the specific needs of this health system was accomplished. A health system with seven affiliated hospitals successfully implemented electronic communication and the management of inpatient paper-chart orders by using faxes and document-imaging technology. This standardized application eliminated the problems associated with the hand delivery of paper orders, the use of the pneumatic tube system, and the printing of traditional faxes.

Piloting a fiber optics and electronic theory curriculum with high school students

NASA Astrophysics Data System (ADS)

Gilchrist, Pamela O.; Carpenter, Eric D.; Gray-Battle, Asia

2014-07-01

Previous participants from a multi-year blended learning intervention focusing on science, technology, engineering and mathematics (STEM) content knowledge, technical, college, and career preparatory skills were recruited to pilot a new module designed by the project staff. Participants met for a total of 22 contact hours receiving lectures from staff and two guest speakers from industries relevant to photonics, fiber optics hands-on experimentation, and practice with documenting progress. Activities included constructing a fiber optics communication system, troubleshooting breadboard circuits and diagrammed circuits as well as hypothesis testing to discover various aspects of fiber optic cables. Participants documented their activities, wrote reflections on the content and learning endeavor and gave talks about their research experiences to staff, peers, and relatives during the last session. Overall, it was found that a significant gain in content knowledge occurred between the time of pre-testing (Mean=0.54) and post-testing time points for the fiber optics portion of the curriculum via the use of a paired samples t-test (Mean=0.71), t=-2.72, p<.05. Additionally, the electronic theory test results were not a normal distribution and for this reason non-parametric testing was used, specifically a Wilcoxon signed-ranks test. Results indicated a significant increase in content knowledge occurred over time between the pre- (Mdn=0.35) and post-testing time points (Mdn=0.80) z=-2.49, p<,05, r=-0.59 for the electronic theory portion of the curriculum. An equivalent control group was recruited from the remaining participant pool, allowing for comparison between groups. The program design, findings, and lessons learned will be reported in this paper.

Electronic camera-management system for 35-mm and 70-mm film cameras

NASA Astrophysics Data System (ADS)

Nielsen, Allan

1993-01-01

Military and commercial test facilities have been tasked with the need for increasingly sophisticated data collection and data reduction. A state-of-the-art electronic control system for high speed 35 mm and 70 mm film cameras designed to meet these tasks is described. Data collection in today's test range environment is difficult at best. The need for a completely integrated image and data collection system is mandated by the increasingly complex test environment. Instrumentation film cameras have been used on test ranges to capture images for decades. Their high frame rates coupled with exceptionally high resolution make them an essential part of any test system. In addition to documenting test events, today's camera system is required to perform many additional tasks. Data reduction to establish TSPI (time- space-position information) may be performed after a mission and is subject to all of the variables present in documenting the mission. A typical scenario would consist of multiple cameras located on tracking mounts capturing the event along with azimuth and elevation position data. Corrected data can then be reduced using each camera's time and position deltas and calculating the TSPI of the object using triangulation. An electronic camera control system designed to meet these requirements has been developed by Photo-Sonics, Inc. The feedback received from test technicians at range facilities throughout the world led Photo-Sonics to design the features of this control system. These prominent new features include: a comprehensive safety management system, full local or remote operation, frame rate accuracy of less than 0.005 percent, and phase locking capability to Irig-B. In fact, Irig-B phase lock operation of multiple cameras can reduce the time-distance delta of a test object traveling at mach-1 to less than one inch during data reduction.

36 CFR 1194.41 - Information, documentation, and support.

Code of Federal Regulations, 2010 CFR

2010-07-01

... TRANSPORTATION BARRIERS COMPLIANCE BOARD ELECTRONIC AND INFORMATION TECHNOLOGY ACCESSIBILITY STANDARDS Information, Documentation, and Support § 1194.41 Information, documentation, and support. (a) Product support... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Information, documentation...

A Requirement Engineering Framework for Electronic Data Sharing of Health Care Data Between Organizations

NASA Astrophysics Data System (ADS)

Liu, Xia; Peyton, Liam; Kuziemsky, Craig

Health care is increasingly provided to citizens by a network of collaboration that includes multiple providers and locations. Typically, that collaboration is on an ad-hoc basis via phone calls, faxes, and paper based documentation. Internet and wireless technologies provide an opportunity to improve this situation via electronic data sharing. These new technologies make possible new ways of working and collaboration but it can be difficult for health care organizations to understand how to use the new technologies while still ensuring that their policies and objectives are being met. It is also important to have a systematic approach to validate that e-health processes deliver the performance improvements that are expected. Using a case study of a palliative care patient receiving home care from a team of collaborating health organizations, we introduce a framework based on requirements engineering. Key concerns and objectives are identified and modeled (privacy, security, quality of care, and timeliness of service). And, then, proposed business processes which use new technologies are modeled in terms of these concerns and objectives to assess their impact and ensure that electronic data sharing is well regulated.

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

PubMed Central

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

2015-01-01

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

16 CFR 316.4 - Requirement to place warning labels on commercial electronic mail that contains sexually oriented...

Code of Federal Regulations, 2014 CFR

2014-01-01

... person who initiates, to a protected computer, the transmission of a commercial electronic mail message... electronic mail message or other form of Internet-based communication requesting not to receive future... received; and (B) Remains capable of receiving such messages or communications for no less than 30 days...

16 CFR 316.4 - Requirement to place warning labels on commercial electronic mail that contains sexually oriented...

Code of Federal Regulations, 2013 CFR

2013-01-01

... person who initiates, to a protected computer, the transmission of a commercial electronic mail message... electronic mail message or other form of Internet-based communication requesting not to receive future... received; and (B) Remains capable of receiving such messages or communications for no less than 30 days...

16 CFR 316.4 - Requirement to place warning labels on commercial electronic mail that contains sexually oriented...

Code of Federal Regulations, 2012 CFR

2012-01-01

... person who initiates, to a protected computer, the transmission of a commercial electronic mail message... electronic mail message or other form of Internet-based communication requesting not to receive future... received; and (B) Remains capable of receiving such messages or communications for no less than 30 days...

16 CFR 316.4 - Requirement to place warning labels on commercial electronic mail that contains sexually oriented...

Code of Federal Regulations, 2011 CFR

2011-01-01

... person who initiates, to a protected computer, the transmission of a commercial electronic mail message... electronic mail message or other form of Internet-based communication requesting not to receive future... received; and (B) Remains capable of receiving such messages or communications for no less than 30 days...

Superconductive hot-electron-bolometer mixer receiver for 800-GHz operation

NASA Astrophysics Data System (ADS)

Kawamura, J.; Blundell, R.; Tong, C.-Y. E.; Papa, D. C.; Hunter, T. R.; Paine, S. N.; Patt, F.; Gol'Tsman, G.; Cherednichenko, S.; Voronov, B.; Gershenzon, E.

2000-04-01

In this paper, we describe a superconductive hot-electron-bolometer mixer receiver designed to operate in the partially transmissive 350-μm atmospheric window. The receiver employs an NbN thin-film microbridge as the mixer element, in which the main cooling mechanism of the hot electrons is through electron-phonon interaction. At a local-oscillator frequency of 808 GHz, the measured double-sideband receiver noise temperature is Trx=970 K, across a 1-GHz intermediate-frequency bandwidth centered at 1.8 GHz. We have measured the linearity of the receiver and the amount of local-oscillator power incident on the mixer for optimal operation, which is PLO ≈ 1 microwatt. This receiver was used in making observations as a facility instrument at the Heinrich Hertz Telescope, Mt. Graham, AZ, during the 1998-1999 winter observing season.

Chaplain Documentation and the Electronic Medical Record: A Survey of ACPE Residency Programs.

PubMed

Tartaglia, Alexander; Dodd-McCue, Diane; Ford, Timothy; Demm, Charles; Hassell, Alma

2016-01-01

This study explores the extent to which chaplaincy departments at ACPE-accredited residency programs make use of the electronic medical record (EMR) for documentation and training. Survey data solicited from 219 programs with a 45% response rate and interview findings from 11 centers demonstrate a high level of usage of the EMR as well as an expectation that CPE residents document each patient/family encounter. Centers provided considerable initial training, but less ongoing monitoring of chaplain documentation. Centers used multiple sources to develop documentation tools for the EMR. One center was verified as having created the spiritual assessment component of the documentation tool from a peer reviewed published model. Interviews found intermittent use of the student chart notes for educational purposes. One center verified a structured manner of monitoring chart notes as a performance improvement activity. Findings suggested potential for the development of a standard documentation tool for chaplain charting and training.

Extended write combining using a write continuation hint flag

DOEpatents

Chen, Dong; Gara, Alan; Heidelberger, Philip; Ohmacht, Martin; Vranas, Pavlos

2013-06-04

A computing apparatus for reducing the amount of processing in a network computing system which includes a network system device of a receiving node for receiving electronic messages comprising data. The electronic messages are transmitted from a sending node. The network system device determines when more data of a specific electronic message is being transmitted. A memory device stores the electronic message data and communicating with the network system device. A memory subsystem communicates with the memory device. The memory subsystem stores a portion of the electronic message when more data of the specific message will be received, and the buffer combines the portion with later received data and moves the data to the memory device for accessible storage.

3 CFR - Presidential Determination on the Eligibility of South Sudan To Receive Defense Articles and...

Code of Federal Regulations, 2013 CFR

2013-01-01

... 3 The President 1 2013-01-01 2013-01-01 false Presidential Determination on the Eligibility of South Sudan To Receive Defense Articles and Defense Services Under the Foreign Assistance Act of 1961, as Amended, and the Arms Export Control Act, as Amended Presidential Documents Other Presidential Documents Presidential Determination No. 2012-4 of...

3 CFR - Eligibility of the Southern African Development Community To Receive Defense Articles and Defense...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 3 The President 1 2010-01-01 2010-01-01 false Eligibility of the Southern African Development Community To Receive Defense Articles and Defense Services Under the Foreign Assistance Act of 1961, as Amended, and the Arms Export Control Act, as Amended Presidential Documents Other Presidential Documents Presidential Determination No. 2009-13 of...

The Document Management Alliance.

ERIC Educational Resources Information Center

Fay, Chuck

1998-01-01

Describes the Document Management Alliance, a standards effort for document management systems that manages and tracks changes to electronic documents created and used by collaborative teams, provides secure access, and facilitates online information retrieval via the Internet and World Wide Web. Future directions are also discussed. (LRW)

Theoretical Synthesis of Mixed Materials for CO2 Capture Applications

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

Duan, Yuhua

These pages provide an example of the layout and style required for the preparation of four-page papers for the TechConnect World 2015 technical proceedings.Documents must be submitted in electronic (Adobe PDFfile) format. Please study the enclosed materials beforebeginning the final preparation of your paper. Proofread your paper carefully before submitting (it will appear in the published volume in exactly the same form). Your PDF manuscript must be uploaded online by April 11th, 2015.You will receive no proofs. Begin your paper with an abstract of no more than 18 lines. Thoroughly summarize your article in this section since this text willmore » be used for on-line listing and classification of the publication.« less

Evaluation of a System of Electronic Documentation for the Nursing Process

PubMed Central

de Oliveira, Neurilene Batista; Peres, Heloisa Helena Ciqueto

2012-01-01

The objective of this study is to evaluate the functional performance and the technical quality of an electronic documentation system designed to document the data of the Nursing Process. The Model of Quality will be the one established by the ISO/IEC 25010. Such research will allow the spreading of the knowledge of an emerging area, thus adding a further initiative to the growing efforts made in the information technology area for health and nursing. PMID:24199110

Minnesota Department of Human Services audit of medication therapy management programs.

PubMed

Smith, Stephanie; Cell, Penny; Anderson, Lowell; Larson, Tom

2013-01-01

To inform medication therapy management (MTM) providers of findings of the Minnesota Department of Human Services review of claims submitted to Minnesota Health Care Programs (MHCP) for patients receiving MTM services and to discuss the impact of the audit on widespread MTM services and future audits. A retrospective review was completed on MTM claims submitted to MHCP from 2008 to 2010. The auditor verified that the Current Procedural Terminology codes billed matched the actual number of medications, conditions, and drug therapy problems assessed during an encounter. 190 claims were reviewed for 57 distinct pharmacies that billed for MTM services from 2008 to 2010, representing 4.5% of all claims submitted. The auditor reported that generally, the documentation within the electronic medical record had the least "up-coding" of all documentation systems. A total of 18 claims were coded at a higher level than appropriate, but only 10 notices were sent out to recover money because the others did not meet the minimum $50 threshold. The auditor expressed concerns that a number of claims billed at the highest complexity level were only 15 minutes long. Providers will need to be cautious of the conditions that they bill as complex and of how they define drug therapy problems. Everything for which is being billed must be clearly assessed or rationalized in the documentation note. The auditor expressed that overall, documentation was well done; however, many MTM providers are now asking how to internally prepare for future audits.

Electronic palliative care coordination systems: Devising and testing a methodology for evaluating documentation

PubMed Central

Allsop, Matthew J; Kite, Suzanne; McDermott, Sarah; Penn, Naomi; Millares-Martin, Pablo; Bennett, Michael I

2016-01-01

Background: The need to improve coordination of care at end of life has driven electronic palliative care coordination systems implementation across the United Kingdom and internationally. No approaches for evaluating electronic palliative care coordination systems use in practice have been developed. Aim: This study outlines and applies an evaluation framework for examining how and when electronic documentation of advance care planning is occurring in end of life care services. Design: A pragmatic, formative process evaluation approach was adopted. The evaluation drew on the Project Review and Objective Evaluation methodology to guide the evaluation framework design, focusing on clinical processes. Setting/participants: Data were extracted from electronic palliative care coordination systems for 82 of 108 general practices across a large UK city. All deaths (n = 1229) recorded on electronic palliative care coordination systems between April 2014 and March 2015 were included to determine the proportion of all deaths recorded, median number of days prior to death that key information was recorded and observations about routine data use. Results: The evaluation identified 26.8% of all deaths recorded on electronic palliative care coordination systems. The median number of days to death was calculated for initiation of an electronic palliative care coordination systems record (31 days), recording a patient’s preferred place of death (8 days) and entry of Do Not Attempt Cardiopulmonary Resuscitation decisions (34 days). Where preferred and actual place of death was documented, these were matching for 75% of patients. Anomalies were identified in coding used during data entry on electronic palliative care coordination systems. Conclusion: This study reports the first methodology for evaluating how and when electronic palliative care coordination systems documentation is occurring. It raises questions about what can be drawn from routine data collected through electronic palliative care coordination systems and outlines considerations for future evaluation. Future evaluations should consider work processes of health professionals using electronic palliative care coordination systems. PMID:27507636

Electronic palliative care coordination systems: Devising and testing a methodology for evaluating documentation.

PubMed

Allsop, Matthew J; Kite, Suzanne; McDermott, Sarah; Penn, Naomi; Millares-Martin, Pablo; Bennett, Michael I

2017-05-01

The need to improve coordination of care at end of life has driven electronic palliative care coordination systems implementation across the United Kingdom and internationally. No approaches for evaluating electronic palliative care coordination systems use in practice have been developed. This study outlines and applies an evaluation framework for examining how and when electronic documentation of advance care planning is occurring in end of life care services. A pragmatic, formative process evaluation approach was adopted. The evaluation drew on the Project Review and Objective Evaluation methodology to guide the evaluation framework design, focusing on clinical processes. Data were extracted from electronic palliative care coordination systems for 82 of 108 general practices across a large UK city. All deaths ( n = 1229) recorded on electronic palliative care coordination systems between April 2014 and March 2015 were included to determine the proportion of all deaths recorded, median number of days prior to death that key information was recorded and observations about routine data use. The evaluation identified 26.8% of all deaths recorded on electronic palliative care coordination systems. The median number of days to death was calculated for initiation of an electronic palliative care coordination systems record (31 days), recording a patient's preferred place of death (8 days) and entry of Do Not Attempt Cardiopulmonary Resuscitation decisions (34 days). Where preferred and actual place of death was documented, these were matching for 75% of patients. Anomalies were identified in coding used during data entry on electronic palliative care coordination systems. This study reports the first methodology for evaluating how and when electronic palliative care coordination systems documentation is occurring. It raises questions about what can be drawn from routine data collected through electronic palliative care coordination systems and outlines considerations for future evaluation. Future evaluations should consider work processes of health professionals using electronic palliative care coordination systems.

75 FR 16763 - Ready-to-Learn Television Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-02

... official version of this document is the document published in the Federal Register. Free Internet access... Service, toll free, at 1-800-877-8339. Electronic Access to This Document: You can view this document, as... Portable Document Format (PDF) on the Internet at the following site: http://www.ed.gov/news/fedregister...

75 FR 38797 - Predominantly Black Institutions Formula Grant Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-06

... official version of this document is the document published in the Federal Register. Free Internet access... (FRS), toll free, at 1-800-877-8339. Electronic Access to This Document: You can view this document, as... Portable Document Format (PDF) on the Internet at the following site: http://www.ed.gov/news/fedregister...

Half a Gift Is Not Half-Hearted: A Giver-Receiver Asymmetry in the Thoughtfulness of Partial Gifts.

PubMed

Kupor, Daniella; Flynn, Frank; Norton, Michael I

2017-12-01

Four studies document an asymmetry in givers' and receivers' evaluations of gifts: Givers underestimate the extent to which receivers perceive partial (but more desirable) gifts to be thoughtful, valuable, and worthy of appreciation. Study 1 documents this asymmetry and suggests that givers underestimate the extent to which partial gifts signal thoughtfulness to receivers. Study 2 replicates this asymmetry in the context of a real gift exchange among friends. Study 3 shows that this asymmetry arises because givers believe that purchasing partial gifts is a greater violation of gift-giving norms than do receivers, leading givers to expect that partial gifts will damage receivers' perceptions of a gift's value. Study 4 offers an intervention that induces givers to select the (partial) gifts that receivers prefer more than givers expect: framing a gift's separate components as complete units.

Effect of Body-Worn Cameras on EMS Documentation Accuracy: A Pilot Study.

PubMed

Ho, Jeffrey D; Dawes, Donald M; McKay, Evan M; Taliercio, Jeremy J; White, Scott D; Woodbury, Blair J; Sandefur, Mark A; Miner, James R

2017-01-01

Current Emergency Medical Services (EMS) documentation practices usually occur from memory after an event is over. While this practice is fairly standard, it is unclear if it can introduce significant error. Modern technology has seen the increased use of recorded video by society to more objectively document notable events. Stationary mounted cameras, cell-phone cameras, and law enforcement officer Body-Worn Cameras (BWCs) are increasingly used by society for this purpose. Video used in this way can often clarify or contradict recall from memory. BWCs are currently not widely used by EMS. The hypothesis is that current EMS documentation practices are inaccurate and that BWCs will have a positive effect on documentation accuracy. This prospective, observational study used a convenience sample of paramedics in a simulation lab. The Paramedics wore a BWC and responded to a simulated call of "One Down" (unresponsive from heroin abuse) involving Role Players (RPs). The paramedics received standardized cues from the RPs during the simulation to keep it on track.  The simulation contained many factors of concern (e.g., weapons and drugs in plain view, unattended minors, etc.) and intentional stressors (e.g., distraught family member, uncooperative patient, etc.). Upon completion of the scenario, paramedic documentation occurred from memory on an electronic template.  After initial documentation, paramedics viewed their BWC recording and were allowed to make tabulated changes. Changes were categorized by a priori criteria as minor, moderate, or major.  Ten paramedics participated with an average age of 33.3 years (range 22-43), 8 males and 2 females. The average length of paramedic career experience was 7.7 years (range 2 months to 20 years). There were 71 total documentation changes (7 minor, 51 moderate, 13 major) made after video review. Linear regression (ANCOVA) indicated changes made indirectly correlated with years of experience (coefficient 8.27, 4.22-12.3, 95% CI, p = 0.002), but all made some changes. Current EMS documentation practices demonstrate significant inaccuracy regardless of years of experience. Use of BWC technology appears to significantly improve EMS documentation accuracy in this pilot study.

42 CFR 37.60 - Submitting required chest roentgenograms and miner identification documents.

Code of Federal Regulations, 2012 CFR

2012-10-01

... prescribed in this subpart, all the forms shall be submitted with his or her name and social security account... miner identification document containing the miner's name, address, social security number and place of... format specified by NIOSH either using portable electronic media, or a secure electronic file transfer...

4 CFR 22.14 - Production of Documents, Electronically Stored Information, Other Tangible Things, or Entry Onto...

Code of Federal Regulations, 2010 CFR

2010-01-01

... Information, Other Tangible Things, or Entry Onto Land [Rule 14]. 22.14 Section 22.14 Accounts GOVERNMENT ACCOUNTABILITY OFFICE GENERAL PROCEDURES RULES OF PROCEDURE OF THE GOVERNMENT ACCOUNTABILITY OFFICE CONTRACT..., or Entry Onto Land [Rule 14]. (a) When documents, electronically stored information, other tangible...

Understanding Iran

DTIC Science & Technology

2009-01-01

SPONSOR/MONITOR’S REPORT NUMBER( S ) 12. DISTRIBUTION /AVAILABILITY STATEMENT Approved for public release; distribution unlimited 13. SUPPLEMENTARY...This document and trademark( s ) contained herein are protected by law as indicated in a notice appearing later in this work. This electronic...documents for commercial use. For information on reprint and linking permissions, please see RAND Permissions. Limited Electronic Distribution Rights

14 CFR 302.4 - General requirements as to documents.

Code of Federal Regulations, 2011 CFR

2011-01-01

... of paper documents, and an electronic registration for electronic filing at the DOT DMS internet... representative of the pleader, have not in any manner knowingly and willfully falsified, concealed or failed to... pleading. I understand that an individual who is found to have violated the provisions of 18 U.S.C. section...

14 CFR 302.4 - General requirements as to documents.

Code of Federal Regulations, 2010 CFR

2010-01-01

... of paper documents, and an electronic registration for electronic filing at the DOT DMS internet... representative of the pleader, have not in any manner knowingly and willfully falsified, concealed or failed to... pleading. I understand that an individual who is found to have violated the provisions of 18 U.S.C. section...

Public Access to Electronic Federal Depository Information in Regional Depository Libraries.

ERIC Educational Resources Information Center

Ford, Stephanie

This study describes regional depository institutions, the organization of their document collections, the staffing of their documents departments, and factors relevant to their providing access to electronic government information. Surveys were sent to 53 regional depository libraries in March 1995. Forty-one of the 53 libraries responded (77%…

Nurses' Perceptions of Nursing Care Documentation in the Electronic Health Record

ERIC Educational Resources Information Center

Jensen, Tracey A.

2013-01-01

Electronic health records (EHRs) will soon become the standard for documenting nursing care. The EHR holds the promise of rapid access to complete records of a patient's encounter with the healthcare system. It is the expectation that healthcare providers input essential data that communicates important patient information to support quality…

Defining Usability Heuristics for Adoption and Efficiency of an Electronic Workflow Document Management System

ERIC Educational Resources Information Center

Fuentes, Steven

2017-01-01

Usability heuristics have been established for different uses and applications as general guidelines for user interfaces. These can affect the implementation of industry solutions and play a significant role regarding cost reduction and process efficiency. The area of electronic workflow document management (EWDM) solutions, also known as…

The impact of using electronic patient records on practices of reading and writing.

PubMed

Laitinen, Heleena; Kaunonen, Marja; Åstedt-Kurki, Paivi

2014-12-01

The aim of this study was to investigate the use of electronic patient records in daily practice. In four wards of a large hospital district in Finland, N = 43 patients' care and activities were observed and analysed in terms of the Grounded Theory method. The findings revealed that using electronic patient records created a particular process of writing and reading. Wireless technology enabled simultaneous patient involvement and point-of-care documentation, additionally supporting real-time reading. Remote and retrospective documentation was distant in terms of both space and time. The remoteness caused double documentation, reduced accuracy and less-efficient use of time. 'Non-reading' practices were witnessed in retrospective reading, causing delays in patient care and increase in workload. Similarly, if documentation was insufficient or non-existent, the consequences were found to be detrimental to the patients. The use of an electronic patient record system has a significant impact on patient care. Therefore, it is crucial to develop wireless technology and interdisciplinary collaboration in order to improve and support high-quality patient care. © The Author(s) 2013.

Analysis of the Air Force Logistics Enterprise: Evaluation of Global Repair Network Options for Supporting the C-130

DTIC Science & Technology

2011-01-01

for each of the target shops. The primary maintenance function would be at the flightline to aid sortie generation. However, on observing that...law as indicated in a notice appearing later in this work. This electronic representation of RAND intellectual property is provided for non ...commercial use only. Unauthorized posting of RAND electronic documents to a non -RAND website is prohibited. RAND electronic documents are protected under

Addition of doxycycline to ciprofloxacin for infection prophylaxis during autologous stem cell transplants for multiple myeloma.

PubMed

Sivik, J M; Davidson, J; Hale, C M; Drabick, J J; Talamo, G

2018-03-21

The most commonly used antibacterial prophylaxis during autologous stem cell transplants (ASCT) for multiple myeloma (MM) involves a fluoroquinolone, such as ciprofloxacin or levofloxacin. We assessed the impact of adding doxycycline to ciprofloxacin as routine antibacterial prophylaxis in these patients. We retrospectively reviewed electronic medical records and our ASCT database to analyze rates and types of bacterial infections in MM patients who underwent ASCT in our institution. Among 419 patients, 118 received ciprofloxacin alone (cipro group), and 301 ciprofloxacin and doxycycline (cipro-doxy group). Neutropenic fever (NF) developed in 63 (53%) and 108 (36%) patients of the cipro and cipro-doxy groups, respectively (p = 0.010). The number of documented bacteremic episodes was 13 (11%) and 14 (4.7%) in the two groups, respectively (p = 0.017). Antimicrobial resistance and Clostridium difficile infections were uncommon. Transplant-related mortality was 1% in both groups. The addition of doxycycline to standard prophylaxis with ciprofloxacin seems to reduce the number of NF episodes and documented bacterial infections in patients with MM undergoing ASCT, without increasing rate of serious complications.

Feasibility of hospital-initiated non-facilitator assisted advance care planning documentation for patients with palliative care needs.

PubMed

Kok, Maaike; van der Werff, Gertruud F M; Geerling, Jenske I; Ruivenkamp, Jaap; Groothoff, Wies; van der Velden, Annette W G; Thoma, Monique; Talsma, Jaap; Costongs, Louk G P; Gans, Reinold O B; de Graeff, Pauline; Reyners, Anna K L

2018-05-24

Advance Care Planning (ACP) and its documentation, accessible to healthcare professionals regardless of where patients are staying, can improve palliative care. ACP is usually performed by trained facilitators. However, ACP conversations would be more tailored to a patient's specific situation if held by a patient's clinical healthcare team. This study assesses the feasibility of ACP by a patient's clinical healthcare team, and analyses the documented information including current and future problems within the palliative care domains. This multicentre study was conducted at the three Groningen Palliative Care Network hospitals in the Netherlands. Patients discharged from hospital with a terminal care indication received an ACP document from clinical staff (non-palliative care trained staff at hospitals I and II; specialist palliative care nurses at hospital III) after they had held ACP conversations. An anonymised copy of this ACP document was analysed. Documentation rates of patient and contact details were investigated, and documentation of current and future problems were analysed both quantitatively and qualitatively. One hundred sixty ACP documents were received between April 2013 and December 2014, with numbers increasing for each consecutive 3-month time period. Advance directives were frequently documented (82%). Documentation rates of current problems in the social (24%), psychological (27%) and spiritual (16%) domains were low compared to physical problems (85%) at hospital I and II, but consistently high (> 85%) at hospital III. Of 545 documented anticipated problems, 92% were physical or care related in nature, 2% social, 5% psychological, and < 1% spiritual. Half of the anticipated non-physical problems originated from hospital III. Hospital-initiated ACP documentation by a patient's clinical healthcare team is feasible: the number of documents received per time period increased throughout the study period, and overall, documentation rates were high. Nonetheless, symptom documentation predominantly regards physical symptoms. With the involvement of specialist palliative care nurses, psychological and spiritual problems are addressed more frequently. Whether palliative care education for non-palliative care experts will improve identification and documentation of non-physical problems remains to be investigated.

Implementation of a next-generation electronic nursing records system based on detailed clinical models and integration of clinical practice guidelines.

PubMed

Min, Yul Ha; Park, Hyeoun-Ae; Chung, Eunja; Lee, Hyunsook

2013-12-01

The purpose of this paper is to describe the components of a next-generation electronic nursing records system ensuring full semantic interoperability and integrating evidence into the nursing records system. A next-generation electronic nursing records system based on detailed clinical models and clinical practice guidelines was developed at Seoul National University Bundang Hospital in 2013. This system has two components, a terminology server and a nursing documentation system. The terminology server manages nursing narratives generated from entity-attribute-value triplets of detailed clinical models using a natural language generation system. The nursing documentation system provides nurses with a set of nursing narratives arranged around the recommendations extracted from clinical practice guidelines. An electronic nursing records system based on detailed clinical models and clinical practice guidelines was successfully implemented in a hospital in Korea. The next-generation electronic nursing records system can support nursing practice and nursing documentation, which in turn will improve data quality.

75 FR 29588 - Notice of Availability of the Models for Plant-Specific Adoption of Technical Specifications Task...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-26

... Documents Access and Management System (ADAMS) under Accession Number ML090510686. The proposed changes... Documents Access and Management System (ADAMS): Publicly available documents created or received at the NRC... expedited approval of plant-specific adoption of TSTF- 501, Revision 1. Documents: You can access publicly...

75 FR 26294 - Notice of Availability of the Models for Plant-Specific Adoption of Technical Specifications Task...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-11

... an errata sheet are available in the Agencywide Documents Access and Management System (ADAMS) under... Agencywide Documents Access and Management System (ADAMS): Publicly available documents created or received... facilitate expedited approval of plant-specific adoption of TSTF-493, Revision 4. Documents: You can access...

Does telephone scheduling assistance increase mammography screening adherence?

PubMed

Payton, Colleen A; Sarfaty, Mona; Beckett, Shirley; Campos, Carmen; Hilbert, Kathleen

2015-11-01

The 2 objectives were: 1) describe the use of a patient navigation process utilized to promote adherence to mammography screening within a primary care practice, and 2) determine the result of the navigation process and estimate the time required to increase mammography screening with this approach in a commercially insured patient population enrolled in a health maintenance organization. An evaluation of a nonrandomized practice improvement intervention. Women eligible for mammography (n = 298) who did not respond to 2 reminder letters were contacted via telephone by a navigator who offered scheduling assistance for mammography screening. The patient navigator scheduled appointments, documented the number of calls, and confirmed completed mammograms in the electronic health record, as well as estimated the time for calls and chart review. Of the 188 participants reached by phone, 112 (59%) scheduled appointments using the patient navigator, 35 (19%) scheduled their own appointments independently prior to the call, and 41 (22%) declined. As a result of the telephone intervention, 78 of the 188 women reached (41%) received a mammogram; also, all 35 women who had independently scheduled a mammogram received one. Chart documentation confirmed that 113 (38%) of the cohort of 298 women completed a mammogram. The estimated time burden for the entire project was 55 hours and 33 minutes, including calling patients, scheduling appointments, and chart review. A patient navigator can increase mammography adherence in a previously nonadherent population by making the screening appointment while the patient is on the phone.

Using Health Information Technology to Improve Adherence to Opioid Prescribing Guidelines in Primary Care

PubMed Central

Zlateva, Ianita; Khatri, Khushbu; Ciaburri, Nicholas

2015-01-01

Objective: To evaluate the impact of a clinical dashboard for opioid analgesic management on opioid prescribing and adherence to opioid practice guidelines in primary care. Methods: A pre/postimplementation evaluation using electronic health record (EHR) data from patients receiving chronic opioid therapy (COT) between April 1, 2011 and March 31, 2013. Measures include annual proportions of COT patients who received urine drug testing, signed an opioid treatment agreement, had a documented assessment of pain-related functional status, and had at least 1 visit with a behavioral health provider. Results: Adherence to several opioid prescribing guidelines improved in the postimplementation year compared with the preimplementation year: (1) the proportions of COT patients with a signed opioid treatment agreement and urine drug testing increased from 49% to 63% and 66% to 86%, respectively. The proportion of COT patients with a documented assessment of functional status increased from 33% to 46% and those with a behavioral health visit increased from 24% to 28%. However, there was a small decline in the proportion of patients prescribed COT from 3.4% to 3.1%. Discussion: Implementation of an opioid dashboard led to increased adherence to certain opioid practice guidelines and a decline in COT. This may be attributable to more efficient team-based pain management facilitated by the dashboard and increased transparency of opioid prescription practices. Health Information Technology solutions such as clinical dashboards can increase adherence to practice guidelines. PMID:25411860

27 CFR 73.32 - May I electronically sign forms I submit electronically to TTB?

Code of Federal Regulations, 2010 CFR

2010-04-01

... AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY (CONTINUED) PROCEDURES AND PRACTICES ELECTRONIC SIGNATURES; ELECTRONIC SUBMISSION OF FORMS Electronic Filing of Documents with TTB § 73.32 May I electronically sign forms I submit electronically to TTB? You may electronically sign the electronic form you...

Managing complex research datasets using electronic tools: A meta-analysis exemplar

PubMed Central

Brown, Sharon A.; Martin, Ellen E.; Garcia, Theresa J.; Winter, Mary A.; García, Alexandra A.; Brown, Adama; Cuevas, Heather E.; Sumlin, Lisa L.

2013-01-01

Meta-analyses of broad scope and complexity require investigators to organize many study documents and manage communication among several research staff. Commercially available electronic tools, e.g., EndNote, Adobe Acrobat Pro, Blackboard, Excel, and IBM SPSS Statistics (SPSS), are useful for organizing and tracking the meta-analytic process, as well as enhancing communication among research team members. The purpose of this paper is to describe the electronic processes we designed, using commercially available software, for an extensive quantitative model-testing meta-analysis we are conducting. Specific electronic tools improved the efficiency of (a) locating and screening studies, (b) screening and organizing studies and other project documents, (c) extracting data from primary studies, (d) checking data accuracy and analyses, and (e) communication among team members. The major limitation in designing and implementing a fully electronic system for meta-analysis was the requisite upfront time to: decide on which electronic tools to use, determine how these tools would be employed, develop clear guidelines for their use, and train members of the research team. The electronic process described here has been useful in streamlining the process of conducting this complex meta-analysis and enhancing communication and sharing documents among research team members. PMID:23681256

Managing complex research datasets using electronic tools: a meta-analysis exemplar.

PubMed

Brown, Sharon A; Martin, Ellen E; Garcia, Theresa J; Winter, Mary A; García, Alexandra A; Brown, Adama; Cuevas, Heather E; Sumlin, Lisa L

2013-06-01

Meta-analyses of broad scope and complexity require investigators to organize many study documents and manage communication among several research staff. Commercially available electronic tools, for example, EndNote, Adobe Acrobat Pro, Blackboard, Excel, and IBM SPSS Statistics (SPSS), are useful for organizing and tracking the meta-analytic process as well as enhancing communication among research team members. The purpose of this article is to describe the electronic processes designed, using commercially available software, for an extensive, quantitative model-testing meta-analysis. Specific electronic tools improved the efficiency of (a) locating and screening studies, (b) screening and organizing studies and other project documents, (c) extracting data from primary studies, (d) checking data accuracy and analyses, and (e) communication among team members. The major limitation in designing and implementing a fully electronic system for meta-analysis was the requisite upfront time to decide on which electronic tools to use, determine how these tools would be used, develop clear guidelines for their use, and train members of the research team. The electronic process described here has been useful in streamlining the process of conducting this complex meta-analysis and enhancing communication and sharing documents among research team members.

Safety Outcomes of Apixaban Compared With Warfarin in Patients With End-Stage Renal Disease.

PubMed

Sarratt, Stefanie C; Nesbit, Ross; Moye, Robert

2017-06-01

Current guidelines make no specific recommendations on the selection of direct oral anticoagulants for the prevention and treatment of venous thromboembolism in patients with end-stage renal disease (ESRD) receiving hemodialysis. Based on these guidelines, warfarin remains the anticoagulant of choice in these patients. To compare bleeding rates in patients receiving apixaban or warfarin with ESRD undergoing chronic hemodialysis. This was a single-center, retrospective, institutional review board-approved cohort analysis. Patients with ESRD undergoing chronic hemodialysis and receiving anticoagulation therapy with either apixaban or warfarin were included in this study. All data were collected from paper charts and electronic medical records and included documentation of bleeding events and related interventions. The primary outcome of this study was clinically relevant major bleeding events. Secondary outcomes included clinically relevant nonmajor bleeding events and minor bleeding events. A total of 160 patients were included in this study (warfarin group, n = 120; apixaban group, n = 40). There were 7 major bleeding events in the warfarin group compared with zero in the apixaban group ( P = 0.34). There were similar rates of clinically relevant nonmajor bleeding events (12.5% vs 5.8%, P = 0.17) and minor bleeding (2.5% vs 2.5%, P = 0.74) events in patients receiving apixaban and warfarin. There were no observed differences in bleeding rates in patients receiving apixaban compared with those receiving warfarin. Apixaban may be a cautious consideration in hemodialysis patients until there is further insight into the effect of subsequent, multiple doses on drug accumulation and clinical outcomes.

Ultrafast Science Opportunities with Electron Microscopy

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

Durr, Hermann

X-rays and electrons are two of the most fundamental probes of matter. When the Linac Coherent Light Source (LCLS), the world’s first x-ray free electron laser, began operation in 2009, it transformed ultrafast science with the ability to generate laser-like x-ray pulses from the manipulation of relativistic electron beams. This document describes a similar future transformation. In Transmission Electron Microscopy, ultrafast relativistic (MeV energy) electron pulses can achieve unsurpassed spatial and temporal resolution. Ultrafast temporal resolution will be the next frontier in electron microscopy and can ideally complement ultrafast x-ray science done with free electron lasers. This document describes themore » Grand Challenge science opportunities in chemistry, material science, physics and biology that arise from an MeV ultrafast electron diffraction & microscopy facility, especially when coupled with linac-based intense THz and X-ray pump capabilities.« less

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

NONE

This document is a monthly publication containing descriptions of information received and generated by the US Nuclear Regulatory Commission (NRC). This information includes (1) docketed material associated with civilian nuclear power plants and other uses of radioactive materials, and (2) nondocketed material received and generated by NRC pertinent to its role as a regulatory agency. The following indexes are included: Personal Author, Corporate Source, Report Number, and Cross Reference of Enclosures to Principal Documents.

The role of health information technology in care coordination in the United States.

PubMed

Hsiao, Chun-Ju; King, Jennifer; Hing, Esther; Simon, Alan E

2015-02-01

Examine the extent to which office-based physicians in the United States receive patient health information necessary to coordinate care across settings and determine whether receipt of information needed to coordinate care is associated with use of health information technology (HIT) (defined by presence or absence of electronic health record system and electronic sharing of information). Cross-sectional study using the 2012 National Electronic Health Records Survey (65% weighted response rate). Office-based physicians. Use of HIT and 3 types of patient health information needed to coordinate care. In 2012, 64% of physicians routinely received the results of a patient's consultation with a provider outside of their practice, whereas 46% routinely received a patient's history and reason for a referred consultation from a provider outside of their practice. About 54% of physicians reported routinely receiving a patient's hospital discharge information. In adjusted analysis, significant differences in receiving necessary information were observed by use of HIT. Compared with those not using HIT, a lower percentage of physicians who used an electronic health record system and shared patient health information electronically failed to receive the results of outside consultations or patient's history and reason for a referred consultation. No significant differences were observed for the receipt of hospital discharge information by use of HIT. Among physicians routinely receiving information needed for care coordination, at least 54% of them did not receive the information electronically. Although a higher percentage of physicians using HIT received patient information necessary for care coordination than those who did not use HIT, more than one third did not routinely receive the needed patient information at all.

47 CFR 1.913 - Application and notification forms; electronic and manual filing.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Portable Document Format (PDF) whenever possible. (2) Any associated documents submitted with an... possible. The attachment should be uploaded via ULS in Adobe Acrobat Portable Document Format (PDF... the table of contents, should be in Adobe Acrobat Portable Document Format (PDF) whenever possible...

78 FR 52776 - Documents to Support Submission of an Electronic Common Technical Document; Availability

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-26

... obtain the documents at either http://www.fda.gov/Drugs/DevelopmentApprovalProcess/FormsSubmission...BloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/default.htm . Dated: August 20, 2013...

78 FR 10181 - Documents To Support Submission of an Electronic Common Technical Document; Availability

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-13

... obtain the documents at either http://www.fda.gov/Drugs/DevelopmentApprovalProcess/FormsSubmission...BloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/default.htm . Dated: February 8, 2013...

An electronic registry for physiotherapists in Belgium.

PubMed

Buyl, Ronald; Nyssen, Marc

2008-01-01

This paper describes the results of the KINELECTRICS project. Since more and more clinical documents are stored and transmitted in an electronic way, the aim of this project was to design an electronic version of the registry that contains all acts of physiotherapists. The solution we present here, not only meets all legal constraints, but also enables to verify the traceability and inalterability of the generated documents, by means of SHA-256 codes. The proposed structure, using XML technology can also form a basis for the development of tools that can be used by the controlling authorities. By means of a certification procedure for software systems, we succeeded in developing a user friendly system that enables end-users that use a quality labeled software package, to automatically produce all the legally necessary documents concerning the registry. Moreover, we hope that this development will be an incentive for non-users to start working in an electronic way.

Electronic Signature Policy

EPA Pesticide Factsheets

Establishes the United States Environmental Protection Agency's approach to adopting electronic signature technology and best practices to ensure electronic signatures applied to official Agency documents are legally valid and enforceable

Email authentication using symmetric and asymmetric key algorithm encryption

NASA Astrophysics Data System (ADS)

Halim, Mohamad Azhar Abdul; Wen, Chuah Chai; Rahmi, Isredza; Abdullah, Nurul Azma; Rahman, Nurul Hidayah Ab.

2017-10-01

Protection of sensitive or classified data from unauthorized access, hackers and other personals is virtue. Storage of data is done in devices such as USB, external hard disk, laptops, I-Pad or at cloud. Cloud computing presents with both ups and downs. However, storing information elsewhere increases risk of being attacked by hackers. Besides, the risk of losing the device or being stolen is increased in case of storage in portable devices. There are array of mediums of communications and even emails used to send data or information but these technologies come along with severe weaknesses such as absence of confidentiality where the message sent can be altered and sent to the recipient. No proofs are shown to the recipient that the message received is altered. The recipient would not find out unless he or she checks with the sender. Without encrypted of data or message, sniffing tools and software can be used to hack and read the information since it is in plaintext. Therefore, an electronic mail authentication is proposed, namely Hybrid Encryption System (HES). The security of HES is protected using asymmetric and symmetric key algorithms. The asymmetric algorithm is RSA and symmetric algorithm is Advance Encryption Standard. With the combination for both algorithms in the HES may provide the confidentiality and authenticity to the electronic documents send from the sender to the recipient. In a nutshell, the HES will help users to protect their valuable documentation and data from illegal third party user.

Spread Spectrum Receiver Electromagnetic Interference (EMI) Test Guide

NASA Technical Reports Server (NTRS)

Wheeler, M. L.

1998-01-01

The objective of this test guide is to document appropriate unit level test methods and techniques for the performance of EMI testing of Direct Sequence (DS) spread spectrum receivers. Consideration of EMI test methods tailored for spread spectrum receivers utilizing frequency spreading, techniques other than direct sequence (such as frequency hopping, frequency chirping, and various hybrid methods) is beyond the scope of this test guide development program and is not addressed as part of this document EMI test requirements for NASA programs are primarily developed based on the requirements contained in MIL-STD-46 1 D (or earlier revisions of MIL-STD-46 1). The corresponding test method guidelines for the MIL-STD-461 D tests are provided in MIL-STD-462D. These test methods are well documented with the exception of the receiver antenna port susceptibility tests (intermodulation, cross modulation, and rejection of undesired signals) which must be tailored to the specific type of receiver that is being tested. Thus, test methods addressed in this guide consist only of antenna port tests designed to evaluate receiver susceptibility characteristics. MIL-STD-462D should be referred for guidance pertaining to test methods for EMI tests other than the antenna port tests. The scope of this test guide includes: (1) a discussion of generic DS receiver performance characteristics; (2) a summary of S-band TDRSS receiver operation; (3) a discussion of DS receiver EMI susceptibility mechanisms and characteristics; (4) a summary of military standard test guidelines; (5) recommended test approach and methods; and (6) general conclusions and recommendations for future studies in the area of spread spectrum receiver testing.

Title list of documents made publicly available, October 1-31, 1997

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

NONE

1997-12-01

This monthly publication describes the information received and published by the U.S. Nuclear Regulatory Commission (NRC). It includes: (1) docketed material associated with civilian nuclear power plants and other uses of radioactive materials, and (2) non-docketed material received and published. This series of documents is indexed by a Personal Author Index, a Corporate Source Index, and a Report Number index. Seven docketed items are included which pertain to licensing, radioactive waste, nuclear power plant design. The 26 non-docketed items include committee reports; NRC correspondence, issuances, and reports; inspections and deficiency findings; and waste management documents.

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

NONE

This monthly publication contains descriptions of the information received and generated by the US Nuclear Regulatory Commission (NRC). This information includes (1) docketed material associated with civilian nuclear power plants and other uses of radioactive materials and (2) nondocketed material received and generated by NRC pertinent to its role as a regulatory agency. As used here, docketed refers to the system by which NRC maintains its regulatory records. This series of documents is indexed by a Personal Author Index, a Corporate Source Index, and a Report Number Index. NRC documents that are publicly available may be examined without charge atmore » the NRC Public Document Room (PDR).« less

Electronic Journals, the Internet, and Scholarly Communication.

ERIC Educational Resources Information Center

Kling, Rob; Callahan, Ewa

2003-01-01

Examines the role of the Internet in supporting scholarly communication via electronic journals. Topics include scholarly electronic communication; a typology of electronic journals; models of electronic documents and scholarly communication forums; publication speed; costs; pricing; access and searching; citations; interactivity; archiving and…

17 CFR 232.105 - Limitation on use of HTML documents and hypertext links.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Limitation on use of HTML... Requirements § 232.105 Limitation on use of HTML documents and hypertext links. (a) Electronic filers must... EDGAR database on the Commission's public web site (www.sec.gov). Electronic filers also may include...

Publishing Accessible Materials on the Web and CD-ROM.

ERIC Educational Resources Information Center

Federal Resource Center for Special Education, Washington, DC.

While it is generally simple to make electronic content accessible, it is also easy inadvertently to make it inaccessible. This guide covers the many formats of electronic documents and points out what to keep in mind and what procedures to follow to make documents accessible to all when disseminating information via the World Wide Web and on…

Understanding Proto-Insurgencies

DTIC Science & Technology

2007-01-01

10. SPONSOR/MONITOR’S ACRONYM( S ) 11. SPONSOR/MONITOR’S REPORT NUMBER( S ) 12. DISTRIBUTION /AVAILABILITY STATEMENT Approved for public release...This document and trademark( s ) contained herein are protected by law as indicated in a notice appearing later in this work. This electronic...documents for commercial use. For information on reprint and linking permissions, please see RAND Permissions. Limited Electronic Distribution Rights This

Understanding Proto-Insurgencies

DTIC Science & Technology

2007-01-01

SPONSOR/MONITOR’S REPORT NUMBER( S ) 12. DISTRIBUTION /AVAILABILITY STATEMENT Approved for public release; distribution unlimited 13. SUPPLEMENTARY...This document and trademark( s ) contained herein are protected by law as indicated in a notice appearing later in this work. This electronic...documents for commercial use. For information on reprint and linking permissions, please see RAND Permissions. Limited Electronic Distribution Rights This

Notes on Operations. The Documentation of Electronic Texts Using Text Encoding Initiative Headers: An Introduction.

ERIC Educational Resources Information Center

Giordano, Richard

1994-01-01

Describes the Text Encoding Initiative (TEI) project and the TEI header, which documents electronic text in a standard interchange format understandable to both librarian catalogers and nonlibrarian text encoders. The form and function of the TEI header is introduced, and its relationship to the MARC record is explained. (10 references) (KRN)

78 FR 51754 - Request To Modify License by Replacing Security Plan With New Radiation Safety Plan; U.S...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-21

... by the presiding officer that the filing demonstrates good cause by satisfying the three factors in... documents over the Internet, or in some cases to mail copies on electronic storage media. Participants may... holidays. Participants who believe that they have a good cause for not submitting documents electronically...

Teaching home care electronic documentation skills to undergraduate nursing students.

PubMed

Nokes, Kathleen M; Aponte, Judith; Nickitas, Donna M; Mahon, Pamela Y; Rodgers, Betsy; Reyes, Nancy; Chaya, Joan; Dornbaum, Martin

2012-01-01

Although there is general consensus that nursing students need knowledge and significant skill to document clinical findings electronically, nursing faculty face many barriers in ensuring that undergraduate students can practice on electronic health record systems (EHRS). External funding supported the development of an educational innovation through a partnership between a home care agency staff and nursing faculty. Modules were developed to teach EHRS skills using a case study of a homebound person requiring wound care and the Medicare-required OASIS documentation system. This article describes the development and implementation of the module for an upper-level baccalaureate nursing program located in New York City. Nursing faculty are being challenged to develop creative and economical solutions to expose nursing students to EHRSs in nonclinical settings.

Phase II Report: Design Study for Automated Document Location and Control System.

ERIC Educational Resources Information Center

Booz, Allen Applied Research, Inc., Bethesda, MD.

The scope of Phase II is the design of a system for document control within the National Agricultural Library (NAL) that will facilitate the processing of the documents selected, ordered, or received; that will avoid backlogs; and that will provide rapid document location reports. The results are set forth as follows: Chapter I, Introduction,…

75 FR 36066 - Promise Neighborhoods Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-24

... official version of this document is the document published in the Federal Register. Free Internet access... Federal Relay Service, toll free, at 1-800-877-8339. Electronic Access to This Document: You can view this... Adobe Portable Document Format (PDF) on the Internet at the following site: http://www.ed.gov/news...

Techniques of Document Management: A Review of Text Retrieval and Related Technologies.

ERIC Educational Resources Information Center

Veal, D. C.

2001-01-01

Reviews present and possible future developments in the techniques of electronic document management, the major ones being text retrieval and scanning and OCR (optical character recognition). Also addresses document acquisition, indexing and thesauri, publishing and dissemination standards, impact of the Internet, and the document management…

75 FR 4794 - National Assessment Governing Board; Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-29

... the document published in the Federal Register. Free Internet access to the official edition of the...: Munira Mwalimu at (202) 357-6906. Electronic Access to This Document: You may view this document, as well... Portable Document Format (PDF) on the Internet at the following site: http://www.ed.gov/news/fedregister...

Suggested Format for Acute Toxicity Studies

EPA Pesticide Factsheets

This document suggests the format for final reports on pesticide studies (right column of the tables in the document) and provides instructions for the creation of PDF Version 1.3 electronic submission documents (left column of the tables).

78 FR 22554 - Document to Support Submission of an Electronic Common Technical Document-Specifications for File...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-16

... documents at either http://www.fda.gov/Drugs/DevelopmentApprovalProcess/FormsSubmissionRequirements...Vaccines/GuidanceComplianceRegulatoryInformation/Guidances/default.htm . Dated: April 10, 2013. Leslie Kux...

Developing an acute-physical-examination template for a Tegional EHR system aimed at improving inexperienced physician's documentation.

PubMed

Lilholt, Lars; Haubro, Camilla Dremstrup; Møller, Jørn Munkhof; Aarøe, Jens; Højen, Anne Randorff; Gøeg, Kirstine Rosenbeck

2013-01-01

It is well-established that to increase acceptance of electronic clinical documentation tools, such as electronic health record (EHR) systems, it is important to have a strong relationship between those who document the clinical encounters and those who reaps the benefit of digitalized and more structured documentation. [1] Therefore, templates for EHR systems benefit from being closely related to clinical practice with a strong focus on primarily solving clinical problems. Clinical use as a driver for structured documentation has been the focus of the acute-physical-examination template (APET) development in the North Denmark Region. The template was developed through a participatory design where precision and clarity of documentation was prioritized as well as fast registration. The resulting template has approximately 700 easy accessible input possibilities and will be evaluated in clinical practice in the first quarter of 2013.

19 CFR 163.1 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-04-01

...; electronically stored or transmitted information or data; books; papers; correspondence; accounts; financial...: (1) Electronic information which was used to develop other electronic records or paper documents; (2) Electronic information which is in a readable format such as a facsimile paper format or an electronic or...

19 CFR 163.1 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-04-01

...; electronically stored or transmitted information or data; books; papers; correspondence; accounts; financial...) Electronic information which was used to develop other electronic records or paper documents; (2) Electronic information which is in a readable format such as a facsimile paper format or an electronic or hardcopy...

Documentation of preventive care for pressure ulcers initiated during annual evaluations in SCI

PubMed Central

2016-01-01

Objective Community-acquired pressure ulcers (PrUs) are a frequent cause of hospitalization of Veterans with spinal cord injury (SCI). The Veterans Health Administration (VHA) recommends that SCI annual evaluations include assessment of PrU risk factors, a thorough skin inspection and sharing of recommendations for PrU prevention strategies. We characterized consistency of preventive skin care during annual evaluations for Veterans with SCI as a first step in identifying strategies to more actively promote PrU prevention care in other healthcare encounters. Design/setting/participants Retrospective cross-sectional observational design, including review of electronic medical records for 206 Veterans with SCI admitted to 2 VA SCI centers from January-December, 2011. Outcome measures Proportion of applicable skin health elements documented (number of applicable elements/skin health elements documented). Results Our sample was primarily white (78%) male (96.1%), and mean age = 61 years. 40% of participants’ were hospitalized for PrU treatment, with a mean of 294 days (median = 345 days) from annual evaluation to the index admission. On average, Veterans received an average of 75.5% (IQR 68-86%) of applicable skin health elements. Documentation of applicable skin health elements was significantly higher during inpatient vs. outpatient annual evaluations (mean elements received = 80.3% and 64.3%, respectively, P > 0.001). No significant differences were observed in documentation of skin health elements by Veterans at high vs. low PrU risk. Conclusion Additional PrU preventive care in the VHA outpatient setting may increase identification and detection of PrU risk factors and early PrU damage for Veterans with SCI in the community, allowing for earlier intervention. PMID:26763668

76 FR 18807 - Proposed Generic Communication; Licensee Justification of Long-Term Surveillance Charge

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-05

... Documents Access and Management System (ADAMS) under accession number ML102080569. DATES: Comment period... and Management System (ADAMS): Publicly available documents created or received at the NRC are...-25,'' dated September 1980 (Agencywide Documents Access and Management System [ADAMS] accession...

Electronics Curriculum.

ERIC Educational Resources Information Center

Prickett, Charlotte

This document presents results of research conducted by industry representatives regarding tasks performed by electronic technicians and line manufacturing electro-mechanical technicians in Arizona electronics industries. Based on this research, a competency-based curriculum was developed for training entry-level electronics technicians. Twelve…

19 CFR 210.4 - Written submissions; representations; sanctions.

Code of Federal Regulations, 2013 CFR

2013-04-01

... document shall be filed in electronic form on one CD-ROM, DVD, or other portable electronic media approved... shall be filed in electronic form on one CD-ROM, DVD, or other portable electronic media approved by the...

19 CFR 210.4 - Written submissions; representations; sanctions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... document shall be filed in electronic form on one CD-ROM, DVD, or other portable electronic media approved... shall be filed in electronic form on one CD-ROM, DVD, or other portable electronic media approved by the...

JSC document index

NASA Technical Reports Server (NTRS)

1988-01-01

The Johnson Space Center (JSC) document index is intended to provide a single source listing of all published JSC-numbered documents their authors, and the designated offices of prime responsibility (OPR's) by mail code at the time of publication. The index contains documents which have been received and processed by the JSC Technical Library as of January 13, 1988. Other JSC-numbered documents which are controlled but not available through the JSC Library are also listed.

Title list of documents made publicly available, July 1--31, 1996: Volume 18, No. 7

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

NONE

This monthly publication describes information received and published by US NRC. This information includes (1) docketed material associated with civilian nuclear power plants and other uses of radioactive materials and (2) nondocketed material received and published by NRC pertinent to its role as a regulatory agency. Following indexes are included: personal author, corporate source, report number, and cross reference of enclosures to principal documents.

27 CFR 73.34 - When is an electronically submitted form considered timely filed?

Code of Federal Regulations, 2010 CFR

2010-04-01

... AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY (CONTINUED) PROCEDURES AND PRACTICES ELECTRONIC SIGNATURES; ELECTRONIC SUBMISSION OF FORMS Electronic Filing of Documents with TTB § 73.34 When is an electronically submitted form considered timely filed? If you submit a form to our electronic...

Time-motion analysis of clinical nursing documentation during implementation of an electronic operating room management system for ophthalmic surgery.

PubMed

Read-Brown, Sarah; Sanders, David S; Brown, Anna S; Yackel, Thomas R; Choi, Dongseok; Tu, Daniel C; Chiang, Michael F

2013-01-01

Efficiency and quality of documentation are critical in surgical settings because operating rooms are a major source of revenue, and because adverse events may have enormous consequences. Electronic health records (EHRs) have potential to impact surgical volume, quality, and documentation time. Ophthalmology is an ideal domain to examine these issues because procedures are high-throughput and demand efficient documentation. This time-motion study examines nursing documentation during implementation of an EHR operating room management system in an ophthalmology department. Key findings are: (1) EHR nursing documentation time was significantly worse during early implementation, but improved to a level near but slightly worse than paper baseline, (2) Mean documentation time varied significantly among nurses during early implementation, and (3) There was no decrease in operating room turnover time or surgical volume after implementation. These findings have important implications for ambulatory surgery departments planning EHR implementation, and for research in system design.

Time-Motion Analysis of Clinical Nursing Documentation During Implementation of an Electronic Operating Room Management System for Ophthalmic Surgery

PubMed Central

Read-Brown, Sarah; Sanders, David S.; Brown, Anna S.; Yackel, Thomas R.; Choi, Dongseok; Tu, Daniel C.; Chiang, Michael F.

2013-01-01

Efficiency and quality of documentation are critical in surgical settings because operating rooms are a major source of revenue, and because adverse events may have enormous consequences. Electronic health records (EHRs) have potential to impact surgical volume, quality, and documentation time. Ophthalmology is an ideal domain to examine these issues because procedures are high-throughput and demand efficient documentation. This time-motion study examines nursing documentation during implementation of an EHR operating room management system in an ophthalmology department. Key findings are: (1) EHR nursing documentation time was significantly worse during early implementation, but improved to a level near but slightly worse than paper baseline, (2) Mean documentation time varied significantly among nurses during early implementation, and (3) There was no decrease in operating room turnover time or surgical volume after implementation. These findings have important implications for ambulatory surgery departments planning EHR implementation, and for research in system design. PMID:24551402

Usage experience with the document archiving and communication system for the storage and retrieval of medical records.

PubMed

Takeda, Toshihiro; Ueda, Kanayo; Manabe, Shiro; Teramoto, Kei; Mihara, Naoki; Matsumura, Yasushi

2013-01-01

Standard Japanese electronic medical record (EMR) systems are associated with major shortcomings. For example, they do not assure lifelong readability of records because each document requires its own viewing software program, a system that is difficult to maintain over long periods of time. It can also be difficult for users to comprehend a patient's clinical history because different classes of documents can only be accessed from their own window. To address these problems, we developed a document-based electronic medical record that aggregates all documents for a patient in a PDF or DocuWorks format. We call this system the Document Archiving and Communication System (DACS). There are two types of viewers in the DACS: the Matrix View, which provides a time line of a patient's history, and the Tree View, which stores the documents in hierarchical document classes. We placed 2,734 document classes into 11 categories. A total of 22,3972 documents were entered per month. The frequency of use of the DACS viewer was 268,644 instances per month. The DACS viewer was used to assess a patient's clinical history.

Metrics for Electronic-Nursing-Record-Based Narratives: cross-sectional analysis.

PubMed

Kim, Kidong; Jeong, Suyeon; Lee, Kyogu; Park, Hyeoun-Ae; Min, Yul Ha; Lee, Joo Yun; Kim, Yekyung; Yoo, Sooyoung; Doh, Gippeum; Ahn, Soyeon

2016-11-30

We aimed to determine the characteristics of quantitative metrics for nursing narratives documented in electronic nursing records and their association with hospital admission traits and diagnoses in a large data set not limited to specific patient events or hypotheses. We collected 135,406,873 electronic, structured coded nursing narratives from 231,494 hospital admissions of patients discharged between 2008 and 2012 at a tertiary teaching institution that routinely uses an electronic health records system. The standardized number of nursing narratives (i.e., the total number of nursing narratives divided by the length of the hospital stay) was suggested to integrate the frequency and quantity of nursing documentation. The standardized number of nursing narratives was higher for patients aged ≥ 70 years (median = 30.2 narratives/day, interquartile range [IQR] = 24.0-39.4 narratives/day), long (≥ 8 days) hospital stays (median = 34.6 narratives/day, IQR = 27.2-43.5 narratives/day), and hospital deaths (median = 59.1 narratives/day, IQR = 47.0-74.8 narratives/day). The standardized number of narratives was higher in "pregnancy, childbirth, and puerperium" (median = 46.5, IQR = 39.0-54.7) and "diseases of the circulatory system" admissions (median = 35.7, IQR = 29.0-43.4). Diverse hospital admissions can be consistently described with nursing-document-derived metrics for similar hospital admissions and diagnoses. Some areas of hospital admissions may have consistently increasing volumes of nursing documentation across years. Usability of electronic nursing document metrics for evaluating healthcare requires multiple aspects of hospital admissions to be considered.