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...

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...

The Use of Multiple Slate Devices to Support Active Reading Activities

ERIC Educational Resources Information Center

Chen, Nicholas Yen-Cherng

2012-01-01

Reading activities in the classroom and workplace occur predominantly on paper. Since existing electronic devices do not support these reading activities as well as paper, users have difficulty taking full advantage of the affordances of electronic documents. This dissertation makes three main contributions toward supporting active reading…

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

36 CFR Appendix - Figures to Part 1194

Code of Federal Regulations, 2013 CFR

2013-07-01

... 36 Parks, Forests, and Public Property 3 2013-07-01 2012-07-01 true Figures to Part 1194 Parks, Forests, and Public Property ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD ELECTRONIC AND INFORMATION TECHNOLOGY ACCESSIBILITY STANDARDS Information, Documentation, and Support Information, documentation, and support. Pt. 1194, Figs....

36 CFR Appendix - Figures to Part 1194

Code of Federal Regulations, 2012 CFR

2012-07-01

... 36 Parks, Forests, and Public Property 3 2012-07-01 2012-07-01 false Figures to Part 1194 Parks, Forests, and Public Property ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD ELECTRONIC AND INFORMATION TECHNOLOGY ACCESSIBILITY STANDARDS Information, Documentation, and Support Information, documentation, and support. Pt. 1194, Figs....

36 CFR Appendix - Figures to Part 1194

Code of Federal Regulations, 2014 CFR

2014-07-01

... 36 Parks, Forests, and Public Property 3 2014-07-01 2014-07-01 false Figures to Part 1194 Parks, Forests, and Public Property ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD ELECTRONIC AND INFORMATION TECHNOLOGY ACCESSIBILITY STANDARDS Information, Documentation, and Support Information, documentation, and support. Pt. 1194, Figs....

36 CFR Appendix - Figures to Part 1194

Code of Federal Regulations, 2011 CFR

2011-07-01

... 36 Parks, Forests, and Public Property 3 2011-07-01 2011-07-01 false Figures to Part 1194 Parks, Forests, and Public Property ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD ELECTRONIC AND INFORMATION TECHNOLOGY ACCESSIBILITY STANDARDS Information, Documentation, and Support Information, documentation, and support. Pt. 1194, Figs....

36 CFR Appendix - Figures to Part 1194

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Figures to Part 1194 Parks, Forests, and Public Property ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD ELECTRONIC AND INFORMATION TECHNOLOGY ACCESSIBILITY STANDARDS Information, Documentation, and Support Information, documentation, and support. Pt. 1194, Figs....

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.

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...

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…

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.

Semantic Clinical Guideline Documents

PubMed Central

Eriksson, Henrik; Tu, Samson W.; Musen, Mark

2005-01-01

Decision-support systems based on clinical practice guidelines can support physicians and other health-care personnel in the process of following best practice consistently. A knowledge-based approach to represent guidelines makes it possible to encode computer-interpretable guidelines in a formal manner, perform consistency checks, and use the guidelines directly in decision-support systems. Decision-support authors and guideline users require guidelines in human-readable formats in addition to computer-interpretable ones (e.g., for guideline review and quality assurance). We propose a new document-oriented information architecture that combines knowledge-representation models with electronic and paper documents. The approach integrates decision-support modes with standard document formats to create a combined clinical-guideline model that supports on-line viewing, printing, and decision support. PMID:16779037

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.

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...

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…

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.

Evaluation of Nursing Documentation Completion of Stroke Patients in the Emergency Department: A Pre-Post Analysis Using Flowsheet Templates and Clinical Decision Support.

PubMed

Richardson, Karen J; Sengstack, Patricia; Doucette, Jeffrey N; Hammond, William E; Schertz, Matthew; Thompson, Julie; Johnson, Constance

2016-02-01

The primary aim of this performance improvement project was to determine whether the electronic health record implementation of stroke-specific nursing documentation flowsheet templates and clinical decision support alerts improved the nursing documentation of eligible stroke patients in seven stroke-certified emergency departments. Two system enhancements were introduced into the electronic record in an effort to improve nursing documentation: disease-specific documentation flowsheets and clinical decision support alerts. Using a pre-post design, project measures included six stroke management goals as defined by the National Institute of Neurological Disorders and Stroke and three clinical decision support measures based on entry of orders used to trigger documentation reminders for nursing: (1) the National Institutes of Health's Stroke Scale, (2) neurological checks, and (3) dysphagia screening. Data were reviewed 6 months prior (n = 2293) and 6 months following the intervention (n = 2588). Fisher exact test was used for statistical analysis. Statistical significance was found for documentation of five of the six stroke management goals, although effect sizes were small. Customizing flowsheets to meet the needs of nursing workflow showed improvement in the completion of documentation. The effects of the decision support alerts on the completeness of nursing documentation were not statistically significant (likely due to lack of order entry). For example, an order for the National Institutes of Health Stroke Scale was entered only 10.7% of the time, which meant no alert would fire for nursing in the postintervention group. Future work should focus on decision support alerts that trigger reminders for clinicians to place relevant orders for this population.

76 FR 5537 - Electronic On-Board Recorders and Hours of Service Supporting Documents

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-01

...The Federal Motor Carrier Safety Administration (FMCSA) proposes to amend the Federal Motor Carrier Safety Regulations (FMCSRs) to require certain motor carriers operating commercial motor vehicles (CMVs) in interstate commerce to use electronic on-board recorders (EOBRs) to document their drivers' hours of service (HOS). Under this proposal, all motor carriers currently required to maintain Records of Duty Status (RODS) for HOS recordkeeping would be required to use EOBRs to systematically and effectively monitor their drivers' compliance with HOS requirements. Additionally, this proposal sets forth the supporting documents that all motor carriers currently required to use RODS would still be required to obtain and keep, as required by section 113(a) of the Hazardous Materials Transportation Authorization Act (HMTAA). It explains, however, that although motor carriers subject to the proposed EOBR requirements would still need to retain some supporting documents, they would be relieved of the requirements to retain supporting documents to verify driving time. FMCSA also proposes to require all motor carriers--both RODS and timecard users--to systematically monitor their drivers' compliance with HOS requirements. Motor carriers would be given 3 years after the effective date of the final rule to comply with these requirements.

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.

An Electronic Nursing Patient Care Plan Helps in Clinical Decision Support.

PubMed

Wong, C M; Wu, S Y; Ting, W H; Ho, K H; Tong, L H; Cheung, N T

2015-01-01

Information technology can help to improve health care delivery. The utilisation of informatics principle enhances the quality of nursing practices through improved communication, documentation and efficiency. The Nursing Profession constitutes 34% of the total workforce in the Hong Kong Hospital Authority (HA) and includes 21,000 nurses in 2012. To enhance the quality of care and patient safety in both hospitals and community care setting, it is essential that an integrated electronic decision support system for nurses is designed to track documentation and support care or service including observations, decisions, actions and outcomes throughout the care process at each point-of-care. The Patient Care Plan project was set up to achieve these objectives. The Project adheres to strict documentation information architecture to ensure data sharing is freely available. Preliminary results showed very promising improvement in clinical care.

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

eCDRweb User Guide–Primary Support

EPA Pesticide Factsheets

This document presents the user guide for the Office of Pollution Prevention and Toxics’ (OPPT) e-CDR web tool. E-CDRweb is the electronic, web-based tool provided by the Environmental Protection Agency (EPA) for the submission of Chemical Data Reporting (CDR) information. This document is the user guide for the Primary Support user of the e-CDRweb tool.

eCDRweb User Guide–Secondary Support

EPA Pesticide Factsheets

This document presents the user guide for the Office of Pollution Prevention and Toxics’ (OPPT) e-CDR web tool. E-CDRweb is the electronic, web-based tool provided by the Environmental Protection Agency (EPA) for the submission of Chemical Data Reporting (CDR) information. This document is the user guide for the Secondary Support user of the e-CDRweb tool.

Semantic retrieval and navigation in clinical document collections.

PubMed

Kreuzthaler, Markus; Daumke, Philipp; Schulz, Stefan

2015-01-01

Patients with chronic diseases undergo numerous in- and outpatient treatment periods, and therefore many documents accumulate in their electronic records. We report on an on-going project focussing on the semantic enrichment of medical texts, in order to support recall-oriented navigation across a patient's complete documentation. A document pool of 1,696 de-identified discharge summaries was used for prototyping. A natural language processing toolset for document annotation (based on the text-mining framework UIMA) and indexing (Solr) was used to support a browser-based platform for document import, search and navigation. The integrated search engine combines free text and concept-based querying, supported by dynamically generated facets (diagnoses, procedures, medications, lab values, and body parts). The prototype demonstrates the feasibility of semantic document enrichment within document collections of a single patient. Originally conceived as an add-on for the clinical workplace, this technology could also be adapted to support personalised health record platforms, as well as cross-patient search for cohort building and other secondary use scenarios.

78 FR 42084 - Electronic Study Data Submission; Data Standard Support; Availability of the Center for Drug...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-15

...] Electronic Study Data Submission; Data Standard Support; Availability of the Center for Drug Evaluation and Research Data Standards Program Documents AGENCY: Food and Drug Administration, HHS. ACTION: Notice... announcing the availability of the CDER Data Standards Strategy (version 1.0) and the CDER Data Standards...

Future of electronic health records: implications for decision support.

PubMed

Rothman, Brian; Leonard, Joan C; Vigoda, Michael M

2012-01-01

The potential benefits of the electronic health record over traditional paper are many, including cost containment, reductions in errors, and improved compliance by utilizing real-time data. The highest functional level of the electronic health record (EHR) is clinical decision support (CDS) and process automation, which are expected to enhance patient health and healthcare. The authors provide an overview of the progress in using patient data more efficiently and effectively through clinical decision support to improve health care delivery, how decision support impacts anesthesia practice, and how some are leading the way using these systems to solve need-specific issues. Clinical decision support uses passive or active decision support to modify clinician behavior through recommendations of specific actions. Recommendations may reduce medication errors, which would result in considerable savings by avoiding adverse drug events. In selected studies, clinical decision support has been shown to decrease the time to follow-up actions, and prediction has proved useful in forecasting patient outcomes, avoiding costs, and correctly prompting treatment plan modifications by clinicians before engaging in decision-making. Clinical documentation accuracy and completeness is improved by an electronic health record and greater relevance of care data is delivered. Clinical decision support may increase clinician adherence to clinical guidelines, but educational workshops may be equally effective. Unintentional consequences of clinical decision support, such as alert desensitization, can decrease the effectiveness of a system. Current anesthesia clinical decision support use includes antibiotic administration timing, improved documentation, more timely billing, and postoperative nausea and vomiting prophylaxis. Electronic health record implementation offers data-mining opportunities to improve operational, financial, and clinical processes. Using electronic health record data in real-time for decision support and process automation has the potential to both reduce costs and improve the quality of patient care. © 2012 Mount Sinai School of Medicine.

Performance Support on the Shop Floor.

ERIC Educational Resources Information Center

Kasvi, Jyrki J. J.; Vartiainen, Matti

2000-01-01

Discussion of performance support on the shop floor highlights four support systems for assembly lines that incorporate personal computer workstations in local area networks and use multimedia documents. Considers new customer-focused production paradigms; organizational learning; knowledge development; and electronic performance support systems…

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.

Mediagraphy: Print and Nonprint Resources.

ERIC Educational Resources Information Center

Educational Media and Technology Yearbook, 1998

1998-01-01

Lists educational media-related journals, books, ERIC documents, journal articles, and nonprint resources classified by Artificial Intelligence, Robotics, Electronic Performance Support Systems; Computer-Assisted Instruction; Distance Education; Educational Research; Educational Technology; Electronic Publishing; Information Science and…

Organizational Influences on the University Electronic Library.

ERIC Educational Resources Information Center

Davies, Clare

1997-01-01

Reviews the literature on the development of full-text electronic libraries in the academic setting. Organizational factors can have impact on electronic library development and ultimate usability. Topics include strategic management, planning and implementation; system specification and design; document provision; user support and training; and…

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.

Procedure for Electronic Management of Rulemaking and Other Docketed Records in the Federal Docket Management System

EPA Pesticide Factsheets

This procedure identifies the specific requirements, processes and supporting documents EPA uses to electronically manage rulemaking and other docketed records in the Federal Docket Management System (FDMS).

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

Are electronic health records ready for genomic medicine?

PubMed

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

2009-07-01

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

[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.

78 FR 41971 - 30-Day Notice of Proposed Information Collection: Electronic Diversity Visa Entry Form

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-12

...: Electronic Diversity Visa Entry Form ACTION: Notice of request for public comment and submission to OMB of... collection instrument and supporting documents, to Sydney Taylor, Visa Services, U.S. [[Page [email protected] SUPPLEMENTARY INFORMATION: Title of Information Collection: Electronic Diversity Visa...

End-user support for primary care electronic medical records: a qualitative case study of users’ needs, expectations and realities

PubMed Central

Shachak, Aviv; Montgomery, Catherine; Dow, Rustam; Barnsley, Jan; Tu, Karen; Jadad, Alejandro R.; Lemieux-Charles, Louise

2015-01-01

Support is considered an important factor for realizing the benefits of health information technology (HIT) but there is a dearth of research on the topic of support, especially in primary care. We conducted a qualitative multiple case study of 4 family health teams (FHTs) and one family health organization (FHO) in Ontario, Canada in an attempt to gain insight into users’ expectations and needs, and the realities of end-user support for primary care electronic medical records (EMRs). Data were collected by semi-structured interviews, documents review, and observation of training sessions. The analysis highlights the important role of on-site information technology (IT) staff and super-users in liaising with various stakeholders to solve technical problems and providing hardware and functional (‘how to’) support; the local development of data support practices to ensure consistent documentation; and the gaps that exist in users’ and support personnel’s understanding of each other’s work processes. PMID:26225209

Electrical Ground Support Equipment Fabrication, Specification for

NASA Technical Reports Server (NTRS)

Denson, Erik C.

2014-01-01

This document specifies parts, materials, and processes used in the fabrication, maintenance, repair, and procurement of electrical and electronic control and monitoring equipment associated with ground support equipment (GSE) at the Kennedy Space Center (KSC).

Component-Level Electronic-Assembly Repair (CLEAR) System Architecture

NASA Technical Reports Server (NTRS)

Oeftering, Richard C.; Bradish, Martin A.; Juergens, Jeffrey R.; Lewis, Michael J.; Vrnak, Daniel R.

2011-01-01

This document captures the system architecture for a Component-Level Electronic-Assembly Repair (CLEAR) capability needed for electronics maintenance and repair of the Constellation Program (CxP). CLEAR is intended to improve flight system supportability and reduce the mass of spares required to maintain the electronics of human rated spacecraft on long duration missions. By necessity it allows the crew to make repairs that would otherwise be performed by Earth based repair depots. Because of practical knowledge and skill limitations of small spaceflight crews they must be augmented by Earth based support crews and automated repair equipment. This system architecture covers the complete system from ground-user to flight hardware and flight crew and defines an Earth segment and a Space segment. The Earth Segment involves database management, operational planning, and remote equipment programming and validation processes. The Space Segment involves the automated diagnostic, test and repair equipment required for a complete repair process. This document defines three major subsystems including, tele-operations that links the flight hardware to ground support, highly reconfigurable diagnostics and test instruments, and a CLEAR Repair Apparatus that automates the physical repair process.

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.

40 CFR 35.6705 - Records retention.

Code of Federal Regulations, 2012 CFR

2012-07-01

.... This requirement applies to all financial and programmatic records, supporting documents, statistical... ten-year period, whichever is later. (c) Substitution of an unalterable electronic format. An unalterable electronic format, acceptable to EPA, may be substituted for the original records. The copying of...

40 CFR 35.6705 - Records retention.

Code of Federal Regulations, 2013 CFR

2013-07-01

.... This requirement applies to all financial and programmatic records, supporting documents, statistical... ten-year period, whichever is later. (c) Substitution of an unalterable electronic format. An unalterable electronic format, acceptable to EPA, may be substituted for the original records. The copying of...

40 CFR 35.6705 - Records retention.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... This requirement applies to all financial and programmatic records, supporting documents, statistical... ten-year period, whichever is later. (c) Substitution of an unalterable electronic format. An unalterable electronic format, acceptable to EPA, may be substituted for the original records. The copying of...

40 CFR 35.6705 - Records retention.

Code of Federal Regulations, 2011 CFR

2011-07-01

.... This requirement applies to all financial and programmatic records, supporting documents, statistical... ten-year period, whichever is later. (c) Substitution of an unalterable electronic format. An unalterable electronic format, acceptable to EPA, may be substituted for the original records. The copying of...

40 CFR 35.6705 - Records retention.

Code of Federal Regulations, 2014 CFR

2014-07-01

.... This requirement applies to all financial and programmatic records, supporting documents, statistical... ten-year period, whichever is later. (c) Substitution of an unalterable electronic format. An unalterable electronic format, acceptable to EPA, may be substituted for the original records. The copying of...

78 FR 34393 - Electronic Submission of Tobacco Product Applications and Other Information; Public Workshop...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-07

... manufacturers experienced with electronic Common Technical Document (eCTD); vendors of software used to support... electronic submission workshop will include discussion on eCTD, which is an International Conference on Harmonization (ICH) specification developed by ICH and its member parties. The eCTD provides an organizational...

78 FR 67204 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-08

... action to submit an information collection request to the Office of Management and Budget (OMB) and... Verification System (LVS) has been developed, providing an electronic method for fulfilling this requirement... publicly available documents, including the draft supporting statement, at the NRC's Public Document Room...

Functional Requirements for an Electronic Work Package System

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

Oxstrand, Johanna H.

This document provides a set of high level functional requirements for a generic electronic work package (eWP) system. The requirements have been identified by the U.S. nuclear industry as a part of the Nuclear Electronic Work Packages - Enterprise Requirements (NEWPER) initiative. The functional requirements are mainly applied to eWP system supporting Basic and Moderate types of smart documents, i.e., documents that have fields for recording input such as text, dates, numbers, and equipment status, and documents which incorporate additional functionalities such as form field data “type“ validation (e.g. date, text, number, and signature) of data entered and/or self-populate basicmore » document information (usually from existing host application meta data) on the form when the user first opens it. All the requirements are categorized by the roles; Planner, Supervisor, Craft, Work Package Approval Reviewer, Operations, Scheduling/Work Control, and Supporting Functions. The categories Statistics, Records, Information Technology are also included used to group the requirements. All requirements are presented in Section 2 through Section 11. Examples of more detailed requirements are provided for the majority of high level requirements. These examples are meant as an inspiration to be used as each utility goes through the process of identifying their specific requirements. The report’s table of contents provides a summary of the high level requirements.« less

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.

Definition of an XML markup language for clinical laboratory procedures and comparison with generic XML markup.

PubMed

Saadawi, Gilan M; Harrison, James H

2006-10-01

Clinical laboratory procedure manuals are typically maintained as word processor files and are inefficient to store and search, require substantial effort for review and updating, and integrate poorly with other laboratory information. Electronic document management systems could improve procedure management and utility. As a first step toward building such systems, we have developed a prototype electronic format for laboratory procedures using Extensible Markup Language (XML). Representative laboratory procedures were analyzed to identify document structure and data elements. This information was used to create a markup vocabulary, CLP-ML, expressed as an XML Document Type Definition (DTD). To determine whether this markup provided advantages over generic markup, we compared procedures structured with CLP-ML or with the vocabulary of the Health Level Seven, Inc. (HL7) Clinical Document Architecture (CDA) narrative block. CLP-ML includes 124 XML tags and supports a variety of procedure types across different laboratory sections. When compared with a general-purpose markup vocabulary (CDA narrative block), CLP-ML documents were easier to edit and read, less complex structurally, and simpler to traverse for searching and retrieval. In combination with appropriate software, CLP-ML is designed to support electronic authoring, reviewing, distributing, and searching of clinical laboratory procedures from a central repository, decreasing procedure maintenance effort and increasing the utility of procedure information. A standard electronic procedure format could also allow laboratories and vendors to share procedures and procedure layouts, minimizing duplicative word processor editing. Our results suggest that laboratory-specific markup such as CLP-ML will provide greater benefit for such systems than generic markup.

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.

Defense Threat Reduction Agency > Research > DTRIAC > STI Support Center

Science.gov Websites

FOIA Electronic Reading Room Privacy Impact Assessment DTRA No Fear Act Reporting Nuclear Test Personnel Review NTPR Fact Sheets NTPR Radiation Dose Assessment Documents US Atmospheric Nuclear Test History Documents US Underground Nuclear Test History Reports NTPR Radiation Exposure Reports Enewetak

Libraries 2000: Transforming Libraries Using Document Delivery, Needs Assessment, and Networked Resources.

ERIC Educational Resources Information Center

Kleiner, Jane P.; Hamaker, Charles A.

1997-01-01

Describes three projects at Louisiana State University libraries designed to utilize document delivery and electronic access to expand collections, identify faculty journal needs, and share resources among academic, public, special, and school libraries. Network developments, grant support, and needs assessment surveys are also discussed.…

77 FR 7562 - Electronic On-Board Recorders and Hours of Service Supporting Documents

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-13

..., and 395 [Docket No. FMCSA-2010-0167] RIN 2126-AB20 Electronic On-Board Recorders and Hours of Service... intent. SUMMARY: FMCSA announces its intent to move forward with the Electronic On-Board Recorders and... Appeals for the Seventh Circuit. OOIDA raised several concerns relating to EOBRs and their potential use...

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.

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.

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

PubMed

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

2016-04-01

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

77 FR 46763 - Documents to Support Submission of an Electronic Common Technical Document; Availability

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-06

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2011-N-0724... not prepared at present to accept submissions utilizing this new version because eCTD software vendors need time to update their software to accommodate this information and because its use will require...

Building Internet-Based Electronic Performance Support for Teaching and Learning.

ERIC Educational Resources Information Center

Laffey, James M.; Musser, Dale

The College of Education, University of Missouri-Columbia is developing and testing a suite of tools that utilize the Internet and work as a system to support learning from field experiences. These tools are built to support preservice teachers, field-based mentors, and college faculty as they collaborate, engage in practice, document their…

“Smart Forms” in an Electronic Medical Record: Documentation-based Clinical Decision Support to Improve Disease Management

PubMed Central

Schnipper, Jeffrey L.; Linder, Jeffrey A.; Palchuk, Matvey B.; Einbinder, Jonathan S.; Li, Qi; Postilnik, Anatoly; Middleton, Blackford

2008-01-01

Clinical decision support systems (CDSS) integrated within Electronic Medical Records (EMR) hold the promise of improving healthcare quality. To date the effectiveness of CDSS has been less than expected, especially concerning the ambulatory management of chronic diseases. This is due, in part, to the fact that clinicians do not use CDSS fully. Barriers to clinicians' use of CDSS have included lack of integration into workflow, software usability issues, and relevance of the content to the patient at hand. At Partners HealthCare, we are developing “Smart Forms” to facilitate documentation-based clinical decision support. Rather than being interruptive in nature, the Smart Form enables writing a multi-problem visit note while capturing coded information and providing sophisticated decision support in the form of tailored recommendations for care. The current version of the Smart Form is designed around two chronic diseases: coronary artery disease and diabetes mellitus. The Smart Form has potential to improve the care of patients with both acute and chronic conditions. PMID:18436911

"Smart Forms" in an Electronic Medical Record: documentation-based clinical decision support to improve disease management.

PubMed

Schnipper, Jeffrey L; Linder, Jeffrey A; Palchuk, Matvey B; Einbinder, Jonathan S; Li, Qi; Postilnik, Anatoly; Middleton, Blackford

2008-01-01

Clinical decision support systems (CDSS) integrated within Electronic Medical Records (EMR) hold the promise of improving healthcare quality. To date the effectiveness of CDSS has been less than expected, especially concerning the ambulatory management of chronic diseases. This is due, in part, to the fact that clinicians do not use CDSS fully. Barriers to clinicians' use of CDSS have included lack of integration into workflow, software usability issues, and relevance of the content to the patient at hand. At Partners HealthCare, we are developing "Smart Forms" to facilitate documentation-based clinical decision support. Rather than being interruptive in nature, the Smart Form enables writing a multi-problem visit note while capturing coded information and providing sophisticated decision support in the form of tailored recommendations for care. The current version of the Smart Form is designed around two chronic diseases: coronary artery disease and diabetes mellitus. The Smart Form has potential to improve the care of patients with both acute and chronic conditions.

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

PubMed

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

2011-06-01

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

TERMTrial--terminology-based documentation systems for cooperative clinical trials.

PubMed

Merzweiler, A; Weber, R; Garde, S; Haux, R; Knaup-Gregori, P

2005-04-01

Within cooperative groups of multi-center clinical trials a standardized documentation is a prerequisite for communication and sharing of data. Standardizing documentation systems means standardizing the underlying terminology. The management and consistent application of terminology systems is a difficult and fault-prone task, which should be supported by appropriate software tools. Today, documentation systems for clinical trials are often implemented as so-called Remote-Data-Entry-Systems (RDE-systems). Although there are many commercial systems, which support the development of RDE-systems there is none offering a comprehensive terminological support. Therefore, we developed the software system TERMTrial which consists of a component for the definition and management of terminology systems for cooperative groups of clinical trials and two components for the terminology-based automatic generation of trial databases and terminology-based interactive design of electronic case report forms (eCRFs). TERMTrial combines the advantages of remote data entry with a comprehensive terminological control.

Component-Level Electronic-Assembly Repair (CLEAR) Operational Concept

NASA Technical Reports Server (NTRS)

Oeftering, Richard C.; Bradish, Martin A.; Juergens, Jeffrey R.; Lewis, Michael J.; Vrnak, Daniel R.

2011-01-01

This Component-Level Electronic-Assembly Repair (CLEAR) Operational Concept document was developed as a first step in developing the Component-Level Electronic-Assembly Repair (CLEAR) System Architecture (NASA/TM-2011-216956). The CLEAR operational concept defines how the system will be used by the Constellation Program and what needs it meets. The document creates scenarios for major elements of the CLEAR architecture. These scenarios are generic enough to apply to near-Earth, Moon, and Mars missions. The CLEAR operational concept involves basic assumptions about the overall program architecture and interactions with the CLEAR system architecture. The assumptions include spacecraft and operational constraints for near-Earth orbit, Moon, and Mars missions. This document addresses an incremental development strategy where capabilities evolve over time, but it is structured to prevent obsolescence. The approach minimizes flight hardware by exploiting Internet-like telecommunications that enables CLEAR capabilities to remain on Earth and to be uplinked as needed. To minimize crew time and operational cost, CLEAR exploits offline development and validation to support online teleoperations. Operational concept scenarios are developed for diagnostics, repair, and functional test operations. Many of the supporting functions defined in these operational scenarios are further defined as technologies in NASA/TM-2011-216956.

Perspective on 2015 DoD Cyber Strategy

DTIC Science & Technology

2015-09-29

Testimony View document details Support RAND Browse Reports & Bookstore Make a charitable contribution Limited Electronic Distribution Rights This...AGING PUBLIC SAFETY SCIENCE AND TECHNOLOGY TERRORISM AND HOMELAND SECURITY Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting ...Directorate for Information Operations and Reports , 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware

User Manuals for a Primary Care Electronic Medical Record System: A Mixed Methods Study of User- and Vendor-Generated Documents.

PubMed

Shachak, Aviv; Dow, Rustam; Barnsley, Jan; Tu, Karen; Domb, Sharon; Jadad, Alejandro R; Lemieux-Charles, Louise

2013-06-04

Tutorials and user manuals are important forms of impersonal support for using software applications including electronic medical records (EMRs). Differences between user- and vendor documentation may indicate support needs, which are not sufficiently addressed by the official documentation, and reveal new elements that may inform the design of tutorials and user manuals. What are the differences between user-generated tutorials and manuals for an EMR and the official user manual from the software vendor? Effective design of tutorials and user manuals requires careful packaging of information, balance between declarative and procedural texts, an action and task-oriented approach, support for error recognition and recovery, and effective use of visual elements. No previous research compared these elements between formal and informal documents. We conducted an mixed methods study. Seven tutorials and two manuals for an EMR were collected from three family health teams and compared with the official user manual from the software vendor. Documents were qualitatively analyzed using a framework analysis approach in relation to the principles of technical documentation described above. Subsets of the data were quantitatively analyzed using cross-tabulation to compare the types of error information and visual cues in screen captures between user- and vendor-generated manuals. The user-developed tutorials and manuals differed from the vendor-developed manual in that they contained mostly procedural and not declarative information; were customized to the specific workflow, user roles, and patient characteristics; contained more error information related to work processes than to software usage; and used explicit visual cues on screen captures to help users identify window elements. These findings imply that to support EMR implementation, tutorials and manuals need to be customized and adapted to specific organizational contexts and workflows. The main limitation of the study is its generalizability. Future research should address this limitation and may explore alternative approaches to software documentation, such as modular manuals or participatory design.

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

PubMed

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

2015-01-01

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

Assessment of 3D Viewers for the Display of Interactive Documents in the Learning of Graphic Engineering

ERIC Educational Resources Information Center

Barbero, Basilio Ramos; Pedrosa, Carlos Melgosa; Mate, Esteban Garcia

2012-01-01

The purpose of this study is to determine which 3D viewers should be used for the display of interactive graphic engineering documents, so that the visualization and manipulation of 3D models provide useful support to students of industrial engineering (mechanical, organizational, electronic engineering, etc). The technical features of 26 3D…

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

Integration of Medical Scribes in the Primary Care Setting: Improving Satisfaction.

PubMed

Imdieke, Brian H; Martel, Marc L

There are little published data on the use of medical scribes in the primary care setting. We assessed the feasibility of incorporating medical scribes in our ambulatory clinic to support provider documentation in the electronic medical record. In our convenience sampling of patient, provider, and staff perceptions of scribes, we found that patients were comfortable having scribes in the clinic. Overall indicators of patient satisfaction were slightly decreased. Providers found scribe support to be valuable and overall clinician documentation time was reduced by more than 50% using scribes.

Cognitive analyses of a paper medical record and electronic medical record on the documentation of two nursing tasks: patient education and adherence assessment of insulin administration.

PubMed Central

Rinkus, Susan M.; Chitwood, Ainsley

2002-01-01

The incorporation of electronic medical records into busy physician clinics has been a major development in the healthcare industry over the past decade. Documentation of key nursing activities, especially when interacting with patients who have chronic diseases, is often lacking or missing from the paper medical record. A case study of a patient with diabetes mellitus was created. Well established methods for the assessment of usability in the areas of human-computer interaction and computer supported cooperative work were employed to compare the nursing documentation of two tasks in a commercially available electronic medical record (eRecord) and in a paper medical record. Overall, the eRecord was found to improve the timeliness and quality of nursing documentation. With certain tasks, the number of steps to accomplish the same task was higher, which may result in the perception by the end user that the tool is more complex and therefore difficult to use. Recommendations for the eRecord were made to expand the documentation of patient teaching and adherence assessment and to incorporate web technology for patient access to medical records and healthcare information. PMID:12463905

Testing a Nursing-Specific Model of Electronic Patient Record documentation with regard to information completeness, comprehensiveness and consistency.

PubMed

von Krogh, Gunn; Nåden, Dagfinn; Aasland, Olaf Gjerløw

2012-10-01

To present the results from the test site application of the documentation model KPO (quality assurance, problem solving and caring) designed to impact the quality of nursing information in electronic patient record (EPR). The KPO model was developed by means of consensus group and clinical testing. Four documentation arenas and eight content categories, nursing terminologies and a decision-support system were designed to impact the completeness, comprehensiveness and consistency of nursing information. The testing was performed in a pre-test/post-test time series design, three times at a one-year interval. Content analysis of nursing documentation was accomplished through the identification, interpretation and coding of information units. Data from the pre-test and post-test 2 were subjected to statistical analyses. To estimate the differences, paired t-tests were used. At post-test 2, the information is found to be more complete, comprehensive and consistent than at pre-test. The findings indicate that documentation arenas combining work flow and content categories deduced from theories on nursing practice can influence the quality of nursing information. The KPO model can be used as guide when shifting from paper-based to electronic-based nursing documentation with the aim of obtaining complete, comprehensive and consistent nursing information. © 2012 Blackwell Publishing Ltd.

The Unlimited Potential of the Electronic Library (Except Where Prohibited by the Copyright Law).

ERIC Educational Resources Information Center

Schmidt, Steven; Lewis, David

This paper describes the creation of a new library facility for Indiana University-Purdue University at Indianapolis, one designed ready to accommodate an infrastructure that would support the new technologies of the electronic information environment. Wiring and fiber-optic schemes are outlined briefly. The document is formatted as a script for…

Electronic Health Record Challenges, Workarounds, and Solutions Observed in Practices Integrating Behavioral Health and Primary Care.

PubMed

Cifuentes, Maribel; Davis, Melinda; Fernald, Doug; Gunn, Rose; Dickinson, Perry; Cohen, Deborah J

2015-01-01

This article describes the electronic health record (EHR)-related experiences of practices striving to integrate behavioral health and primary care using tailored, evidenced-based strategies from 2012 to 2014; and the challenges, workarounds and initial health information technology (HIT) solutions that emerged during implementation. This was an observational, cross-case comparative study of 11 diverse practices, including 8 primary care clinics and 3 community mental health centers focused on the implementation of integrated care. Practice characteristics (eg, practice ownership, federal designation, geographic area, provider composition, EHR system, and patient panel characteristics) were collected using a practice information survey and analyzed to report descriptive information. A multidisciplinary team used a grounded theory approach to analyze program documents, field notes from practice observation visits, online diaries, and semistructured interviews. Eight primary care practices used a single EHR and 3 practices used 2 different EHRs, 1 to document behavioral health and 1 to document primary care information. Practices experienced common challenges with their EHRs' capabilities to 1) document and track relevant behavioral health and physical health information, 2) support communication and coordination of care among integrated teams, and 3) exchange information with tablet devices and other EHRs. Practices developed workarounds in response to these challenges: double documentation and duplicate data entry, scanning and transporting documents, reliance on patient or clinician recall for inaccessible EHR information, and use of freestanding tracking systems. As practices gained experience with integration, they began to move beyond workarounds to more permanent HIT solutions ranging in complexity from customized EHR templates, EHR upgrades, and unified EHRs. Integrating behavioral health and primary care further burdens EHRs. Vendors, in cooperation with clinicians, should intentionally design EHR products that support integrated care delivery functions, such as data documentation and reporting to support tracking patients with emotional and behavioral problems over time and settings, integrated teams working from shared care plans, template-driven documentation for common behavioral health conditions such as depression, and improved registry functionality and interoperability. This work will require financial support and cooperative efforts among clinicians, EHR vendors, practice assistance organizations, regulators, standards setters, and workforce educators. © Copyright 2015 by the American Board of Family Medicine.

Integrated Information Support System (IISS). Volume 8. User Interface Subsystem. Part 39. Electronic Documentation System (EDS) User’s Manual

DTIC Science & Technology

1990-09-30

conveying any rights or permission to manufacture, use, or market any patented invention that may in any way be related thereto. This technical report...Definition - Select .... 7-9 7-6 Character Class Definition - Other Options 7-10 7-7 Pattern/Action/State Defintion -Select 7-11 7-8 Pattern/Action/State...representation. Compound Document: A document which may contain mixed content i.e. text, graphics, etc. Conforming SGML Application: An SGML application that

Functional requirements document for NASA/MSFC Earth Science and Applications Division: Data and information system (ESAD-DIS). Interoperability, 1992

NASA Technical Reports Server (NTRS)

Stephens, J. Briscoe; Grider, Gary W.

1992-01-01

These Earth Science and Applications Division-Data and Information System (ESAD-DIS) interoperability requirements are designed to quantify the Earth Science and Application Division's hardware and software requirements in terms of communications between personal and visualization workstation, and mainframe computers. The electronic mail requirements and local area network (LAN) requirements are addressed. These interoperability requirements are top-level requirements framed around defining the existing ESAD-DIS interoperability and projecting known near-term requirements for both operational support and for management planning. Detailed requirements will be submitted on a case-by-case basis. This document is also intended as an overview of ESAD-DIs interoperability for new-comers and management not familiar with these activities. It is intended as background documentation to support requests for resources and support requirements.

Considerations regarding the deployment of hypermedia at JSC

NASA Technical Reports Server (NTRS)

Kacmar, Charles J.

1993-01-01

Electronic documents and systems are becoming the primary means of managing information for ground and space operations at NASA. These documents will utilize hypertext and hypermedia technologies to aid users in structuring and accessing information. Documents will be composed of static and dynamic data consisting of user-defined annotations and hypermedia links. The report consists of three major sections. First, it provides an overview of hypermedia and surveys the use of hypermedia throughout JSC. Second, it briefly describes a prototypical hypermedia system that was developed in conjunction with this work. This system was constructed to demonstrate various hypermedia features and to serve as a platform for supporting the electronic documentation needs for the MIDAS system developed by the Intelligent Systems Branch of the Automation and Robotics Division (Pac92). Third, it discusses emerging hypermedia technologies which have either been untapped by vendors or present significant challenges to the Agency.

Integrated information systems for electronic chemotherapy medication administration.

PubMed

Levy, Mia A; Giuse, Dario A; Eck, Carol; Holder, Gwen; Lippard, Giles; Cartwright, Julia; Rudge, Nancy K

2011-07-01

Chemotherapy administration is a highly complex and distributed task in both the inpatient and outpatient infusion center settings. The American Society of Clinical Oncology and the Oncology Nursing Society (ASCO/ONS) have developed standards that specify procedures and documentation requirements for safe chemotherapy administration. Yet paper-based approaches to medication administration have several disadvantages and do not provide any decision support for patient safety checks. Electronic medication administration that includes bar coding technology may provide additional safety checks, enable consistent documentation structure, and have additional downstream benefits. We describe the specialized configuration of clinical informatics systems for electronic chemotherapy medication administration. The system integrates the patient registration system, the inpatient order entry system, the pharmacy information system, the nursing documentation system, and the electronic health record. We describe the process of deploying this infrastructure in the adult and pediatric inpatient oncology, hematology, and bone marrow transplant wards at Vanderbilt University Medical Center. We have successfully adapted the system for the oncology-specific documentation requirements detailed in the ASCO/ONS guidelines for chemotherapy administration. However, several limitations remain with regard to recording the day of treatment and dose number. Overall, the configured systems facilitate compliance with the ASCO/ONS guidelines and improve the consistency of documentation and multidisciplinary team communication. Our success has prompted us to deploy this infrastructure in our outpatient chemotherapy infusion centers, a process that is currently underway and that will require a few unique considerations.

Guidelines and standard procedures for studies of ground-water quality; selection and installation of wells, and supporting documentation

USGS Publications Warehouse

Lapham, W.W.; Wilde, F.D.; Koterba, M.T.

1997-01-01

This is the first of a two-part report to document guidelines and standard procedures of the U.S. Geological Survey for the acquisition of data in ground-water-quality studies. This report provides guidelines and procedures for the selection and installation of wells for water-quality studies/*, and the required or recommended supporting documentation of these activities. Topics include (1) documentation needed for well files, field folders, and electronic files; (2) criteria and information needed for the selection of water-supply and observation wells, including site inventory and data collection during field reconnaissance; and (3) criteria and preparation for installation of monitoring wells, including the effects of equipment and materials on the chemistry of ground-water samples, a summary of drilling and coring methods, and information concerning well completion, development, and disposition.

Extra dimensions: 3D in PDF documentation

DOE PAGES

Graf, Norman A.

2011-01-11

Experimental science is replete with multi-dimensional information which is often poorly represented by the two dimensions of presentation slides and print media. Past efforts to disseminate such information to a wider audience have failed for a number of reasons, including a lack of standards which are easy to implement and have broad support. Adobe's Portable Document Format (PDF) has in recent years become the de facto standard for secure, dependable electronic information exchange. It has done so by creating an open format, providing support for multiple platforms and being reliable and extensible. By providing support for the ECMA standard Universalmore » 3D (U3D) file format in its free Adobe Reader software, Adobe has made it easy to distribute and interact with 3D content. By providing support for scripting and animation, temporal data can also be easily distributed to a wide, non-technical audience. We discuss how the field of radiation imaging could benefit from incorporating full 3D information about not only the detectors, but also the results of the experimental analyses, in its electronic publications. In this article, we present examples drawn from high-energy physics, mathematics and molecular biology which take advantage of this functionality. Furthermore, we demonstrate how 3D detector elements can be documented, using either CAD drawings or other sources such as GEANT visualizations as input.« less

Extra dimensions: 3D and time in PDF documentation

NASA Astrophysics Data System (ADS)

Graf, N. A.

2011-01-01

Experimental science is replete with multi-dimensional information which is often poorly represented by the two dimensions of presentation slides and print media. Past efforts to disseminate such information to a wider audience have failed for a number of reasons, including a lack of standards which are easy to implement and have broad support. Adobe's Portable Document Format (PDF) has in recent years become the de facto standard for secure, dependable electronic information exchange. It has done so by creating an open format, providing support for multiple platforms and being reliable and extensible. By providing support for the ECMA standard Universal 3D (U3D) file format in its free Adobe Reader software, Adobe has made it easy to distribute and interact with 3D content. By providing support for scripting and animation, temporal data can also be easily distributed to a wide, non-technical audience. We discuss how the field of radiation imaging could benefit from incorporating full 3D information about not only the detectors, but also the results of the experimental analyses, in its electronic publications. In this article, we present examples drawn from high-energy physics, mathematics and molecular biology which take advantage of this functionality. We demonstrate how 3D detector elements can be documented, using either CAD drawings or other sources such as GEANT visualizations as input.

Extra Dimensions: 3D and Time in PDF Documentation

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

Graf, N.A.; /SLAC

2012-04-11

Experimental science is replete with multi-dimensional information which is often poorly represented by the two dimensions of presentation slides and print media. Past efforts to disseminate such information to a wider audience have failed for a number of reasons, including a lack of standards which are easy to implement and have broad support. Adobe's Portable Document Format (PDF) has in recent years become the de facto standard for secure, dependable electronic information exchange. It has done so by creating an open format, providing support for multiple platforms and being reliable and extensible. By providing support for the ECMA standard Universalmore » 3D (U3D) file format in its free Adobe Reader software, Adobe has made it easy to distribute and interact with 3D content. By providing support for scripting and animation, temporal data can also be easily distributed to a wide, non-technical audience. We discuss how the field of radiation imaging could benefit from incorporating full 3D information about not only the detectors, but also the results of the experimental analyses, in its electronic publications. In this article, we present examples drawn from high-energy physics, mathematics and molecular biology which take advantage of this functionality. We demonstrate how 3D detector elements can be documented, using either CAD drawings or other sources such as GEANT visualizations as input.« less

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

PubMed

Chung, Joohyun; Cho, Insook

2017-07-01

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

Mediagraphy: Print and Nonprint Resources.

ERIC Educational Resources Information Center

Educational Media and Technology Yearbook, 1999

1999-01-01

Provides annotated listings for current journals, books, ERIC documents, articles, and nonprint resources in the following categories: artificial intelligence/robotics/electronic performance support systems; computer-assisted instruction; distance education; educational research; educational technology; information science and technology;…

Exploring Midwives' Need and Intention to Adopt Electronic Integrated Antenatal Care.

PubMed

Markam, Hosizah; Hochheiser, Harry; Kuntoro, Kuntoro; Notobroto, Hari Basuki

2018-01-01

Documentation requirements for the Indonesian integrated antenatal care (ANC) program suggest the need for electronic systems to address gaps in existing paper documentation practices. Our goals were to quantify midwives' documentation completeness in a primary healthcare center, understand documentation challenges, develop a tool, and assess intention to use the tool. We analyzed existing ANC records in a primary healthcare center in Bangkalan, East Java, and conducted interviews with stakeholders to understand needs for an electronic system in support of ANC. Development of the web-based Electronic Integrated ANC (e-iANC) system used the System Development Life Cycle method. Training on the use of the system was held in the computer laboratory for 100 midwives chosen from four primary healthcare centers in each of five regions. The Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire was used to assess their intention to adopt e-iANC. The midwives' intention to adopt e-iANC was significantly influenced by performance expectancy, effort expectancy and facilitating conditions. Age, education level, and computer literacy did not significantly moderate the effects of performance expectancy and effort expectancy on adoption intention. The UTAUT results indicated that the factors that might influence intention to adopt e-iANC are potentially addressable. Results suggest that e-iANC might well be accepted by midwives.

Crossing the "digital divide:" implementing an electronic medical record system in a rural Kenyan health center to support clinical care and research.

PubMed

Tierney, William M; Rotich, Joseph K; Smith, Faye E; Bii, John; Einterz, Robert M; Hannan, Terry J

2002-01-01

To improve care, one must measure it. In the US, electronic medical record systems have been installed in many institutions to support health care management, quality improvement, and research. Developing countries lack such systems and thus have difficulties managing scarce resources and investigating means of improving health care delivery and outcomes. We describe the implementation and use of the first documented electronic medical record system in ambulatory care in sub-Saharan Africa. After one year, it has captured data for more than 13,000 patients making more than 26,000 visits. We present lessons learned and modifications made to this system to improve its capture of data and ability to support a comprehensive clinical care and research agenda.

User Manuals for a Primary Care Electronic Medical Record System: A Mixed Methods Study of User- and Vendor-Generated Documents

PubMed Central

Dow, Rustam; Barnsley, Jan; Tu, Karen; Domb, Sharon; Jadad, Alejandro R.; Lemieux-Charles, Louise

2015-01-01

Research problem Tutorials and user manuals are important forms of impersonal support for using software applications including electronic medical records (EMRs). Differences between user- and vendor documentation may indicate support needs, which are not sufficiently addressed by the official documentation, and reveal new elements that may inform the design of tutorials and user manuals. Research question What are the differences between user-generated tutorials and manuals for an EMR and the official user manual from the software vendor? Literature review Effective design of tutorials and user manuals requires careful packaging of information, balance between declarative and procedural texts, an action and task-oriented approach, support for error recognition and recovery, and effective use of visual elements. No previous research compared these elements between formal and informal documents. Methodology We conducted an mixed methods study. Seven tutorials and two manuals for an EMR were collected from three family health teams and compared with the official user manual from the software vendor. Documents were qualitatively analyzed using a framework analysis approach in relation to the principles of technical documentation described above. Subsets of the data were quantitatively analyzed using cross-tabulation to compare the types of error information and visual cues in screen captures between user- and vendor-generated manuals. Results and discussion The user-developed tutorials and manuals differed from the vendor-developed manual in that they contained mostly procedural and not declarative information; were customized to the specific workflow, user roles, and patient characteristics; contained more error information related to work processes than to software usage; and used explicit visual cues on screen captures to help users identify window elements. These findings imply that to support EMR implementation, tutorials and manuals need to be customized and adapted to specific organizational contexts and workflows. The main limitation of the study is its generalizability. Future research should address this limitation and may explore alternative approaches to software documentation, such as modular manuals or participatory design. PMID:26190888

5 CFR 1201.14 - Electronic filing procedures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... (PDF), and image files (files created by scanning). A list of formats allowed can be found at e-Appeal..., or by uploading the supporting documents in the form of one or more PDF files in which each...

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

Creation of structured documentation templates using Natural Language Processing techniques.

PubMed

Kashyap, Vipul; Turchin, Alexander; Morin, Laura; Chang, Frank; Li, Qi; Hongsermeier, Tonya

2006-01-01

Structured Clinical Documentation is a fundamental component of the healthcare enterprise, linking both clinical (e.g., electronic health record, clinical decision support) and administrative functions (e.g., evaluation and management coding, billing). One of the challenges in creating good quality documentation templates has been the inability to address specialized clinical disciplines and adapt to local clinical practices. A one-size-fits-all approach leads to poor adoption and inefficiencies in the documentation process. On the other hand, the cost associated with manual generation of documentation templates is significant. Consequently there is a need for at least partial automation of the template generation process. We propose an approach and methodology for the creation of structured documentation templates for diabetes using Natural Language Processing (NLP).

Integrated Information Systems for Electronic Chemotherapy Medication Administration

PubMed Central

Levy, Mia A.; Giuse, Dario A.; Eck, Carol; Holder, Gwen; Lippard, Giles; Cartwright, Julia; Rudge, Nancy K.

2011-01-01

Introduction: Chemotherapy administration is a highly complex and distributed task in both the inpatient and outpatient infusion center settings. The American Society of Clinical Oncology and the Oncology Nursing Society (ASCO/ONS) have developed standards that specify procedures and documentation requirements for safe chemotherapy administration. Yet paper-based approaches to medication administration have several disadvantages and do not provide any decision support for patient safety checks. Electronic medication administration that includes bar coding technology may provide additional safety checks, enable consistent documentation structure, and have additional downstream benefits. Methods: We describe the specialized configuration of clinical informatics systems for electronic chemotherapy medication administration. The system integrates the patient registration system, the inpatient order entry system, the pharmacy information system, the nursing documentation system, and the electronic health record. Results: We describe the process of deploying this infrastructure in the adult and pediatric inpatient oncology, hematology, and bone marrow transplant wards at Vanderbilt University Medical Center. We have successfully adapted the system for the oncology-specific documentation requirements detailed in the ASCO/ONS guidelines for chemotherapy administration. However, several limitations remain with regard to recording the day of treatment and dose number. Conclusion: Overall, the configured systems facilitate compliance with the ASCO/ONS guidelines and improve the consistency of documentation and multidisciplinary team communication. Our success has prompted us to deploy this infrastructure in our outpatient chemotherapy infusion centers, a process that is currently underway and that will require a few unique considerations. PMID:22043185

Computer-based nursing documentation in nursing homes: A feasibility study.

PubMed

Yu, Ping; Qiu, Yiyu; Crookes, Patrick

2006-01-01

The burden of paper-based nursing documentation has led to increasing complaints and decreasing job satisfaction amongst aged-care workers in Australian nursing homes. The automation of nursing documentation has been identified as one of the possible strategies to address this issue. A major obstacle to the introduction of IT solutions, however, has been a prevailing doubt concerning the ability and/or the willingness of aged-care workers to accept such innovation. This research investigates the attitudes of aged-care workers towards adopting IT innovation. Questionnaire survey were conducted in 13 nursing homes around the Illawarra and Sydney regions in Australia. The survey found that an unexpected 89.3% of participants supported the strategy of introducing electronic nursing documentation systems into residential aged-care facilities. 94.3% of them would use such a system depending on circumstances. Despite a shortage of computers in the workplace, which is a major barrier, this research provides strong evidence that care workers in residential aged-care facilities are willing to accept electronic nursing documentation practice and the uptake of information technology in residential aged-care is feasible in Australia.

Structured clinical documentation in the electronic medical record to improve quality and to support practice-based research in epilepsy.

PubMed

Narayanan, Jaishree; Dobrin, Sofia; Choi, Janet; Rubin, Susan; Pham, Anna; Patel, Vimal; Frigerio, Roberta; Maurer, Darryck; Gupta, Payal; Link, Lourdes; Walters, Shaun; Wang, Chi; Ji, Yuan; Maraganore, Demetrius M

2017-01-01

Using the electronic medical record (EMR) to capture structured clinical data at the point of care would be a practical way to support quality improvement and practice-based research in epilepsy. We describe our stepwise process for building structured clinical documentation support tools in the EMR that define best practices in epilepsy, and we describe how we incorporated these toolkits into our clinical workflow. These tools write notes and capture hundreds of fields of data including several score tests: Generalized Anxiety Disorder-7 items, Neurological Disorders Depression Inventory for Epilepsy, Epworth Sleepiness Scale, Quality of Life in Epilepsy-10 items, Montreal Cognitive Assessment/Short Test of Mental Status, and Medical Research Council Prognostic Index. The tools summarize brain imaging, blood laboratory, and electroencephalography results, and document neuromodulation treatments. The tools provide Best Practices Advisories and other clinical decision support when appropriate. The tools prompt enrollment in a DNA biobanking study. We have thus far enrolled 231 patients for initial visits and are starting our first annual follow-up visits and provide a brief description of our cohort. We are sharing these EMR tools and captured data with other epilepsy clinics as part of a Neurology Practice Based Research Network, and are using the tools to conduct pragmatic trials using subgroup-based adaptive designs. © 2016 The Authors. Epilepsia published by Wiley Periodicals, Inc. on behalf of International League Against Epilepsy.

E-submission chronic toxicology study supplemental files

EPA Pesticide Factsheets

The formats and instructions in these documents are designed to be used as an example or guide for registrants to format electronic files for submission of animal toxicology data to OPP for review in support of registration and reevaluation of pesticides.

Exploring Midwives' Need and Intention to Adopt Electronic Integrated Antenatal Care

PubMed Central

Markam, Hosizah; Hochheiser, Harry; Kuntoro, Kuntoro; Notobroto, Hari Basuki

2018-01-01

Documentation requirements for the Indonesian integrated antenatal care (ANC) program suggest the need for electronic systems to address gaps in existing paper documentation practices. Our goals were to quantify midwives' documentation completeness in a primary healthcare center, understand documentation challenges, develop a tool, and assess intention to use the tool. We analyzed existing ANC records in a primary healthcare center in Bangkalan, East Java, and conducted interviews with stakeholders to understand needs for an electronic system in support of ANC. Development of the web-based Electronic Integrated ANC (e-iANC) system used the System Development Life Cycle method. Training on the use of the system was held in the computer laboratory for 100 midwives chosen from four primary healthcare centers in each of five regions. The Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire was used to assess their intention to adopt e-iANC. The midwives' intention to adopt e-iANC was significantly influenced by performance expectancy, effort expectancy and facilitating conditions. Age, education level, and computer literacy did not significantly moderate the effects of performance expectancy and effort expectancy on adoption intention. The UTAUT results indicated that the factors that might influence intention to adopt e-iANC are potentially addressable. Results suggest that e-iANC might well be accepted by midwives. PMID:29618961

High-G Verification of Lithium-Polymer (Li-Po) Pouch Cells

DTIC Science & Technology

2016-05-19

should not be construed as an official Department of the Army position, policy, or decision, unless so designated by other documentation. The...telemetry systems supporting the design , development, and testing of smart and precision mortar and artillery projectiles. 15. SUBJECT TERMS Telemetry...electronics have enabled smaller and more powerful electronic devices to be developed as designers are able to package more capability in smaller spaces. At

The opportunities for and challenges of common integrated electronics

NASA Astrophysics Data System (ADS)

Nelson, J. R.; Retterer, Bernard L.; Cloud, Harley A.

1994-02-01

This document summarizes a portion of IDA's work concerning common integrated electronics and the potential cost savings of using common electronic hardware and software. It addresses trends in avionics costs and recent experiences in applying common electronic standards to weapon programs as a way to reduce costs. The following essential elements of a program to acquire common integrated electronics are explored: (1) integrated system architecture; (2) advanced technology programs; (3) open system standards; (4) standard common modules; and (5) associated management and policies. The principal recommendation is that OSD support and coordinate such a-program by taking a strong leadership role and setting standards policy.

A systematic review of near real-time and point-of-care clinical decision support in anesthesia information management systems.

PubMed

Simpao, Allan F; Tan, Jonathan M; Lingappan, Arul M; Gálvez, Jorge A; Morgan, Sherry E; Krall, Michael A

2017-10-01

Anesthesia information management systems (AIMS) are sophisticated hardware and software technology solutions that can provide electronic feedback to anesthesia providers. This feedback can be tailored to provide clinical decision support (CDS) to aid clinicians with patient care processes, documentation compliance, and resource utilization. We conducted a systematic review of peer-reviewed articles on near real-time and point-of-care CDS within AIMS using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Studies were identified by searches of the electronic databases Medline and EMBASE. Two reviewers screened studies based on title, abstract, and full text. Studies that were similar in intervention and desired outcome were grouped into CDS categories. Three reviewers graded the evidence within each category. The final analysis included 25 articles on CDS as implemented within AIMS. CDS categories included perioperative antibiotic prophylaxis, post-operative nausea and vomiting prophylaxis, vital sign monitors and alarms, glucose management, blood pressure management, ventilator management, clinical documentation, and resource utilization. Of these categories, the reviewers graded perioperative antibiotic prophylaxis and clinical documentation as having strong evidence per the peer reviewed literature. There is strong evidence for the inclusion of near real-time and point-of-care CDS in AIMS to enhance compliance with perioperative antibiotic prophylaxis and clinical documentation. Additional research is needed in many other areas of AIMS-based CDS.

Progress in electronic medical record adoption in Canada.

PubMed

2015-12-01

To determine the rate of adoption of electronic medical records (EMRs) by physicians across Canada, provincial incentives, and perceived benefits of and barriers to EMR adoption. Data on EMR adoption in Canada were collected from CINAHL, MEDLINE, PubMed, EMBASE, the Cochrane Library, the Health Council of Canada, Canada Health Infoway, government websites, regional EMR associations, and health professional association websites. After removal of duplicate articles, 236 documents were found matching the original search. After using the filter Canada, 12 documents remained. Additional documents were obtained from each province's EMR website and from the Canada Health Infoway website. Since 2006, Canadian EMR adoption rates have increased from about 20% of practitioners to an estimated 62% of practitioners in 2013, with substantial regional disparities ranging from roughly 40% of physicians in New Brunswick and Quebec to more than 75% of physicians in Alberta. Provincial incentives vary widely but appear to have only a weak relationship with the rate of adoption. Many adopters use only a fraction of their software's available functions. User-cited benefits to adoption include time savings, improved record keeping, heightened patient safety, and confidence in retrieved data when EMRs are used efficiently. Barriers to adoption include financial and time constraints, lack of knowledgeable support personnel, and lack of interoperability with hospital and pharmacy systems. Canadian physicians remain at the stage of EMR adoption. Progression in EMR use requires experienced, knowledgeable technical support during implementation, and financial support for the transcription of patient data from paper to electronic media. The interoperability of EMR offerings for hospitals, pharmacies, and clinics is the rate-limiting factor in achieving a unified EMR solution for Canada.

CWA 15793 2011 Planning and Implementation Tool

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

Gross, Alan; Nail, George

This software, built on an open source platform called Electron (runs on Chromium and Node.js), is designed to assist organizations in the implementation of a biorisk management system consistent with the requirements of the international, publicly available guidance document CEN Workshop Agreement 15793:2011 (CWA 15793). The software includes tools for conducting organizational gap analysis against CWA 15793 requirements, planning tools to support the implementation of CWA 15793 requirements, and performance monitoring support. The gap analysis questions are based on the text of CWA 15793, and its associated guidance document, CEN Workshop Agreement 16393:2012. The authors have secured permission from themore » publisher of CWA 15793, the European Committee for Standardization (CEN), to use language from the document in the software, with the understanding that the software will be made available freely, without charge.« less

Documentation of psychotropic PRN medication administration: An evaluation of electronic health records compared with paper charts and verbal reports.

PubMed

Martin, Krystle; Ham, Elke; Hilton, Zoe

2018-05-12

To describe the documentation of pro re nata (PRN) medication for anxiety, and to compare documentation at two hospitals providing similar psychiatric services, one that used paper charts and another that used an electronic health record (EHR). We also assessed congruence between nursing documentation and verbal reports from staff about the PRN administration process. The ability to accurately document patients' symptoms and the care given is considered a core competency of the nursing profession (Wilkinson, 2007); however, researchers have found poor concordance between nursing notes and verbal reports or observations of events (e.g., De Marinis, Piredda, Pascarella et al., 2009) and considerable information missing (e.g., Marinis et al., 2010). Additionally, the administration of PRN medication has consistently been noted to be poorly documented (e.g., Baker, Lovell, & Harris, 2008). The project was a mixed method, two-phase study that collected data from two sites. In phase 1, nursing documentation of PRN medication administrations was reviewed in patient charts; phase 2 included verbal reports from staff about this practice. Nurses using EHR documented more information than those using paper charts, including the reason for PRN administration, who initiated the administration, and effectiveness. There were some differences between written and verbal reports, including whether potential side effects were explained to patients prior to PRN administration. We continue the calls for attention to be paid to improving the quality of nursing documentation. Our results support the shift to using EHR, yet not relying on this method completely to ensure comprehensiveness of documentation. Efforts to address the quality of documentation, particularly for PRN administration, are needed. This could be done through training, using structured report templates, and switching to electronic databases. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Women's health nursing in the context of the National Health Information Infrastructure.

PubMed

Jenkins, Melinda L; Hewitt, Caroline; Bakken, Suzanne

2006-01-01

Nurses must be prepared to participate in the evolving National Health Information Infrastructure and the changes that will consequently occur in health care practice and documentation. Informatics technologies will be used to develop electronic health records with integrated decision support features that will likely lead to enhanced health care quality and safety. This paper provides a summary of the National Health Information Infrastructure and highlights electronic health records and decision support systems within the context of evidence-based practice. Activities at the Columbia University School of Nursing designed to prepare nurses with the necessary informatics competencies to practice in a National Health Information Infrastructure-enabled health care system are described. Data are presented from electronic (personal digital assistant) encounter logs used in our Women's Health Nurse Practitioner program to support evidence-based advanced practice nursing care. Implications for nursing practice, education, and research in the evolving National Health Information Infrastructure are discussed.

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.

22 CFR 62.32 - Summer work travel.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Travel Program Brochure; (3) The Department of State's toll-free help line telephone number; (4) The... sufficient financial resources to support themselves during their search for employment; (v) Undertake.... Such contact may be in-person, by telephone, or via electronic mail and must be properly documented...

45 CFR 307.5 - Mandatory computerized support enforcement systems.

Code of Federal Regulations, 2013 CFR

2013-10-01

... hardware, operational system software, and electronic linkages with the separate components of an... plans to use and how they will interface with the base system; (3) Provide documentation that the... and for operating costs including hardware, operational software and applications software of a...

45 CFR 307.5 - Mandatory computerized support enforcement systems.

Code of Federal Regulations, 2014 CFR

2014-10-01

... hardware, operational system software, and electronic linkages with the separate components of an... plans to use and how they will interface with the base system; (3) Provide documentation that the... and for operating costs including hardware, operational software and applications software of a...

45 CFR 307.5 - Mandatory computerized support enforcement systems.

Code of Federal Regulations, 2012 CFR

2012-10-01

... hardware, operational system software, and electronic linkages with the separate components of an... plans to use and how they will interface with the base system; (3) Provide documentation that the... and for operating costs including hardware, operational software and applications software of a...

76 FR 31016 - Proposed Collection; Comment Request for Regulation Project

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-27

... Fiduciary Relationship; Form 2120, Multiple Support Declaration; Form 2439, Notice to Shareholder of... document contains regulations designed to eliminate regulatory impediments to the electronic filing of Form 1040, U.S. Individual Income Tax Return. These regulations generally affect taxpayers who file Form...

Technology in HRD.

ERIC Educational Resources Information Center

1998

This document contains four papers from a symposium on technology in human resource development (HRD). "COBRA, an Electronic Performance Support System for the Analysis of Jobs and Tasks" (Theo J. Bastiaens) is described as an integrated computerized environment that provides tools, information, advice, and training to help employees do…

Tobacco documents research methodology

PubMed Central

McCandless, Phyra M; Klausner, Kim; Taketa, Rachel; Yerger, Valerie B

2011-01-01

Tobacco documents research has developed into a thriving academic enterprise since its inception in 1995. The technology supporting tobacco documents archiving, searching and retrieval has improved greatly since that time, and consequently tobacco documents researchers have considerably more access to resources than was the case when researchers had to travel to physical archives and/or electronically search poorly and incompletely indexed documents. The authors of the papers presented in this supplement all followed the same basic research methodology. Rather than leave the reader of the supplement to read the same discussion of methods in each individual paper, presented here is an overview of the methods all authors followed. In the individual articles that follow in this supplement, the authors present the additional methodological information specific to their topics. This brief discussion also highlights technological capabilities in the Legacy Tobacco Documents Library and updates methods for organising internal tobacco documents data and findings. PMID:21504933

Electrical, Electronic, and Electromechanical (EEE) parts management and control requirements for NASA space flight programs

NASA Technical Reports Server (NTRS)

1989-01-01

This document establishes electrical, electronic, and electromechanical (EEE) parts management and control requirements for contractors providing and maintaining space flight and mission-essential or critical ground support equipment for NASA space flight programs. Although the text is worded 'the contractor shall,' the requirements are also to be used by NASA Headquarters and field installations for developing program/project parts management and control requirements for in-house and contracted efforts. This document places increased emphasis on parts programs to ensure that reliability and quality are considered through adequate consideration of the selection, control, and application of parts. It is the intent of this document to identify disciplines that can be implemented to obtain reliable parts which meet mission needs. The parts management and control requirements described in this document are to be selectively applied, based on equipment class and mission needs. Individual equipment needs should be evaluated to determine the extent to which each requirement should be implemented on a procurement. Utilization of this document does not preclude the usage of other documents. The entire process of developing and implementing requirements is referred to as 'tailoring' the program for a specific project. Some factors that should be considered in this tailoring process include program phase, equipment category and criticality, equipment complexity, and mission requirements. Parts management and control requirements advocated by this document directly support the concept of 'reliability by design' and are an integral part of system reliability and maintainability. Achieving the required availability and mission success objectives during operation depends on the attention given reliability and maintainability in the design phase. Consequently, it is intended that the requirements described in this document are consistent with those of NASA publications, 'Reliability Program Requirements for Aeronautical and Space System Contractors,' NHB 5300.4(1A-l); 'Maintainability Program Requirements for Space Systems,' NHB 5300.4(1E); and 'Quality Program Provisions for Aeronautical and Space System Contractors,' NHB 5300.4(1B).

Method for modeling social care processes for national information exchange.

PubMed

Miettinen, Aki; Mykkänen, Juha; Laaksonen, Maarit

2012-01-01

Finnish social services include 21 service commissions of social welfare including Adoption counselling, Income support, Child welfare, Services for immigrants and Substance abuse care. This paper describes the method used for process modeling in the National project for IT in Social Services in Finland (Tikesos). The process modeling in the project aimed to support common national target state processes from the perspective of national electronic archive, increased interoperability between systems and electronic client documents. The process steps and other aspects of the method are presented. The method was developed, used and refined during the three years of process modeling in the national project.

Computer-Based Medical System

NASA Technical Reports Server (NTRS)

1998-01-01

SYMED, Inc., developed a unique electronic medical records and information management system. The S2000 Medical Interactive Care System (MICS) incorporates both a comprehensive and interactive medical care support capability and an extensive array of digital medical reference materials in either text or high resolution graphic form. The system was designed, in cooperation with NASA, to improve the effectiveness and efficiency of physician practices. The S2000 is a MS (Microsoft) Windows based software product which combines electronic forms, medical documents, records management, and features a comprehensive medical information system for medical diagnostic support and treatment. SYMED, Inc. offers access to its medical systems to all companies seeking competitive advantages.

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.

78 FR 41721 - New Standards to Enhance Package Visibility

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-11

... supporting electronic documentation including piece-level address or ZIP+4[supreg] Code information effective... package strategy relies on the availability of piece- level information provided through the widespread use of IMpb. IMpb can offer a number of benefits to mailers by providing piece- level visibility...

Human factors considerations in the design and evaluation of moving map displays of ownership on the airport surface

DOT National Transportation Integrated Search

2004-09-01

The Federal Aviation Administration (FAA) has requested human factors guidance to support the new moving map Technical Standard Order (TSO)-C165, Electronic Map Display Equipment for Graphical Depiction of Aircraft Position. This document was develop...

Electronic Health Record Tools to Care for At-Risk Older Drivers: A Quality Improvement Project.

PubMed

Casey, Colleen M; Salinas, Katherine; Eckstrom, Elizabeth

2015-06-01

Evaluating driving safety of older adults is an important health topic, but primary care providers (PCP) face multiple barriers in addressing this issue. The study's objectives were to develop an electronic health record (EHR)-based Driving Clinical Support Tool, train PCPs to perform driving assessments utilizing the tool, and systematize documentation of assessment and management of driving safety issues via the tool. The intervention included development of an evidence-based Driving Clinical Support Tool within the EHR, followed by training of internal medicine providers in the tool's content and use. Pre- and postintervention provider surveys and chart review of driving-related patient visits were conducted. Surveys included self-report of preparedness and knowledge to evaluate at-risk older drivers and were analyzed using paired t-test. A chart review of driving-related office visits compared documentation pre- and postintervention including: completeness of appropriate focused history and exam, identification of deficits, patient education, and reporting to appropriate authorities when indicated. Data from 86 providers were analyzed. Pre- and postintervention surveys showed significantly increased self-assessed preparedness (p < .001) and increased driving-related knowledge (p < .001). Postintervention charts showed improved documentation of correct cognitive testing, more referrals/consults, increased patient education about community resources, and appropriate regulatory reporting when deficits were identified. Focused training and an EHR-based clinical support tool improved provider self-reported preparedness and knowledge of how to evaluate at-risk older drivers. The tool improved documentation of driving-related issues and led to improved access to interdisciplinary care coordination. Published by Oxford University Press on behalf of the Gerontological Society of America 2015.

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.

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...

Electronic Procedures for Medical Operations

NASA Technical Reports Server (NTRS)

2015-01-01

Electronic procedures are replacing text-based documents for recording the steps in performing medical operations aboard the International Space Station. S&K Aerospace, LLC, has developed a content-based electronic system-based on the Extensible Markup Language (XML) standard-that separates text from formatting standards and tags items contained in procedures so they can be recognized by other electronic systems. For example, to change a standard format, electronic procedures are changed in a single batch process, and the entire body of procedures will have the new format. Procedures can be quickly searched to determine which are affected by software and hardware changes. Similarly, procedures are easily shared with other electronic systems. The system also enables real-time data capture and automatic bookmarking of current procedure steps. In Phase II of the project, S&K Aerospace developed a Procedure Representation Language (PRL) and tools to support the creation and maintenance of electronic procedures for medical operations. The goal is to develop these tools in such a way that new advances can be inserted easily, leading to an eventual medical decision support system.

Development of an instrument to measure the quality of documented nursing diagnoses, interventions and outcomes: the Q-DIO.

PubMed

Müller-Staub, Maria; Lunney, Margaret; Odenbreit, Matthias; Needham, Ian; Lavin, Mary Ann; van Achterberg, Theo

2009-04-01

This paper aims to report the development stages of an audit instrument to assess standardised nursing language. Because research-based instruments were not available, the instrument Quality of documentation of nursing Diagnoses, Interventions and Outcomes (Q-DIO) was developed. Standardised nursing language such as nursing diagnoses, interventions and outcomes are being implemented worldwide and will be crucial for the electronic health record. The literature showed a lack of audit instruments to assess the quality of standardised nursing language in nursing documentation. A qualitative design was used for instrument development. Criteria were first derived from a theoretical framework and literature reviews. Second, the criteria were operationalized into items and eight experts assessed face and content validity of the Q-DIO. Criteria were developed and operationalized into 29 items. For each item, a three or five point scale was applied. The experts supported content validity and showed 88.25% agreement for the scores assigned to the 29 items of the Q-DIO. The Q-DIO provides a literature-based audit instrument for nursing documentation. The strength of Q-DIO is its ability to measure the quality of nursing diagnoses and related interventions and nursing-sensitive patient outcomes. Further testing of Q-DIO is recommended. Based on the results of this study, the Q-DIO provides an audit instrument to be used in clinical practice. Its criteria can set the stage for the electronic nursing documentation in electronic health records.

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

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-29

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

7 CFR 25.606 - Financial management and records.

Code of Federal Regulations, 2014 CFR

2014-01-01

... retained in electronic form. (b) Grantees must retain financial records, supporting documents, statistical... 7 Agriculture 1 2014-01-01 2014-01-01 false Financial management and records. 25.606 Section 25... COMMUNITIES Round II and Round IIS Grants § 25.606 Financial management and records. (a) In complying with the...

7 CFR 25.606 - Financial management and records.

Code of Federal Regulations, 2012 CFR

2012-01-01

... retained in electronic form. (b) Grantees must retain financial records, supporting documents, statistical... 7 Agriculture 1 2012-01-01 2012-01-01 false Financial management and records. 25.606 Section 25... COMMUNITIES Round II and Round IIS Grants § 25.606 Financial management and records. (a) In complying with the...

7 CFR 25.606 - Financial management and records.

Code of Federal Regulations, 2011 CFR

2011-01-01

... retained in electronic form. (b) Grantees must retain financial records, supporting documents, statistical... 7 Agriculture 1 2011-01-01 2011-01-01 false Financial management and records. 25.606 Section 25... COMMUNITIES Round II and Round IIS Grants § 25.606 Financial management and records. (a) In complying with the...

7 CFR 25.606 - Financial management and records.

Code of Federal Regulations, 2013 CFR

2013-01-01

... retained in electronic form. (b) Grantees must retain financial records, supporting documents, statistical... 7 Agriculture 1 2013-01-01 2013-01-01 false Financial management and records. 25.606 Section 25... COMMUNITIES Round II and Round IIS Grants § 25.606 Financial management and records. (a) In complying with the...

The Challenges of Creating a Benchmarking Process for Administrative and Support Services

ERIC Educational Resources Information Center

Manning, Terri M.

2007-01-01

In the current climate of emphasis on outcomes assessment, colleges and universities are working diligently to create assessment processes for student learning outcomes, competence in general education, student satisfaction with services, and electronic tracking media to document evidence of competence in graduates. Benchmarking has become a…

7 CFR 25.606 - Financial management and records.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 1 2010-01-01 2010-01-01 false Financial management and records. 25.606 Section 25... COMMUNITIES Round II and Round IIS Grants § 25.606 Financial management and records. (a) In complying with the... retained in electronic form. (b) Grantees must retain financial records, supporting documents, statistical...

Implementation of a scalable, web-based, automated clinical decision support risk-prediction tool for chronic kidney disease using C-CDA and application programming interfaces.

PubMed

Samal, Lipika; D'Amore, John D; Bates, David W; Wright, Adam

2017-11-01

Clinical decision support tools for risk prediction are readily available, but typically require workflow interruptions and manual data entry so are rarely used. Due to new data interoperability standards for electronic health records (EHRs), other options are available. As a clinical case study, we sought to build a scalable, web-based system that would automate calculation of kidney failure risk and display clinical decision support to users in primary care practices. We developed a single-page application, web server, database, and application programming interface to calculate and display kidney failure risk. Data were extracted from the EHR using the Consolidated Clinical Document Architecture interoperability standard for Continuity of Care Documents (CCDs). EHR users were presented with a noninterruptive alert on the patient's summary screen and a hyperlink to details and recommendations provided through a web application. Clinic schedules and CCDs were retrieved using existing application programming interfaces to the EHR, and we provided a clinical decision support hyperlink to the EHR as a service. We debugged a series of terminology and technical issues. The application was validated with data from 255 patients and subsequently deployed to 10 primary care clinics where, over the course of 1 year, 569 533 CCD documents were processed. We validated the use of interoperable documents and open-source components to develop a low-cost tool for automated clinical decision support. Since Consolidated Clinical Document Architecture-based data extraction extends to any certified EHR, this demonstrates a successful modular approach to clinical decision support. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Wide-Temperature Electronics for Thermal Control of Nanosats

NASA Technical Reports Server (NTRS)

Dickman, John Ellis; Gerber, Scott

2000-01-01

This document represents a presentation which examines the wide and low-temperature electronics required for NanoSatellites. In the past, larger spacecraft used Radioisotope Heating Units (RHU's). The advantage of the use of these electronics is that they could eliminate or reduce the requirement for RHU's, reduce system weight and simplify spacecraft design by eliminating containment/support structures for RHU's. The Glenn Research Center's Wide/Low Temperature Power Electronics Program supports the development of power systems capable of reliable, efficient operation over wide and low temperature ranges. Included charts review the successes and failures of various electronic devices, the IRF541 HEXFET, The NE76118n-Channel GaAS MESFET, the Lithium Carbon Monofluoride Primary Battery, and a COTS DC-DC converter. The preliminary result of wide/low temperature testing of CTS and custom parts and power circuit indicate that through careful selection of components and technologies it is possible to design and build power circuits which operate from room temperature to near 100K.

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...

Recruiting Strategies to Support the Armys All-Volunteer Force

DTIC Science & Technology

2016-01-01

Volunteer Force C O R P O R A T I O N Limited Print and Electronic Distribution Rights This document and trademark(s) contained herein are protected by law...the Army’s All- Volunteer Force cost and did so by increasing amounts, respectively. Under average conditions, more recruiters, a larger EDEP, or...Recruiting Strategies to Support the Army’s All- Volunteer Force Other Policy Changes: Waivers, Quality Marks, and Prior Service Accessions

An Electron/Photon/Relaxation Data Library for MCNP6

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

Hughes, III, H. Grady

The capabilities of the MCNP6 Monte Carlo code in simulation of electron transport, photon transport, and atomic relaxation have recently been significantly expanded. The enhancements include not only the extension of existing data and methods to lower energies, but also the introduction of new categories of data and methods. Support of these new capabilities has required major additions to and redesign of the associated data tables. In this paper we present the first complete documentation of the contents and format of the new electron-photon-relaxation data library now available with the initial production release of MCNP6.

Implementation of Improvements in an Electronic Documentation Nursing Process System Structured on NANDA-I, NOC and NIC (NNN) Classification.

PubMed

Peres, Heloísa; Cruz, Diná; Tellez, Michelle; de Cássia Gengo E Silva, Rita; Ortiz, Diley; Diogo, Regina; Ortiz, Dóris R

2016-01-01

The aim of this study was to present the experience of a teaching hospital with the implementation of improvements to an electronic documentation system of the nursing process (PROCEnf-USP®). The improvements were based on functional performance and technical quality of the system. It was adopted Scrum^™ method for version control PROCEnf-USP® by enabling agility, flexibility and possibility of integration between development and users. The PROCEnf-USP® has been used since 2009 and has professional and academic environments. The current version lets you generate reports and supports decisions about diagnoses, outcomes and interventions. It is provided the use of indicators to monitor results and registration at the point of care. The establishment of important.

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

Code of Federal Regulations, 2014 CFR

2014-04-01

...; ELECTRONIC SUBMISSION OF FORMS Electronic Filing of Documents with TTB § 73.31 May I submit forms... above; (c) You submit the electronic form to an electronic document receiving system that we have... submit the form through an electronic document receiving system that TTB has designated for the receipt...

Model tool to describe chemical structures in XML format utilizing structural fragments and chemical ontology.

PubMed

Sankar, Punnaivanam; Alain, Krief; Aghila, Gnanasekaran

2010-05-24

We have developed a model structure-editing tool, ChemEd, programmed in JAVA, which allows drawing chemical structures on a graphical user interface (GUI) by selecting appropriate structural fragments defined in a fragment library. The terms representing the structural fragments are organized in fragment ontology to provide a conceptual support. ChemEd describes the chemical structure in an XML document (ChemFul) with rich semantics explicitly encoding the details of the chemical bonding, the hybridization status, and the electron environment around each atom. The document can be further processed through suitable algorithms and with the support of external chemical ontologies to generate understandable reports about the functional groups present in the structure and their specific environment.

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...

Modern Corneal Eye-Banking Using a Software-Based IT Management Solution.

PubMed

Kern, C; Kortuem, K; Wertheimer, C; Nilmayer, O; Dirisamer, M; Priglinger, S; Mayer, W J

2018-01-01

Increasing government legislation and regulations in manufacturing have led to additional documentation regarding the pharmaceutical product requirements of corneal grafts in the European Union. The aim of this project was to develop a software within a hospital information system (HIS) to support the documentation process, to improve the management of the patient waiting list and to increase informational flow between the clinic and eye bank. After an analysis of the current documentation process, a new workflow and software were implemented in our electronic health record (EHR) system. The software takes over most of the documentation and reduces the time required for record keeping. It guarantees real-time tracing of all steps during human corneal tissue processing from the start of production until allocation during surgery and includes follow-up within the HIS. Moreover, listing of the patient for surgery as well as waiting list management takes place in the same system. The new software for corneal eye banking supports the whole process chain by taking over both most of the required documentation and the management of the transplant waiting list. It may provide a standardized IT-based solution for German eye banks working within the same HIS.

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).

Space station systems: A bibliography with indexes (supplement 7)

NASA Technical Reports Server (NTRS)

1988-01-01

This bibliography lists 1,158 reports, articles, and other documents introduced into the NASA scientific and technical information system between January 1, 1988 and June 30, 1988. Its purpose is to provide helpful information to researchers, designers and managers engaged in Space Station technology development and mission design. Coverage includes documents that define major systems and subsystems related to structures and dynamic control, electronics and power supplies, propulsion, and payload integration. In addition, orbital construction methods, servicing and support requirements, procedures and operations, and missions for the current and future Space Station are included.

Space station systems: A bibliography with indexes (supplement 10)

NASA Technical Reports Server (NTRS)

1990-01-01

This bibliography lists 1,422 reports, articles, and other documents introduced into the NASA scientific and technical information system between July 1, 1989 and December 31, 1989. Its purpose is to provide helpful information to researchers, designers and managers engaged in Space Station technology development and mission design. Coverage includes documents that define major systems and subsystems related to structures and dynamic control, electronics and power supplies, propulsion, and payload integration. In addition, orbital construction methods, servicing and support requirements, procedures and operations, and missions for the current and future Space Station are included.

Space Station Systems: a Bibliography with Indexes (Supplement 8)

NASA Technical Reports Server (NTRS)

1988-01-01

This bibliography lists 950 reports, articles, and other documents introduced into the NASA scientific and technical information system between July 1, 1989 and December 31, 1989. Its purpose is to provide helpful information to researchers, designers and managers engaged in Space Station technology development and mission design. Coverage includes documents that define major systems and subsystems related to structures and dynamic control, electronics and power supplies, propulsion, and payload integration. In addition, orbital construction methods, servicing and support requirements, procedures and operations, and missions for the current and future Space Station are included.

Space station systems: A bibliography with indexes (supplement 9)

NASA Technical Reports Server (NTRS)

1989-01-01

This bibliography lists 1,313 reports, articles, and other documents introduced into the NASA scientific and technical information system between January 1, 1989 and June 30, 1989. Its purpose is to provide helpful information to researchers, designers and managers engaged in Space Station technology development and mission design. Coverage includes documents that define major systems and subsystems related to structures and dynamic control, electronics and power supplies, propulsion, and payload integration. In addition, orbital construction methods, servicing and support requirements, procedures and operations, and missions for the current and future Space Station are included.

The Full Monty: Locating Resources, Creating, and Presenting a Web Enhanced History Course.

ERIC Educational Resources Information Center

Bazillion, Richard J.; Braun, Connie L.

2001-01-01

Discusses how to develop a history course using the World Wide Web; course development software; full text digitized articles, electronic books, primary documents, images, and audio files; and computer equipment such as LCD projectors and interactive whiteboards. Addresses the importance of support for faculty using technology in teaching. (PAL)

77 FR 72865 - Announcement of Requirements and Registration for “Mobilizing Data for Pressure Ulcer Prevention...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-06

...'s electronic documentation systems require nurses to enter oversimplified text narratives or check... the healthcare continuum while reducing health care costs. A mobile health app would support nurses... appropriate nursing knowledge, nurses achieve the ability to track changes in patient status and to exchange...

Supporting Learning and Information Sharing in Natural Resource Management with Technologies for Electronic Documents

ERIC Educational Resources Information Center

Alem, Leila; McLean, Alistair

2005-01-01

Community participation is central to achieving sustainable natural resource management. A prerequisite to informed participation is that community and stakeholder groups have access to different knowledge sources, are more closely attuned to the different issues and viewpoints, and are sufficiently equipped to understand and maybe resolve complex…

Orbiter lessons learned: A guide to future vehicle development

NASA Technical Reports Server (NTRS)

Greenberg, Harry Stan

1993-01-01

Topics addressed are: (1) wind persistence loads methodology; (2) emphasize supportability in design of reusable vehicles; (3) design for robustness; (4) improved aerodynamic environment prediction methods for complex vehicles; (5) automated integration of aerothermal, manufacturing, and structures analysis; (6) continued electronic documentation of structural design and analysis; and (7) landing gear rollout load simulations.

76 FR 20611 - Electronic On-Board Recorders and Hours of Service Supporting Documents

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-13

..., used, and disseminated (e.g., in post- accident litigation or in personal litigation such as divorce proceedings). Based on the factors above, the Agency has determined that the statute requires it to protect... Doc. 2011-8789 Filed 4-12-11; 8:45 am] BILLING CODE 4910-EX-P ...

Kratylos: A Tool for Sharing Interlinearized and Lexical Data in Diverse Formats

ERIC Educational Resources Information Center

Kaufman, Daniel; Finkel, Raphael

2018-01-01

In this paper we present Kratylos, at www.kratylos.org/, a web application that creates searchable multimedia corpora from data collections in diverse formats, including collections of interlinearized glossed text (IGT) and dictionaries. There exists a crucial lacuna in the electronic ecology that supports language documentation and linguistic…

Improving Information Access through Technology: A Plan for Louisiana's Public Libraries.

ERIC Educational Resources Information Center

Jaques, Thomas F.

Strengthening technology in Louisiana's public libraries will support equitable and convenient access to electronic information resources for all citizens at library sites, in homes, and in business. The plan presented in this document is intended to enhance and expand technology in the state's public libraries. After discussion of the crucial…

Improving Primary Care Provider Practices in Youth Concussion Management.

PubMed

Arbogast, Kristy B; Curry, Allison E; Metzger, Kristina B; Kessler, Ronni S; Bell, Jeneita M; Haarbauer-Krupa, Juliet; Zonfrillo, Mark R; Breiding, Matthew J; Master, Christina L

2017-08-01

Primary care providers are increasingly providing youth concussion care but report insufficient time and training, limiting adoption of best practices. We implemented a primary care-based intervention including an electronic health record-based clinical decision support tool ("SmartSet") and in-person training. We evaluated consequent improvement in 2 key concussion management practices: (1) performance of a vestibular oculomotor examination and (2) discussion of return-to-learn/return-to-play (RTL/RTP) guidelines. Data were included from 7284 primary care patients aged 0 to 17 years with initial concussion visits between July 2010 and June 2014. We compared proportions of visits pre- and post-intervention in which the examination was performed or RTL/RTP guidelines provided. Examinations and RTL/RTP were documented for 1.8% and 19.0% of visits pre-intervention, respectively, compared with 71.1% and 72.9% post-intervention. A total of 95% of post-intervention examinations were documented within the SmartSet. An electronic clinical decision support tool, plus in-person training, may be key to changing primary care provider behavior around concussion care.

Processing medical data: a systematic review

PubMed Central

2013-01-01

Background Medical data recording is one of the basic clinical tools. Electronic Health Record (EHR) is important for data processing, communication, efficiency and effectiveness of patients’ information access, confidentiality, ethical and/or legal issues. Clinical record promote and support communication among service providers and hence upscale quality of healthcare. Qualities of records are reflections of the quality of care patients offered. Methods Qualitative analysis was undertaken for this systematic review. We reviewed 40 materials Published from 1999 to 2013. We searched these materials from databases including ovidMEDLINE and ovidEMBASE. Two reviewers independently screened materials on medical data recording, documentation and information processing and communication. Finally, all selected references were summarized, reconciled and compiled as one compatible document. Result Patients were dying and/or getting much suffering as the result of poor quality medical records. Electronic health record minimizes errors, saves unnecessary time, and money wasted on processing medical data. Conclusion Many countries have been complaining for incompleteness, inappropriateness and illegibility of records. Therefore creating awareness on the magnitude of the problem has paramount importance. Hence available correct patient information has lots of potential in reducing errors and support roles. PMID:24107106

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.

Development of a digital clinical pathway for emergency medicine: Lessons from usability testing and implementation failure.

PubMed

Gutenstein, Marc; Pickering, John W; Than, Martin

2018-06-01

Clinical pathways are used to support the management of patients in emergency departments. An existing document-based clinical pathway was used as the foundation on which to design and build a digital clinical pathway for acute chest pain, with the aim of improving clinical calculations, clinician decision-making, documentation, and data collection. Established principles of decision support system design were used to build an application within the existing electronic health record, before testing with a multidisciplinary team of doctors using a think-aloud protocol. Technical authoring was successful, however, usability testing revealed that the user experience and the flexibility of workflow within the application were critical barriers to implementation. Emergency medicine and acute care decision support systems face particular challenges to existing models of linear workflow that should be deliberately addressed in digital pathway design. We make key recommendations regarding digital pathway design in emergency medicine.

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…

29 CFR 2520.104b-1 - Disclosure.

Code of Federal Regulations, 2011 CFR

2011-07-01

... documents furnished in electronic form at any location where the participant is reasonably expected to... or non-electronic form, to receiving documents through electronic media and has not withdrawn such consent; (B) In the case of documents to be furnished through the Internet or other electronic...

29 CFR 2520.104b-1 - Disclosure.

Code of Federal Regulations, 2014 CFR

2014-07-01

... documents furnished in electronic form at any location where the participant is reasonably expected to... or non-electronic form, to receiving documents through electronic media and has not withdrawn such consent; (B) In the case of documents to be furnished through the Internet or other electronic...

29 CFR 2520.104b-1 - Disclosure.

Code of Federal Regulations, 2012 CFR

2012-07-01

... documents furnished in electronic form at any location where the participant is reasonably expected to... or non-electronic form, to receiving documents through electronic media and has not withdrawn such consent; (B) In the case of documents to be furnished through the Internet or other electronic...

29 CFR 2520.104b-1 - Disclosure.

Code of Federal Regulations, 2013 CFR

2013-07-01

... documents furnished in electronic form at any location where the participant is reasonably expected to... or non-electronic form, to receiving documents through electronic media and has not withdrawn such consent; (B) In the case of documents to be furnished through the Internet or other electronic...

Documentation of Sexual Partner Gender Is Low in Electronic Health Records: Observations, Predictors, and Recommendations to Improve Population Health Management in Primary Care

PubMed Central

Yehia, Baligh R.

2015-01-01

Abstract The 2011 Institute of Medicine report on LGBT health recommended that sexual orientation and gender identity (SO/GI) be documented in electronic health records (EHRs). Most EHRs cannot document all aspects of SO/GI, but some can record gender of sexual partners. This study sought to determine the proportion of patients who have the gender of sexual partners recorded in the EHR and to identify factors associated with documentation. A retrospective analysis was done of EHR data for 40 family medicine (FM) and general internal medicine (IM) practices, comprising 170,570 adult patients seen in 2012. The primary outcome was EHR documentation of sexual partner gender. Multivariate logistic regression assessed the impact of patient, provider, and practice factors on documentation. In all, 76,767 patients (45%) had the gender of sexual partners recorded, 4.3% of whom had same-gender partners (3.5% of females, 5.6% of males). Likelihood of documentation was independently higher for women; blacks; those with a preventive visit; those with a physician assistant, nurse practitioner, or resident primary care provider (vs. attending); those at urban practices; those at smaller practices; and those at a residency FM practice. Older age and Medicare insurance were associated with lower documentation. Sexual partner gender documentation is important to identify patients for targeted prevention and support, and holds great potential for population health management, yet documentation in the EHR currently is low. Primary care practices should routinely record the gender of sexual partners, and additional work is needed to identify best practices for collecting and using SO/GI data in this setting. (Population Health Management 2015;18:217–222). PMID:25290634

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.

Usability Assessment of Secure Messaging for Clinical Document Sharing between Health Care Providers and Patients.

PubMed

Jahn, Michelle A; Porter, Brian W; Patel, Himalaya; Zillich, Alan J; Simon, Steven R; Russ, Alissa L

2018-04-01

 Web-based patient portals feature secure messaging systems that enable health care providers and patients to communicate information. However, little is known about the usability of these systems for clinical document sharing.  This article evaluates the usability of a secure messaging system for providers and patients in terms of its ability to support sharing of electronic clinical documents.  We conducted usability testing with providers and patients in a human-computer interaction laboratory at a Midwestern U.S. hospital. Providers sent a medication list document to a fictitious patient via secure messaging. Separately, patients retrieved the clinical document from a secure message and returned it to a fictitious provider. We collected use errors, task completion, task time, and satisfaction.  Twenty-nine individuals participated: 19 providers (6 physicians, 6 registered nurses, and 7 pharmacists) and 10 patients. Among providers, 11 (58%) attached and sent the clinical document via secure messaging without requiring assistance, in a median (range) of 4.5 (1.8-12.7) minutes. No patients completed tasks without moderator assistance. Patients accessed the secure messaging system within 3.6 (1.2-15.0) minutes; retrieved the clinical document within 0.8 (0.5-5.7) minutes; and sent the attached clinical document in 6.3 (1.5-18.1) minutes. Although median satisfaction ratings were high, with 5.8 for providers and 6.0 for patients (scale, 0-7), we identified 36 different use errors. Physicians and pharmacists requested additional features to support care coordination via health information technology, while nurses requested features to support efficiency for their tasks.  This study examined the usability of clinical document sharing, a key feature of many secure messaging systems. Our results highlight similarities and differences between provider and patient end-user groups, which can inform secure messaging design to improve learnability and efficiency. The observations suggest recommendations for improving the technical aspects of secure messaging for clinical document sharing. Schattauer GmbH Stuttgart.

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...

Documenting coordination of cancer care between primary care providers and oncology specialists in Canada.

PubMed

Brouwers, Melissa C; Vukmirovic, Marija; Tomasone, Jennifer R; Grunfeld, Eva; Urquhart, Robin; O'Brien, Mary Ann; Walker, Melanie; Webster, Fiona; Fitch, Margaret

2016-10-01

To report on the findings of the CanIMPACT (Canadian Team to Improve Community-Based Cancer Care along the Continuum) Casebook project, which systematically documented Canadian initiatives (ie, programs and projects) designed to improve or support coordination and continuity of cancer care between primary care providers (PCPs) and oncology specialists. Pan-Canadian environmental scan. Canada. Individuals representing the various initiatives provided data for the analysis. Initiatives included in the Casebook met the following criteria: they supported coordination and collaboration between PCPs and oncology specialists; they were related to diagnosis, treatment, survivorship, or personalized medicine; and they included breast or colorectal cancer or both. Data were collected on forms that were compiled into summaries (ie, profiles) for each initiative. Casebook initiatives were organized based on the targeted stage of the cancer care continuum, jurisdiction, and strategy (ie, model of care or type of intervention) employed. Thematic analysis identified similarities and differences among employed strategies, the level of primary care engagement, implementation barriers and facilitators, and initiative evaluation. The CanIMPACT Casebook profiles 24 initiatives. Eleven initiatives targeted the survivorship stage of the cancer care continuum and 15 focused specifically on breast or colorectal cancer or both. Initiative teams implemented the following strategies: nurse patient navigation, multidisciplinary care teams, electronic communication or information systems, PCP education, and multicomponent initiatives. Initiatives engaged PCPs at various levels. Implementation barriers included lack of care standardization across jurisdictions and incompatibility among electronic communication systems. Implementation facilitators included having clinical and program leaders publicly support the initiative, repurposing existing resources, receiving financial support, and establishing a motivated and skilled project or program team. The lack of evaluative data made it difficult to identify the most effective interventions or models of care. The CanIMPACT Casebook documents Canadian efforts to improve or support the coordination of cancer care by PCPs and oncology specialists as a means to improve patient outcomes and cancer system performance. Copyright© the College of Family Physicians of Canada.

High-Voltage Clock Driver for Photon-Counting CCD Characterization

NASA Technical Reports Server (NTRS)

Baker, Robert

2013-01-01

A document discusses the CCD97 from e2v technologies as it is being evaluated at Goddard Space Flight Center's Detector Characterization Laboratory (DCL) for possible use in ultra-low background noise space astronomy applications, such as Terrestrial Planet Finder Coronagraph (TPF-C). The CCD97 includes a photoncounting mode where the equivalent output noise is less than one electron. Use of this mode requires a clock signal at a voltage level greater than the level achievable by the existing CCD (charge-coupled-device) electronics. A high-voltage waveform generator has been developed in code 660/601 to support the CCD97 evaluation. The unit generates required clock waveforms at voltage levels from -20 to +50 V. It deals with standard and arbitrary waveforms and supports pixel rates from 50 to 500 kHz. The system is designed to interface with existing Leach CCD electronics.

25 CFR 224.54 - How must a tribe submit an application?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false How must a tribe submit an application? 224.54 Section... Obtaining Tribal Energy Resource Agreements Processing Applications § 224.54 How must a tribe submit an application? A tribe must submit an application and all supporting documents in written and electronic form to...

25 CFR 224.54 - How must a tribe submit an application?

Code of Federal Regulations, 2012 CFR

2012-04-01

... 25 Indians 1 2012-04-01 2011-04-01 true How must a tribe submit an application? 224.54 Section 224... Obtaining Tribal Energy Resource Agreements Processing Applications § 224.54 How must a tribe submit an application? A tribe must submit an application and all supporting documents in written and electronic form to...

25 CFR 224.54 - How must a tribe submit an application?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false How must a tribe submit an application? 224.54 Section... Obtaining Tribal Energy Resource Agreements Processing Applications § 224.54 How must a tribe submit an application? A tribe must submit an application and all supporting documents in written and electronic form to...

25 CFR 224.54 - How must a tribe submit an application?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 1 2011-04-01 2011-04-01 false How must a tribe submit an application? 224.54 Section... Obtaining Tribal Energy Resource Agreements Processing Applications § 224.54 How must a tribe submit an application? A tribe must submit an application and all supporting documents in written and electronic form to...

75 FR 773 - TSCA Section 5 Premanufacture and Significant New Use Notification Electronic Reporting...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-06

... via CDX, optical disc (CD or DVD), and paper. Regardless of the method of submission, EPA will require... support documents (including NOCs), though optical discs may continue to be used. Two years after the effective date of this final rule, optical discs will no longer be accepted, and all submitters must submit...

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...

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...

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.

Solid waste information and tracking system client-server conversion project management plan

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

May, D.L.

1998-04-15

This Project Management Plan is the lead planning document governing the proposed conversion of the Solid Waste Information and Tracking System (SWITS) to a client-server architecture. This plan presents the content specified by American National Standards Institute (ANSI)/Institute of Electrical and Electronics Engineers (IEEE) standards for software development, with additional information categories deemed to be necessary to describe the conversion fully. This plan is a living document that will be reviewed on a periodic basis and revised when necessary to reflect changes in baseline design concepts and schedules. This PMP describes the background, planning and management of the SWITS conversion.more » It does not constitute a statement of product requirements. Requirements and specification documentation needed for the SWITS conversion will be released as supporting documents.« less

Standardized exchange of clinical documents--towards a shared care paradigm in glaucoma treatment.

PubMed

Gerdsen, F; Müller, S; Jablonski, S; Prokosch, H-U

2006-01-01

The exchange of medical data from research and clinical routine across institutional borders is essential to establish an integrated healthcare platform. In this project we want to realize the standardized exchange of medical data between different healthcare institutions to implement an integrated and interoperable information system supporting clinical treatment and research of glaucoma. The central point of our concept is a standardized communication model based on the Clinical Document Architecture (CDA). Further, a communication concept between different health care institutions applying the developed document model has been defined. With our project we have been able to prove that standardized communication between an Electronic Medical Record (EMR), an Electronic Health Record (EHR) and the Erlanger Glaucoma Register (EGR) based on the established conceptual models, which rely on CDA rel.1 level 1 and SCIPHOX, could be implemented. The HL7-tool-based deduction of a suitable CDA rel.2 compliant schema showed significant differences when compared with the manually created schema. Finally fundamental requirements, which have to be implemented for an integrated health care platform, have been identified. An interoperable information system can enhance both clinical treatment and research projects. By automatically transferring screening findings from a glaucoma research project to the electronic medical record of our ophthalmology clinic, clinicians could benefit from the availability of a longitudinal patient record. The CDA as a standard for exchanging clinical documents has demonstrated its potential to enhance interoperability within a future shared care paradigm.

Documentation of e-cigarette use and associations with smoking from 2012 to 2015 in an integrated healthcare delivery system.

PubMed

Young-Wolff, Kelly C; Klebaner, Daniella; Folck, Bruce; Tan, Andy S L; Fogelberg, Renee; Sarovar, Varada; Prochaska, Judith J

2018-04-01

It is unclear whether use of electronic nicotine delivery systems (ENDS) precedes cigarette smoking initiation, relapse, and/or quitting. Healthcare systems with electronic health records (EHRs) provide unique data to examine ENDS use and changes in smoking. We examined the incidence of ENDS use (2012-2015) based on clinician documentation and tested whether EHR documented ENDS use is associated with twelve-month changes in patient smoking status using a matched retrospective cohort design. The sample was Kaiser Permanente Northern California (KPNC) patients aged ≥12 with documented ENDS use (N = 7926); 57% were current smokers, 35% former smokers, and 8% never-smokers. ENDS documentation incidence peaked in 2014 for current and former smokers and in 2015 for never-smokers. We matched patients with documented ENDS use to KPNC patients without documented ENDS use (N = 7926) on age, sex, race/ethnicity, and smoking status. Documented ENDS use predicted the likelihood of smoking in the following year. Among current smokers, ENDS use was associated with greater odds of quitting smoking (OR = 1.17, 95%CI = 1.05-1.31). Among former smokers, ENDS use was associated with greater odds of smoking relapse (OR = 1.53, 95%CI = 1.22-1.92). Among never-smokers, ENDS use was associated with greater odds of initiating smoking (OR = 7.41, 95%CI = 3.14-17.5). The overall number of current smokers at 12 months was slightly higher among patients with (N = 3931) versus without (N = 3850) documented ENDS use. Results support both potential harm reduction of ENDS use (quitting combustibles among current smokers) and potential for harm (relapse to combustibles among former smokers, initiation for never-smokers). Copyright © 2018 Elsevier Inc. All rights reserved.

Building electronic forms for elderly program: integrated care model for high risk elders in Hong Kong.

PubMed

Yiu, Rex; Fung, Vicky; Szeto, Karen; Hung, Veronica; Siu, Ricky; Lam, Johnny; Lai, Daniel; Maw, Christina; Cheung, Adah; Shea, Raman; Choy, Anna

2013-01-01

In Hong Kong, elderly patients discharged from hospital are at high risk of unplanned readmission. The Integrated Care Model (ICM) program is introduced to provide continuous and coordinated care for high risk elders from hospital to community to prevent unplanned readmission. A multidisciplinary working group was set up to address the requirements on developing the electronic forms for ICM program. Six (6) forms were developed. These forms can support ICM service delivery for the high risk elders, clinical documentation, statistical analysis and information sharing.

The effect of the electronic medical record on nurses' work.

PubMed

Robles, Jane

2009-01-01

The electronic medical record (EMR) is a workplace reality for most nurses. Its advantages include a single consolidated record for each person; capacity for data interfaces and alerts; improved interdisciplinary communication; and evidence-based decision support. EMRs can add to work complexity, by forcing better documentation of previously unrecorded data and/or because of poor design. Well-designed and well-implemented computerized provider order entry (CPOE) systems can streamline nurses' work. Generational differences in acceptance of and facility with EMRs can be addressed through open, healthy communication.

How to improve vital sign data quality for use in clinical decision support systems? A qualitative study in nine Swedish emergency departments.

PubMed

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

2016-06-04

Vital sign data are important for clinical decision making in emergency care. Clinical Decision Support Systems (CDSS) have been advocated to increase patient safety and quality of care. However, the efficiency of CDSS depends on the quality of the underlying vital sign data. Therefore, possible factors affecting vital sign data quality need to be understood. This study aims to explore the factors affecting vital sign data quality in Swedish emergency departments and to determine in how far clinicians perceive vital sign data to be fit for use in clinical decision support systems. A further aim of the study is to provide recommendations on how to improve vital sign data quality in emergency departments. Semi-structured interviews were conducted with sixteen physicians and nurses from nine hospitals and vital sign documentation templates were collected and analysed. Follow-up interviews and process observations were done at three of the hospitals to verify the results. Content analysis with constant comparison of the data was used to analyse and categorize the collected data. Factors related to care process and information technology were perceived to affect vital sign data quality. Despite electronic health records (EHRs) being available in all hospitals, these were not always used for vital sign documentation. Only four out of nine sites had a completely digitalized vital sign documentation flow and paper-based triage records were perceived to provide a better mobile workflow support than EHRs. Observed documentation practices resulted in low currency, completeness, and interoperability of the vital signs. To improve vital sign data quality, we propose to standardize the care process, improve the digital documentation support, provide workflow support, ensure interoperability and perform quality control. Vital sign data quality in Swedish emergency departments is currently not fit for use by CDSS. To address both technical and organisational challenges, we propose five steps for vital sign data quality improvement to be implemented in emergency care settings.

Space station systems: A bibliography with indexes (supplement 6)

NASA Technical Reports Server (NTRS)

1988-01-01

This bibliography lists 1,133 reports, articles, and other documents introduced into the NASA scientific and technical information system between July 1, 1987 and December 31, 1987. Its purpose is to provide helpful information to the researcher, manager, and designer in technology development and mission design according to system, interactive analysis and design, structural and thermal analysis and design, structural concepts and control systems, electronics, advanced materials, assembly concepts, propulsion, and solar power satellite systems. The coverage includes documents that define major systems and subsystems, servicing and support requirements, procedures and operations, and missions for the current and future Space Station.

Space station systems: A bibliography with indexes (supplement 3)

NASA Technical Reports Server (NTRS)

1987-01-01

This bibliography lists 780 reports, articles and other documents introduced into the NASA scientific and technical information system between January 1, 1986 and June 30, 1986. Its purpose is to provide helpful information to the researcher, manager, and designer in technology development and mission design according to system, interactive analysis and design, structural and thermal analysis and design, structural concepts and control systems, electronics, advanced materials, assembly concepts, propulsion, and solar power satellite system. The coverage includes documents that define major systems and subsystems, servicing and support requirements, procedures and operations, and missions for the current and future space station.

Space station systems: A bibliography with indexes (supplement 2)

NASA Technical Reports Server (NTRS)

1986-01-01

This bibliography lists 904 reports, articles and other documents introduced into the NASA scientific and technical information system between July 1, 1985 and December 31, 1985. Its purpose is to provide helpful information to the researcher, manager, and designer in technology development and mission design according to system, interactive analysis and design, structural and thermal analysis and design, structural concepts and control systems, electronics, advanced materials, assembly concepts, propulsion, and solar power satellite systems. The coverage includes documents that define major systems and subsystems, servicing and support requirements, procedures and operations, and missions for the current and future space station.

Space station systems: A bibliography with indexes

NASA Technical Reports Server (NTRS)

1987-01-01

This bibliography lists 967 reports, articles, and other documents introduced into the NASA scientific and technical information system between January 1, 1987 and June 30, 1987. Its purpose is to provide helpful information to the researcher, manager, and designer in technology development and mission design according to system, interactive analysis and design, structural and thermal analysis and design, structural concepts and control systems, electronics, advanced materials, assembly concepts, propulsion, and solar power satellite systems. The coverage includes documents that define major systems and subsystems, servicing and support requirements, procedures and operations, and missions for the current and future space station.

KernPaeP - a web-based pediatric palliative documentation system for home care.

PubMed

Hartz, Tobias; Verst, Hendrik; Ueckert, Frank

2009-01-01

KernPaeP is a new web-based on- and offline documentation system, which has been developed for pediatric palliative care-teams supporting patient documentation and communication among health care professionals. It provides a reliable system making fast and secure home care documentation possible. KernPaeP is accessible online by registered users using any web-browser. Home care teams use an offline version of KernPaeP running on a netbook for patient documentation on site. Identifying and medical patient data are strictly separated and stored on two database servers. The system offers a stable, enhanced two-way algorithm for synchronization between the offline component and the central database servers. KernPaeP is implemented meeting highest security standards while still maintaining high usability. The web-based documentation system allows ubiquitous and immediate access to patient data. Sumptuous paper work is replaced by secure and comprehensive electronic documentation. KernPaeP helps saving time and improving the quality of documentation. Due to development in close cooperation with pediatric palliative professionals, KernPaeP fulfils the broad needs of home-care documentation. The technique of web-based online and offline documentation is in general applicable for arbitrary home care scenarios.

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)

Tools in a clinical information system supporting clinical trials at a Swiss University Hospital.

PubMed

Weisskopf, Michael; Bucklar, Guido; Blaser, Jürg

2014-12-01

Issues concerning inadequate source data of clinical trials rank second in the most common findings by regulatory authorities. The increasing use of electronic clinical information systems by healthcare providers offers an opportunity to facilitate and improve the conduct of clinical trials and the source documentation. We report on a number of tools implemented into the clinical information system of a university hospital to support clinical research. In 2011/2012, a set of tools was developed in the clinical information system of the University Hospital Zurich to support clinical research, including (1) a trial registry for documenting metadata on the clinical trials conducted at the hospital, (2) a patient-trial-assignment-tool to tag patients in the electronic medical charts as participants of specific trials, (3) medical record templates for the documentation of study visits and trial-related procedures, (4) online queries on trials and trial participants, (5) access to the electronic medical records for clinical monitors, (6) an alerting tool to notify of hospital admissions of trial participants, (7) queries to identify potentially eligible patients in the planning phase as trial feasibility checks and during the trial as recruitment support, and (8) order sets to facilitate the complete and accurate performance of study visit procedures. The number of approximately 100 new registrations per year in the voluntary trial registry in the clinical information system now matches the numbers of the existing mandatory trial registry of the hospital. Likewise, the yearly numbers of patients tagged as trial participants as well as the use of the standardized trial record templates increased to 2408 documented trial enrolments and 190 reports generated/month in the year 2013. Accounts for 32 clinical monitors have been established in the first 2 years monitoring a total of 49 trials in 16 clinical departments. A total of 15 months after adding the optional feature of hospital admission alerts of trial participants, 107 running trials have activated this option, including 48 out of 97 studies (49.5%) registered in the year 2013, generating approximately 85 alerts per month. The popularity of the presented tools in the clinical information system illustrates their potential to facilitate the conduct of clinical trials. The tools also allow for enhanced transparency on trials conducted at the hospital. Future studies on monitoring and inspection findings will have to evaluate their impact on quality and safety. © The Author(s) 2014.

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...

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

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

Quality of Electronic Nursing Records: The Impact of Educational Interventions During a Hospital Accreditation Process.

PubMed

Nomura, Aline Tsuma Gaedke; Pruinelli, Lisiane; da Silva, Marcos Barragan; Lucena, Amália de Fátima; Almeida, Miriam de Abreu

2018-03-01

Hospital accreditation is a strategy for the pursuit of quality of care and safety for patients and professionals. Targeted educational interventions could help support this process. This study aimed to evaluate the quality of electronic nursing records during the hospital accreditation process. A retrospective study comparing 112 nursing records during the hospital accreditation process was conducted. Educational interventions were implemented, and records were evaluated preintervention and postintervention. Mann-Whitney and χ tests were used for data analysis. Results showed that there was a significant improvement in the nursing documentation quality postintervention. When comparing records preintervention and postintervention, results showed a statistically significant difference (P < .001) between the two periods. The comparison between items showed that most scores were significant. Findings indicated that educational interventions performed by nurses led to a positive change that improved nursing documentation and, consequently, better care practices.

Designing an Electronic Patient Management System for Multiple Sclerosis: Building a Next Generation Multiple Sclerosis Documentation System.

PubMed

Kern, Raimar; Haase, Rocco; Eisele, Judith Christina; Thomas, Katja; Ziemssen, Tjalf

2016-01-08

Technologies like electronic health records or telemedicine devices support the rapid mediation of health information and clinical data independent of time and location between patients and their physicians as well as among health care professionals. Today, every part of the treatment process from diagnosis, treatment selection, and application to patient education and long-term care may be enhanced by a quality-assured implementation of health information technology (HIT) that also takes data security standards and concerns into account. In order to increase the level of effectively realized benefits of eHealth services, a user-driven needs assessment should ensure the inclusion of health care professional perspectives into the process of technology development as we did in the development process of the Multiple Sclerosis Documentation System 3D. After analyzing the use of information technology by patients suffering from multiple sclerosis, we focused on the needs of neurological health care professionals and their handling of health information technology. Therefore, we researched the status quo of eHealth adoption in neurological practices and clinics as well as health care professional opinions about potential benefits and requirements of eHealth services in the field of multiple sclerosis. We conducted a paper-and-pencil-based mail survey in 2013 by sending our questionnaire to 600 randomly chosen neurological practices in Germany. The questionnaire consisted of 24 items covering characteristics of participating neurological practices (4 items), the current use of network technology and the Internet in such neurological practices (5 items), physicians' attitudes toward the general and MS-related usefulness of eHealth systems (8 items) and toward the clinical documentation via electronic health records (4 items), and physicians' knowledge about the Multiple Sclerosis Documentation System (3 items). From 600 mailed surveys, 74 completed surveys were returned. As much as 9 of the 10 practices were already connected to the Internet (67/74), but only 49% preferred a permanent access. The most common type of HIT infrastructure was a complete practice network with several access points. Considering data sharing with research registers, 43% opted for an online interface, whereas 58% decided on an offline method of data transmission. eHealth services were perceived as generally useful for physicians and nurses in neurological practices with highest capabilities for improvements in clinical documentation, data acquisition, diagnosis of specific MS symptoms, physician-patient communication, and patient education. Practices specialized in MS in comparison with other neurological practices presented an increased interest in online documentation. Among the participating centers, 91% welcomed the opportunity of a specific clinical documentation for MS and 87% showed great interest in an extended and more interconnected electronic documentation of MS patients. Clinical parameters (59/74) were most important in documentation, followed by symptomatic parameters like measures of fatigue or depression (53/74) and quality of life (47/74). Physicians and nurses may significantly benefit from an electronically assisted documentation and patient management. Many aspects of patient documentation and education will be enhanced by eHealth services if the most informative measures are integrated in an easy-to-use and easily connectable approach. MS-specific eHealth services were highly appreciated, but the current level of adoption is still behind the level of interest in an extended and more interconnected electronic documentation of MS patients.

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.

Do Joint Fighter Programs Save Money? Technical Appendixes on Methodology

DTIC Science & Technology

2013-01-01

Bookstore Make a charitable contribution Limited Electronic Distribution Rights This document and trademark(s) contained herein are protected by...research clients and sponsors. Support RAND—make a tax-deductible charitable contribution at www.rand.org/giving/contribute.html R® is a registered...Evidence, Organisation for Economic Co-Operation and Development, Economics Department Working Paper 317, January 17, 2002. Anderson, Fred, Northrop

Do Joint Fighter Programs Save Money?

DTIC Science & Technology

2013-01-01

Reports & Bookstore Make a charitable contribution Limited Electronic Distribution Rights This document and trademark(s) contained herein are protected by...reflect the opinions of its research clients and sponsors. Support RAND—make a tax-deductible charitable contribution at www.rand.org/giving...Ahn, Sanghoon, Competition, Innovation and Productivity Growth: A Review of Theory and Evidence, Paris: Organisation for Economic Co-Operation and

77 FR 37330 - Reef Fish Fishery of the Gulf of Mexico; 2012 Commercial Accountability Measure and Closure for...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-21

... effective 12:01 a.m., local time on July 1, 2012, until 12:01 a.m., local time on January 1, 2013. ADDRESSES: Electronic copies of documents supporting the final temporary rule implementing gray triggerfish management... . SUPPLEMENTARY INFORMATION: The reef fish fishery of the Gulf is managed under the Fishery Management Plan for...

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.

Predictors of successful use of a web-based healthcare document storage and sharing system for pediatric cancer survivors: Cancer SurvivorLink™.

PubMed

Williamson, Rebecca; Meacham, Lillian; Cherven, Brooke; Hassen-Schilling, Leann; Edwards, Paula; Palgon, Michael; Espinoza, Sofia; Mertens, Ann

2014-09-01

Cancer SurvivorLink™, www.cancersurvivorlink.org , is a patient-controlled communication tool where survivors can electronically store and share documents with healthcare providers. Functionally, SurvivorLink serves as an electronic personal health record-a record of health-related information managed and controlled by the survivor. Recruitment methods to increase registration and the characteristics of registrants who completed each step of using SurvivorLink are described. Pediatric cancer survivors were recruited via mailings, survivor clinic, and community events. Recruitment method and Aflac Survivor Clinic attendance was determined for each registrant. Registration date, registrant type (parent vs. survivor), zip code, creation of a personal health record in SurvivorLink, storage of documents, and document sharing were measured. Logistic regression was used to determine the characteristics that predicted creation of a health record and storage of documents. To date, 275 survivors/parents have completed registration: 63 were recruited via mailing, 99 from clinic, 56 from community events, and 57 via other methods. Overall, 66.9 % registrants created a personal health record and 45.7 % of those stored a health document. There were no significant predictors for creating a personal health record. Attending a survivor clinic was the strongest predictor of document storage (p < 0.01). Of those with a document stored, 21.4 % shared with a provider. Having attended survivor clinic is the biggest predictor of registering and using SurvivorLink. Many survivors must advocate for their survivorship care. Survivor Link provides educational material and supports the dissemination of survivor-specific follow-up recommendations to facilitate shared clinical care decision making.

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.

Framework and prototype for a secure XML-based electronic health records system.

PubMed

Steele, Robert; Gardner, William; Chandra, Darius; Dillon, Tharam S

2007-01-01

Security of personal medical information has always been a challenge for the advancement of Electronic Health Records (EHRs) initiatives. eXtensible Markup Language (XML), is rapidly becoming the key standard for data representation and transportation. The widespread use of XML and the prospect of its use in the Electronic Health (e-health) domain highlights the need for flexible access control models for XML data and documents. This paper presents a declarative access control model for XML data repositories that utilises an expressive XML role control model. The operational semantics of this model are illustrated by Xplorer, a user interface generation engine which supports search-browse-navigate activities on XML repositories.

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.

Automated Text Markup for Information Retrieval from an Electronic Textbook of Infectious Disease

PubMed Central

Berrios, Daniel C.; Kehler, Andrew; Kim, David K.; Yu, Victor L.; Fagan, Lawrence M.

1998-01-01

The information needs of practicing clinicians frequently require textbook or journal searches. Making these sources available in electronic form improves the speed of these searches, but precision (i.e., the fraction of relevant to total documents retrieved) remains low. Improving the traditional keyword search by transforming search terms into canonical concepts does not improve search precision greatly. Kim et al. have designed and built a prototype system (MYCIN II) for computer-based information retrieval from a forthcoming electronic textbook of infectious disease. The system requires manual indexing by experts in the form of complex text markup. However, this mark-up process is time consuming (about 3 person-hours to generate, review, and transcribe the index for each of 218 chapters). We have designed and implemented a system to semiautomate the markup process. The system, information extraction for semiautomated indexing of documents (ISAID), uses query models and existing information-extraction tools to provide support for any user, including the author of the source material, to mark up tertiary information sources quickly and accurately.

Structured vs. Unstructured: Factors Affecting Adverse Drug Reaction Documentation in an EMR Repository

PubMed Central

Skentzos, Stephen; Shubina, Maria; Plutzky, Jorge; Turchin, Alexander

2011-01-01

Adverse reactions to medications to which the patient was known to be intolerant are common. Electronic decision support can prevent them but only if history of adverse reactions to medications is recorded in structured format. We have conducted a retrospective study of 31,531 patients with adverse reactions to statins documented in the notes, as identified with natural language processing. The software identified statin adverse reactions with sensitivity of 86.5% and precision of 91.9%. Only 9020 of these patients had an adverse reaction to a statin recorded in structured format. In multivariable analysis the strongest predictor of structured documentation was utilization of EMR functionality that integrated the medication list with the structured medication adverse reaction repository (odds ratio 48.6, p < 0.0001). Integration of information flow between EMR modules can help improve documentation and potentially prevent adverse drug events. PMID:22195188

NASA Scientific and Technical Information Standards

NASA Technical Reports Server (NTRS)

2006-01-01

This document presents general recommended standards for documenting scientific and technical information (STI) from a number of scientific and engineering disciplines. It is a companion publication to NASA SP-7084, "Grammar, Punctuation, and Capitalization: A Handbook for Technical Writers and Editors," and is intended primarily for STI personnel and publishing personnel within NASA and who support NASA STI publishing. Section 1 gives an overview of NASA STI publications. Section 2 discusses figure preparation considerations. Section 3 covers table design, and Section 4 gives information about symbols and math related to STI publishing. Section 5 covers units of measure. Section 6 discusses References, and Section 7 discusses electronic documents. Section 8 covers information related to the review of STI prior to publication; this covers both technical and dissemination review and approval, including data quality. Section 9 discusses printing and dissemination related to STI, and Section 10 gives abbreviations and acronyms used in the document.

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.

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.

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...

Electrical, Electronic, and Electromechanical (EEE) Parts Management and Control Requirements for Space Flight Hardware and Critical Ground Support Equipment...aka... The NASA EEE Parts Standard, NASA-STD 8739.10

NASA Technical Reports Server (NTRS)

Majewicz, Peter; Sampson, Michael

2016-01-01

Describes development and content of a new NASA Standard for Electrical Electronic and Electromechanical (EEE) parts. This Standard reflects current practices, instead of changing them. Most NASA Centers utilize local documents, but there is minimal consistency across the Agency. A gap analysis clearly shows the differences that exist among the different centers and with respect to the NASA Parts Policy. Once approved, the new standard can be referenced in contracts and agreements with organizations outside of NASA.

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/.

Langmuir Probe Spacecraft Potential End Item Specification Document

NASA Technical Reports Server (NTRS)

Gilchrist, Brian; Curtis, Leslie (Technical Monitor)

2001-01-01

This document describes the Langmuir Probe Spacecraft Potential (LPSP) investigation of the plasma environment in the vicinity of the ProSEDS Delta II spacecraft. This investigation will employ a group of three (3) Langmuir Probe Assemblies, LPAs, mounted on the Delta II second stage to measure the electron density and temperature (n(sub e) and T(sub e)), the ion density (n(sub i)), and the spacecraft potential (V(sub s)) relative to the surrounding ionospheric plasma. This document is also intended to define the technical requirements and flight-vehicle installation interfaces for the design, development, assembly, testing, qualification, and operation of the LPSP subsystem for the Propulsive Small Expendable Deployer System (ProSEDS) and its associated Ground Support Equipment (GSE). This document also defines the interfaces between the LPSP instrument and the ProSEDS Delta II spacecraft, as well as the design, fabrication, operation, and other requirements established to meet the mission objectives. The LPSP is the primary measurement instrument designed to characterize the background plasma environment and is a supporting instrument for measuring spacecraft potential of the Delta II vehicle used for the ProSEDS mission. Specifically, the LPSP will use the three LPAs equally spaced around the Delta II body to make measurements of the ambient ionospheric plasma during passive operations to aid in validating existing models of electrodynamic-tether propulsion. These same probes will also be used to measure Delta II spacecraft potential when active operations occur. When the electron emitting plasma contractor is on, dense neutral plasma is emitted. Effective operation of the plasma contactor (PC) will mean a low potential difference between the Delta II second stage and the surrounding plasma and represents one of the voltage parameters needed to fully characterize the electrodynamic-tether closed circuit. Given that the LP already needs to be well away from any near-field disturbances around the Delta II, it is possible to use the same probe with a simple reconfiguration of the electronics to measure potential with respect to the ambient plasma. The LP measurement techniques are outlined in the following text and discussed in detail in the Appendix. The scientific goals of the investigation, the physical and electrical characteristics of the instrument, and the on-orbit measurement requirements are also discussed in this document.

Electronic Clinic Journaling: The Use of Weblogs to Support Evidence-Based Practice in Doctor of Audiology Students

ERIC Educational Resources Information Center

Neldon, Gayle B.

2009-01-01

Evidence-based practice (EBP) is a strategy for the provision of high quality health care. The use of journals to document clinical experiences and reflection has been used in speech-language pathology as well as nursing and psychology. This study uses qualitative analysis to study what AuD students learn about evidence-based practice from writing…

Support for Development of Electronics and Materials Technologies by the Governments of the United States, Japan, West Germany, France, and the United Kingdom.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC.

The governments of the United States, Japan, West Germany, France, and the United Kingdom each have large research and development efforts involving government agencies, universities and industry. This document provides a comparative overview of policies and programs which contribute to the development of technologies in the general area of…

AAA (2010) CAPD clinical practice guidelines: need for an update.

PubMed

DeBonis, David A

2017-09-01

Review and critique of the clinical value of the AAA CAPD guidance document in light of criteria for credible and useful guidance documents, as discussed by Field and Lohr. A qualitative review of the of the AAA CAPD guidelines using a framework by Field and Lohr to assess their relative value in supporting the assessment and management of CAPD referrals. Relevant literature available through electronic search tools and published texts were used along with the AAA CAPD guidance document and the chapter by Field and Lohr. The AAA document does not meet many of the key requirements discussed by Field and Lohr. It does not reflect the current literature, fails to help clinicians understand for whom auditory processing testing and intervention would be most useful, includes contradictory suggestions which reduce clarity and appears to avoid conclusions that might cast the CAPD construct in a negative light. It also does not include input from diverse affected groups. All of these reduce the document's credibility. The AAA CAPD guidance document will need to be updated and re-conceptualised in order to provide meaningful guidance for clinicians.

Physician Order Entry Clerical Support Improves Physician Satisfaction and Productivity.

PubMed

Contratto, Erin; Romp, Katherine; Estrada, Carlos A; Agne, April; Willett, Lisa L

2017-05-01

To examine the impact of clerical support personnel for physician order entry on physician satisfaction, productivity, timeliness with electronic health record (EHR) documentation, and physician attitudes. All seven part-time physicians at an academic general internal medicine practice were included in this quasi-experimental (single group, pre- and postintervention) mixed-methods study. One full-time clerical support staff member was trained and hired to enter physician orders in the EHR and conduct previsit planning. Physician satisfaction, productivity, timeliness with EHR documentation, and physician attitudes toward the intervention were measured. Four months after the intervention, physicians reported improvements in overall quality of life (good quality, 71%-100%), personal balance (43%-71%), and burnout (weekly, 43%-14%; callousness, 14%-0%). Matched for quarter, productivity increased: work relative value unit (wRVU) per session increased by 20.5% (before, April-June 2014; after, April-June 2015; range -9.2% to 27.5%). Physicians reported feeling more supported, more focused on patient care, and less stressed and fatigued after the intervention. This study supports the use of physician order entry clerical personnel as a simple, cost-effective intervention to improve the work lives of primary care physicians.

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.

Managing care pathways combining SNOMED CT, archetypes and an electronic guideline system.

PubMed

Bernstein, Knut; Andersen, Ulrich

2008-01-01

Today electronic clinical guideline systems exist, but they are not well integrated with electronic health records. This paper thus proposes that the patient's "position" in the pathway during the patient journey should be made visible to all involved healthcare parties and the patient. This requires that the generic knowledge, which is represented in the guidelines, is combined with the patient specific information - and then made accessible for all relevant parties. In addition to the decision support provided by the guideline system documentation support can be provided by templates based on archetypes. This paper provides a proposal for how the guideline system and the EHR can be integrated by the use of archetypes and SNOMED CT. SNOMED CT provides the common reference terminology and the semantic links between the systems. The proposal also includes the use of a National Patient Index for storing data about the patient's position in the pathway and for sharing this information by all involved parties.

Quality improvement and practice-based research in neurology using the electronic medical record

PubMed Central

Frigerio, Roberta; Kazmi, Nazia; Meyers, Steven L.; Sefa, Meredith; Walters, Shaun A.; Silverstein, Jonathan C.

2015-01-01

Abstract We describe quality improvement and practice-based research using the electronic medical record (EMR) in a community health system–based department of neurology. Our care transformation initiative targets 10 neurologic disorders (brain tumors, epilepsy, migraine, memory disorders, mild traumatic brain injury, multiple sclerosis, neuropathy, Parkinson disease, restless legs syndrome, and stroke) and brain health (risk assessments and interventions to prevent Alzheimer disease and related disorders in targeted populations). Our informatics methods include building and implementing structured clinical documentation support tools in the EMR; electronic data capture; enrollment, data quality, and descriptive reports; quality improvement projects; clinical decision support tools; subgroup-based adaptive assignments and pragmatic trials; and DNA biobanking. We are sharing EMR tools and deidentified data with other departments toward the creation of a Neurology Practice-Based Research Network. We discuss practical points to assist other clinical practices to make quality improvements and practice-based research in neurology using the EMR a reality. PMID:26576324

Feedback mechanisms including real-time electronic alerts to achieve near 100% timely prophylactic antibiotic administration in surgical cases.

PubMed

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

2010-11-01

Administration of prophylactic antibiotics during surgery is generally performed by the anesthesia providers. Timely antibiotic administration within the optimal time window before incision is critical for prevention of surgical site infections. However, this often becomes a difficult task for the anesthesia team during the busy part of a case when the patient is being anesthetized. Starting with the implementation of an anesthesia information management system (AIMS), we designed and implemented several feedback mechanisms to improve compliance of proper antibiotic delivery and documentation. This included generating e-mail feedback of missed documentation, distributing monthly summary reports, and generating real-time electronic alerts with a decision support system. In 20,974 surgical cases for the period, June 2008 to January 2010, the interventions of AIMS install, e-mail feedback, summary reports, and real-time alerts changed antibiotic compliance by -1.5%, 2.3%, 4.9%, and 9.3%, respectively, when compared with the baseline value of 90.0% ± 2.9% when paper anesthesia records were used. Highest antibiotic compliance was achieved when using real-time alerts. With real-time alerts, monthly compliance was >99% for every month between June 2009 and January 2010. Installation of AIMS itself did not improve antibiotic compliance over that achieved with paper anesthesia records. However, real-time guidance and reminders through electronic messages generated by a computerized decision support system (Smart Anesthesia Messenger, or SAM) significantly improved compliance. With such a system a consistent compliance of >99% was achieved.

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...

Using the eXtensible Markup Language (XML) in a regional electronic patient record for patients with malignant diseases.

PubMed

Wolff, A C; Mludek, V; van der Haak, M; Bork, W; Bülzebruck, H; Drings, P; Schmücker, P; Wannenmacher, M; Haux, R

2001-01-01

Communication between different institutions which are responsible for the treatment of the same patient is of outstanding significance, especially in the field of tumor diseases. Regional electronic patient records could support the co-operation of different institutions by providing ac-cess to all necessary information whether it belongs to the own institution or to a partner. The Department of Medical Informatics, University of Heidelberg is performing a project in co-operation with the Thoraxclinic-Heidelberg and the Department of Clinical Radiology, University of Heidelberg with the goal: to define an architectural concept for interlinking the electronic patient record of the two clinical institutions to build a common virtual electronic patient record and carry out an exemplary implementation, to examine composition, structure and content of medical documents for tumor patients with the aim of defining an XML-based markup language allowing summarizing overviews and suitable granularities, and to integrate clinical practice guidelines and other external knowledge with the electronic patient record using XML-technologies to support the physician in the daily decision process. This paper will show, how a regional electronic patient record could be built on an architectural level and describe elementary steps towards a on content-oriented structuring of medical records.

National briefing summaries: Nuclear fuel cycle and waste management

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

Schneider, K.J.; Bradley, D.J.; Fletcher, J.F.

Since 1976, the International Program Support Office (IPSO) at the Pacific Northwest Laboratory (PNL) has collected and compiled publicly available information concerning foreign and international radioactive waste management programs. This National Briefing Summaries is a printout of an electronic database that has been compiled and is maintained by the IPSO staff. The database contains current information concerning the radioactive waste management programs (with supporting information on nuclear power and the nuclear fuel cycle) of most of the nations (except eastern European countries) that now have or are contemplating nuclear power, and of the multinational agencies that are active in radioactivemore » waste management. Information in this document is included for three additional countries (China, Mexico, and USSR) compared to the prior issue. The database and this document were developed in response to needs of the US Department of Energy.« less

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...

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...

Effects of documentation-based decision support on chronic disease management.

PubMed

Schnipper, Jeffrey L; Linder, Jeffrey A; Palchuk, Matvey B; Yu, D Tony; McColgan, Kerry E; Volk, Lynn A; Tsurikova, Ruslana; Melnikas, Andrea J; Einbinder, Jonathan S; Middleton, Blackford

2010-12-01

To evaluate whether a new documentation-based clinical decision support system (CDSS) is effective in addressing deficiencies in the care of patients with coronary artery disease (CAD) and diabetes mellitus (DM). Controlled trial randomized by physician. We assigned primary care physicians (PCPs) in 10 ambulatory practices to usual care or the CAD/DM Smart Form for 9 months. The primary outcome was the proportion of deficiencies in care that were addressed within 30 days after a patient visit. The Smart Form was used for 5.6% of eligible patients. In the intention-to-treat analysis, patients of intervention PCPs had a greater proportion of deficiencies addressed within 30 days of a visit compared with controls (11.4% vs 10.1%, adjusted and clustered odds ratio =1.14; 95% confidence interval, 1.02-1.28; P = .02). Differences were more pronounced in the "on-treatment" analysis: 17.0% of deficiencies were addressed after visits in which the Smart Form was used compared with 10.6% of deficiencies after visits in which it was not used (P <.001). Measures that improved included documentation of smoking status and prescription of antiplatelet agents when appropriate. Overall use of the CAD/DM Smart Form was low, and improvements in management were modest. When used, documentation-based decision support shows promise, and future studies should focus on refining such tools, integrating them into current electronic health record platforms, and promoting their use, perhaps through organizational changes to primary care practices.

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...

Electronic Health Record Application Support Service Enablers.

PubMed

Neofytou, M S; Neokleous, K; Aristodemou, A; Constantinou, I; Antoniou, Z; Schiza, E C; Pattichis, C S; Schizas, C N

2015-08-01

There is a huge need for open source software solutions in the healthcare domain, given the flexibility, interoperability and resource savings characteristics they offer. In this context, this paper presents the development of three open source libraries - Specific Enablers (SEs) for eHealth applications that were developed under the European project titled "Future Internet Social and Technological Alignment Research" (FI-STAR) funded under the "Future Internet Public Private Partnership" (FI-PPP) program. The three SEs developed under the Electronic Health Record Application Support Service Enablers (EHR-EN) correspond to: a) an Electronic Health Record enabler (EHR SE), b) a patient summary enabler based on the EU project "European patient Summary Open Source services" (epSOS SE) supporting patient mobility and the offering of interoperable services, and c) a Picture Archiving and Communications System (PACS) enabler (PACS SE) based on the dcm4che open source system for the support of medical imaging functionality. The EHR SE follows the HL7 Clinical Document Architecture (CDA) V2.0 and supports the Integrating the Healthcare Enterprise (IHE) profiles (recently awarded in Connectathon 2015). These three FI-STAR platform enablers are designed to facilitate the deployment of innovative applications and value added services in the health care sector. They can be downloaded from the FI-STAR cataloque website. Work in progress focuses in the validation and evaluation scenarios for the proving and demonstration of the usability, applicability and adaptability of the proposed enablers.

Backscattered electron SEM imaging of resin sections from plant specimens: observation of histological to subcellular structure and CLEM.

PubMed

Rizzo, N W; Duncan, K E; Bourett, T M; Howard, R J

2016-08-01

We have refined methods for biological specimen preparation and low-voltage backscattered electron imaging in the scanning electron microscope that allow for observation at continuous magnifications of ca. 130-70 000 X, and documentation of tissue and subcellular ultrastructure detail. The technique, based upon early work by Ogura & Hasegawa (1980), affords use of significantly larger sections from fixed and resin-embedded specimens than is possible with transmission electron microscopy while providing similar data. After microtomy, the sections, typically ca. 750 nm thick, were dried onto the surface of glass or silicon wafer and stained with heavy metals-the use of grids avoided. The glass/wafer support was then mounted onto standard scanning electron microscopy sample stubs, carbon-coated and imaged directly at an accelerating voltage of 5 kV, using either a yttrium aluminum garnet or ExB backscattered electron detector. Alternatively, the sections could be viewed first by light microscopy, for example to document signal from a fluorescent protein, and then by scanning electron microscopy to provide correlative light/electron microscope (CLEM) data. These methods provide unobstructed access to ultrastructure in the spatial context of a section ca. 7 × 10 mm in size, significantly larger than the typical 0.2 × 0.3 mm section used for conventional transmission electron microscopy imaging. Application of this approach was especially useful when the biology of interest was rare or difficult to find, e.g. a particular cell type, developmental stage, large organ, the interface between cells of interacting organisms, when contextual information within a large tissue was obligatory, or combinations of these factors. In addition, the methods were easily adapted for immunolocalizations. © 2015 The Author. Journal of Microscopy published by John Wiley & Sons, Ltd on behalf of the Royal Microscopical Society.

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.

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...

Equipment concept design and development plans for microgravity science and applications research on space station: Combustion tunnel, laser diagnostic system, advanced modular furnace, integrated electronics laboratory

NASA Technical Reports Server (NTRS)

Uhran, M. L.; Youngblood, W. W.; Georgekutty, T.; Fiske, M. R.; Wear, W. O.

1986-01-01

Taking advantage of the microgravity environment of space NASA has initiated the preliminary design of a permanently manned space station that will support technological advances in process science and stimulate the development of new and improved materials having applications across the commercial spectrum. Previous studies have been performed to define from the researcher's perspective, the requirements for laboratory equipment to accommodate microgravity experiments on the space station. Functional requirements for the identified experimental apparatus and support equipment were determined. From these hardware requirements, several items were selected for concept designs and subsequent formulation of development plans. This report documents the concept designs and development plans for two items of experiment apparatus - the Combustion Tunnel and the Advanced Modular Furnace, and two items of support equipment the Laser Diagnostic System and the Integrated Electronics Laboratory. For each concept design, key technology developments were identified that are required to enable or enhance the development of the respective hardware.

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.

Adapting the Army’s Training and Leader Development Programs for Future Challenges

DTIC Science & Technology

2013-01-01

development information from the insti- tutional domain. • Collective training support products are proposed improvements in the primary prod- ucts...not to argue for a totally centralized approach. Decentralized initiatives are ben- eficial , and training program managers and executors should continue...institution that helps improve policy and decisionmaking through research and analysis. This electronic document was made available from www.rand.org as a

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...

HL7 Structured Product Labeling - electronic prescribing information for provider order entry decision support.

PubMed

Schadow, Gunther

2005-01-01

Prescribing errors are an important cause of adverse events, and lack of knowledge of the drug is a root cause for prescribing errors. The FDA is issuing new regulations that will make the drug labels much more useful not only to physicians, but also to computerized order entry systems that support physicians to practice safe prescribing. For this purpose, FDA works with HL7 to create the Structured Product Label (SPL) standard that includes a document format as well as a drug knowledge representation, this poster introduces the basic concepts of SPL.

Cost analysis and student survey results of library support for distance education

PubMed Central

Rodman, Ruey L.

2003-01-01

This paper describes the costs associated with providing library support for a series of distance-education courses at The Ohio State University (OSU). These courses are designed as a pilot program offered by the OSU Office of Geriatrics and Gerontology. Costs to the library are analyzed for document delivery, electronic reserves, reference services, and librarian activities. Also included are the results of a student evaluation survey. The students are full-time working professionals who cannot attend regularly scheduled classes on campus. Conclusions extrapolate costs for each course, student, and service. PMID:12568160

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.

The future of bibliographic standards in a networked information environment

NASA Technical Reports Server (NTRS)

1997-01-01

The main mission of the CENDI Cataloging Working Group is to provide guidelines for cataloging practices that support the sharing of database records among the CENDI agencies, and that incorporate principles based on cost effectiveness and efficiency. Recent efforts include the extension of COSATI Guidelines for the Cataloging of Technical Reports to include non-print materials, and the mapping of each agency's export file structure to USMARC. Of primary importance is the impact of electronic documents and the distributed nature of the networked information environment. Topics discussed during the workshop include the following: Trade-offs in Cataloging and Indexing Internet Information; The Impact on Current and Future Standards; A Look at WWW Metadata Initiatives; Standards for Electronic Journals; The Present and Future Search Engines; The Roles for Text Analysis Software; Advanced Search Engine Meets Metathesaurus; Locator Schemes for Internet Resources; Identifying and Cataloging Web Document Types; In Search of a New Bibliographic Record. The videos in this set include viewgraphs of charts and related materials of the workshop.

[Challenges of Digital Medicine].

PubMed

Blaser, Jürg

2018-06-01

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

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...

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

Two-stage Framework for a Topology-Based Projection and Visualization of Classified Document Collections

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

Oesterling, Patrick; Scheuermann, Gerik; Teresniak, Sven

During the last decades, electronic textual information has become the world's largest and most important information source available. People have added a variety of daily newspapers, books, scientific and governmental publications, blogs and private messages to this wellspring of endless information and knowledge. Since neither the existing nor the new information can be read in its entirety, computers are used to extract and visualize meaningful or interesting topics and documents from this huge information clutter. In this paper, we extend, improve and combine existing individual approaches into an overall framework that supports topological analysis of high dimensional document point cloudsmore » given by the well-known tf-idf document-term weighting method. We show that traditional distance-based approaches fail in very high dimensional spaces, and we describe an improved two-stage method for topology-based projections from the original high dimensional information space to both two dimensional (2-D) and three dimensional (3-D) visualizations. To show the accuracy and usability of this framework, we compare it to methods introduced recently and apply it to complex document and patent collections.« less

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.

Extra dimensions: 3d and time in pdf documentation

NASA Astrophysics Data System (ADS)

Graf, N. A.

2008-07-01

High energy physics is replete with multi-dimensional information which is often poorly represented by the two dimensions of presentation slides and print media. Past efforts to disseminate such information to a wider audience have failed for a number of reasons, including a lack of standards which are easy to implement and have broad support. Adobe's Portable Document Format (PDF) has in recent years become the de facto standard for secure, dependable electronic information exchange. It has done so by creating an open format, providing support for multiple platforms and being reliable and extensible. By providing support for the ECMA standard Universal 3D (U3D) file format in its free Adobe Reader software, Adobe has made it easy to distribute and interact with 3D content. By providing support for scripting and animation, temporal data can also be easily distributed to a wide audience. In this talk, we present examples of HEP applications which take advantage of this functionality. We demonstrate how 3D detector elements can be documented, using either CAD drawings or other sources such as GEANT visualizations as input. Using this technique, higher dimensional data, such as LEGO plots or time-dependent information can be included in PDF files. In principle, a complete event display, with full interactivity, can be incorporated into a PDF file. This would allow the end user not only to customize the view and representation of the data, but to access the underlying data itself.

Extra Dimensions: 3D and Time in PDF Documentation

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

Graf, Norman A.; /SLAC

2011-11-10

High energy physics is replete with multi-dimensional information which is often poorly represented by the two dimensions of presentation slides and print media. Past efforts to disseminate such information to a wider audience have failed for a number of reasons, including a lack of standards which are easy to implement and have broad support. Adobe's Portable Document Format (PDF) has in recent years become the de facto standard for secure, dependable electronic information exchange. It has done so by creating an open format, providing support for multiple platforms and being reliable and extensible. By providing support for the ECMA standardmore » Universal 3D (U3D) file format in its free Adobe Reader software, Adobe has made it easy to distribute and interact with 3D content. By providing support for scripting and animation, temporal data can also be easily distributed to a wide audience. In this talk, we present examples of HEP applications which take advantage of this functionality. We demonstrate how 3D detector elements can be documented, using either CAD drawings or other sources such as GEANT visualizations as input. Using this technique, higher dimensional data, such as LEGO plots or time-dependent information can be included in PDF files. In principle, a complete event display, with full interactivity, can be incorporated into a PDF file. This would allow the end user not only to customize the view and representation of the data, but to access the underlying data itself.« less

Center of Excellence for Geospatial Information Science research plan 2013-18

USGS Publications Warehouse

Usery, E. Lynn

2013-01-01

The U.S. Geological Survey Center of Excellence for Geospatial Information Science (CEGIS) was created in 2006 and since that time has provided research primarily in support of The National Map. The presentations and publications of the CEGIS researchers document the research accomplishments that include advances in electronic topographic map design, generalization, data integration, map projections, sea level rise modeling, geospatial semantics, ontology, user-centered design, volunteer geographic information, and parallel and grid computing for geospatial data from The National Map. A research plan spanning 2013–18 has been developed extending the accomplishments of the CEGIS researchers and documenting new research areas that are anticipated to support The National Map of the future. In addition to extending the 2006–12 research areas, the CEGIS research plan for 2013–18 includes new research areas in data models, geospatial semantics, high-performance computing, volunteered geographic information, crowdsourcing, social media, data integration, and multiscale representations to support the Three-Dimensional Elevation Program (3DEP) and The National Map of the future of the U.S. Geological Survey.

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.

The Feasibility of Digital Pen and Paper Technology for Vital Sign Data Capture in Acute Care Settings

PubMed Central

Dykes, Patricia C.; Benoit, Angela; Chang, Frank; Gallagher, Joan; Li, Qi; Spurr, Cindy; McGrath, E. Jan; Kilroy, Susan M.; Prater, Marita

2006-01-01

The transition from paper to electronic documentation systems in acute care settings is often gradual and characterized by a period in which paper and electronic processes coexist. Intermediate technologies are needed to “bridge” the gap between paper and electronic systems as a means to improve work flow efficiency through data acquisition at the point of care in structured formats to inform decision support and facilitate reuse. The purpose of this paper is to report on the findings of a study conducted on three acute care units at Brigham and Women’s Hospital and Massachusetts General Hospital in Boston, MA to evaluate the feasibility of digital pen and paper technology as a means to capture vital sign data in the context of acute care workflows and to make data available in a flow sheet in the electronic medical record. PMID:17238337

The feasibility of digital pen and paper technology for vital sign data capture in acute care settings.

PubMed

Dykes, Patricia C; Benoit, Angela; Chang, Frank; Gallagher, Joan; Li, Qi; Spurr, Cindy; McGrath, E Jan; Kilroy, Susan M; Prater, Marita

2006-01-01

The transition from paper to electronic documentation systems in acute care settings is often gradual and characterized by a period in which paper and electronic processes coexist. Intermediate technologies are needed to "bridge" the gap between paper and electronic systems as a means to improve work flow efficiency through data acquisition at the point of care in structured formats to inform decision support and facilitate reuse. The purpose of this paper is to report on the findings of a study conducted on three acute care units at Brigham and Women's Hospital and Massachusetts General Hospital in Boston, MA to evaluate the feasibility of digital pen and paper technology as a means to capture vital sign data in the context of acute care workflows and to make data available in a flow sheet in the electronic medical record.

5 CFR 1201.4 - General definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... documents associated with electronic filings under paragraph (h) of § 1201.14, on the MSPB. (l) Date of... date of electronic submission. (m) Electronic filing (e-filing). Filing and receiving documents in... of Personnel Management reconsideration decisions concerning retirement benefits, and appeals of...

5 CFR 1201.4 - General definitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... documents associated with electronic filings under paragraph (h) of § 1201.14, on the MSPB. (l) Date of... date of electronic submission. (m) Electronic filing (e-filing). Filing and receiving documents in... of Personnel Management reconsideration decisions concerning retirement benefits, and appeals of...

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...

An Internationally Consented Standard for Nursing Process-Clinical Decision Support Systems in Electronic Health Records.

PubMed

Müller-Staub, Maria; de Graaf-Waar, Helen; Paans, Wolter

2016-11-01

Nurses are accountable to apply the nursing process, which is key for patient care: It is a problem-solving process providing the structure for care plans and documentation. The state-of-the art nursing process is based on classifications that contain standardized concepts, and therefore, it is named Advanced Nursing Process. It contains valid assessments, nursing diagnoses, interventions, and nursing-sensitive patient outcomes. Electronic decision support systems can assist nurses to apply the Advanced Nursing Process. However, nursing decision support systems are missing, and no "gold standard" is available. The study aim is to develop a valid Nursing Process-Clinical Decision Support System Standard to guide future developments of clinical decision support systems. In a multistep approach, a Nursing Process-Clinical Decision Support System Standard with 28 criteria was developed. After pilot testing (N = 29 nurses), the criteria were reduced to 25. The Nursing Process-Clinical Decision Support System Standard was then presented to eight internationally known experts, who performed qualitative interviews according to Mayring. Fourteen categories demonstrate expert consensus on the Nursing Process-Clinical Decision Support System Standard and its content validity. All experts agreed the Advanced Nursing Process should be the centerpiece for the Nursing Process-Clinical Decision Support System and should suggest research-based, predefined nursing diagnoses and correct linkages between diagnoses, evidence-based interventions, and patient outcomes.

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...

Modeling of outpatient prescribing process in iran: a gateway toward electronic prescribing system.

PubMed

Ahmadi, Maryam; Samadbeik, Mahnaz; Sadoughi, Farahnaz

2014-01-01

Implementation of electronic prescribing system can overcome many problems of the paper prescribing system, and provide numerous opportunities of more effective and advantageous prescribing. Successful implementation of such a system requires complete and deep understanding of work content, human force, and workflow of paper prescribing. The current study was designed in order to model the current business process of outpatient prescribing in Iran and clarify different actions during this process. In order to describe the prescribing process and the system features in Iran, the methodology of business process modeling and analysis was used in the present study. The results of the process documentation were analyzed using a conceptual model of workflow elements and the technique of modeling "As-Is" business processes. Analysis of the current (as-is) prescribing process demonstrated that Iran stood at the first levels of sophistication in graduated levels of electronic prescribing, namely electronic prescription reference, and that there were problematic areas including bottlenecks, redundant and duplicated work, concentration of decision nodes, and communicative weaknesses among stakeholders of the process. Using information technology in some activities of medication prescription in Iran has not eliminated the dependence of the stakeholders on paper-based documents and prescriptions. Therefore, it is necessary to implement proper system programming in order to support change management and solve the problems in the existing prescribing process. To this end, a suitable basis should be provided for reorganization and improvement of the prescribing process for the future electronic systems.

Multimedia platform for authoring and presentation of clinical rounds in cardiology

NASA Astrophysics Data System (ADS)

Ratib, Osman M.; Allada, Vivekanand; Dahlbom, Magdalena; Lapstra, Lorelle

2003-05-01

We developed a multimedia presentation platform that allows retrieving data from any digital and analog modalities and to prepare a script of a clinical presentation in an XML format. This system was designed for cardiac multi-disciplinary conferences involving different cardiology specialists as well as cardiovascular surgeons. A typical presentation requires preparation of summary reports of data obtained from the different investigations and imaging techniques. An XML-based scripting methodology was developed to allow for preparation of clinical presentations. The image display program uses the generated script for the sequential presentation of different images that are displayed on pre-determined presentation settings. The ability to prepare and present clinical conferences electronically is more efficient and less time consuming than conventional settings using analog and digital documents, films and videotapes. The script of a given presentation can further be saved as part of the patient record for subsequent review of the documents and images that supported a given medical or therapeutic decision. This also constitutes a perfect documentation method for surgeons and physicians responsible of therapeutic procedures that were decided upon during the clinical conference. It allows them to review the relevant data that supported a given therapeutic decision.

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

PubMed

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

2017-01-01

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

Building Structured Personal Health Records from Photographs of Printed Medical Records.

PubMed

Li, Xiang; Hu, Gang; Teng, Xiaofei; Xie, Guotong

2015-01-01

Personal health records (PHRs) provide patient-centric healthcare by making health records accessible to patients. In China, it is very difficult for individuals to access electronic health records. Instead, individuals can easily obtain the printed copies of their own medical records, such as prescriptions and lab test reports, from hospitals. In this paper, we propose a practical approach to extract structured data from printed medical records photographed by mobile phones. An optical character recognition (OCR) pipeline is performed to recognize text in a document photo, which addresses the problems of low image quality and content complexity by image pre-processing and multiple OCR engine synthesis. A series of annotation algorithms that support flexible layouts are then used to identify the document type, entities of interest, and entity correlations, from which a structured PHR document is built. The proposed approach was applied to real world medical records to demonstrate the effectiveness and applicability.

Building Structured Personal Health Records from Photographs of Printed Medical Records

PubMed Central

Li, Xiang; Hu, Gang; Teng, Xiaofei; Xie, Guotong

2015-01-01

Personal health records (PHRs) provide patient-centric healthcare by making health records accessible to patients. In China, it is very difficult for individuals to access electronic health records. Instead, individuals can easily obtain the printed copies of their own medical records, such as prescriptions and lab test reports, from hospitals. In this paper, we propose a practical approach to extract structured data from printed medical records photographed by mobile phones. An optical character recognition (OCR) pipeline is performed to recognize text in a document photo, which addresses the problems of low image quality and content complexity by image pre-processing and multiple OCR engine synthesis. A series of annotation algorithms that support flexible layouts are then used to identify the document type, entities of interest, and entity correlations, from which a structured PHR document is built. The proposed approach was applied to real world medical records to demonstrate the effectiveness and applicability. PMID:26958219

The EHR-ARCHE project: satisfying clinical information needs in a Shared Electronic Health Record system based on IHE XDS and Archetypes.

PubMed

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

2013-12-01

While contributing to an improved continuity of care, Shared Electronic Health Record (EHR) systems may also lead to information overload of healthcare providers. Document-oriented architectures, such as the commonly employed IHE XDS profile, which only support information retrieval at the level of documents, are particularly susceptible for this problem. The objective of the EHR-ARCHE project was to develop a methodology and a prototype to efficiently satisfy healthcare providers' information needs when accessing a patient's Shared EHR during a treatment situation. We especially aimed to investigate whether this objective can be reached by integrating EHR Archetypes into an IHE XDS environment. Using methodical triangulation, we first analysed the information needs of healthcare providers, focusing on the treatment of diabetes patients as an exemplary application domain. We then designed ISO/EN 13606 Archetypes covering the identified information needs. To support a content-based search for fine-grained information items within EHR documents, we extended the IHE XDS environment with two additional actors. Finally, we conducted a formative and summative evaluation of our approach within a controlled study. We identified 446 frequently needed diabetes-specific information items, representing typical information needs of healthcare providers. We then created 128 Archetypes and 120 EHR documents for two fictive patients. All seven diabetes experts, who evaluated our approach, preferred the content-based search to a conventional XDS search. Success rates of finding relevant information was higher for the content-based search (100% versus 80%) and the latter was also more time-efficient (8-14min versus 20min or more). Our results show that for an efficient satisfaction of health care providers' information needs, a content-based search that rests upon the integration of Archetypes into an IHE XDS-based Shared EHR system is superior to a conventional metadata-based XDS search. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

The EHR-ARCHE project: Satisfying clinical information needs in a Shared Electronic Health Record System based on IHE XDS and Archetypes☆

PubMed Central

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

2013-01-01

Purpose While contributing to an improved continuity of care, Shared Electronic Health Record (EHR) systems may also lead to information overload of healthcare providers. Document-oriented architectures, such as the commonly employed IHE XDS profile, which only support information retrieval at the level of documents, are particularly susceptible for this problem. The objective of the EHR-ARCHE project was to develop a methodology and a prototype to efficiently satisfy healthcare providers’ information needs when accessing a patient's Shared EHR during a treatment situation. We especially aimed to investigate whether this objective can be reached by integrating EHR Archetypes into an IHE XDS environment. Methods Using methodical triangulation, we first analysed the information needs of healthcare providers, focusing on the treatment of diabetes patients as an exemplary application domain. We then designed ISO/EN 13606 Archetypes covering the identified information needs. To support a content-based search for fine-grained information items within EHR documents, we extended the IHE XDS environment with two additional actors. Finally, we conducted a formative and summative evaluation of our approach within a controlled study. Results We identified 446 frequently needed diabetes-specific information items, representing typical information needs of healthcare providers. We then created 128 Archetypes and 120 EHR documents for two fictive patients. All seven diabetes experts, who evaluated our approach, preferred the content-based search to a conventional XDS search. Success rates of finding relevant information was higher for the content-based search (100% versus 80%) and the latter was also more time-efficient (8–14 min versus 20 min or more). Conclusions Our results show that for an efficient satisfaction of health care providers’ information needs, a content-based search that rests upon the integration of Archetypes into an IHE XDS-based Shared EHR system is superior to a conventional metadata-based XDS search. PMID:23999002

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.

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.

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

Barriers, supports, and effective interventions for uptake of human papillomavirus- and other vaccines within global and Canadian Indigenous peoples: a systematic review protocol.

PubMed

Mrklas, Kelly J; MacDonald, Shannon; Shea-Budgell, Melissa A; Bedingfield, Nancy; Ganshorn, Heather; Glaze, Sarah; Bill, Lea; Healy, Bonnie; Healy, Chyloe; Guichon, Juliet; Colquhoun, Amy; Bell, Christopher; Richardson, Ruth; Henderson, Rita; Kellner, James; Barnabe, Cheryl; Bednarczyk, Robert A; Letendre, Angeline; Nelson, Gregg S

2018-03-02

Despite the existence of human papilloma virus (HPV) vaccines with demonstrated safety and effectiveness and funded HPV vaccination programs, coverage rates are persistently lower and cervical cancer burden higher among Canadian Indigenous peoples. Barriers and supports to HPV vaccination in Indigenous peoples have not been systematically documented, nor have interventions to increase uptake in this population. This protocol aims to appraise the literature in Canadian and global Indigenous peoples, relating to documented barriers and supports to vaccination and interventions to increase acceptability/uptake or reduce hesitancy of vaccination. Although HPV vaccination is the primary focus, we anticipate only a small number of relevant studies to emerge from the search and will, therefore, employ a broad search strategy to capture literature related to both HPV vaccination and vaccination in general in global Indigenous peoples. Eligible studies will include global Indigenous peoples and discuss barriers or supports and/or interventions to improve uptake or to reduce hesitancy, for the HPV vaccine and/or other vaccines. Primary outcomes are documented barriers or supports or interventions. All study designs meeting inclusion criteria will be considered, without restricting by language, location, or data type. We will use an a priori search strategy, comprised of key words and controlled vocabulary terms, developed in consultation with an academic librarian, and reviewed by a second academic librarian using the PRESS checklist. We will search several electronic databases from date of inception, without restrictions. A pre-defined group of global Indigenous websites will be reviewed for relevant gray literature. Bibliographic searches will be conducted for all included studies to identify relevant reviews. Data analysis will include an inductive, qualitative, thematic synthesis and a quantitative analysis of measured barriers and supports, as well as a descriptive synthesis and quantitative summary of measures for interventions. To our knowledge, this study will contribute the first systematic review of documented barriers, supports, and interventions for vaccination in general and for HPV vaccination. The results of this study are expected to inform future research, policies, programs, and community-driven initiatives to enhance acceptability and uptake of HPV vaccination among Indigenous peoples. PROSPERO Registration Number: CRD42017048844.

A Unified Electronic Tool for CPR and Emergency Treatment Escalation Plans Improves Communication and Early Collaborative Decision Making for Acute Hospital Admissions.

PubMed

Johnson, Mae; Whyte, Martin; Loveridge, Robert; Yorke, Richard; Naleem, Shairana

2017-01-01

The National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) report 'Time to Intervene' (2012) stated that in a substantial number of cases, resuscitation is attempted when it was thought a 'do not attempt cardiopulmonary resuscitation' (DNACPR) decision should have been in place. Early decisions about CPR status and advance planning about limits of care now form part of national recommendations by the UK Resuscitation Council (2016). Treatment escalation plans (TEP) document what level of treatment intervention would be appropriate if a patient were to become acutely unwell and were not previously formally in place at King's College Hospital. A unifying paper based form was successfully piloted in the Acute Medical Unit, introducing the TEP and bringing together decision making around both treatment escalation and CPR status. Subsequently an electronic order-set for CPR status and treatment escalation was launched in April 2015 which led to a highly visible CPR and escalation status banner on the main screen at the top of the patient's electronic record. Ultimately due to further iterations in the electronic process by December 2016, all escalation decisions for acutely admitted patients now have high quality supporting, explanatory documentation with 100% having TEPs in place. There is now widespread multidisciplinary engagement in the process of defining limits of care for acutely admitted medical patients within the first 14 hours of admission and a strategy for rolling this process out across all the divisions of the hospital through our Deteriorating Patient Group (DPG). The collaborative design with acute medical, palliative and intensive care teams and the high visibility provided by the electronic process in the Electronic Patient Record (EPR) has enhanced communication with these teams, patients, nursing staff and the multidisciplinary team by ensuring clarity through a universally understood process about escalation and CPR. Clarity and openness about these discussions have been welcomed by patient focus groups facilitated via our acute medicine patient experience committee. There has been a shift in medical culture where transparency about limits of care has contributed to improving patient safety and quality of care through reducing unnecessary CPR supported by focus groups of staff.

Endocrine disruptive estrogens role in electron transfer: bio-electrochemical remediation with microbial mediated electrogenesis.

PubMed

Kumar, A Kiran; Reddy, M Venkateswar; Chandrasekhar, K; Srikanth, S; Mohan, S Venkata

2012-01-01

Bioremediation of selected endocrine disrupting compounds (EDCs)/estrogens viz. estriol (E3) and ethynylestradiol (EE2) was evaluated in bio-electrochemical treatment (BET) system with simultaneous power generation. Estrogens supplementation along with wastewater documented enhanced electrogenic activity indicating their function in electron transfer between biocatalyst and anode as electron shuttler. EE2 addition showed more positive impact on the electrogenic activity compared to E3 supplementation. Higher estrogen concentration showed inhibitory effect on the BET performance. Poising potential during start up phase showed a marginal influence on the power output. The electrons generated during substrate degradation might have been utilized for the EDCs break down. Fuel cell behavior and anodic oxidation potential supported the observed electrogenic activity with the function of estrogens removal. Voltammetric profiles, dehydrogenase and phosphatase enzyme activities were also found to be in agreement with the power generation, electron discharge and estrogens removal. Copyright © 2011 Elsevier Ltd. All rights reserved.

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

PubMed

Kossman, Susan P; Scheidenhelm, Sandra L

2008-01-01

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

Physics and Engineering Design of the ITER Electron Cyclotron Emission Diagnostic

NASA Astrophysics Data System (ADS)

Rowan, W. L.; Austin, M. E.; Houshmandyar, S.; Phillips, P. E.; Beno, J. H.; Ouroua, A.; Weeks, D. A.; Hubbard, A. E.; Stillerman, J. A.; Feder, R. E.; Khodak, A.; Taylor, G.; Pandya, H. K.; Danani, S.; Kumar, R.

2015-11-01

Electron temperature (Te) measurements and consequent electron thermal transport inferences will be critical to the non-active phases of ITER operation and will take on added importance during the alpha heating phase. Here, we describe our design for the diagnostic that will measure spatial and temporal profiles of Te using electron cyclotron emission (ECE). Other measurement capability includes high frequency instabilities (e.g. ELMs, NTMs, and TAEs). Since results from TFTR and JET suggest that Thomson Scattering and ECE differ at high Te due to driven non-Maxwellian distributions, non-thermal features of the ITER electron distribution must be documented. The ITER environment presents other challenges including space limitations, vacuum requirements, and very high-neutron-fluence. Plasma control in ITER will require real-time Te. The diagnosic design that evolved from these sometimes-conflicting needs and requirements will be described component by component with special emphasis on the integration to form a single effective diagnostic system. Supported by PPPL/US-DA via subcontract S013464-C to UT Austin.

Space Station Furnace Facility. Experiment/Facility Requirements Document (E/FRD), volume 2, appendix 5

NASA Technical Reports Server (NTRS)

Kephart, Nancy

1992-01-01

The function of the Space Station Furnace Facility (SSFF) is to support materials research into the crystal growth and solidification processes of electronic and photonic materials, metals and alloys, and glasses and ceramics. To support this broad base of research requirements, the SSFF will employ a variety of furnace modules operated, regulated, and supported by a core of common subsystems. Furnace modules may be reconfigured or specifically developed to provide unique solidifcation conditions for each set of experiments. The SSFF modular approach permits the addition of new or scaled-up furnace modules to support the evolution of the facility as new science requirements are identified. The SSFF Core is of modular design to permit augmentation for enhanced capabilities. The fully integrated configuration of the SSFF will consist of three racks with the capability of supporting up to two furnace modules per rack. The initial configuration of the SSFF will consist of two of the three racks and one furnace module. This Experiment/Facility Requirements Document (E/FRD) describes the integrated facility requirements for the Space Station Freedom (SSF) Integrated Configuration-1 (IC1) mission. The IC1 SSFF will consist of two racks: the Core Rack, with the centralized subsystem equipment, and the Experiment Rack-1, with Furnace Module-1 and the distributed subsystem equipment to support the furnace.

Xyce parallel electronic simulator design.

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

Thornquist, Heidi K.; Rankin, Eric Lamont; Mei, Ting

2010-09-01

This document is the Xyce Circuit Simulator developer guide. Xyce has been designed from the 'ground up' to be a SPICE-compatible, distributed memory parallel circuit simulator. While it is in many respects a research code, Xyce is intended to be a production simulator. As such, having software quality engineering (SQE) procedures in place to insure a high level of code quality and robustness are essential. Version control, issue tracking customer support, C++ style guildlines and the Xyce release process are all described. The Xyce Parallel Electronic Simulator has been under development at Sandia since 1999. Historically, Xyce has mostly beenmore » funded by ASC, the original focus of Xyce development has primarily been related to circuits for nuclear weapons. However, this has not been the only focus and it is expected that the project will diversify. Like many ASC projects, Xyce is a group development effort, which involves a number of researchers, engineers, scientists, mathmaticians and computer scientists. In addition to diversity of background, it is to be expected on long term projects for there to be a certain amount of staff turnover, as people move on to different projects. As a result, it is very important that the project maintain high software quality standards. The point of this document is to formally document a number of the software quality practices followed by the Xyce team in one place. Also, it is hoped that this document will be a good source of information for new developers.« less

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…

Acquisition plan for Digital Document Storage (DDS) prototype system

NASA Technical Reports Server (NTRS)

1990-01-01

NASA Headquarters maintains a continuing interest in and commitment to exploring the use of new technology to support productivity improvements in meeting service requirements tasked to the NASA Scientific and Technical Information (STI) Facility, and to support cost effective approaches to the development and delivery of enhanced levels of service provided by the STI Facility. The DDS project has been pursued with this interest and commitment in mind. It is believed that DDS will provide improved archival blowback quality and service for ad hoc requests for paper copies of documents archived and serviced centrally at the STI Facility. It will also develop an operating capability to scan, digitize, store, and reproduce paper copies of 5000 NASA technical reports archived annually at the STI Facility and serviced to the user community. Additionally, it will provide NASA Headquarters and field installations with on-demand, remote, electronic retrieval of digitized, bilevel, bit mapped report images along with branched, nonsequential retrieval of report subparts.

Are electronic medical records helpful for care coordination? Experiences of physician practices.

PubMed

O'Malley, Ann S; Grossman, Joy M; Cohen, Genna R; Kemper, Nicole M; Pham, Hoangmai H

2010-03-01

Policies promoting widespread adoption of electronic medical records (EMRs) are premised on the hope that they can improve the coordination of care. Yet little is known about whether and how physician practices use current EMRs to facilitate coordination. We examine whether and how practices use commercial EMRs to support coordination tasks and identify work-around practices have created to address new coordination challenges. Semi-structured telephone interviews in 12 randomly selected communities. Sixty respondents, including 52 physicians or staff from 26 practices with commercial ambulatory care EMRs in place for at least 2 years, chief medical officers at four EMR vendors, and four national thought leaders. Six major themes emerged: (1) EMRs facilitate within-office care coordination, chiefly by providing access to data during patient encounters and through electronic messaging; (2) EMRs are less able to support coordination between clinicians and settings, in part due to their design and a lack of standardization of key data elements required for information exchange; (3) managing information overflow from EMRs is a challenge for clinicians; (4) clinicians believe current EMRs cannot adequately capture the medical decision-making process and future care plans to support coordination; (5) realizing EMRs' potential for facilitating coordination requires evolution of practice operational processes; (6) current fee-for-service reimbursement encourages EMR use for documentation of billable events (office visits, procedures) and not of care coordination (which is not a billable activity). There is a gap between policy-makers' expectation of, and clinical practitioners' experience with, current electronic medical records' ability to support coordination of care. Policymakers could expand current health information technology policies to support assessment of how well the technology facilitates tasks necessary for coordination. By reforming payment policy to include care coordination, policymakers could encourage the evolution of EMR technology to include capabilities that support coordination, for example, allowing for inter-practice data exchange and multi-provider clinical decision support.

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.

Data Management System

NASA Technical Reports Server (NTRS)

1997-01-01

CENTRA 2000 Inc., a wholly owned subsidiary of Auto-trol technology, obtained permission to use software originally developed at Johnson Space Center for the Space Shuttle and early Space Station projects. To support their enormous information-handling needs, a product data management, electronic document management and work-flow system was designed. Initially, just 33 database tables comprised the original software, which was later expanded to about 100 tables. This system, now called CENTRA 2000, is designed for quick implementation and supports the engineering process from preliminary design through release-to-production. CENTRA 2000 can also handle audit histories and provides a means to ensure new information is distributed. The product has 30 production sites worldwide.

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.

Nanomechanics of Actively Controlled Deployable Optics

NASA Technical Reports Server (NTRS)

Peterson, Lee D.

2000-01-01

This document is the interim, annual report for the research grant entitled "Nanomechanics of Actively Controlled Deployed Optics." It is supported by NASA Langley Research Center Cooperative Agreement NCC-1 -281. Dr. Mark S. Lake is the technical monitor of the research program. This document reports activities for the year 1998, beginning 3/11/1998, and for the year 1999. The objective of this report is to summarize the results and the status of this research. This summary appears in Section 2.0. Complete details of the results of this research have been reported in several papers, publications and theses. Section 3.0 lists these publications and, when available, presents their abstracts. Each publication is available in electronic form from a web site identified in Section 3.0.

A Closed-Cycle Optical Cryostat and Improved Optical Elements for Studies of Dissipation at the Molecular Scale

DTIC Science & Technology

2016-02-05

diode laser, Raman spectroscopy REPORT DOCUMENTATION PAGE 11. SPONSOR/MONITOR’S REPORT NUMBER(S) 10. SPONSOR/MONITOR’S ACRONYM(S) ARO 8...this project supported the acquisition of a closed-cycle optical cryostat from Montana Instruments, as well as a new 785 nm diode laser and ultrahigh...planned experiments on inelastic electron tunneling spectroscopy that require TɝK for optimal resolution. Additionally, the spatial position of

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.

75 FR 75705 - Notice of Availability of the Models for Plant-Specific Adoption of Technical Specifications Task...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-06

..., Rockville, Maryland. NRC's Agencywide Documents Access and Management System (ADAMS): Publicly available documents created or received at the NRC are available electronically at the NRC's Electronic Reading Room... Specifications End States (BAW- 2441).'' TSTF-431, Revision 3, is available in the Agencywide Documents Access...

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)

5 CFR 1201.4 - General definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... commercial or personal delivery, or by electronic filing (e-filing) in accordance with § 1201.14. (j) Date of... the document was delivered to the commercial delivery service. The date of filing by e-filing is the date of electronic submission. (m) Electronic filing (e-filing). Filing and receiving documents in...

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.

Technical Assistance for the Conservation of Built Heritage at Bagan, Myanmar

NASA Astrophysics Data System (ADS)

Mezzino, D.; Santana Quintero, M.; Ma Pwint, P.; Tin Htut Latt, W.; Rellensmann, C.

2016-06-01

Presenting the outcomes of a capacity building activity, this contribution illustrates a replicable recording methodology to obtain timely, relevant and accurate information about conditions, materials and transformations of heritage structures. The purpose of the presented training activity consisted in developing local capabilities for the documentation of the built heritage at Bagan, Myanmar, employing different IT-supported techniques. Under the Director of UNESCO, the direct supervision of the chief of the culture unit, and in close consultation and cooperation with the Association of Myanmar Architects, the Department of Archaeology National Museum and Library (DoA) a documentation strategy has been developed in order to set up a recording methodology for the over three thousand Bagan monuments. The site, located in central Myanmar, in South East Asia, was developed between the IX and the XIII century as capital of the Myanmar kingdom. In the last years, this outstanding site has been exposed to an increasing number of natural hazards including earthquakes and flooding that strongly affected its built structures. Therefore, a documentation strategy to quickly capture shape, color, geometry and conditions of the monuments, in order to develop proper conservation projects, was needed. The scope of the training activity consisted in setting up a recording strategy updating the existing Bagan inventory, using three Buddhist temples as pilot cases study. The three documented temples were different in size, construction period, conditions and shape. The documentation included several IT-supported techniques including: Electronic Distance Measurements (EDM), SFM Photogrammetry, Laser Scanning, Record Photography as well as hand measurement and field notes. The monuments' surveying has been developed in accordance with the guidelines and standards established by the ICOMOS International Committee for Documentation of Cultural Heritage (CIPA). Recommendations on how to extend the adopted methodology to the other Bagan monuments have been also elaborated.

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...

Making sense of complex electronic records: socio-technical design in social care.

PubMed

Wastell, David; White, Sue

2014-03-01

Dealing with complex electronic documentation is an integral part of much contemporary professional work. In this paper, we address the design of electronic records for social care professionals in the UK. Recent reforms in UK child welfare have followed a top-down, managerial approach emphasizing conformance to standard processes. The vicissitudes of a major national IT project, the Integrated Children's System, show the limitations of this approach, in particular the detrimental effect it has had on professional autonomy. Following in the foot-steps of Ken Eason, we argue that socio-technical design, by focussing on innovative applications of technology to support users (rather than the interests of the bureaucracy) offers a more promising alternative. A user-centred design exercise is presented to illustrate this approach in action. A novel interface was developed for handling the heterogeneous bundle of documents which make up the social care record, helping social workers make better sense of case-files. The prototype draws on the metaphor of the dining-room table as a way of overcoming the limitations of the computer display. We conclude that socio-technical thinking engenders a shift in mind-set, opening up a radically different design space compared to current design orthodoxy. Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.

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] .

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...

Cooperative problem solving with personal mobile information tools in hospitals.

PubMed

Buchauer, A; Werner, R; Haux, R

1998-01-01

Health-care professionals have a broad range of needs for information and cooperation while working at different points of care (e.g., outpatient departments, wards, and functional units such as operating theaters). Patient-related data and medical knowledge have to be widely available to support high-quality patient care. Furthermore, due to the increased specialization of health-care professionals, efficient collaboration is required. Personal mobile information tools have a considerable potential to realize almost ubiquitous information and collaborative support. They enable to unite the functionality of conventional tools such as paper forms, dictating machines, and pagers into one tool. Moreover, they can extend the support already provided by clinical workstations. An approach is described for the integration of mobile information tools with heterogeneous hospital information systems. This approach includes identification of functions which should be provided on mobile tools. Major functions are the presentation of medical records and reports, electronic mailing to support interpersonal communication, and the provision of editors for structured clinical documentation. To realize those functions on mobile tools, we propose a document-based client-server architecture that enables mobile information tools to interoperate with existing computer-based application systems. Open application systems and powerful, partially wireless, hospital-wide networks are the prerequisites for the introduction of mobile information tools.

The structure and dynamics of interactive documents

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

Rocha, J.T.

1999-04-01

Advances in information technology continue to accelerate as the new millennium approaches. With these advances, electronic information management is becoming increasingly important and is now supported by a seemingly bewildering array of hardware and software whose sole purpose is the design and implementation of interactive documents employing multimedia applications. Multimedia memory and storage applications such as Compact Disk-Read Only Memory (CD-ROMs) are already a familiar interactive tool in both the entertainment and business sectors. Even home enthusiasts now have the means at their disposal to design and produce CD-ROMs. More recently, Digital Video Disk (DVD) technology is carving its ownmore » niche in these markets and may (once application bugs are corrected and prices are lowered) eventually supplant CD-ROM technology. CD-ROM and DVD are not the only memory and storage applications capable of supporting interactive media. External, high-capacity drives and disks such as the Iomega{copyright} zip{reg_sign} and jaz{reg_sign} are also useful platforms for launching interactive documents without the need for additional hardware such as CD-ROM burners and copiers. The main drawback here, however, is the relatively high unit price per disk when compared to the unit cost of CD-ROMs. Regardless of the application chosen, there are fundamental structural characteristics that must be considered before effective interactive documents can be created. Additionally, the dynamics of interactive documents employing hypertext links are unique and bear only slight resemblance to those of their traditional hard-copy counterparts. These two considerations form the essential content of this paper.« less

Lesson 5: Overview of CROMERR Requirements for Electronic Reporting

EPA Pesticide Factsheets

The purpose of the CROMERR requirements is to ensure that authorized programs that receive electronic documents in lieu of paper can rely on those documents for purposes of enforcement-related litigation.

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.

HEPA Filter Disposal Write-Up 10/19/16

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

Loll, C.

Process knowledge (PK) collection on HEPA filters is handled via the same process as other waste streams at LLNL. The Field technician or Characterization point of contact creates an information gathering document (IGD) in the IGD database, with input provided from the generator, and submits it for electronic approval. This document is essentially a waste generation profile, detailing the physical, chemical as well as radiological characteristics, and hazards, of a waste stream. It will typically contain a general, but sometimes detailed, description of the work processes which generated the waste. It will contain PK as well as radiological and industrialmore » hygiene analytical swipe results, and any other analytical or other supporting knowledge related to characterization. The IGD goes through an electronic approval process to formalize the characterization and to ensure the waste has an appropriate disposal path. The waste generator is responsible for providing initial process knowledge information, and approves the IGD before it routed to chemical and radiological waste characterization professionals. This is the standard characterization process for LLNL-generated HEPA Filters.« less

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…

77 FR 35691 - Update to Electronic Common Technical Document Module 1

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-14

... Electronic Common Technical Document (eCTD) Module 1, which is used for electronic submission of... they are received with a limit of 350. SUPPLEMENTARY INFORMATION: The eCTD is an International... Research (CBER) have been receiving submissions in the eCTD format since 2003, and the eCTD has been the...

A European inventory of common electronic health record data elements for clinical trial feasibility

PubMed Central

2014-01-01

Background Clinical studies are a necessity for new medications and therapies. Many studies, however, struggle to meet their recruitment numbers in time or have problems in meeting them at all. With increasing numbers of electronic health records (EHRs) in hospitals, huge databanks emerge that could be utilized to support research. The Innovative Medicine Initiative (IMI) funded project ‘Electronic Health Records for Clinical Research’ (EHR4CR) created a standardized and homogenous inventory of data elements to support research by utilizing EHRs. Our aim was to develop a Data Inventory that contains elements required for site feasibility analysis. Methods The Data Inventory was created in an iterative, consensus driven approach, by a group of up to 30 people consisting of pharmaceutical experts and informatics specialists. An initial list was subsequently expanded by data elements of simplified eligibility criteria from clinical trial protocols. Each element was manually reviewed by pharmaceutical experts and standard definitions were identified and added. To verify their availability, data exports of the source systems at eleven university hospitals throughout Europe were conducted and evaluated. Results The Data Inventory consists of 75 data elements that, on the one hand are frequently used in clinical studies, and on the other hand are available in European EHR systems. Rankings of data elements were created from the results of the data exports. In addition a sub-list was created with 21 data elements that were separated from the Data Inventory because of their low usage in routine documentation. Conclusion The data elements in the Data Inventory were identified with the knowledge of domain experts from pharmaceutical companies. Currently, not all information that is frequently used in site feasibility is documented in routine patient care. PMID:24410735

'Who's actually gonna read this?' An evaluation of staff experiences of the value of information contained in written care plans in supporting care in three different dementia care settings.

PubMed

Drummond, C; Simpson, A

2017-08-01

WHAT IS KNOWN ON THE SUBJECT?: A written plan is designed to improve communication and co-ordinate care between mental health inpatient wards and community settings. Reports of care plan quality issues and staff and service user dissatisfaction with healthcare bureaucracy have focused on working age mental health or general hospital settings. Little is known about mental health staff perspectives on the value of written care plans in supporting dementia care. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Competing demands on staff time and resources to meet administrative standards for care plans caused a tension with their own professional priorities for supporting care. Mental health staff face difficulties using electronic records alongside other systems of information sharing. Further exploration is needed of the gap between frontline staff values and those of the local organization and managers when supporting good dementia care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Frontline staff should be involved in designing new information systems including care plans. Care plan documentation needs to be refocused to ensure it is effective in enabling staff to communicate amongst themselves and with others to support people with dementia. Practice-based mentors could be deployed to strengthen good practice in effective information sharing. Background Reports of increased healthcare bureaucracy and concerns over care plan quality have emerged from research and surveys into staff and service user experiences. Little is known of mental health staff perspectives on the value of written care plans in supporting dementia care. Aim To investigate the experiences and views of staff in relation to care planning in dementia services in one National Health Service (NHS) provider Trust in England. Method Grounded Theory methodology was used. A purposive sample of 11 multidisciplinary staff were interviewed across three sites in one NHS Trust. Interviews were transcribed, coded and analysed using the constant comparative method. Findings Five themes were identified and are explored in detail below: (1) Repetition; (2) the impact of electronic records on practice; (3) ambivalence about the value of paperwork; (4) time conflicts; and (5) alternative sources of information to plan care. Discussion Participants perceived that written care plans did not help staff with good practice in planning care or to support dementia care generally. Staff were frustrated by repetitive documentation, inflexible electronic records and conflicting demands on their time. Implications for practice Frontline staff should be involved in designing new information systems including care plans. © 2017 John Wiley & Sons Ltd.

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"

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 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.

Avionics Systems Laboratory/Building 16. Historical Documentation

NASA Technical Reports Server (NTRS)

Slovinac, Patricia; Deming, Joan

2011-01-01

As part of this nation-wide study, in September 2006, historical survey and evaluation of NASA-owned and managed facilities that was conducted by NASA s Lyndon B. Johnson Space Center (JSC) in Houston, Texas. The results of this study are presented in a report entitled, "Survey and Evaluation of NASA-owned Historic Facilities and Properties in the Context of the U.S. Space Shuttle Program, Lyndon B. Johnson Space Center, Houston, Texas," prepared in November 2007 by NASA JSC s contractor, Archaeological Consultants, Inc. As a result of this survey, the Avionics Systems Laboratory (Building 16) was determined eligible for listing in the NRHP, with concurrence by the Texas State Historic Preservation Officer (SHPO). The survey concluded that Building 5 is eligible for the NRHP under Criteria A and C in the context of the U.S. Space Shuttle program (1969-2010). Because it has achieved significance within the past 50 years, Criteria Consideration G applies. At the time of this documentation, Building 16 was still used to support the SSP as an engineering research facility, which is also sometimes used for astronaut training. This documentation package precedes any undertaking as defined by Section 106 of the NHPA, as amended, and implemented in 36 CFR Part 800, as NASA JSC has decided to proactively pursue efforts to mitigate the potential adverse affects of any future modifications to the facility. It includes a historical summary of the Space Shuttle program; the history of JSC in relation to the SSP; a narrative of the history of Building 16 and how it supported the SSP; and a physical description of the structure. In addition, photographs documenting the construction and historical use of Building 16 in support of the SSP, as well as photographs of the facility documenting the existing conditions, special technological features, and engineering details, are included. A contact sheet printed on archival paper, and an electronic copy of the work product on CD, are also provided

Communications and Tracking Development Laboratory/Building 44. Historical Documentation

NASA Technical Reports Server (NTRS)

Slovinac, Patricia

2011-01-01

As part of this nation-wide study, in September 2006, historical survey and evaluation of NASA-owned and managed facilities was conducted by NASA's Lyndon B. Johnson Space Center (JSC) in Houston, Texas. The results of this study are presented in a report entitled, Survey and Evaluation of NASA-owned Historic Facilities and Properties in the Context of the U.S. Space Shuttle Program, Lyndon B. Johnson Space Center, Houston, Texas, prepared in November 2007 by NASA JSC s contractor, Archaeological Consultants, Inc. As a result of this survey, the Communications and Tracking Development Laboratory (Building 44) was determined eligible for listing in the NRHP, with concurrence by the Texas State Historic Preservation Officer (SHPO). The survey concluded that Building 44 is eligible for the NRHP under Criteria A and C in the context of the U.S. Space Shuttle Program (1969-2010). Because it has achieved significance within the past 50 years, Criteria Consideration G applies. At the time of this documentation, Building 44 was still used to support the SSP as an engineering research facility, which is also sometimes used for astronaut training. This documentation package precedes any undertaking as defined by Section 106 of the NHPA, as amended, and implemented by 36 CFR Part 800, as NASA JSC has decided to proactively pursue efforts to mitigate the potential adverse affects of any future modifications to the facility. It includes a historical summary of the Space Shuttle Program; the history of JSC in relation to the SSP; a narrative of the history of Building 44 and how it supported the SSP; and a physical description of the building. In addition, photographs documenting the construction and historical use of Building 44 in support of the SSP, as well as photographs of the facility documenting the existing conditions, special technological features, and engineering details, are included. A contact sheet printed on archival paper, and an electronic copy of the work product on CD, are also provided.

Model Development for EHR Interdisciplinary Information Exchange of ICU Common Goals

PubMed Central

Collins, Sarah A.; Bakken, Suzanne; Vawdrey, David K.; Coiera, Enrico; Currie, Leanne

2010-01-01

Purpose Effective interdisciplinary exchange of patient information is an essential component of safe, efficient, and patient–centered care in the intensive care unit (ICU). Frequent handoffs of patient care, high acuity of patient illness, and the increasing amount of available data complicate information exchange. Verbal communication can be affected by interruptions and time limitations. To supplement verbal communication, many ICUs rely on documentation in electronic health records (EHRs) to reduce errors of omission and information loss. The purpose of this study was to develop a model of EHR interdisciplinary information exchange of ICU common goals. Methods The theoretical frameworks of distributed cognition and the clinical communication space were integrated and a previously published categorization of verbal information exchange was used. 59.5 hours of interdisciplinary rounds in a Neurovascular ICU were observed and five interviews and one focus group with ICU nurses and physicians were conducted. Results Current documentation tools in the ICU were not sufficient to capture the nurses' and physicians' collaborative decision-making and verbal communication of goal-directed actions and interactions. Clinicians perceived the EHR to be inefficient for information retrieval, leading to a further reliance on verbal information exchange. Conclusion The model suggests that EHRs should support: 1) Information tools for the explicit documentation of goals, interventions, and assessments with synthesized and summarized information outputs of events and updates; and 2) Messaging tools that support collaborative decision-making and patient safety double checks that currently occur between nurses and physicians in the absence of EHR support. PMID:20974549

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.

Process and implementation of participatory ergonomic interventions: a systematic review.

PubMed

van Eerd, Dwayne; Cole, Donald; Irvin, Emma; Mahood, Quenby; Keown, Kiera; Theberge, Nancy; Village, Judy; St Vincent, Marie; Cullen, Kim

2010-10-01

Participatory ergonomic (PE) interventions may vary in implementation. A systematic review was done to determine the evidence regarding context, barriers and facilitators to the implementation of participatory ergonomic interventions in workplaces. In total, 17 electronic databases were searched. Data on PE process and implementation were extracted from documents meeting content and quality criteria and synthesised. The search yielded 2151 references. Of these, 190 documents were relevant and 52 met content and quality criteria. Different ergonomic teams were described in the documents as were the type, duration and content of ergonomic training. PE interventions tended to focus on physical and work process changes and report positive impacts. Resources, programme support, ergonomic training, organisational training and communication were the most often noted facilitators or barriers. Successful PE interventions require the right people to be involved, appropriate ergonomic training and clear responsibilities. Addressing key facilitators and barriers such as programme support, resources, and communication is paramount. STATEMENT OF RELEVANCE: A recent systematic review has suggested that PE has some effect on reducing symptoms, lost days of work and claims. Systematic reviews of effectiveness provide practitioners with the desire to implement but do not provide clear information about how. This article reviews the literature on process and implementation of PE.

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.

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.

The use of electronic health records in Spanish hospitals.

PubMed

Marca, Guillem; Perez, Angel; Blanco-Garcia, Martin German; Miravalles, Elena; Soley, Pere; Ortiga, Berta

The aims of this study were to describe the level of adoption of electronic health records in Spanish hospitals and to identify potential barriers and facilitators to this process. We used an observational cross-sectional design. The survey was conducted between September and December 2011, using an electronic questionnaire distributed through email. We obtained a 30% response rate from the 214 hospitals contacted, all belonging to the Spanish National Health Service. The level of adoption of electronic health records in Spanish hospitals was found to be high: 39.1% of hospitals surveyed had a comprehensive EHR system while a basic system was functioning in 32.8% of the cases. However, in 2011 one third of the hospitals did not have a basic electronic health record system, although some have since implemented electronic functionalities, particularly those related to clinical documentation and patient administration. Respondents cited the acquisition and implementation costs as the main barriers to implementation. Facilitators for EHR implementation were: the possibility to hire technical support, both during and post implementation; security certification warranty; and objective third-party evaluations of EHR products. In conclusion, the number of hospitals that have electronic health records is in general high, being relatively higher in medium-sized hospitals.

Guideline for Performing Systematic Approach to Evaluate and Qualify Legacy Documents that Support Advanced Reactor Technology Activity

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

Honma, George

The establishment of a systematic process for the evaluation of historic technology information for use in advanced reactor licensing is described. Efforts are underway to recover and preserve Experimental Breeder Reactor II and Fast Flux Test Facility historical data. These efforts have generally emphasized preserving information from data-acquisition systems and hard-copy reports and entering it into modern electronic formats suitable for data retrieval and examination. The guidance contained in this document has been developed to facilitate consistent and systematic evaluation processes relating to quality attributes of historic technical information (with focus on sodium-cooled fast reactor (SFR) technology) that will bemore » used to eventually support licensing of advanced reactor designs. The historical information may include, but is not limited to, design documents for SFRs, research-and-development (R&D) data and associated documents, test plans and associated protocols, operations and test data, international research data, technical reports, and information associated with past U.S. Nuclear Regulatory Commission (NRC) reviews of SFR designs. The evaluation process is prescribed in terms of SFR technology, but the process can be used to evaluate historical information for any type of advanced reactor technology. An appendix provides a discussion of typical issues that should be considered when evaluating and qualifying historical information for advanced reactor technology fuel and source terms, based on current light water reactor (LWR) requirements and recent experience gained from Next Generation Nuclear Plant (NGNP).« less

Taming Big Data: An Information Extraction Strategy for Large Clinical Text Corpora.

PubMed

Gundlapalli, Adi V; Divita, Guy; Carter, Marjorie E; Redd, Andrew; Samore, Matthew H; Gupta, Kalpana; Trautner, Barbara

2015-01-01

Concepts of interest for clinical and research purposes are not uniformly distributed in clinical text available in electronic medical records. The purpose of our study was to identify filtering techniques to select 'high yield' documents for increased efficacy and throughput. Using two large corpora of clinical text, we demonstrate the identification of 'high yield' document sets in two unrelated domains: homelessness and indwelling urinary catheters. For homelessness, the high yield set includes homeless program and social work notes. For urinary catheters, concepts were more prevalent in notes from hospitalized patients; nursing notes accounted for a majority of the high yield set. This filtering will enable customization and refining of information extraction pipelines to facilitate extraction of relevant concepts for clinical decision support and other uses.

Impact of electronic health record clinical decision support on the management of pediatric obesity.

PubMed

Shaikh, Ulfat; Berrong, Jeanette; Nettiksimmons, Jasmine; Byrd, Robert S

2015-01-01

Clinicians vary significantly in their adherence to clinical guidelines for overweight/obesity. This study assessed the impact of electronic health record-based clinical decision support in improving the diagnosis and management of pediatric obesity. The study team programmed a point-of-care alert linked to a checklist and standardized documentation templates to appear during health maintenance visits for overweight/obese children in an outpatient teaching clinic and compared outcomes through medical record reviews of 574 (287 control and 287 intervention) visits. The results demonstrated a statistically significant increase in the diagnosis of overweight/obesity, scheduling of follow-up appointments, frequency of ordering recommended laboratory investigations, and assessment and counseling for nutrition and physical activity. Although clinical guideline adherence increased significantly, it was far from universal. It is unknown if modest improvements in adherence to clinical guidelines translate to improvements in children's health. However, this intervention was relatively easy to implement and produced measurable improvements in health care delivery. © 2014 by the American College of Medical Quality.

Worldwide telemedicine services based on distributed multimedia electronic patient records by using the second generation Web server hyperwave.

PubMed

Quade, G; Novotny, J; Burde, B; May, F; Beck, L E; Goldschmidt, A

1999-01-01

A distributed multimedia electronic patient record (EPR) is a central component of a medicine-telematics application that supports physicians working in rural areas of South America, and offers medical services to scientists in Antarctica. A Hyperwave server is used to maintain the patient record. As opposed to common web servers--and as a second generation web server--Hyperwave provides the capability of holding documents in a distributed web space without the problem of broken links. This enables physicians to browse through a patient's record by using a standard browser even if the patient's record is distributed over several servers. The patient record is basically implemented on the "Good European Health Record" (GEHR) architecture.

Electronic Preprints

NASA Astrophysics Data System (ADS)

Hanisch, R.

1999-12-01

Despite the tremendous advances in electronic publications and the increasing rapidity with which papers are now moving from acceptance into ``print,'' preprints continue to be an important mode of communication within the astronomy community. The Los Alamos e-preprint service, astro-ph, provides for rapid and cost-free (to authors and readers) dissemination of manuscripts. As the use of astro-ph has increased the number of paper preprints in circulation to libraries has decreased, and institutional preprint series appear to be waning. It is unfortunate, however, that astro-ph does not function in collaboration with the refereed publications. For example, there is no systematic tracking of manuscripts from preprint to their final, published form, and as a centralized archive it is difficult to distribute the tracking and maintenance functions. It retains documents that have been superseded or have become obsolete. We are currently developing a distributed preprint and document management system which can support both distributed collections of preprints (e.g., traditional institutional preprint series), can link to the LANL collections, can index other documents in the ``grey'' literature (observatory reports, telescope and instrument user's manuals, calls for proposals, etc.), and can function as a manuscript submission tool for the refereed journals. This system is being developed to work cooperatively with the refereed literature so that, for example, links to preprints are updated to links to the final published papers.

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

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...

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

PubMed Central

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

2010-01-01

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

Quality and Certification of Electronic Health Records

PubMed Central

Hoerbst, A.; Ammenwerth, E.

2010-01-01

Background Numerous projects, initiatives, and programs are dedicated to the development of Electronic Health Records (EHR) worldwide. Increasingly more of these plans have recently been brought from a scientific environment to real life applications. In this context, quality is a crucial factor with regard to the acceptance and utility of Electronic Health Records. However, the dissemination of the existing quality approaches is often rather limited. Objectives The present paper aims at the description and comparison of the current major quality certification approaches to EHRs. Methods A literature analysis was carried out in order to identify the relevant publications with regard to EHR quality certification. PubMed, ACM Digital Library, IEEExplore, CiteSeer, and Google (Scholar) were used to collect relevant sources. The documents that were obtained were analyzed using techniques of qualitative content analysis. Results The analysis discusses and compares the quality approaches of CCHIT, EuroRec, IHE, openEHR, and EN13606. These approaches differ with regard to their focus, support of service-oriented EHRs, process of (re-)certification and testing, number of systems certified and tested, supporting organizations, and regional relevance. Discussion The analyzed approaches show differences with regard to their structure and processes. System vendors can exploit these approaches in order to improve and certify their information systems. Health care organizations can use these approaches to support selection processes or to assess the quality of their own information systems. PMID:23616834

Evaluating computer capabilities in a primary care practice-based research network.

PubMed

Ariza, Adolfo J; Binns, Helen J; Christoffel, Katherine Kaufer

2004-01-01

We wanted to assess computer capabilities in a primary care practice-based research network and to understand how receptive the practices were to new ideas for automation of practice activities and research. This study was conducted among members of the Pediatric Practice Research Group (PPRG). A survey to assess computer capabilities was developed to explore hardware types, software programs, Internet connectivity and data transmission; views on privacy and security; and receptivity to future electronic data collection approaches. Of the 40 PPRG practices participating in the study during the autumn of 2001, all used IBM-compatible systems. Of these, 45% used stand-alone desktops, 40% had networked desktops, and approximately 15% used laptops and minicomputers. A variety of software packages were used, with most practices (82%) having software for some aspect of patient care documentation, patient accounting (90%), business support (60%), and management reports and analysis (97%). The main obstacles to expanding use of computers in patient care were insufficient staff training (63%) and privacy concerns (82%). If provided with training and support, most practices indicated they were willing to consider an array of electronic data collection options for practice-based research activities. There is wide variability in hardware and software use in the pediatric practice setting. Implementing electronic data collection in the PPRG would require a substantial start-up effort and ongoing training and support at the practice site.

Localized Electron Heating by Strong Guide-Field Magnetic Reconnection

NASA Astrophysics Data System (ADS)

Guo, Xuehan; Sugawara, Takumichi; Inomoto, Michiaki; Yamasaki, Kotaro; Ono, Yasushi; UTST Team

2015-11-01

Localized electron heating of magnetic reconnection was studied under strong guide-field (typically Bt 15Bp) using two merging spherical tokamak plasmas in Univ. Tokyo Spherical Tokamak (UTST) experiment. Our new slide-type two-dimensional Thomson scattering system documented for the first time the electron heating localized around the X-point. The region of high electron temperature, which is perpendicular to the magnetic field, was found to have a round shape with radius of 2 [cm]. Also, it was localized around the X-point and does not agree with that of energy dissipation term Et .jt . When we include a guide-field effect term Bt / (Bp + αBt) for Et .jt where α =√{ (vin2 +vout2) /v∥2 } , the energy dissipation area becomes localized around the X-point, suggesting that the electrons are accelerated by the reconnection electric field parallel to the magnetic field and thermalized around the X-point. This work was supported by JSPS A3 Foresight Program ``Innovative Tokamak Plasma Startup and Current Drive in Spherical Torus,'' a Grant-in-Aid from the Japan Society for the Promotion of Science (JSPS) Fellows 15J03758.

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.

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.

Experiment/facility requirements document for the Space Station Furnace Facility. Section 1: Integrated configuration

NASA Astrophysics Data System (ADS)

1992-05-01

The function of the Space Station Furnace Facility (SSFF) is to support materials research into the crystal growth and solidification processes of electronic and photonic materials, metals and alloys, and glasses and ceramics. To support this broad base of research requirements, the SSFF will employ a variety of furnace modules which will be operated, regulated, and supported by a core of common subsystems. Furnace modules may be reconfigured or specifically developed to provide unique solidification conditions for each set of experiments. The SSFF modular approach permits the addition of new or scaled-up furnace modules to support the evolution of the facility as new science requirements are identified. The SSFF Core is of modular design to permit augmentation for enhanced capabilities. The fully integrated configuration of the SSFF will consist of three racks with the capability of supporting up to two furnace modules per rack. The initial configuration of the SSFF will consist of two of the three racks and one furnace module. This Experiment/Facility Requirements Document (E/FRD) describes the integrated facility requirements for the Space Station Freedom (SSF) Integrated Configuration-1 (IC1) mission. The IC1 SSFF will consist of two racks: the Core Rack, with the centralized subsystem equipment; and the Experiment Rack-1, with Furnace Module-1 and the distributed subsystem equipment to support the furnace. The SSFF support functions are provided by the following Core subsystems: power conditioning and distribution subsystem (SSFF PCDS); data management subsystem (SSFF DMS); thermal control Subsystem (SSFF TCS); gas distribution subsystem (SSFF GDS); and mechanical structures subsystem (SSFF MSS).

Experiment/facility requirements document for the Space Station Furnace Facility. Section 1: Integrated configuration

NASA Technical Reports Server (NTRS)

1992-01-01

The function of the Space Station Furnace Facility (SSFF) is to support materials research into the crystal growth and solidification processes of electronic and photonic materials, metals and alloys, and glasses and ceramics. To support this broad base of research requirements, the SSFF will employ a variety of furnace modules which will be operated, regulated, and supported by a core of common subsystems. Furnace modules may be reconfigured or specifically developed to provide unique solidification conditions for each set of experiments. The SSFF modular approach permits the addition of new or scaled-up furnace modules to support the evolution of the facility as new science requirements are identified. The SSFF Core is of modular design to permit augmentation for enhanced capabilities. The fully integrated configuration of the SSFF will consist of three racks with the capability of supporting up to two furnace modules per rack. The initial configuration of the SSFF will consist of two of the three racks and one furnace module. This Experiment/Facility Requirements Document (E/FRD) describes the integrated facility requirements for the Space Station Freedom (SSF) Integrated Configuration-1 (IC1) mission. The IC1 SSFF will consist of two racks: the Core Rack, with the centralized subsystem equipment; and the Experiment Rack-1, with Furnace Module-1 and the distributed subsystem equipment to support the furnace. The SSFF support functions are provided by the following Core subsystems: power conditioning and distribution subsystem (SSFF PCDS); data management subsystem (SSFF DMS); thermal control Subsystem (SSFF TCS); gas distribution subsystem (SSFF GDS); and mechanical structures subsystem (SSFF MSS).

Use of a structured template to facilitate practice-based learning and improvement projects.

PubMed

McClain, Elizabeth K; Babbott, Stewart F; Tsue, Terance T; Girod, Douglas A; Clements, Debora; Gilmer, Lisa; Persons, Diane; Unruh, Greg

2012-06-01

The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to meet and demonstrate outcomes across 6 competencies. Measuring residents' competency in practice-based learning and improvement (PBLI) is particularly challenging. We developed an educational tool to meet ACGME requirements for PBLI. The PBLI template helped programs document quality improvement (QI) projects and supported increased scholarly activity surrounding PBLI learning. We reviewed program requirements for 43 residency and fellowship programs and identified specific PBLI requirements for QI activities. We also examined ACGME Program Information Form responses on PBLI core competency questions surrounding QI projects for program sites visited in 2008-2009. Data were integrated by a multidisciplinary committee to develop a peer-protected PBLI template guiding programs through process, documentation, and evaluation of QI projects. All steps were reviewed and approved through our GME Committee structure. An electronic template, companion checklist, and evaluation form were developed using identified project characteristics to guide programs through the PBLI process and facilitate documentation and evaluation of the process. During a 24 month period, 27 programs have completed PBLI projects, and 15 have reviewed the template with their education committees, but have not initiated projects using the template. The development of the tool generated program leaders' support because the tool enhanced the ability to meet program-specific objectives. The peer-protected status of this document for confidentiality and from discovery has been beneficial for program usage. The document aggregates data on PBLI and QI initiatives, offers opportunities to increase scholarship in QI, and meets the ACGME goal of linking measures to outcomes important to meeting accreditation requirements at the program and institutional level.

Use of a Structured Template to Facilitate Practice-Based Learning and Improvement Projects

PubMed Central

McClain, Elizabeth K.; Babbott, Stewart F.; Tsue, Terance T.; Girod, Douglas A.; Clements, Debora; Gilmer, Lisa; Persons, Diane; Unruh, Greg

2012-01-01

Background The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to meet and demonstrate outcomes across 6 competencies. Measuring residents' competency in practice-based learning and improvement (PBLI) is particularly challenging. Purpose We developed an educational tool to meet ACGME requirements for PBLI. The PBLI template helped programs document quality improvement (QI) projects and supported increased scholarly activity surrounding PBLI learning. Methods We reviewed program requirements for 43 residency and fellowship programs and identified specific PBLI requirements for QI activities. We also examined ACGME Program Information Form responses on PBLI core competency questions surrounding QI projects for program sites visited in 2008–2009. Data were integrated by a multidisciplinary committee to develop a peer-protected PBLI template guiding programs through process, documentation, and evaluation of QI projects. All steps were reviewed and approved through our GME Committee structure. Results An electronic template, companion checklist, and evaluation form were developed using identified project characteristics to guide programs through the PBLI process and facilitate documentation and evaluation of the process. During a 24 month period, 27 programs have completed PBLI projects, and 15 have reviewed the template with their education committees, but have not initiated projects using the template. Discussion The development of the tool generated program leaders' support because the tool enhanced the ability to meet program-specific objectives. The peer-protected status of this document for confidentiality and from discovery has been beneficial for program usage. The document aggregates data on PBLI and QI initiatives, offers opportunities to increase scholarship in QI, and meets the ACGME goal of linking measures to outcomes important to meeting accreditation requirements at the program and institutional level. PMID:23730444

A two-stage clinical decision support system for early recognition and stratification of patients with sepsis: an observational cohort study.

PubMed

Amland, Robert C; Lyons, Jason J; Greene, Tracy L; Haley, James M

2015-10-01

To examine the diagnostic accuracy of a two-stage clinical decision support system for early recognition and stratification of patients with sepsis. Observational cohort study employing a two-stage sepsis clinical decision support to recognise and stratify patients with sepsis. The stage one component was comprised of a cloud-based clinical decision support with 24/7 surveillance to detect patients at risk of sepsis. The cloud-based clinical decision support delivered notifications to the patients' designated nurse, who then electronically contacted a provider. The second stage component comprised a sepsis screening and stratification form integrated into the patient electronic health record, essentially an evidence-based decision aid, used by providers to assess patients at bedside. Urban, 284 acute bed community hospital in the USA; 16,000 hospitalisations annually. Data on 2620 adult patients were collected retrospectively in 2014 after the clinical decision support was implemented. 'Suspected infection' was the established gold standard to assess clinical decision support clinimetric performance. A sepsis alert activated on 417 (16%) of 2620 adult patients hospitalised. Applying 'suspected infection' as standard, the patient population characteristics showed 72% sensitivity and 73% positive predictive value. A postalert screening conducted by providers at bedside of 417 patients achieved 81% sensitivity and 94% positive predictive value. Providers documented against 89% patients with an alert activated by clinical decision support and completed 75% of bedside screening and stratification of patients with sepsis within one hour from notification. A clinical decision support binary alarm system with cross-checking functionality improves early recognition and facilitates stratification of patients with sepsis.

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...

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...

Rate of electronic health record adoption in South Korea: A nation-wide survey.

PubMed

Kim, Young-Gun; Jung, Kyoungwon; Park, Young-Taek; Shin, Dahye; Cho, Soo Yeon; Yoon, Dukyong; Park, Rae Woong

2017-05-01

The adoption rate of electronic health record (EHR) systems in South Korea has continuously increased. However, in contrast to the situation in the United States (US), where there has been a national effort to improve and standardize EHR interoperability, no consensus has been established in South Korea. The goal of this study was to determine the current status of EHR adoption in South Korean hospitals compared to that in the US. All general and tertiary teaching hospitals in South Korea were surveyed regarding their EHR status in 2015 with the same questionnaire as used previously. The survey form estimated the level of adoption of EHR systems according to 24 core functions in four categories (clinical documentation, result view, computerized provider order entry, and decision supports). The adoption level was classified into comprehensive and basic EHR systems according to their functionalities. EHRs and computerized physician order entry systems were used in 58.1% and 86.0% of South Korean hospitals, respectively. Decision support systems and problem list documentation were the functions most frequently missing from comprehensive and basic EHR systems. The main barriers cited to adoption of EHR systems were the cost of purchasing (48%) and the ongoing cost of maintenance (11%). The EHR adoption rate in Korean hospitals (37.2%) was higher than that in US hospitals in 2010 (15.1%), but this trend was reversed in 2015 (58.1% vs. 75.2%). The evidence suggests that these trends were influenced by the level of financial and political support provided to US hospitals after the HITECH Act was passed in 2009. The EHR adoption rate in Korea has increased, albeit more slowly than in the US. It is logical to suggest that increased funding and support tied to the HITECH Act in the US partly explains the difference in the adoption rates of EHRs in both countries. Copyright © 2017 Elsevier B.V. All rights reserved.

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.

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.

Use of speech-to-text technology for documentation by healthcare providers.

PubMed

Ajami, Sima

2016-01-01

Medical records are a critical component of a patient's treatment. However, documentation of patient-related information is considered a secondary activity in the provision of healthcare services, often leading to incomplete medical records and patient data of low quality. Advances in information technology (IT) in the health system and registration of information in electronic health records (EHR) using speechto- text conversion software have facilitated service delivery. This narrative review is a literature search with the help of libraries, books, conference proceedings, databases of Science Direct, PubMed, Proquest, Springer, SID (Scientific Information Database), and search engines such as Yahoo, and Google. I used the following keywords and their combinations: speech recognition, automatic report documentation, voice to text software, healthcare, information, and voice recognition. Due to lack of knowledge of other languages, I searched all texts in English or Persian with no time limits. Of a total of 70, only 42 articles were selected. Speech-to-text conversion technology offers opportunities to improve the documentation process of medical records, reduce cost and time of recording information, enhance the quality of documentation, improve the quality of services provided to patients, and support healthcare providers in legal matters. Healthcare providers should recognize the impact of this technology on service delivery.

Evaluating the usability of speech recognition to create clinical documentation using a commercial electronic health record.

PubMed

Hodgson, Tobias; Magrabi, Farah; Coiera, Enrico

2018-05-01

To conduct a usability study exploring the value of using speech recognition (SR) for clinical documentation tasks within an electronic health record (EHR) system. Thirty-five emergency department clinicians completed a system usability scale (SUS) questionnaire. The study was undertaken after participants undertook randomly allocated clinical documentation tasks using keyboard and mouse (KBM) or SR. SUS scores were analyzed and the results with KBM were compared to SR results. Significant difference in SUS scores between EHR system use with and without SR were observed (KBM 67, SR 61; P = 0.045; CI, 0.1 to 12.0). Nineteen of 35 participants scored higher for EHR with KBM, 11 higher for EHR with SR and 5 gave the same score for both. Factor analysis showed no significant difference in scores for the sub-element of usability (EHR with KBM 65, EHR with SR 62; P = 0.255; CI, -2.6 to 9.5). Scores for the sub-element of learnability were significantly different (KBM 72, SR 55; P < 0.001; CI, 9.8 to 23.5). A significant correlation was found between the perceived usability of the two system configurations (EHR with KBM or SR) and the efficiency of documentation (time to document) (P = 0.002; CI, 10.5 to -0.1) but not with safety (number of errors) (P = 0.90; CI, -2.3 to 2.6). SR was associated with significantly reduced overall usability scores, even though it is often positioned as ease of use technology. SR was perceived to impose larger costs in terms of learnability via training and support requirements for EHR based documentation when compared to using KBM. Lower usability scores were significantly associated with longer documentation times. The usability of EHR systems with any input modality is an area that requires continued development. The addition of an SR component to an EHR system may cause a significant reduction in terms of perceived usability by clinicians. Copyright © 2018 Elsevier B.V. All rights reserved.

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.

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…

45 CFR 1602.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... electronic documents, among others. (c) Educational institution means a preschool, a public or private... will look to the use to which a requester will put the documents requested. When the Corporation has... documentary materials, regardless of whether the format is physical or electronic, made or received by the...

Supporting public involvement in interview and other panels: a systematic review.

PubMed

Baxter, Susan; Clowes, Mark; Muir, Delia; Baird, Wendy; Broadway-Parkinson, Andrea; Bennett, Carole

2017-10-01

Members of the public are increasingly being invited to become members of a variety of different panels and boards. This study aimed to systematically search the literature to identify studies relating to support or training provided to members of the public who are asked to be members of an interview panel. A systematic search for published and unpublished studies was carried out from June to September 2015. The search methods included electronic database searching, reference list screening, citation searching and scrutinizing online sources. We included studies of any design including published and unpublished documents which outlined preparation or guidance relating to public participants who were members of interview panels or representatives on other types of panels or committees. Results were synthesised via narrative methods. Thirty-six documents were included in the review. Scrutiny of this literature highlighted ten areas which require consideration when including members of the public on interview panels: financial resources; clarity of role; role in the interview process; role in evaluation; training; orientation/induction; information needs; terminology; support; and other public representative needs such as timing, accessibility and support with information technology. The results of the review emphasize a range of elements that need to be fully considered when planning the involvement of public participants on interview panels. It highlights potential issues relating to the degree of involvement of public representatives in evaluating/grading decisions and the need for preparation and on-going support. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Technical Support Documents Used to Develop the Chesapeake Bay TMDL

EPA Pesticide Factsheets

The Chesapeake Bay TMDL development was supported by several technical documents for water quality standards and allocation methodologies specific to the Chesapeake Bay. This page provides the technical support documents.

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

Onboard shuttle on-line software requirements system: Prototype

NASA Technical Reports Server (NTRS)

Kolkhorst, Barbara; Ogletree, Barry

1989-01-01

The prototype discussed here was developed as proof of a concept for a system which could support high volumes of requirements documents with integrated text and graphics; the solution proposed here could be extended to other projects whose goal is to place paper documents in an electronic system for viewing and printing purposes. The technical problems (such as conversion of documentation between word processors, management of a variety of graphics file formats, and difficulties involved in scanning integrated text and graphics) would be very similar for other systems of this type. Indeed, technological advances in areas such as scanning hardware and software and display terminals insure that some of the problems encountered here will be solved in the near-term (less than five years). Examples of these solvable problems include automated input of integrated text and graphics, errors in the recognition process, and the loss of image information which results from the digitization process. The solution developed for the Online Software Requirements System is modular and allows hardware and software components to be upgraded or replaced as industry solutions mature. The extensive commercial software content allows the NASA customer to apply resources to solving the problem and maintaining documents.

Closing the Loop in ICU Decision Support: Physiologic Event Detection, Alerts, and Documentation

PubMed Central

Norris, Patrick R.; Dawant, Benoit M.

2002-01-01

Automated physiologic event detection and alerting is a challenging task in the ICU. Ideally care providers should be alerted only when events are clinically significant and there is opportunity for corrective action. However, the concepts of clinical significance and opportunity are difficult to define in automated systems, and effectiveness of alerting algorithms is difficult to measure. This paper describes recent efforts on the Simon project to capture information from ICU care providers about patient state and therapy in response to alerts, in order to assess the value of event definitions and progressively refine alerting algorithms. Event definitions for intracranial pressure and cerebral perfusion pressure were studied by implementing a reliable system to automatically deliver alerts to clinical users’ alphanumeric pagers, and to capture associated documentation about patient state and therapy when the alerts occurred. During a 6-month test period in the trauma ICU at Vanderbilt University Medical Center, 530 alerts were detected in 2280 hours of data spanning 14 patients. Clinical users electronically documented 81% of these alerts as they occurred. Retrospectively classifying documentation based on therapeutic actions taken, or reasons why actions were not taken, provided useful information about ways to potentially improve event definitions and enhance system utility.

A process evaluation of systematic risk and needs assessment for caregivers in specialised palliative care.

PubMed

Thomsen, Kia Toft; Guldin, Mai-Britt; Nielsen, Mette Kjærgaard; Ollars, Chaitali Laura; Jensen, Anders Bonde

2017-04-08

Caregiving is strenuous and it may be associated with adverse psychological outcomes. During the palliative care trajectory, there are unique opportunities for providing support and preventing poor bereavement outcome. However, the tasks of palliative care staff in relation to caregivers are often unclear in the daily practice. Assessment is recommended to establish risk and needs and standards for caregiver support are available. Still, the feasibility of applying these standards among caregivers in everyday clinical practice has not been tested so far. This study tested the feasibility of an intervention based on key elements of the "Bereavement support standards for specialist palliative care services" in a Danish specialised palliative home care team. We followed the UK Medical Research Council's guidelines for the process evaluation of complex interventions. The intervention consisted of: 1. Systematic risk and needs assessment for caregivers at care entry; 2. Interdisciplinary conference to prepare a support plan; 3. Targeted support; 4. The establishment of an electronic medical record for caregivers to document targeted support. Outcomes included the reach, fidelity and acceptability of the intervention as well as the assessment of contextual factors. The intervention reached 76 of 164 caregivers (46%). The interdisciplinary risk assessment and documentation of a support plan was conducted in 57 (75%) of the enrolled caregivers. Finally, a separate medical record was established according to the intervention blueprint for 62% of caregivers receiving targeted support. After managing initial challenges, palliative care staff reported that the intervention was useful and acceptable. The intervention proved feasible and useful. Still, we identified barriers to the implementation which should be taken into consideration when planning implementation of a systematic risk and needs assessment and in the establishment of medical records for caregivers.

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)

COSPO/CENDI Industry Day Conference

NASA Technical Reports Server (NTRS)

1995-01-01

The conference's objective was to provide a forum where government information managers and industry information technology experts could have an open exchange and discuss their respective needs and compare them to the available, or soon to be available, solutions. Technical summaries and points of contact are provided for the following sessions: secure products, protocols, and encryption; information providers; electronic document management and publishing; information indexing, discovery, and retrieval (IIDR); automated language translators; IIDR - natural language capabilities; IIDR - advanced technologies; IIDR - distributed heterogeneous and large database support; and communications - speed, bandwidth, and wireless.

Emerged/Emerging Disruptive Technologies (E2DT) (Technologies de rupture apparues/emergentes (E2DT)). Proceedings of the RTO Information Systems Technology Panel (IST) Symposium held in Madrid, Spain on 7-8 May 2011

DTIC Science & Technology

2011-05-01

with the potential to impact future military Information Systems. The second is to explore and identify innovative applications of these emerging or...NATO) BP 25, F-92201 Neuilly- sur -Seine Cedex, France RTO-MP-IST-099 Approved for Public release, distribution unlimited. Supporting documents are...Analysis and Studies Panel • SCI Systems Concepts and Integration Panel • SET Sensors and Electronics Technology Panel These bodies are made up of

Barriers and facilitators to electronic documentation in a rural hospital.

PubMed

Whittaker, Alice A; Aufdenkamp, Marilee; Tinley, Susan

2009-01-01

The purpose of the study was to explore nurses' perceptions of barriers and facilitators to adoption of an electronic health record (EHR) in a rural Midwestern hospital. This study was a qualitative, descriptive design. The Staggers and Parks Nurse-Computer Interaction Framework was used to guide directed content analysis. Eleven registered nurses from oncology and medical-surgical units were interviewed using three semistructured interview questions. Predetermined codes and operational definitions were developed from the Staggers and Parks framework. Narrative data were analyzed by each member of the research team and group consensus on coding was reached through group discussions. Participants were able to identify computer-related, nurse-related, and contextual barriers and facilitators to implementation of EHR. In addition, two distinct patterns of perceptions and acceptance were identified. The Staggers and Parks Nurse-Computer Interaction framework was found to be useful in identifying computer, nurse, and contextual characteristics that act as facilitators or barriers to adoption of an EHR system. Acceptance and use of an EHR are enhanced when barriers are managed and facilitators are supported. Understanding and management of facilitators and barriers to EHR adoption may impact nurses' ability to provide and document nursing care.

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...

Approaches to eliminating chlorofluorocarbon use in manufacturing.

PubMed Central

Boyhan, W S

1992-01-01

Until quite recently, chlorofluorocarbons (CFCs) had been considered the safest and most benign of industrial chemicals. Their physical and chemical properties made them an integral part of manufacturing processes for electronics products. The recognition that CFCs destroy the stratospheric ozone layer, with consequent enormous consequences to all forms of life on earth, has led to international agreements which will end virtually all possibly before. This impending phaseout of CFCs has caused electronics manufacturers to examine alternative chemicals and processing methods. This manuscript documents the steps AT&T has taken to reach its goal of 100% phaseout of CFCs by years-end 1994. These actions include top-down management support with combined bottom-up thrusts, an internal information gathering and dissemination center, internal technology transfer, and external corporate activism. Images PMID:11607258

HIS-Based Support of Follow-Up Documentation – Concept and Implementation for Clinical Studies

PubMed Central

Herzberg, S.; Fritz, F.; Rahbar, K.; Stegger, L.; Schäfers, M.; Dugas, M.

2011-01-01

Objective Follow-up data must be collected according to the protocol of each clinical study, i.e. at certain time points. Missing follow-up information is a critical problem and may impede or bias the analysis of study data and result in delays. Moreover, additional patient recruitment may be necessary due to incomplete follow-up data. Current electronic data capture (EDC) systems in clinical studies are usually separated from hospital information systems (HIS) and therefore can provide limited functionality to support clinical workflow. In two case studies, we assessed the feasibility of HIS-based support of follow-up documentation. Methods We have developed a data model and a HIS-based workflow to provide follow-up forms according to clinical study protocols. If a follow-up form was due, a database procedure created a follow-up event which was translated by a communication server into an HL7 message and transferred to the import interface of the clinical information system (CIS). This procedure generated the required follow-up form and enqueued a link to it in a work list of the relating study nurses and study physicians, respectively. Results A HIS-based follow-up system automatically generated follow-up forms as defined by a clinical study protocol. These forms were scheduled into work lists of study nurses and study physicians. This system was integrated into the clinical workflow of two clinical studies. In a study from nuclear medicine, each scenario from the test concept according to the protocol of the single photon emission computer tomography/computer tomography (SPECT/CT) study was simulated and each scenario passed the test. For a study in psychiatry, 128 follow-up forms were automatically generated within 27 weeks, on average five forms per week (maximum 12, minimum 1 form per week). Conclusion HIS-based support of follow-up documentation in clinical studies is technically feasible and can support compliance with study protocols. PMID:23616857

Development of functional requirements for electronic health communication: preliminary results from the ELIN project.

PubMed

Christensen, Tom; Grimsmo, Anders

2005-01-01

User participation is important for developing a functional requirements specification for electronic communication. General practitioners and practising specialists, however, often work in small practices without the resources to develop and present their requirements. It was necessary to find a method that could engage practising doctors in order to promote their needs related to electronic communication. Qualitative research methods were used, starting a process to develop and study documents and collect data from meetings in project groups. Triangulation was used, in that the participants were organised into a panel of experts, a user group, a supplier group and an editorial committee. The panel of experts created a list of functional requirements for electronic communication in health care, consisting of 197 requirements, in addition to 67 requirements selected from an existing Norwegian standard for electronic patient records (EPRs). Elimination of paper copies sent in parallel with electronic messages, optimal workflow, a common electronic 'envelope' with directory services for units and end-users, and defined requirements for content with the possibility of decision support were the most important requirements. The results indicate that we have found a method of developing functional requirements which provides valid results both for practising doctors and for suppliers of EPR systems.

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,…

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...

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...

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.

Preliminary Assessment of the Flow of Used Electronics, In ...

EPA Pesticide Factsheets

Electronic waste (e-waste) is the largest growing municipal waste stream in the United States. The improper disposal of e-waste has environmental, economic, and social impacts, thus there is a need for sustainable stewardship of electronics. EPA/ORD has been working to improve our understanding of the quantity and flow of electronic devices from initial purchase to final disposition. Understanding the pathways of used electronics from the consumer to their final disposition would provide insight to decision makers about their impacts and support efforts to encourage improvements in policy, technology, and beneficial use. This report is the first stage of study of EPA/ORD's efforts to understand the flows of used electronics and e-waste by reviewing the regulatory programs for the selected states and identifying the key lessons learned and best practices that have emerged since their inception. Additionally, a proof-of-concept e-waste flow model has been developed to provide estimates of the quantity of e-waste generated annually at the national level, as well as for selected states. This report documents a preliminary assessment of available data and development of the model that can be used as a starting point to estimate domestic flows of used electronics from generation, to collection and reuse, to final disposition. The electronics waste flow model can estimate the amount of electronic products entering the EOL management phase based on unit sales dat

Fingerprints of collisionless reconnection at the separator, I, Ambipolar-Hall signatures

NASA Astrophysics Data System (ADS)

Scudder, J. D.; Mozer, F. S.; Maynard, N. C.; Russell, C. T.

2002-10-01

Plasma, electric, and magnetic field data on the Polar spacecraft have been analyzed for the 29 May 1996 magnetopause traversal searching for evidence of in situ reconnection and traversal of the separator. In this paper we confine our analysis to model-free observations and intrasensor coherence of detection of the environs of the separator. (1) We illustrate the first documented penetration of the separator of collisionless magnetic reconnection in temporal proximity to successful Walén tests with opposite slopes. (2) We present the first direct measurements of E∥ at the magnetopause. (3) We make the first empirical argument that E∥ derives from the electron pressure gradient force. (4) We document the first detection of the electron pressure ridge astride the magnetic depression that extends from the separator. (5) We provide the first empirical detection of the reconnection rate at the magnetopause with the locally sub-Alfvénic ion inflow, MAi ≃ 0.1, and trans-Alfvénic exhaust at high electron pressure of MiA ≃ 1.1-5. (6) We exhibit the first empirical detection of supra-Alfvénic electron flows parallel to B in excess of 5 in narrow sheets. (7) We illustrate the detection of heat flux sheets indicative of separatrices near, but not always in superposition, with the supra-Alfvénic parallel electron bulk flows. (8) We present the first evidence that pressure gradient scales are short enough to explain the electron fluid's measured cross-field drifts not explained by E × B drift but predicted by the measured size of E∥. (9) We illustrate that the size of the observed E∥ is well organized with the limit implied by Vasyliunas's analysis of the generalized Ohm's law of scale length ?, indicative of the intermediate scale of the diffusion region. (10) We document the first detection of departure from electron gyrotropy not only at the separator crossing but also in its vicinity, an effect presaged by [1975]. (11) We make the first reports of very large values of electron βe ≃ 680 localized at the separator, which imply that the electron thermal gyroradius exceeds the electron inertial length by more than an order of magnitude there. This clearly delineates that the environs of the reversed field region in this data contain non-MHD scales. The ambipolar association and the measured E∥ data imply the presence of the nonideal ρs scale in these layers surrounding the null point. The high βe signals the possible demagnetization of the thermal electrons in any structures with spatial scales of the electron skin depth, which is theoretically anticipated to surround the magnetic null line of the separator proper. This possibility is supported by the large number of temporally unaliased spectra at high βe that are inconsistent with gyrotropy.

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.

Adverse Event extraction from Structured Product Labels using the Event-based Text-mining of Health Electronic Records (ETHER)system.

PubMed

Pandey, Abhishek; Kreimeyer, Kory; Foster, Matthew; Botsis, Taxiarchis; Dang, Oanh; Ly, Thomas; Wang, Wei; Forshee, Richard

2018-01-01

Structured Product Labels follow an XML-based document markup standard approved by the Health Level Seven organization and adopted by the US Food and Drug Administration as a mechanism for exchanging medical products information. Their current organization makes their secondary use rather challenging. We used the Side Effect Resource database and DailyMed to generate a comparison dataset of 1159 Structured Product Labels. We processed the Adverse Reaction section of these Structured Product Labels with the Event-based Text-mining of Health Electronic Records system and evaluated its ability to extract and encode Adverse Event terms to Medical Dictionary for Regulatory Activities Preferred Terms. A small sample of 100 labels was then selected for further analysis. Of the 100 labels, Event-based Text-mining of Health Electronic Records achieved a precision and recall of 81 percent and 92 percent, respectively. This study demonstrated Event-based Text-mining of Health Electronic Record's ability to extract and encode Adverse Event terms from Structured Product Labels which may potentially support multiple pharmacoepidemiological tasks.

39 CFR 3050.23 - Documentation supporting incremental cost estimates in the Postal Service's section 3652 report.

Code of Federal Regulations, 2010 CFR

2010-07-01

... incremental cost model shall be reported. ... 39 Postal Service 1 2010-07-01 2010-07-01 false Documentation supporting incremental cost... REGULATORY COMMISSION PERSONNEL PERIODIC REPORTING § 3050.23 Documentation supporting incremental cost...

25 CFR 162.213 - What supporting documents must be provided prior to BIA's grant or approval of an agricultural...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false What supporting documents must be provided prior to BIA's....213 What supporting documents must be provided prior to BIA's grant or approval of an agricultural... organizational and financial documents, as needed to show that the lease will be enforceable against the tenant...

Organizational learning in the implementation and adoption of national electronic health records: case studies of two hospitals participating in the National Programme for Information Technology in England.

PubMed

Takian, Amirhossein; Sheikh, Aziz; Barber, Nicholas

2014-09-01

To explore the role of organizational learning in enabling implementation and supporting adoption of electronic health record systems into two English hospitals. In the course of conducting our prospective and sociotechnical evaluation of the implementation and adoption of electronic health record into 12 "early adopter" hospitals across England, we identified two hospitals implementing virtually identical versions of the same "off-the-shelf" software (Millennium) within a comparable timeframe. We undertook a longitudinal qualitative case study-based analysis of these two hospitals (referred to hereafter as Alpha and Omega) and their implementation experiences. Data included the following: 63 in-depth interviews with various groups of internal and external stakeholders; 41-h on-site observation; and content analysis of 218 documents of various types. Analysis was both inductive and deductive, the latter being informed by the "sociotechnical changing" theoretical perspective. Although Alpha and Omega shared a number of contextual similarities, our evaluation revealed fundamental differences in visions of electronic health record and the implementation strategy between the hospitals, which resulted in distinct local consequences of electronic health record implementation and impacted adoption. Both hospitals did not, during our evaluation, see the hoped-for benefits to the organization as a result of the introduction of electronic health record, such as speeding-up tasks. Nonetheless, the Millennium software worked out to be easier to use at Omega. Interorganizational learning was at the heart of this difference. Despite the turbulent overall national "roll out" of electronic health record systems into the English hospitals, considerable opportunities for organizational learning were offered by sequential delivery of the electronic health record software into "early adopter" hospitals. We argue that understanding the process of organizational learning and its enabling factors has the potential to support efforts at implementing national electronic health record implementation endeavors. © The Author(s) 2013.

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)

Mission Control Center/Building 30. Historical Documentation

NASA Technical Reports Server (NTRS)

2010-01-01

As part of this nation-wide study, in September 2006, historical survey and evaluation of NASA-owned and managed facilities was conducted by NASA's Lyndon B. Johnson Space Center (JSC) in Houston, Texas. The results of this study are presented in a report entitled, Survey and Evaluation of NASA-owned Historic Facilities and Properties in the Context of the U.S. Space Shuttle Program, Lyndon B. Johnson Space Center, Houston, Texas, prepared in November 2007 by NASA JSC s contractor, Archaeological Consultants, Inc. As a result of this survey, the Mission Control Center (Building 30) was determined eligible for listing in the NRHP, with concurrence by the Texas State Historic Preservation Officer (SHPO). The survey concluded that Building 30 is eligible for the NRHP under Criteria A and C in the context of the U.S. Space Shuttle Program (1969-2010). Because it has achieved significance within the past 50 years, Criteria Consideration G applies. It should be noted that the Mission Control Center was designated a National Historic Landmark in 1985 for its role in the Apollo 11 Lunar Landing. At the time of this documentation, Building 30 was still used to support the SSP as an engineering research facility, which is also sometimes used for astronaut training. This documentation package precedes any undertaking as defined by Section 106 of the NHPA, as amended, and implemented in 36 CFR Part 800, as NASA JSC has decided to proactively pursue efforts to mitigate the potential adverse affects of any future modifications to the facility. It includes a historical summary of the Space Shuttle program; the history of JSC in relation to the SSP; a narrative of the history of Building 30 and how it supported the SSP; and a physical description of the structure. In addition, photographs documenting the construction and historical use of Building 30 in support of the SSP, as well as photographs of the facility documenting the existing conditions, special technological features, and engineering details, are included. A contact sheet printed on archival paper, and an electronic copy of the work product on CD, are also provided.

Book Out! An Inventory Story

NASA Technical Reports Server (NTRS)

Panait, Claudia M.

2004-01-01

The NASA Glenn Library is a science and engineering research library providing the most current books, journals, CD-ROM's and documents to support the study of aeronautics, space propulsion and power, communications technology, materials and structures and microgravity science. The GRC technical library also supports the research and development efforts of all scientists and engineers on site via full text electronic files, literature searching, technical reports, etc. As an intern in the NASA Glenn Library, I attempt to support these objectives through efficiently and effectively fulfilling the assignment that was given to me. The assignment that was relegated to me was to catalog National Advisory Committee for Aeronautics, NASA Technical Documents into NASA Galaxie. This process consists of holdings being added to existing Galaxie records, upgrades and editing done to the bibliographic records when needed, adding URL's into Galaxie when they were missing from the record. NASA ASAP and Digidoc was used to locate URL's of PDF's that were not in Galaxie. A spreadsheet of documents with no URL's were maintained. Also, a subject channel of web, fill-text, paid and free, journal and other subject specific pages were developed and expanded fiom current content of intranet pages. To expand upon the second half of my assignment, I was given the project of taking inventory of the library s book collection. I kept record of the books that were not accounted for on a master list I was given to work fiom and submitted them for correction and addition. I also made sure the books were placed in the appropriate order and made corrections to any discrepancies that existed between the master list and what was on the shelf. Upon completion of this assignment, I will have verified that 21,113 books were in the correct location, order and have the correct corresponding serial number and barcode. In conclusion, as of this date I have input around 750 documents into NASA Galaxie, inputting about half of the NASA Technical Documents into the system. The rest of my tenure in this program will consist of finishing the other half of the reports. In regard to the second assignment, I still have about three-quarters of the collection to record and correct.

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

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.

TREC 2010 legal track: method and results of the ELK collaboration

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

Spearing, Shelly; Roman, Jorge; Mc Kay, Bain

The ELK team ([E]WA-IIT, [L]os Alamos National laboratory (LANL), and [K]ayvium Corporation (ELK)) used the legal Track task 302 as an opportunity to compare and integrate advanced semantic-automation strategies. The team members believe that enabling parties to discover, consume, analyze, and make decisions in a noisy and information-overloaded environment requires new tools. Together, as well as independently, they are actively developing these tools and view the TREC exercise as an opportunity to test, compare, and complement tools and approaches. Our collaboration is new to TREC, brought together by a shared interest in document relevance, concept-in-context identification and annotation, and themore » recognition that words out-of-context do not a match make. The team's intent was to lay the foundation for automating the mining and analysis of large volumes of electronic information by litigants and their lawyers, not only in the context of document discovery, but also to support litigation strategy, motion practice, deposition, trial tactics, etc. The premise was that a Subject Matter Expert- (SME-) built model can be automatically mapped onto various search engines for document retrieval, organization, relevance scoring, analysis and decision support. In the end, we ran nearly a dozen models, mostly, but not exclusively, with Kayvium Corporation's knowledge automation technology. The Sal Database Search Engine we used had a bug in its proximity feature, requiring that we develop a workaround. While the work-around was successful, it left us with insufficient time to converge the models to achieve expected quality. However, with optimized proximity processing in place, we would be able to run the model many more times, and believe repeatable quality would be a matter of working through a few requests to get the approach right. We believe that with more time, the results we would achieve might point towards a new way of processing documents for litigation support, so litigators can be confident that results are complete but not overly inclusive.« less

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...

Measuring Nursing Care Time and Tasks in Long-Term Services and Supports: One Size Does Not Fit All

PubMed Central

Sochalski, Julie A.; Foust, Janice B.; Zubritsky, Cynthia D.; Hirschman, Karen B.; Abbott, Katherine M.; Naylor, Mary D.

2015-01-01

Background Although nursing care personnel comprise the majority of staff in long-term care services and supports (LTSS), a method for measuring the provision of nursing care has not yet been developed. Purpose/Methods We sought to understand the challenges of measuring nursing care across different types of LTSS using a qualitative approach that included the triangulation of data from three unique sources. Results Six primary challenges to measuring nursing care across LTSS emerged: level of detail about time of day, amount of time, or type of tasks varied by type of nursing and organization; time and tasks were documented in clinical records and administrative databases; data existed both on paper and electronically; several sources of information were needed to create the fullest picture of nursing care; data was inconsistently available for contracted providers; documentation of informal caregiving was unavailable. Differences were observed for assisted living facilities and home and community based services compared to nursing homes and across organizations within a setting. A commonality across settings and organizations was the availability of an electronically stored care plan specifying individual needs but not necessarily how these would be met. Conclusions The findings demonstrate the variability of data availability and specificity across three distinct LTSS settings. This study is an initial step toward establishing a process for measuring the provision of nursing care across LTSS to be able to explore the range of nursing care needs of LTSS recipients and how these needs are fulfilled. PMID:22902975

Magnetospheric Radio Tomography: Observables, Algorithms, and Experimental Analysis

NASA Technical Reports Server (NTRS)

Cummer, Steven

2005-01-01

This grant supported research towards developing magnetospheric electron density and magnetic field remote sensing techniques via multistatic radio propagation and tomographic image reconstruction. This work was motivated by the need to better develop the basic technique of magnetospheric radio tomography, which holds substantial promise as a technology uniquely capable of imaging magnetic field and electron density in the magnetosphere on large scales with rapid cadence. Such images would provide an unprecedented and needed view into magnetospheric processes. By highlighting the systems-level interconnectedness of different regions, our understanding of space weather processes and ability to predict them would be dramatically enhanced. Three peer-reviewed publications and 5 conference presentations have resulted from this work, which supported 1 PhD student and 1 postdoctoral researcher. One more paper is in progress and will be submitted shortly. Because the main results of this research have been published or are soon to be published in refereed journal articles listed in the reference section of this document, we provide here an overview of the research and accomplishments without describing all of the details that are contained in the articles.

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...